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Given the rising numbers of older adults in Canada experiencing falls, evidence-based identification of fall risks and plans for prevention across the continuum of care is a significant priority for health care providers. A scoping review was conducted to synthesize published international clinical practice guidelines (CPGs) and recommendations for fall risk screening and assessment in older adults (defined as 65 years of age and older). Of the 22 CPGs, 6 pertained to multiple settings, 9 pertained to community-dwelling older adults only, 2 each pertained to acute care and long-term care settings only, and 3 did not specify setting. Two criteria, prior fall history and gait and balance abnormalities, were applied either independently or sequentially in 19 CPG fall risk screening algorithms. Fall risk assessment components were more varied across CPGs but commonly included: detailed fall history; detailed evaluation of gait, balance, and/or mobility; medication review; vision; and environmental hazards assessment. Despite these similarities, more work is needed to streamline assessment approaches for heterogeneous and complex older adult populations across the care continuum. Support is also needed for sustainable implementation of CPGs in order to improve health outcomes.
Increased summer ice velocities on the Greenland ice sheet are driven by meltwater input to the subglacial environment. However, spatial patterns of surface input and partitioning of meltwater between different pathways to the base remain poorly understood. To further our understanding of surface drainage, we apply a supraglacial hydrology model to the Paakitsoq region, West Greenland for three contrasting melt seasons. During an average melt season, crevasses drain ~47% of surface runoff, lake hydrofracture drains ~3% during the hydrofracturing events themselves, while the subsequent surface-to-bed connections drain ~21% and moulins outside of lake basins drain ~15%. Lake hydrofracture forms the primary drainage pathway at higher elevations (above ~850 m) while crevasses drain a significant proportion of meltwater at lower elevations. During the two higher intensity melt seasons, model results show an increase (~5 and ~6% of total surface runoff) in the proportion of runoff drained above ~1300 m relative to the melt season of average intensity. The potential for interannual changes in meltwater partitioning could have implications for how the dynamics of the ice sheet respond to ongoing changes in meltwater production.
Volumetric atrophy and microstructural alterations in diffusion tensor imaging (DTI) measures of the hippocampus have been reported in people with Alzheimer's disease (AD) and mild cognitive impairment (MCI). However, no study to date has jointly investigated concomitant microstructural and volumetric changes of the hippocampus in dementia with Lewy bodies (DLB).
A total of 84 subjects (23 MCI, 17 DLB, 14 AD, and 30 healthy controls) were recruited for a multi-modal imaging (3T MRI and DTI) study that included neuropsychological evaluation. Freesurfer was used to segment the total hippocampus and delineate its subfields. The hippocampal segmentations were co-registered to the mean diffusivity (MD) and fractional anisotropy (FA) maps obtained from the DTI images.
Both AD and MCI groups showed significantly smaller hippocampal volumes compared to DLB and controls, predominantly in the CA1 and subiculum subfields. Compared to controls, hippocampal MD was elevated in AD, but not in MCI. DLB was characterized by both volumetric and microstructural preservation of the hippocampus. In MCI, higher hippocampal MD was associated with greater atrophy of the hippocampus and CA1 region. Hippocampal volume was a stronger predictor of memory scores compared to MD within the MCI group.
Through a multi-modal integration, we report novel evidence that the hippocampus in DLB is characterized by both macrostructural and microstructural preservation. Contrary to recent suggestions, our findings do not support the view that DTI measurements of the hippocampus are superior to volumetric changes in characterizing group differences, particularly between MCI and controls.
We studied neuroinflammation in individuals with late-life, depression, as a
risk factor for dementia, using [11C]PK11195 positron emission
tomography (PET). Five older participants with major depression and 13
controls underwent PET and multimodal 3T magnetic resonance imaging (MRI),
with blood taken to measure C-reactive protein (CRP). We found significantly
higher CRP levels in those with late-life depression and raised
[11C]PK11195 binding compared with controls in brain regions
associated with depression, including subgenual anterior cingulate cortex,
and significant hippocampal subfield atrophy in cornu ammonis 1 and
subiculum. Our findings suggest neuroinflammation requires further
investigation in late-life depression, both as a possible aetiological
factor and a potential therapeutic target.
The government's cocoa spraying gangs in Ghana treat about two million hectares of the crop against black pod disease and mirids, the key insect pests of cocoa in West Africa, each August through to December, based on recommendations issued in the 1950s. A few cocoa farmers use additional pesticides. We studied the temporal distribution of two important mirid species, Distantiella theobroma (Dist.) and Sahlbergella singularis Hagl., in 1991, 1999, 2003 and 2012 to determine the appropriate timing for the application of control measures in current farming systems. There was a significant correlation between mirid abundance and pod availability on trees, as well as the number of basal shoots and the cocoa variety grown. Mirid populations peaked between January and April and from September to October. Surveys (interviews and focus group discussions involving over 300 farmers in 33 cocoa-growing districts) on pesticide use, sources of recommendations, and perceived successes and failures of current cocoa pest treatments suggested that the 1950 recommendations on the timing of insecticide application need revising.
We present preliminary results of a 4-month campaign carried out in the framework of the Mons project, where time-resolved Hα observations are used to study the wind and circumstellar properties of a number of OB stars.
We present the results from the spectroscopic follow-up of WR140 (WC7 + O4-5) during its last periastron passage in january 2009. This object is known as the archetype of colliding wind binaries and has a relatively large period (≃8 years) and eccentricity (≃0.89). We provide updated values for the orbital parameters, new estimates for the WR and O star masses and new constraints on the mass-loss rates.
