Inappropriate prescribing to the oldest old patients admitted to hospital: prevalence, most frequently used medicines, and associated factors

Background: Scientific evidence on treatments of chronic diseases in patients 85 years old or older is very limited, as is available information on inappropriate prescription (IP) and its associated factors. The study aimed to describe medicine prescription, potentially inappropriate medicines (PIM) and potentially prescribing omissions (PPO) and their associated factors on this population. Methods: In the context of an observational, prospective and multicentric study carried out in elderly patients admitted to seven Spanish hospitals for a year, a sub-analysis of those aged 85 years and over was performed. To assess PIMs, the Beers and STOPP criteria were used, and to assess PPOs, the START and the ACOVE-3 criteria were used. To assess factors associated with IP, a multivariate logistic regression analysis was performed. Patients were selected randomly every week on consecutive days from the hospitalization lists. Results: A total of 336 patients were included in the sub-analysis with a median (Q1-Q3) age of 88 (8690) years. The median medicines taken during the month prior to admission was 10 (713). Forty-seven point two per cent of patients had at least one Beers-listed PIM, 63.3% at least one STOPP-listed PIM, 53.6% at least one START-listed PPO, and 59.4% at least one ACOVE-3-listed PPO. Use of benzodiazepines in patients who are prone to falls (18.3%) and omission of calcium and vitamin D supplements in patients with osteoporosis (13.3%) were the most common PIM and PPO, respectively. The main factor associated with the Beers-listed and the STOPP-listed PIM was consumption of 10 or more medicines (OR = 5.7, 95% CI 1.8-17.9 and OR = 13.4, 95% CI 4.0-44.0, respectively). The main factors associated with the START-listed PPO was a non-community dwelling origin (OR 2.3, 95% CI 1.0-5.0), and multimorbidity (OR1.8, 95% CI 1.0-3.1). Conclusions: Prescribed medicines and PIM and PPO prevalence were high among patients 85 years and over. Benzodiazepine use in those who are prone to falls and omission of calcium and vitamin D in those with osteoporosis were the most frequent PIM and PPO, respectively. Factors associated with PIM and PPO differed with polypharmacy being the most important factor associated with PIM.

Application of Open Innovation Paradigm in Small and Medium Enterprises in Russia

The objective of this study is to explore how the Open Innovation paradigm is applied in by small and medium-size enterprises in Russia. The focus of the study is to understand how the processes of research and development and commercialization proceed in these kind of companies and to which extent they apply open innovation principles. Russian leadership makes certain steps for transition from the export of raw materials to an innovative model of economic growth. The research aims to disclose actual impact of these attempts. The closed innovation model and the erosion factors which lead to the destruction of an old one and emergence of new model are described. Features of open innovation implementation and intellectual property rights protection in small and medium enterprises are presented. To achieve the objective, a qualitative case study approach was chosen. Research includes facts and figures, views and opinions of management of studied companies related to innovation process in the company and in Russia in general. The research depicts the features of Open Innovation implementation by SMEs in Russia. A large number of research centers with necessary equipment and qualified personnel allow case companies to use external R&D effectively. They cooperate actively with research institutes, universities and laboratories. Thus, they apply inbound Open Innovation. On the contrary, lack of venture capital, low demand for technologies within the domestic market and weak protection of intellectual property limit the external paths to new markets. Licensing-out and creation of spin-off are isolated cases. Therefore, outbound Open Innovation is not a regular practice.

Education export as a form of knowledge transfer : The potential of Finnish education export in Chile

