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The number of older people choosing to relocate to retirement villages (RVs) is increasing rapidly. This choice is often a way to decrease social isolation while still living independently. Loneliness is a significant health issue and contributes to overall frailty, yet RV resident loneliness is poorly understood. Our aim is to describe the prevalence of loneliness and associated factors in a New Zealand RV population.
A resident survey was used to collect demographics, social engagement, loneliness, and function, as well as a comprehensive geriatric assessment (international Resident Assessment Instrument [interRAI]) as part of the “Older People in Retirement Villages Study.”
RVs, Auckland, New Zealand.
Participants included RV residents living in 33 RVs (n = 578).
Two types of recruitment: randomly sampled cohort (n = 217) and volunteer sample (n = 361). Independently associated factors for loneliness were determined through multiple logistic regression with odds ratios (ORs).
Of the participants, 420 (72.7%) were female, 353 (61.1%) lived alone, with the mean age of 81.3 years. InterRAI assessment loneliness (yes/no question) was 25.8% (n = 149), and the resident survey found that 37.4% (n = 216) feel lonely sometimes/often/always. Factors independently associated with interRAI loneliness included being widowed (adjusted OR 8.27; 95% confidence interval [CI] 4.15–16.48), being divorced/separated/never married (OR 4.76; 95% CI 2.15–10.54), poor/fair quality of life (OR 3.37; 95% CI 1.43–7.94), moving to an RV to gain more social connections (OR 1.55; 95% CI 0.99–2.43), and depression risk (medium risk: OR 2.58, 95% CI 1.53–4.35; high risk: OR 4.20, 95% CI 1.47–11.95).
A considerable proportion of older people living in RVs reported feelings of loneliness, particularly those who were without partners, at risk of depression and decreased quality of life and those who had moved into RVs to increase social connections. Early identification of factors for loneliness in RV residents could support interventions to improve quality of life and positively impact RV resident health and well-being.
Involuntary admission and treatment is often a traumatic experience for patients and there is a wide variation in attitudes towards care even when patients are recovered.
The purpose of this large prospective study was to identify clinical predictors of attitudes towards care during involuntary admission.
Three hundred and ninety-one consecutively admitted involuntarily patients to three psychiatric inpatient units over a 30-month period were invited to participate in the study. Comprehensive assessments at admission and 3 months after discharge were attained including measures of symptoms, insight, functioning, attitudes towards involuntary admission and coercive experiences. Multiple linear regression modelling was used to determine the optimal explanatory variables for attitudes towards care.
Two hundred and sixty-three individuals participated at baseline and 156 (59%) successfully completed follow-up assessments. Individuals improved significantly over time clinically and in their attitudes towards their care. At baseline greater insight (P < 0.001) and less symptoms (P = 0.02) were associated with more positive attitudes towards care as was older age (P = 0.001). At follow-up, greater insight (P < 0.001), less symptoms (P = 0.02) and being older (P = 0.04) were associated with more positive attitudes towards care. More positive attitudes towards care at follow-up were associated with greater improvements in insight over time (P < 0.001) and having a diagnosis of an affective psychosis (P = 0.0009).
The best predictors of positive attitudes towards care during and after involuntary admission are illness related factors, such as levels of insight and improvement in insight, rather than service or legislation related factors, such as the use of coercive measures, seclusion and restraint.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The History, Electrocardiogram (ECG), Age, Risk Factors, and Troponin (HEART) score is a decision aid designed to risk stratify emergency department (ED) patients with acute chest pain. It has been validated for ED use, but it has yet to be evaluated in a prehospital setting.
A prehospital modified HEART score can predict major adverse cardiac events (MACE) among undifferentiated chest pain patients transported to the ED.
A retrospective cohort study of patients with chest pain transported by two county-based Emergency Medical Service (EMS) agencies to a tertiary care center was conducted. Adults without ST-elevation myocardial infarction (STEMI) were included. Inter-facility transfers and those without a prehospital 12-lead ECG or an ED troponin measurement were excluded. Modified HEART scores were calculated by study investigators using a standardized data collection tool for each patient. All MACE (death, myocardial infarction [MI], or coronary revascularization) were determined by record review at 30 days. The sensitivity and negative predictive values (NPVs) for MACE at 30 days were calculated.
