Nurses’ views on the implementation of Individualised Medication Administration Guides in patients with dysphagia in care homes

As conditions such as stroke, cancer, Parkinson's disease and Huntingdon's chorea are commonly found in care homes between 15% and 30% of residents in care homes have been found to have difficulties in swallowing their medicines.To address the difficulties associated with administering medicines to patients who cannot swallow (with dysphagia), Individualised Medication Administration Guides (I-MAGs) were introduced by a specialised pharmacist in Care for Elderly wards in a general hospital in East Anglia. The guides contained detailed information about how to administer each medication and they were individualised to the needs of the patient. The I-MAGs were printed in green forms and attached to the medication chart in order to be used in conjunction with it. The ward nurses reported an increase in their confidence when administering medication when I-MAGs were present in the ward. Some patients with I-MAG were discharged to care homes where the I-MAG might have been equally useful. However, the design of such guides is not known to be suitable for care homes environment where they have never been used before. This study aims to explore the opinions of nurses and carers within care homes on the relevance and acceptability of individualised medication administration guides for patients with dysphagia (PWD).

Medicines related dysphagia in primary care: The prevalence of and impact on community pharmacists

Dysphagia is a common and problematic symptom characterised by varying degrees of difficulty swallowing food, fluids and medicines of differing consistencies. International primary care based studies have identified that between 1 in 4 and 1 in 5 patients have some form of dysphagia, it can affect medicines taking behaviour and healthcare professionals are largely unaware of this1,2. Similar research has not been undertaken in the UK. Adherence related pharmacy based services in the UK provide an opportunity for community pharmacists to identify the problem and facilitate better medicines use. The aim of this pilot study was to estimate the level of patient reported dysphagia in older persons using community pharmacies in the UK, describe how it affects their medicine taking behaviour and identify whether advanced pharmacy services are related to improved awareness of this.

ERAP2 is associated with ankylosing spondylitis in HLA-B27-positive and HLA-B27-negative patients

The association of endoplasmic reticulum aminopeptidase 2 (ERAP2) with ankylosing spondylitis (AS) was recently described in the large International Genetics of AS Consortium Immunochip study...

Association of IL23R and ERAP1 genes with ankylosing spondylitis in a Portuguese population

Objective: Association between ankylosing spondylitis (AS) and two genes, ERAP1 and IL23R, has recently been reported in North American and British populations. The population attributable risk fraction for ERAP1 in this study was 25%, and for IL23R, 9%. Confirmation of these findings to ERAP1 in other ethnic groups has not yet been demonstrated. We sought to test the association between single nucleotide polymorphisms (SNPs) in these genes and susceptibility to AS among a Portuguese population. We also investigated the role of these genes in clinical manifestations of AS, including age of symptom onset, the Bath Ankylosing Spondylitis Disease Activity, Metrology and Functional Indices, and the modified Stoke Ankylosing Spondylitis Spinal Score. Methods: The study was conducted on 358 AS cases and 285 ethnically matched Portuguese healthy controls. AS was defined according to the modified New York Criteria. Genotyping of IL23R and ERAP1 allelic variants was carried out with TaqMan allelic discrimination assays. Association analysis was performed using the Cochrane-Armitage and linear regression tests of genotypes as implemented in PLINK for dichotomous and quantitative variables respectively. A meta-analysis for Portuguese and previously published Spanish IL23R data was performed using the StatsDirect® Statistical tools, by fixed and random effects models. Results: A total of 14 nsSNPs markers (8 for IL23R, 5 for ERAPl, 1 for LN-PEP) were analysed. Three markers (2 for IL23R and 1 for ERAP1) showed significant single-locus disease associations, confirming that the association of these genes with AS in the Portuguese population. The strongest associated SNP in IL23R was rs1004819 (OR=1.4, p=0.0049), and in ERAP1 was rs30187 (OR=1.26, p=0.035). The population attributable risk fractions in the Portuguese population for these SNPs are 11% and 9.7% respectively. No association was seen with any SNP in LN-PEP, which flanks ERAP1 and was associated with AS in the British population. No association was seen with clinical manifestations of AS. Conclusions: These results show that IL23R and ERAP1 genes are also associated with susceptibility to AS in the Portuguese population, and that they contribute a significant proportion of the population risk for this disease.

