Cholinesterase Inhibitor and Memantine Use in Newly Admitted Nursing Home Residents with Dementia

OBJECTIVES: To quantify the use of cholinesterase inhibitors (ChEIs) and memantine in nursing home (NH) residents with dementia upon NH admission and 3 months later and to examine factors associated with reduction in therapy.

DESIGN: Retrospective cohort study.

SETTING: Nationwide sample of U.S. NHs.

PARTICIPANTS: Three thousand ?ve hundred six NH residents with dementia newly admitted in 2006.

MEASUREMENTS: Data from pharmacy dispensing records were used to determine ChEI and memantine medication use upon NH admission and at 3-month follow-up. The Minimum Data Set was used to determine resident- and facility-level characteristics. Severity of dementia was de?ned using the Cognitive Performance Scale (CPS).

RESULTS: Overall, 40.1% (n51,407) of newly admitted NH residents with dementia received ChEIs and memantine on NH admission. Use of ChEIs and memantine on admission was significantly greater in residents with mild to moderately severe dementia (41.2%) than in those with advanced dementia (33.3%, P5.001). After 3 months, ChEI and memantine use decreased by about half in both groups (48.6% with mild to moderately severe dementia vs 57.0% with advanced dementia, Po.05). NH residents with advanced dementia were significantly more likely reduce their use of ChEIs and memantine than those with mild to moderately severe dementia (odds ratio 51.44, 95% con?dence interval 51.03–2.01, P5.04).

CONCLUSION: Many NH residents with advanced dementia receive ChEIs and memantine upon NH admission, and approximately half of these decrease their medication use over the ensuing months. Further study is required to optimize use of ChEIs and memantine in NH populations and to determine the effects of withdrawing therapy on resident outcomes.

An evaluation of an adapted United States model of pharmaceutical care to improve psychoactive prescribing for nursing home residents in Northern Ireland (Fleetwood NI Study).

OBJECTIVES: To test the effect of an adapted U.S. model of pharmaceutical care on prescribing of inappropriate psychoactive (anxiolytic, hypnotic, and antipsychotic) medications and falls in nursing homes for older people in Northern Ireland (NI).

DESIGN: Cluster randomized controlled trial.

SETTING: Nursing homes randomized to intervention (receipt of the adapted model of care; n=11) or control (usual care continued; n=11).

PARTICIPANTS: Residents aged 65 and older who provided informed consent (N=334; 173 intervention, 161 control).

INTERVENTION: Specially trained pharmacists visited intervention homes monthly for 12 months and reviewed residents' clinical and prescribing information, applied an algorithm that guided them in assessing the appropriateness of psychoactive medication, and worked with prescribers (general practitioners) to improve the prescribing of these drugs. The control homes received usual care.

MEASUREMENTS: The primary end point was the proportion of residents prescribed one or more inappropriate psychoactive medicine according to standardized protocols; falls were evaluated using routinely collected falls data mandated by the regulatory body for nursing homes in NI.

RESULTS: The proportion of residents taking inappropriate psychoactive medications at 12 months in the intervention homes (25/128, 19.5%) was much lower than in the control homes (62/124, 50.0%) (odds ratio=0.26, 95% confidence interval=0.14–0.49) after adjustment for clustering within homes. No differences were observed at 12 months in the falls rate between the intervention and control groups.

CONCLUSION: Marked reductions in inappropriate psychoactive medication prescribing in residents resulted from pharmacist review of targeted medications, but there was no effect on falls.

The experience of individuals with renal failure participating in home haemodialysis: An interpretative phenomenological analysis.

This study explored the experience of individuals with renal failure undertaking home haemodialysis (HHD). Semi-structured interviews were conducted with six participants who were active HHD users in a UK region. Participants’ accounts were transcribed verbatim and analysed using an interpretative phenomenological approach. Three main themes were identified: (1) embracing treatment and lifestyle freedom and flexibility; (2) re-establishing a sense of self and preferred self-identity; and (3) integrating aspects of active engagement and aspects of supported, life-sustaining dependence. A ‘good fit’ between the HHD user (an independent, self-determined health participant) and the healthcare provision (personalized, enabling) is proposed.

A heterosynaptic learning rule for neural networks

In this article we intoduce a novel stochastic Hebb-like learning rule for neural networks that is neurobiologically motivated. This learning rule combines features of unsupervised (Hebbian) and supervised (reinforcement) learning and is stochastic with respect to the selection of the time points when a synapse is modified. Moreover, the learning rule does not only affect the synapse between pre- and postsynaptic neuron, which is called homosynaptic plasticity, but effects also further remote synapses of the pre-and postsynaptic neuron. This more complex form of synaptic plasticity has recently come under investigations in neurobiology and is called heterosynaptic plasticity. We demonstrate that this learning rule is useful in training neural networks by learning parity functions including the exclusive-or (XOR) mapping in a multilayer feed-forward network. We find, that our stochastic learning rule works well, even in the presence of noise. Importantly, the mean leaxning time increases with the number of patterns to be learned polynomially, indicating efficient learning.