Knowledge transfer is a complex process. Knowledge transfer in the form of exporting education products from one system of education to another is particularly complicated, because each system has been developed in a particular context to meet the requirements seen as relevant at each time. National innovation systems are often seen to form an essential framework within which the development of a country, its economy and level of knowledge are considered and promoted. These systems are orientated towards the future, and as such they also provide a framework for the knowledge transfer related to the development of education. In the best of circumstances they are able to facilitate and boost this transfer both from the viewpoint of the provider and the recipient. The leading thought and the idea of the study is that education export is a form of knowledge transfer, which is illustrated by the existing models included. The purpose of this study is to explore, analyze and describe the factors and phenomena related to education export, and more specifically, those related to the experiences and potential of Finnish education export to Chile. For better understanding, of the multiplicity of the issue involved, the current status of education export between Finland and Chile and he existing efforts within the Finnish innovation network will be outlined as well as new forms of co-operation between Finland and Chile in educational matters explored. Several countries have started to commercialize their education system in order to establish themselves as emerging education exporters. Moreover, the demand for education reform is accurate in many developing countries. This offers a good match between Finland and Chile to be the example countries of the research. The main research findings suggest that there are several business areas in education export. These include degrees in education, training services and education technologies for example The factors that influence education export can be divided into four groups, including academic, cultural, political and economic aspects. Challenges to overcome include the lack of product or services to be sold, lack of market and cultural knowledge of the buyer country, financing and lack of suitable pricing model. National innovation systems could be seen as enabling entities for successful education export. The extensive networks that national innovation systems aim to form, could operate as a basis for joining the forces in selling knowledge as well as receiving knowledge in a constructive way.

Prevalence and risk factors for Leptospira spp. in cattle herds in the south central region of Paraná state

The aim of this study was to determine the prevalence of anti-Leptospira spp. antibodies and the risk factors for Leptospira spp. infection in breeding cattle herds in the south central region of Paraná state. It was based on the statistic delineation/serological samples and information regarding the selected farms employed in the study of bovine brucellosis for Paraná state in the context of National Program for Control and Eradication of Brucellosis and Tuberculosis. A total of 1.880 females aged >24 months from 274 non vaccinated herds were studied. Serum samples were tested for antibodies against Leptospira spp. using microscopic agglutination test (MAT) with 22 Leptospira serovars. The epidemiological questionnaire was applied on all the selected farms and aimed to obtain epidemiological data. Hundred eighty one of 274 herds were positive for Leptospira spp./presenting prevalence of positive herds of 66.06% (IC95%=60.12-71,65%). Presence of >43 cattle (OR=3.120; IC=1.418-6.867)/animal purchase (OR=2.010; IC=1.154-3.500)/rent of pastures (OR=2.925; IC=1.060-8.068) and presence of maternity paddock (OR=1.981; IC=1,068-3,676) were identified as risk factors for leptospirosis due to any serovar in the multivariate logistic regression. Risk factors for leptospirosis due to serovar Hardjo were presence of >43 cattle (OR=3.622; IC=1.512-8,677)/animal purchase (OR=3.143; IC=1.557-6.342)/rent of pastures (OR=4.070; IC=1.370-12.087) and presence of horses (OR=2.981; IC=1.321-6.726). These results indicate that Leptospira spp. infection is widespread in the south central region of Paraná state and that factors related to the herd characteristic and management are associated with the infection.

ERP implementation in SMEs : Consultant – Client Views On Critical Success Factors

ERP system is now attracting the SMEs, as it is now economical and affordable for them. The current research emphasizes on “how to make ERP successful for SMEs”. The researchers have identified various critical success factors in implementation of ERP. The research gap noticed by author is the missing point of view of ERP consultant. This thesis investigates the answer of research question “What are the critical success factors in implementation of ERP system in SMEs in opinion of ERP consultants and acquiring organizations”. The purpose of this study is to identify the highly important and less important factors. The study results will suggest the ERP managers where they have to concentrate more in order to achieve success. Literature is reviewed in order to setup a base for empirical study. Aplenty of work is found related to CSFs, SMEs and ERP. The authors and factors are organized in form of a table that tells which author is agreed upon which factor. Final result of literature review is a list of 14 CSFs. The qualitative research methodology is used to investigate the ERP in Pakistani SMEs. A case study approach is selected because of unified nature of SMEs in Pakistan. A rice mill is selected as a case because it contains maximum SME attributes. The opinion of a Microsoft certified consultant is obtained by a semi-structured interview. Similarly a semi-structured interview is conducted with CIO of SME that acquired ERP. Both the interviewees are asked about all 14 factors, whether they are agree or not and why. The collected evidences then analyzed by tabulation. The factors upon which both the participants found agreed, taken as highly important. Similarly the factors upon which both participants found disagree, taken as less important. Study results present a grid with four quadrants, the CSFs highly important in opinion of both, the CSFs less important in opinion of both, CSFs important in opinion of consultant but not client, CSFs important in opinion of client but not consultant. In discussion part, the significance of each factor is discussed individually. It is discussed that why some factors are high/less important for SMEs in Pakistan. The study output communicates a message that the success of ERP system in SMEs is linked with careful management of five important factors, the project management, top management support, user training and education, consultant participation and ERP teamwork and composition. The ERP consultants and managers can divert their concentration from less important factors such as user involvement, culture readiness and ERP package selection, toward the highly important factors. The limitations of the study are small number of interviews and less people involved, provide an opportunity for future research in this field of information system.