Spectrum of ankylosing spondylitis in Portugal. Development of BASDAI, BASFI, BASMI and mSASSS reference centile charts

The availability of population-specific normative data regarding disease severity measures is essential for patient assessment. The goals of the current study were to characterize the pattern of ankylosing spondylitis (AS) in Portuguese patients and to develop reference centile charts for BASDAI, BASFI, BASMI and mSASSS, the most widely used assessment tools in AS. AS cases were recruited from hospital outpatient clinics, with AS defined according to the modified New York criteria. Demographic and clinical data were recorded. All radiographs were evaluated by two independent experienced readers. Centile charts for BASDAI, BASFI, BASMI and mSASSS were constructed for both genders, using generalized linear models and regression models with duration of disease as independent variable. A total of 369 patients (62.3% male, mean ± (SD) age 45.4 ± 13.2 years, mean ± (SD) disease duration 11.4 ± 10.5 years, 70.7% B27-positive) were included. Family history of AS in a first-degree relative was reported in 17.6% of the cases. Regarding clinical disease pattern, at the time of assessment 42.3% had axial disease, 2.4% peripheral disease, 40.9% mixed disease and 7.1% isolated enthesopatic disease. Anterior uveitis (33.6%) was the most common extra-articular manifestation. The centile charts suggest that females reported greater disease activity and more functional impairment than males but had lower BASMI and mSASSS scores. Data collected through this study provided a demographic and clinical profile of patients with AS in Portugal. The development of centile charts constitutes a useful tool to assess the change of disease pattern over time and in response to therapeutic interventions.

Identification of multiple risk variants for ankylosing spondylitis through high-density genotyping of immune-related loci

Ankylosing spondylitis is a common, highly heritable inflammatory arthritis affecting primarily the spine and pelvis. In addition to HLA-B*27 alleles, 12 loci have previously been identified that are associated with ankylosing spondylitis in populations of European ancestry, and 2 associated loci have been identified in Asians. In this study, we used the Illumina Immunochip microarray to perform a case-control association study involving 10,619 individuals with ankylosing spondylitis (cases) and 15,145 controls. We identified 13 new risk loci and 12 additional ankylosing spondylitis-associated haplotypes at 11 loci. Two ankylosing spondylitis-associated regions have now been identified encoding four aminopeptidases that are involved in peptide processing before major histocompatibility complex (MHC) class I presentation. Protective variants at two of these loci are associated both with reduced aminopeptidase function and with MHC class I cell surface expression.

Manuel F. Lisan papers 1902-1969

Contains a typescript of memoirs (some sections in several drafts) covering the period until 1907 and describing Lisan's youth in Russia, his journey to America, his early years in Philadelphia, and his travels throughout Pennsylvania. The memoirs also relate in some detail Lisan's Zionist activities in Russia and America and his reaction to world Jewish events. Includes also correspondence covering the years 1902-1969 dealing with Lisan's Zionist activities, as well as announcements (1909-1910) of the Maccabean Zionist Society in Philadelphia and receipts and a Land Certificate from the American Zion Commonwealth and a share certificate from the Jewish Colonial Trust.

Letter from Manuel Josephson to Moses Seixas, February 4, 1890

Digital image

DNA sequences and austral taxa indicate generic synonymy of Paratrichocladius Santos-Abreu with Cricotopus Wulp (Diptera: Chironomidae)

In the century since the description of the orthoclad genus Paratrichocladius Santos-Abreu (Diptera: Chironomidae), separation in any life stage from the cosmopolitan, diverse Cricotopus Wulp has been problematic. Molecular analysis reveals the presence of two species in Australia that conform in morphology to Paratrichocladius and which form a well-supported clade including Paratrichocladius micans (Kieffer) from Africa and a distinct southern African larva. This clade clusters with taxa allied with Cricotopus albitibia (Walker), in turn nested within all other sampled Australian Cricotopus. Relevant nodes strongly support Cricotopus as nonmonophyletic without inclusion of Paratrichocladius. We synonymize Paratrichocladius with Cricotopus syn.n, treating Paratrichocladius as a subgenus. Cricotopus (Paratrichocladius) australiensis Cranston sp.n. is described for Trichocladius pluriserialis Freeman from Australia, which is not the same species under that name in New Zealand. Cricotopus (Paratrichocladius) bifenestrus Cranston sp.n. from Australia is described, also in all life stages. The many new combinations, listed in an Appendix, include three replacement names for new secondary homonyms, namely: Cricotopus (Paratrichocladius) sinobicinctus Cranston & Krosch nom.n. for Paratrichocladius bicinctus Fu, Sæther & Wang, Cricotopus draysoni Cranston & Krosch nom.n. for Cricotopus brevicornis Drayson, Krosch & Cranston, and Cricotopus (Paratrichocladius) sikhotealinus Makarchenko & Makarchenko nom.n. for Cricotopus orientalis Kieffer. We conclude with comments on wider issues in the taxonomy of Paratrichocladius, especially concerning New Zealand species.

