Effectiveness of case management and post-acute services in older people after hospital discharge

Objective: To evaluate the benefits of coordinating community services through the Post-Acute Care (PAC) program in older patients after discharge from hospital. Design: Prospective multicentre, randomised controlled trial with six months of follow-up with blinded outcome measurement. Setting: Four university-affiliated metropolitan general hospitals in Victoria. Participants: All patients aged 65 years and over who were discharged between August 1998 and October 1999 and required community services after discharge. Interventions: Participants were randomly allocated to receive services of a Post-Acute Care (PAC) coordinator (intervention) versus usual discharge planning (control). Main outcome measures: Comparison of quality of life and carer stress at one-month post-discharge, mortality, hospital readmissions, use of community services and community and hospital costs over the six months post-discharge. Results: 654 patients were randomised, and 598 were included in the analysis (311 in the PAC group and 287 in the control group). There was no difference in mortality between the groups (both 6%), but significantly greater overall quality-of-life scores at one-month follow-up in the PAC group. There was no difference in unplanned readmissions, but PAC patients used significantly fewer hospital bed-days in the six months after discharge (mean, 3.0 days; 95% CI, 2.1-3.9) than control patients (5.2 days; 95% CI, 3.8-6.7). Total costs (including hospitalisation, community services and the intervention) were lower in the PAC than the control group (mean difference, $1545; 95% CI, $11-$3078). Conclusions: The PAC program is beneficial in the transition from hospital to the community in older patients.

Physiological responses to repeated bouts of high-intensity ultraendurance cycling - a field study case report

The present study aimed to 1) examine the relationship between laboratory-based measures and high-intensity ultraendurance (HIU) performance during an intermittent 24-h relay ultraendurance mountain bike race (similar to20 min cycling, similar to60min recovery), and 2) examine physiological and performance based changes throughout the HIU event. Prior to the HIU event, four highly-trained male cyclists (age = 24.0 +/- 2.1 yr; mass = 75.0 +/- 2.7 kg; (V)over dot O-2peak = 70 +/- 3 ml.kg(-1).min(-1)) performed 1) a progressive exercise test to determine peak Volume of oxygen uptake ((V)over dot O-2peak), peak power output (PPO), and ventilatory threshold (T-vent), 2) time-to-fatigue tests at 100% (TF100) and 150% of PPO (TF150), and 3) a laboratory simulated 40-km time trial (TT40). Blood lactate (Lac(-)), haematocrit and haemoglobin were measured at 6-h intervals throughout the HIU event, while heart rate (HR) was recorded continuously. Intermittent HIU performance, performance HR, recovery HR, and Lac declined (P < 0.05), while plasma volume expanded (P < 0.05) during the HIU event. TF100 was related to the decline in lap time (r = -0.96; P < 0.05), and a trend (P = 0.081) was found between TF150 and average intermittent HIU speed (r = 0.92). However, other measures (V)over dot O-2peak, PPO, T-vent, and TT40) were not related to HIU performance. Measures of high-intensity endurance performance (TF100, TF150) were better predictors of intermittent HIU performance than traditional laboratory-based measures of aerobic capacity.

An approach to verifying and debugging simulation models governed by ordinary differential equations: Part 2. Residuals analysis and a case study

In Part 1 of this paper a methodology for back-to-back testing of simulation software was described. Residuals with error-dependent geometric properties were generated. A set of potential coding errors was enumerated, along with a corresponding set of feature matrices, which describe the geometric properties imposed on the residuals by each of the errors. In this part of the paper, an algorithm is developed to isolate the coding errors present by analysing the residuals. A set of errors is isolated when the subspace spanned by their combined feature matrices corresponds to that of the residuals. Individual feature matrices are compared to the residuals and classified as 'definite', 'possible' or 'impossible'. The status of 'possible' errors is resolved using a dynamic subset testing algorithm. To demonstrate and validate the testing methodology presented in Part 1 and the isolation algorithm presented in Part 2, a case study is presented using a model for biological wastewater treatment. Both single and simultaneous errors that are deliberately introduced into the simulation code are correctly detected and isolated. Copyright (C) 2003 John Wiley Sons, Ltd.

Climate change and biotic invasions: a case history of a tropical woody vine

The impacts of climate change in the potential distribution and relative abundance of a C3 shrubby vine, Cryptostegia grandiflora, were investigated using the CLIMEX modelling package. Based upon its current naturalised distribution, C. grandiflora appears to occupy only a small fraction of its potential distribution in Australia under current climatic conditions; mostly in apparently sub-optimal habitat. The potential distribution of C. grandiflora is sensitive towards changes in climate and atmospheric chemistry in the expected range of this century, particularly those that result in increased temperature and water use efficiency. Climate change is likely to increase the potential distribution and abundance of the plant, further increasing the area at risk of invasion, and threatening the viability of current control strategies markedly. By identifying areas at risk of invasion, and vulnerabilities of control strategies, this analysis demonstrates the utility of climate models for providing information suitable to help formulate large-scale, long-term strategic plans for controlling biotic invasions. The effects of climate change upon the potential distribution of C. grandiflora are sufficiently great that strategic control plans for biotic invasions should routinely include their consideration. Whilst the effect of climate change upon the efficacy of introduced biological control agents remain unknown, their possible effect in the potential distribution of C. grandiflora will likely depend not only upon their effects on the population dynamics of C. grandiflora, but also on the gradient of climatic suitability adjacent to each segment of the range boundary.