Microenterprise success and failure factors

The purpose of this study is to identify factors contributory to success or failure of a microenterprise. Microenterprise is an enterprise with less than10 employees. About 99 % of all Finnish enterprises fall in this category. Earlier studies do not provide a comprehensive view on microenterprise success and failure factors. The theoretical part discusses the definition of success and failure, previous research and results already established about the topic and categories of business environment. The empirical part is founded on quantitative survey results from 204 Finnish microenterprises. The questions of the survey were based on previous surveys, literature and intuition. Both success and failure factors were enquired. Summary of the results was made and the results were compared among successful and unsuccessful enterprises. In open-end questions, the most important factors mentioned to affect enterprise performance positively were "Employees", "Customers" and "Skills, knowledge, education and experience." The most important factors affecting enterprise performance negatively were "Economical situation", "Employees availability and attitudes" as well as "Political decisions and passed laws". In Likert-scale set of questions, the most significant factors from the point of view of enterprise performance were "Product and / or service good quality", "Good reputation of the company" and "Staff's strong skills". The least significant factors were "Effect of marketing and promotion", "Conflicts" and "Differences of points of views of different generations". By Likert-scale set of questions, it was also tested which operations the enterprises perform, and according to the results, successful enterprises found "Performing a market research", "Use of distribution channel in sales" and "Expanding to new markets" less important than unsuccessful enterprises. The tests proved that the age of the enterprise correlates with the level of success of the enterprise: The younger the enterprise, the more successful it is. In addition, the results show that if the enterprise is family based, the less successful it is. In addition, there was also slight correlation between success and the level of growth, indicating that higher the level of growth the more successful the enterprise is. From the business environment point of view, the key finding was that internal factors affect more on the success of an enterprise than external factors, and that external factors affect more on the failure of an enterprise than internal factors.

Opportunities, constraints and constrained opportunities – A study on mothers’ working time patterns in 22 European countries

The aim of this study was to analyse mothers’ working time patterns across 22 European countries. The focus was on three questions: how much mothers prefer to work, how much they actually work, and to what degree their preferred and actual working times are (in)consistent with each other. The focus was on cross-national differences in mothers’ working time patterns, comparison of mothers’ working times to that of childless women and fathers, as well as on individual- and country-level factors that explain the variation between them. In the theoretical background, the departure point was an integrative theoretical approach where the assumption is that there are various kinds of explanations for the differences in mothers’ working time patterns – namely structural, cultural and institutional – , and that these factors are laid in two levels: individual- and country-levels. Data were extracted from the European Social Survey (ESS) 2010 / 2011. The results showed that mothers’ working time patterns, both preferred and actual working times, varied across European countries. Four clusters were formed to illustrate the differences. In the full-time pattern, full-time work was the most important form of work, leaving all other working time forms marginal. The full-time pattern was perceived in terms of preferred working times in Bulgaria and Portugal. In polarised pattern countries, fulltime work was also important, but it was accompanied by a large share of mothers not working at all. In the case of preferred working times, many Eastern and Southern European countries followed it whereas in terms of actual working times it included all Eastern and Southern European countries as well as Finland. The combination pattern was characterised by the importance of long part-time hours and full-time work. It was the preferred working time pattern in the Nordic countries, France, Slovenia, and Spain, but Belgium, Denmark, France, Norway, and Sweden followed it in terms of actual working times. The fourth cluster that described mothers’ working times was called the part-time pattern, and it was illustrated by the prevalence of short and long part-time work. In the case of preferred working times, it was followed in Belgium, Germany, Ireland, the Netherlands and Switzerland. Besides Belgium, the part-time pattern was followed in the same countries in terms of actual working times. The consistency between preferred and actual working times was rather strong in a majority of countries. However, six countries fell under different working time patterns when preferred and actual working times were compared. Comparison of working mothers’, childless women’s, and fathers’ working times showed that differences between these groups were surprisingly small. It was only in part-time pattern countries that working mothers worked significantly shorter hours than working childless women and fathers. Results therefore revealed that when mothers’ working times are under study, an important question regarding the population examined is whether it consists of all mothers or only working mothers. Results moreover supported the use of the integrative theoretical approach when studying mothers’ working time patterns. Results indicate that mothers’ working time patterns in all countries are shaped by various opportunities and constraints, which are comprised of structural, cultural, institutional, and individual-level factors.