Over the study period, 794 patients met inclusion criteria. A MACE at 30 days was present in 10.7% (85/794) of patients with 12 deaths (1.5%), 66 MIs (8.3%), and 12 coronary revascularizations without MI (1.5%). The modified HEART score identified 33.2% (264/794) of patients as low risk. Among low-risk patients, 1.9% (5/264) had MACE (two MIs and three revascularizations without MI). The sensitivity and NPV for 30-day MACE was 94.1% (95% CI, 86.8-98.1) and 98.1% (95% CI, 95.6-99.4), respectively.
Prehospital modified HEART scores have a high NPV for MACE at 30 days. A study in which prehospital providers prospectively apply this decision aid is warranted.
To evaluate and compare the opinions of key stakeholders involved in the involuntary admission and treatment of patients under the Mental Health Act (MHA) 2001 regarding their views towards the operation of the legislation.
We employed a descriptive survey design. A questionnaire was distributed to stakeholders involved in the operation of the MHA 2001 (except service users, whose views were explored in a separate qualitative study) via paper or online versions evaluating their opinions regarding the operation of the MHA 2001 in relation to assessment, care, rights, transfer and information available.
Stakeholders agreed that in their opinion that patients generally benefit from the care they receive (79%) and that the MHA 2001 ensures an independent and fair review of the person’s detention (65%). However, only 23% of stakeholders were satisfied with the process of transferring patients to hospital and with the clinical assessment procedures therein (37%), with the greatest levels of dissatisfaction amongst Gardai (Police), general practitioners (GPs) and family members.
While the introduction of the MHA 2001 has assisted delivery of care to patients with improved adherence to international human rights frameworks applicable at the time of its enactment, substantial dissatisfaction with the implementation of the MHA 2001 in practice is experienced by stakeholders particularly at the distressing phase of clinical assessment and transfer to hospital.
Tuberous sclerosis complex (TSC) is associated with intellectual disability, but the risk pathways are poorly understood.
The Tuberous Sclerosis 2000 Study is a prospective longitudinal study of the natural history of TSC. One hundred and twenty-five UK children age 0–16 years with TSC and born between January 2001 and December 2006 were studied. Intelligence was assessed using standardized measures at ≥2 years of age. The age of onset of epilepsy, the type of seizure disorder, the frequency and duration of seizures, as well as the response to treatment was assessed at interview and by review of medical records. The severity of epilepsy in the early years was estimated using the E-Chess score. Genetic studies identified the mutations and the number of cortical tubers was determined from brain scans.
TSC2 mutations were associated with significantly higher cortical tuber count than TSC1 mutations. The extent of brain involvement, as indexed by cortical tuber count, was associated with an earlier age of onset and severity of epilepsy. In turn, the severity of epilepsy was strongly associated with the degree of intellectual impairment. Structural equation modelling supported a causal pathway from genetic abnormality to cortical tuber count to epilepsy severity to intellectual outcome. Infantile spasms and status epilepticus were important contributors to seizure severity.
The findings support the proposition that severe, early onset epilepsy may impair intellectual development in TSC and highlight the potential importance of early, prompt and effective treatment or prevention of epilepsy in tuberous sclerosis.
We report on an influenza B outbreak in an Ontario long-term care facility in which 2 immunized residents receiving oseltamivir prophylaxis for at least 5 days developed laboratory-confirmed influenza B infection. All isolates were tested for the most common oseltamivir resistance, and none of them had resistance identified.
Simple alkanedithiols exhibit the same molecular conductance whether measured in air, under vacuum or under liquids of different polarity. Here, we show that the presence of water ‘gates’ the conductance of a family of oligothiophene–containing molecular wires, and that the longer the oligothiophene, the larger is the effect; for the longest example studied, the molecular conductance is over two orders of magnitude larger in the presence of water, an unprecedented result suggesting that ambient water is a crucial factor to be taken into account when measuring single molecule conductances (SMC), or in the design of future molecular electronic devices. Theoretical investigation of electron transport through the molecules, using the ab initio non-equilibrium Green's function (SMEAGOL) method, shows that water molecules interact with the thiophene rings, shifting the transport resonances enough to increase greatly the SMC of the longer, more conjugated examples.