Measuring Inconsistency in a Network Intrusion Detection Rule Set Based on Snort

In this preliminary study, we investigate how inconsistency in a network intrusion detection rule set can be measured. To achieve this, we first examine the structure of these rules which are based on Snort and incorporate regular expression (Regex) pattern matching. We then identify primitive elements in these rules in order to translate the rules into their (equivalent) logical forms and to establish connections between them. Additional rules from background knowledge are also introduced to make the correlations among rules more explicit. We measure the degree of inconsistency in formulae of such a rule set (using the Scoring function, Shapley inconsistency values and Blame measure for prioritized knowledge) and compare the informativeness of these measures. Finally, we propose a new measure of inconsistency for prioritized knowledge which incorporates the normalized number of atoms in a language involved in inconsistency to provide a deeper inspection of inconsistent formulae. We conclude that such measures are useful for the network intrusion domain assuming that introducing expert knowledge for correlation of rules is feasible.

Bridging Jeffrey's Rule, AGM Revision and Dempster Conditioning in the Theory of Evidence

Belief revision characterizes the process of revising an agent’s beliefs when receiving new evidence. In the field of artificial intelligence, revision strategies have been extensively studied in the context of logic-based formalisms and probability kinematics. However, so far there is not much literature on this topic in evidence theory. In contrast, combination rules proposed so far in the theory of evidence, especially Dempster rule, are symmetric. They rely on a basic assumption, that is, pieces of evidence being combined are considered to be on a par, i.e. play the same role. When one source of evidence is less reliable than another, it is possible to discount it and then a symmetric combination operation
is still used. In the case of revision, the idea is to let prior knowledge of an agent be altered by some input information. The change problem is thus intrinsically asymmetric. Assuming the input information is reliable, it should be retained whilst the prior information should be changed minimally to that effect. To deal with this issue, this paper defines the notion of revision for the theory of evidence in such a way as to bring together probabilistic and logical views. Several revision rules previously proposed are reviewed and we advocate one of them as better corresponding to the idea of revision. It is extended to cope with inconsistency between prior and input information. It reduces to Dempster
rule of combination, just like revision in the sense of Alchourron, Gardenfors, and Makinson (AGM) reduces to expansion, when the input is strongly consistent with the prior belief function. Properties of this revision rule are also investigated and it is shown to generalize Jeffrey’s rule of updating, Dempster rule of conditioning and a form of AGM revision.

Working with the 'System' and 'Lifeworld': Using Action Research to Enhance Resilience and Attachment in a Children's Home

Residential child care workers in the UK are caught betwen competing imperatives on a grand scale. On the one hand, they are required to implement an increasing raft of policy. On the other, they must proactively engage with the young people under their care.

The Architecture of Home in Cairo: Socio-Spatial Practice of the Hawari's Everyday Life

The hawari of Cairo - narrow non-straight alleyways - are the basic urban units that have formed the medieval city since its foundation back in 969 AD. Until early in the C20th, they made up the primary urban divisions of the city and were residential in nature. Contemporary hawari, by contrast, are increasingly dominated by commercial and industrial activity. This medieval urban maze of extremely short, broken, zigzag streets and dead ends are defensible territories, powerful institutions, and important social systems. While the hawari have been studied as an exemplar for urban structure of medieval Islamic urbanism, and as individual building typologies, this book is the first to examine in detail the socio-spatial practice of the architecture of home in the city. It investigates how people live, communicate and relate to each other within their houses or shared spaces of the alleys, and in doing so, to uncover several new socio-spatial dimensions and meanings in this architectural form.

In an attempt to re-establish the link between architecture past and present, and to understand the changing social needs of communities, this book uncovers the notion of home as central to understand architecture in such a city with long history as Cairo. It firstly describes the historical development of the domestic spaces (indoor and outdoor), and provides an inclusive analysis of spaces of everyday activities in the hawari of old Cairo. It then broadens its analysis to other parts of the city, highlighting different customs and representations of home in the city at large. Cairo, in the context of this book, is represented as the most sophisticated urban centre in the Middle East with different and sometimes contrasting approaches to the architecture of home, as a practice and spatial system.

In order to analyse the complexity and interconnectedness of the components and elements of the hawari as a 'collective home', it layers its narratives of architectural and social developments as a domestic environment over the past two hundred years, and in doing so, explores the in-depth social meaning and performance of spaces, both private and public.