Heart rate variability in young adults - Reference values and associations with cardiometabolic risk factors and vascular properties. The Cardiovascular Risk in Young Finns Study.

Background: The function of the autonomic nervous system (ANS) can be evaluated with heart rate variability (HRV). Decreased HRV is associated with aging, the male sex, increased heart rate, and overall increased cardiometabolic risk. It has been hypothesized that early atherosclerotic vascular changes and ANS function are related. Aims: The aims were to assess reference values on HRV in young adults, and examine associations with HRV and cardiometabolic risk factors and metabolic syndrome (MetS) and to study relations between HRV and ultrasonographically measured vascular properties. Participants and methods: The present thesis is part of the Cardiovascular Risk in Young Finns Study. The thesis is based on the follow-up study in 2001, when the study individuals were 24-39 years of age. HRV data were available on 1 956 individuals. Results: HRV was inversely associated with age and heart rate (for all p<0.001). Highfrequency HRV (HF) was higher, and low-frequency HRV (LF) lower in women than men (p<0.0001 for both). MetS was associated with 11% decreased HF and 12% increased LF/HF-ratio in women, and 8% decreased HF and 4% increased LF/HF-ratio in men. Carotid artery distensibility was independently associated with HF and total HRV (for both p<0.05). Conclusions: The reference values in young adults were generated. Decreased HRV was associated with age, the male sex and increased heart rate. Women had higher HF and lower LF variability than men. MetS was related to decrease in HRV. The observed associations between carotid elasticity and HRV, supports the hypothesis that reduction in carotid elasticity may lead to decrease in autonomic cardiac control.

Glial fibrillary acidic protein (GFAP): modulation by growth factors and its implication in astrocyte differentiation

Intermediate filament (IF) proteins constitute an extremely large multigene family of developmentally and tissue-regulated cytoskeleton proteins abundant in most vertebrate cell types. Astrocyte precursors of the CNS usually express vimentin as the major IF. Astrocyte maturation is followed by a switch between vimentin and glial fibrillary acidic protein (GFAP) expression, with the latter being recognized as an astrocyte maturation marker. Levels of GFAP are regulated under developmental and pathological conditions. Upregulation of GFAP expression is one of the main characteristics of the astrocytic reaction commonly observed after CNS lesion. In this way, studies on GFAP regulation have been shown to be useful to understand not only brain physiology but also neurological disease. Modulators of GFAP expression include several hormones such as thyroid hormone, glucocorticoids and several growth factors such as FGF, CNTF and TGFß, among others. Studies of the GFAP gene have already identified several putative growth factor binding domains in its promoter region. Data obtained from transgenic and knockout mice have provided new insights into IF protein functions. This review highlights the most recent studies on the regulation of IF function by growth factors and hormones.

Cross-talk between neurons and glia: highlights on soluble factors

The development of the nervous system is guided by a balanced action between intrinsic factors represented by the genetic program and epigenetic factors characterized by cell-cell interactions which neural cells might perform throughout nervous system morphogenesis. Highly relevant among them are neuron-glia interactions. Several soluble factors secreted by either glial or neuronal cells have been implicated in the mutual influence these cells exert on each other. In this review, we will focus our attention on recent advances in the understanding of the role of glial and neuronal trophic factors in nervous system development. We will argue that the functional architecture of the brain depends on an intimate neuron-glia partnership.