Inércia da taxa de juros : teoria e evidência para a economia brasileira (2005-2013)

No âmbito da condução da política monetária, as funções de reação estimadas em estudos empíricos, tanto para a economia brasileira como para outras economias, têm mostrado uma boa aderência aos dados. Porém, os estudos mostram que o poder explicativo das estimativas aumenta consideravelmente quando se inclui um componente de suavização da taxa de juros, representado pela taxa de juros defasada. Segundo Clarida, et. al. (1998) o coeficiente da taxa de juros defasada (situado ente 0,0 e 1,0) representaria o grau de inércia da política monetária, e quanto maior esse coeficiente, menor e mais lenta é a resposta da taxa de juros ao conjunto de informações relevantes. Por outro lado, a literatura empírica internacional mostra que esse componente assume um peso expressivo nas funções de reação, o que revela que os BCs ajustam o instrumento de modo lento e parcimonioso. No entanto, o caso brasileiro é de particular interesse porque os trabalhos mais recentes têm evidenciado uma elevação no componente inercial, o que sugere que o BCB vem aumentando o grau de suavização da taxa de juros nos últimos anos. Nesse contexto, mais do que estimar uma função de reação forward looking para captar o comportamento global médio do Banco Central do Brasil no período de Janeiro de 2005 a Maio de 2013, o trabalho se propôs a procurar respostas para uma possível relação de causalidade dinâmica entre a trajetória do coeficiente de inércia e as variáveis macroeconômicas relevantes, usando como método a aplicação do filtro de Kalman para extrair a trajetória do coeficiente de inércia e a estimação de um modelo de Vetores Autorregressivos (VAR) que incluirá a trajetória do coeficiente de inércia e as variáveis macroeconômicas relevantes. De modo geral, pelas regressões e pelo filtro de Kalman, os resultados mostraram um coeficiente de inércia extremamente elevado em todo o período analisado, e coeficientes de resposta global muito pequenos, inconsistentes com o que é esperado pela teoria. Pelo método VAR, o resultado de maior interesse foi o de que choques positivos na variável de inércia foram responsáveis por desvios persistentes no hiato do produto e, consequentemente, sobre os desvios de inflação e de expectativas de inflação em relação à meta central.

Condiloma lingual: a case report

O condiloma acuminado é uma doença sexualmente transmissível causada pelo Papilomavírus humano (HPV). Freqüente na região anogenital e rara na cavidade oral. No entanto, o aumento da atividade oro-sexual vem cada vez mais favorecendo a instalação da infecção do HPV na mucosa oral. O presente relato descreve um condiloma na cavidade oral em um paciente do sexo masculino, de 35 anos, com história de prática de sexo oral, cujo diagnóstico foi confirmado pela biópsia. O tratamento instituído foi efetuado com o uso de ácido tricloacético a 80%, ocorrendo remoção completa da lesão. Foi feito uma revisão da literatura acerca da incidência, quadro clínico, diagnóstico, tratamento e profilaxia.

Identity and the concept of the West: the case of Brazil and India

This study aims to provide insights about how Brazil and India view and relate to the concept of the West, and how this affects their identity and foreign policy. Both countries' notions about the West are the subject of lively domestic discussion both in academia and the media, reflecting the struggle these countries find themselves in to define their identity as they rise. I argue that the concept of the West serves, in both Brazil and India, as a crucial concept to articulate their own identity-by a complex combination of criticizing, distancing itself from, or attempting to emulate the West.

Governance of global climate change in the Brazilian Amazon: the case of Amazonian municipalities of Brazil

With regards to the debate about governance of climate change, it should be assumed that the Amazon region plays an important role, as this large area is highly vulnerable to its effects. In this sense, this article aims to discuss how some Amazonian municipalities of Brazil have been taking part in the complexes and multilayered processes of climate governance.

Exploring the interplay between Framing and Securitization theory: the case of the Arab Spring protests in Bahrain

This article advances the theoretical integration between securitization theory and the framing approach, resulting in a set of criteria hereby called security framing. It seeks to make a twofold contribution: to sharpen the study of the ideational elements that underlie the construction of threats, and to advance towards a greater assessment of the audience's preferences. The case study under examination is the 2011 military intervention of the countries of the Gulf Cooperation Council in Bahrain. The security framing of this case will help illuminate the dynamics at play in one of the most important recent events in Gulf politics.