The direct initiation of gaseous detonation is investigated experimentally in the cylindrical geometry. By using a long source of energy deposition along a line (i.e. pentaerythritoltetranitrate (PETN) detonating cord), undesirable charge initiation and confinement effects are eliminated. This permitted the different flow fields of direct initiation of detonation to be studied unambiguously. Although the detonation velocity in the detonating cord is finite, it was sufficiently large compared to the acoustic velocity in the surrounding gas to permit the different flow fields to be investigated within the hypersonic analogy framework, by which the detonating cord synchronizes a continuous series of cylindrical initiation events along its length. The hypersonic approximation was validated in experiments conducted in a non-reactive medium (air). In the supercritical regime of initiation in combustible gas, stable oblique detonations were observed, confirming their existence and stability. In the critical regime, the onset of detonation was observed to occur consistently from stochastic detonative centres. These centres appeared during the initial decay of the blast wave to sub-Chapman–Jouguet (CJ) velocities. The photographic evidence revealed the three-dimensional details of the detonation kernels' amplification. The present results in the cylindrical geometry are further used to discuss criteria for direct initiation of detonations. In conjunction with previous experiments in the spherical and planar geometries, a criterion for direct initiation is found to involve a critical decay rate of the reacting blast wave. In light of the experimental evidence of the inherent three-dimensional effects during the initiation phase, the strict one-dimensionality of current theoretical models is discussed.
The synthesis of materials with void volumes in excess of 50% is an ongoing challenge in molecular sieve science. It has been shown that a correlation exists between the minimum framework density (FD) and the smallest ring in which all tetrahedral atoms reside (MINR). Based on this evidence it appears that materials containing 3-membered rings (3MR) will be necessary in order to obtain FDs lower than those currently attainable. Several framework beryllosilicate minerals including the natural zeolite, lovdarite, contain 3MRs. Unfortunately, beryllium can form highly toxic compounds that limit its suitability for many applications. Thus, in this study we have searched for a replacement for Be and have found that zinc is a suitable substitute with respect to the formation of three-membered rings.
We report here VPI-7, a novel zincosilicate molecular sieve which contains three-membered rings. The VPI-7 framework contains rings composed of 3–, 4– and 5 T-atoms which form unidimensional 8– and intersecting 9MR channels.
1. When fractionated by sodium dodecylsulphate-polyacrylamide gel electrophoresis (SDS-PAGE), strained rumen fluid from sheep fed on pelleted lucerne (Medicago sativa) hay showed no major protein components that stain with Coomassie Blue. This feature made it possible to monitor the fate of individual polypeptides within a protein mixture incubated in rumen fluid in vitro.
2. Extracts from a number of seed meals (sunflower (Helianthus annuus), lupin (Lupinus angustifolius), rape (Brassica napus) and pea (Pisum sativum L.)), as well as casein and bovine serum albumin, were examined in this system. The protein components of each seed type showed a wide range of resistances to degradation. One protein in pea seeds (pea albumin 1), which is particularly rich in cysteine, was almost as resistant to rumen degradation as bovine serum albumin.
3. Analysis of synthetic-fibre-bag experiments by SDS-PAGE showed that the rate of loss of total protein from solid meal residues does not provide an index of the resistance of individual protein components of the meal to rumen degradation. While there was no qualitative change in the protein profile of residual pea-seed meal inside a synthetic-fibre bag, there was considerable variation in the rate at which individual, solubilized protein components were degraded in the surrounding rumen fluid.
Studies of experimentally induced respiratory infections and illnesses showed that influenza impaired performance on a visual search task but had no effect on a simple motor task, whereas colds impaired the motor task but not the search task. The effect of influenza on the search task was observed in both volunteers with significant clinical symptoms and volunteers who were shown, by virological techniques, to be infected but who had no significant clinical illness. Performance was also impaired during the incubation period of this illness, which confirms that subclinical influenza virus infections can have behavioural effects. In contrast to influenza, the effects of colds were restricted to volunteers who had significant clinical symptoms, and the impairments in performance were observed only when the symptoms were apparent.