Synagogue account with Manuel Myers

Digital image

Letter from Gershom Seixas to Manuel Myers regarding increase in salary

Digital image

Letter from Manuel Josephson to K.K.S.I. regarding joint letter to George Washington

Digital image

The Mediated Immediacy : João Batista Libanio and the Question of Latin American Liberation Theology

This study is a systematic analysis of mediated immediacy in the production of the Brazilian professor of theology João Batista Libanio. He stresses both ethical mediation and the immediate character of the faith. Libanio has sought an answer to the problem of science and faith. He makes use of the neo-scholastic distinction between matter and form. According to St. Thomas Aquinas, God cannot be known as a scientific object, but it is possible to predicate a formal theological content of other subject matter with the help of revelation. This viewpoint was emphasized in neo-Thomism and supported by the liberation theologians. For them, the material starting point was social science. It becomes a theologizable or revealable (revelabile) reality. This social science has its roots in Latin American Marxism which was influenced by the school of Louis Althusser and considered Marxism a science of history . The synthesis of Thomism and Marxism is a challenge Libanio faced, especially in his Teologia da libertação from 1987. He emphasized the need for a genuinely spiritual and ethical discernment, and was particularly critical of the ethical implications of class struggle. Libanio s thinking has a strong hermeneutic flavor. It is more important to understand than to explain. He does not deny the need for social scientific data, but that they cannot be the exclusive starting point of theology. There are different readings of the world, both scientific and theological. A holistic understanding of the nature of religious experience is needed. Libanio follows the interpretation given by H. C. de Lima Vaz, according to whom the Hegelian dialectic is a rational circulation between the totality and its parts. He also recalls Oscar Cullmann s idea of God s Kingdom that is already and not yet . In other words, there is a continuous mediation of grace into the natural world. This dialectic is reflected in ethics. Faith must be verified in good works. Libanio uses the Thomist fides caritate formata principle and the modern orthopraxis thinking represented by Edward Schillebeeckx. One needs both the ortho of good faith and the praxis of the right action. The mediation of praxis is the mediation of human and divine love. Libanio s theology has strong roots in the Jesuit spirituality that places the emphasis on contemplation in action.

Rendimiento agroindustrial de la variedad L 68-40 (Sacharum SP) en respuesta a las aplicaciones de N, P y K, cultivada en un suelo rojo en caña planta

El presente estudio se realizó en el ingenio AGROINSA, de junio de 1994 a febrero de 1995. Se evaluó el rendimiento agro­ industrial en caña de azúcar . Se plantó la variedad L 68-40. El diseño experimental utilizado fue el de Bloques Completamente Azarizado (BCA), las variables analizadas fueron brotación, ahijamiento, diámetro, población, altura, peso promedio de tallos, rendimiento agrícola, rendimiento industrial y rendimiento agro-industrial. Los datos que se obtuvieron se sometieron al análisis de varianza y de regresión, además se realizó la separación de medias según Duncan a un 5 % de margen de error. En todas las variables evaluadas se observó diferencia significativa a excepción del diámetro y el rendimiento industrial, siendo el nitrógeno el elemento que presentó mayor influencia positiva, no encontrándose ningún efecto para el fósforo y el potasio. Las mejores dosis de nitrógeno para producir el 90 por ciento del rendimiento máximo agrícola y agro-industrial, obtenida a través del modelo matemático cuadrático fueron 58 y 55 kg/ha de N, respectivamente.

Memoria poética y geografía en Don Juan Manuel

Integran este número de la revista ponencias presentadas en Studia Hispanica Medievalia VIII: Actas de las IX Jornadas Internacionales de Literatura Española Medieval, 2008, y de Homenaje al Quinto Centenario de Amadis de Gaula.