Mitochondrial K+ transport and cardiac protection during ischemia/reperfusion

Mitochondrial ion transport, oxidative phosphorylation, redox balance, and physical integrity are key factors in tissue survival following potentially damaging conditions such as ischemia/reperfusion. Recent research has demonstrated that pharmacologically activated inner mitochondrial membrane ATP-sensitive K+ channels (mitoK ATP) are strongly cardioprotective under these conditions. Furthermore, mitoK ATP are physiologically activated during ischemic preconditioning, a procedure which protects against ischemic damage. In this review, we discuss mechanisms by which mitoK ATP may be activated during preconditioning and the mitochondrial and cellular consequences of this activation, focusing on end-effects which may promote ischemic protection. These effects include decreased loss of tissue ATP through reverse activity of ATP synthase due to increased mitochondrial matrix volumes and lower transport of adenine nucleotides into the matrix. MitoK ATP also decreases the release of mitochondrial reactive oxygen species by promoting mild uncoupling in concert with K+/H+ exchange. Finally, mitoK ATP activity may inhibit mitochondrial Ca2+ uptake during ischemia, which, together with decreased reactive oxygen release, can prevent mitochondrial permeability transition, loss of organelle function, and loss of physical integrity. We discuss how mitochondrial redox status, K+ transport, Ca2+ transport, and permeability transitions are interrelated during ischemia/reperfusion and are determinant factors regarding the extent of tissue damage.

Power Consumption Measurement and Scenario Based Energy Model in Wearable Computing Applications

The power is still today an issue in wearable computing applications. The aim of the present paper is to raise awareness of the power consumption of wearable computing devices in specific scenarios to be able in the future to design energy efficient wireless sensors for context recognition in wearable computing applications. The approach is based on a hardware study. The objective of this paper is to analyze and compare the total power consumption of three representative wearable computing devices in realistic scenarios such as Display, Speaker, Camera and microphone, Transfer by Wi-Fi, Monitoring outdoor physical activity and Pedometer. A scenario based energy model is also developed. The Samsung Galaxy Nexus I9250 smartphone, the Vuzix M100 Smart Glasses and the SimValley Smartwatch AW-420.RX are the three devices representative of their form factors. The power consumption is measured using PowerTutor, an android energy profiler application with logging option and using unknown parameters so it is adjusted with the USB meter. The result shows that the screen size is the main parameter influencing the power consumption. The power consumption for an identical scenario varies depending on the wearable devices meaning that others components, parameters or processes might impact on the power consumption and further study is needed to explain these variations. This paper also shows that different inputs (touchscreen is more efficient than buttons controls) and outputs (speaker sensor is more efficient than display sensor) impact the energy consumption in different way. This paper gives recommendations to reduce the energy consumption in healthcare wearable computing application using the energy model.

Form(s)-of-life: agamben's reading of Wittgenstein and the potential uses of a notion

Giorgio Agamben and Ludwig Wittgenstein seem to have very little in common: the former is concerned with traditional ontological issues while the latter was interested in logics and ordinary language, avoiding metaphysical issues as something we cannot speak about. However, both share a crucial notion for their philosophical projects: form of life. In this paper, I try to show that, despite their different approaches and goals, form of life is for both a crucial notion for thinking ethics and life in-common. Addressing human existence in its constitutive relation to language, this notion deconstructs traditional dichotomies like bios and zoé, the cultural and the biological, enabling both authors to think of a life which cannot be separated from its forms, recognizing the commonality of logos as the specific trait of human existence. Through an analogical reading between both theoretical frameworks, I suggest that the notion of form-of-life, elaborated by Wittgenstein to address human production of meaning, becomes the key notion in Agamben's affirmative thinking since it enables us to consider the common ontologically in its relation to Human potentialities and to foresee a new, common use of the world and ourselves.