This survey of Son of man-Forschung makes no claim to completeness, which in any case is probably unattainable, but seeks to review the main trends and developments since my earlier book Jesus and the Son of Man (1964).
A number of scholars still find authentic words of Jesus in all three groups of sayings: those referring to his earthly activity, those foretelling his passion and resurrection, and those looking to the parousia and glory of the Son of man. Among them are Goppelt, Moule, Maddox, Marshall, Barrett, and Bruce.
Goppelt adds to the authentic sayings the following: Mark 2.10, 28; the Q present sayings Matt. 8.20, par.; 11.19, par.; 12.32, par.; the future saying Luke 12.8, regarded as more original than parr. Matt. 10.32 and Mark 8.38; and a passion prediction behind Mark 8.31, traceable to the oldest Palestinian tradition and possibly to Jesus in the form, ‘The Son of man must suffer many things and be rejected (and after three days be raised up)’; this last part is implicit, because in the idea of the suffering righteous man rejection leads to exaltation.
Marshall does not take into account all the texts. The establishment of the fact (sic) that Jesus referred to himself as Son of man in his earthly ministry makes it impossible to believe that in the future sayings he could have referred to someone else, for he could not have spoken about two Sons of men! Jesus, therefore, refers to himself in Luke 12.8f.; 12.40, par. Matt. 24.44; Luke 18.8b; Mark 14.62.
The antiquity of a saying attributed to Jesus may be tested in several ways; but antiquity does not guarantee authenticity. In his study of Son of man sayings and their non-Son of man rivals or parallels, Jeremias is concerned with the question of the priority of one or the other of the two types. Clearly, investigation of the relative age of traditional sayings must precede the further inquiry into authenticity. The present study has not found sufficient evidence to justify acceptance of either Jeremias' preference for the non-Son of man parallels, or Borsch's contrary arguments in favour of the Son of man versions as the more primitive type. Jeremias' other thesis is that the oldest Son of man sayings of all are likely to be those without non-Son of man rivals (konkurrenzlos). Our investigation, however, has produced the result that the only sayings of this category to which authenticity can be assigned with any degree of probability are the three closely associated sayings in Luke 17.24, 26f., 28–30. These, together with Luke 12.8f. and 11.29f., the only authentic sayings of the other category, constitute the ‘kernel sayings’.
Full account has been taken of the ‘sentence of holy law’ investigated by Käsemann (Perrin's ‘eschatological judgment pronouncement’ or ‘judgment saying’), and of the ‘eschatological correlative’ (Perrin's ‘comparison saying’) more recently isolated by R. A. Edwards. Both these types are represented among the kernel sayings: Luke 12.8f. is a sentence of holy law, and Luke 11.30; 17.24, 26, 28a + 30 are eschatological correlatives.
The appearance not only of another book about the Son of man, but of one by an author already responsible for an earlier work on the subject, may perhaps require some explanation. In the last chapter of my earlier book, Jesus and the Son of Man (1964), the thesis was outlined that Jesus confidently expected vindication of his mission after his death by being given, in the presence of God, a status of exaltation that involved the judgmental functions traditionally associated with the apocalyptic Son of man. The present work seeks to develop this thesis, and to that extent it is a logical sequel to JSM. It was suggested as a worthwhile undertaking by study of subsequent contributions to the unending debate, some of which have been used in support of the thesis presented here, while others, setting out theories which appear to me to be unconvincing, have served only to strengthen my adherence to it. The contribution of the present study, therefore, is not the presentation of a fresh or novel theory, but the defence, promotion, and development, against the background of recent significant work, and by detailed investigation of the relevant texts, of the theme stated above.
The first two chapters, constituting Part One, are intended mainly as necessary prolegomena to the study of texts in Part Two. Although not an actual part of the argument, these chapters are far from being a mere catalogue of the principal views and theories put forward since 1964.