Crystal growth, Raman scattering and optical properties of the superconductor Cd2Re2O7(16O, 18O)/

Using the Physical Vapor Transport method, single crystals of Cd2Re207 have been grown, and crystals of dimensions up to 8x6x2 mm have been achieved. X-ray diffraction from a single crystal of Cd2Re207 has showed the crystal growth in the (111) plane. Powder X-ray diffraction measurements were performed on ^^O and ^^O samples, however no difference was observed. Assigning the space group Fd3m to Cd2Re207 at room temperature and using structure factor analysis, the powder X-ray diffraction pattern of the sample was explained through systematic reflection absences. The temperatiure dependence of the resistivity measurement of ^^O has revealed two structural phase transitions at 120 and 200 K, and the superconducting transition at 1.0 K. Using Factor Group Analysis on three different structiures of Cd2Re207, the number of IR and Raman active phonon modes close to the Brillouin zone centre have been determined and the results have been compared to the temperature-dependence of the Raman shifts of ^^O and ^*0 samples. After scaling (via removing Bose-Einstein and Rayleigh scattering factors from the scattered light) all spectra, each spectrum was fitted with a number of Lorentzian peaks. The temperature-dependence of the FWHM and Raman shift of mode Eg, shows the effects of the two structurjil phase transitions above Tc. The absolute reflectance of Cd2Re207 - '^O single crystals in the far-infrared spectral region (7-700 cm~^) has been measured in the superconducting state (0.5 K), right above the superconducting state (1.5 K), and in the normal state (4.2 K). Thermal reflectance of the sample at 0.5 K and 1.5 K indicates a strong absorption feature close to 10 cm~^ in the superconducting state with a reference temperature of 4.2 K. By means of Kramers-Kronig analysis, the absolute reflectance was used to calculate the optical conductivity and dielectric function. The real part of optical conductivity shows five distinct active phonon modes at 44, 200, 300, 375, and 575 cm~' at all temperatures including a Drude-like behavior at low frequencies. The imaginary part of the calculated dielectric function indicates a mode softening of the mode 44 cm~' below Tc.

An analysis of the methyl rotation dynamics in the So (x' A) and T (a A) states of thioacetaldehyde from Pyrolysis jet spectra /

Jet-cooled, laser-induced phosphorescence excitation spectra (LIP) of thioacetaldehyde CH3CHS, CH3CDS, CD3CHS and CD3CDS have been observed over the region 15800 - 17300 cm"^ in a continuous pyrolysis jet. The vibronic band structure of the singlet-triplet n -* n* transition were attributed to the strong coupling of the methyl torsion and aldehydic hydrogen wagging modes . The vibronic peaks have been assigned in terms of two upper electronic state (T^) vibrations; the methyl torsion mode v^g, and the aldehydic hydrogen wagging mode v^^. The electronic origin O^a^ is unequivocally assigned as follows: CH3CHS (16294.9 cm"'' ), CH3CDS (16360.9 cm"'' ), CD3CHS (16299.7 cm"^ ), and CD3CDS (16367.2 cm"'' ). To obtain structural and dynamical information about the two electronic states, potential surfaces V(e,a) for the 6 (methyl torsion) and a (hydrogen wagging) motions were generated by ab initio quantum mechanical calculations with a 6-3 IG* basis in which the structural parameters were fully relaxed. The kinetic energy coefficients BQ(a,e) , B^(a,G) , and the cross coupling term B^(a,e) , were accurately represented as functions of the two active coordinates, a and 9. The calculations reveal that the molecule adopts an eclipsed conformation for the lower Sq electronic state (a=0°,e=0"') with a barrier height to internal rotation of 541.5 cm"^ which is to be compared to 549.8 cm"^ obtained from the microwave experiment. The conformation of the upper T^ electronic state was found to be staggered (a=24 . 68° ,e=-45. 66° ) . The saddle point in the path traced out by the aldehyde wagging motion was calculated to be 175 cm"^ above the equilibrium configuration. The corresponding maxima in the path taken by methyl torsion was found to be 322 cm'\ The small amplitude normal vibrational modes were also calculated to aid in the assignment of the spectra. Torsional-wagging energy manifolds for the two states were derived from the Hamiltonian H(a,e) which was solved variationally using an extended two dimensional Fourier expansion as a basis set. A torsionalinversion band spectrum was derived from the calculated energy levels and Franck-Condon factors, and was compared with the experimental supersonic-jet spectra. Most of the anomalies which were associated with the interpretation of the observed spectrum could be accounted for by the band profiles derived from ab initio SCF calculations. A model describing the jet spectra was derived by scaling the ab initio potential functions. The global least squares fitting generates a triplet state potential which has a minimum at (a=22.38° ,e=-41.08°) . The flatter potential in the scaled model yielded excellent agreement between the observed and calculated frequency intervals.