The network approach proposed by Cramer et al. suggests fascinating new directions of research on mental disorders. Research is needed to find evidence for the causal power of symptoms, to examine symptoms thoroughly, to investigate individual differences in edge strength, to discover etiological processes for each symptom, and to determine whether and why symptoms cohere into distinct mental disorders.
This paper is the introduction to the Macroeconomic Dynamics Special Issue on Measurement with Theory. The Guest Editors of the special issue are William A. Barnett, W. Erwin Diewert, Shigeru Iwata, and Arnold Zellner. The papers included are part of a larger initiative to promote measurement with theory in economics.
The Working Group FITS (WG-FITS) is the international control authority for the Flexible Image Transport System (FITS) data format. The WG-FITS was formed in 1988 by a formal resolution of the IAU XX General Assembly in Baltimore (MD, USA), 1988, to maintain the existing FITS standards and to approve future extensions to FITS.
Paediatric cardiac services are poorly developed or totally absent in underdeveloped countries. Institutions, foundations and interested individuals in those nations in which sophisticated paediatric cardiac surgery is practised have the ability to alleviate this problem by sponsoring paediatric cardio-surgical missions to provide care, and train local caregivers in developing, transitional, and third world countries. The ultimate benefit of such a programme is to improve the surgical abilities of the host institution. The purpose of this report is to present the impact of our programme over a period of 14 years.
We specifically reviewed our database of patients from our missions, our team lists, surgical results, and the number and type of personnel trained in the institutions that we have assisted. In order for the institution to be entered into the study, the foundation had to provide at least 2 months of training. In addition, the institution had to respond to a simple questionnaire concerning the number and types of surgery performed at their facility before and after intervention by the foundation.
We made 140 trips to 27 institutions in 19 countries, with 12 of the visited institutions qualifying for inclusion. Of these, 9 institutions reported an increase in the number and complexity of cases currently being performed in their facility since the team intervened. This goal had not been accomplished in 3 institutions. The reasons for failure included the economic situation of the country, hospital and national politics, personality conflicts, and continued lack of hardware and disposables.
Paediatric cardiac service assistance can improve local services. A significant commitment is required by all parties involved.
Maya Blue is a colour that is more than a pigment; it had roles in status, ritual and performance, being daubed onto pots and people before sacrifice. Here researchers use experimental and historical evidence to discover how it was made, including direct scientific analysis of Maya Blue on a pot thrown into the sacred well at Chichén Itzá. The results indicate that the formation of the colour was actually part of the ritual.
Mrs. K, an 82-year-old woman with moderate to severe Alzheimer's dementia, advanced heart failure, emphysema, and diabetes mellitus with neuropathy and nephropathy has just been readmitted with difficulty breathing, two days after being discharged to the care of her daughter. In the previous admission for the same problem, she was treated in the intensive care unit, narrowly avoiding intubation by the use of aggressive pulmonary toilet, antibiotics, and diuretics for possible pneumonia and congestive heart failure. Just after her second admission, the attending physician approached Mrs. K's daughter to discuss forgoing life-sustaining treatment. “In my opinion, if your mother should have a cardiac arrest, resuscitating her would be futile,” said Mrs. K's physician. The daughter reacted angrily and insisted that “everything be done,” because her mom is strong and can get better (as she has previously).
What is conflict in the healthcare setting at the end of life?
Conflict may be defined as disagreement between people when a decision must be made or an action taken. Healthcare providers encounter conflict in everyday practice, and one of the most difficult and distressing situations physicians face is conflict with family members over forgoing life-sustaining treatment. What should be a cooperative effort to achieve treatment goals turns into an exercise in frustration and distress.
Why is conflict in the healthcare setting at the end of life important?
In the hospital, death is routine to the caregivers, but not to patients and families.
The lack of well-trained, dedicated infection control personnel prevents optimal control of nosocomial infections in Latin American pediatric oncology centers. We collaboratively planned and implemented a multinational training course in San Salvador, El Salvador, to address this need.
The course relied on its organizers' experience in training international healthcare providers, the availability of the International Training Center for Nurses, previous infection control collaboration with the Hospital Nacional de Niños Benjamin Bloom, and resources available at the University of El Salvador. The 4-week course consisted of lecture sessions combined with practical laboratory and hospital experience.
Two courses, one conducted in 2005 and one in 2006, trained 44 professionals from 15 Latin American countries. Evaluations showed that course content and teacher performance met the trainees' needs and that all trainees acquired the necessary knowledge and skills.
The course met the need for the training of Latin American infection control practitioners. Our experience can serve as a model for other organizations interested in strengthening infection control and prevention at international sites.
The business meeting began with a brief review of the current rules and procedures of the WG, which are documented on the WG web page. Four regional FITS committees have been established by the WG, covering North American, Europe, Japan, and Australian/New Zealand, to provide advice to the WG on pending proposals. While it is recognized that this committee structure might need to be revised to provide representation to other regions, the current system is working well, and there were no motions to make any changes at this time.
Hospital-acquired Legionella pneumonia has a fatality rate of 28%, and the source is the water distribution system. Two prevention strategies have been advocated. One approach to prevention is clinical surveillance for disease without routine environmental monitoring. Another approach recommends environmental monitoring even in the absence of known cases of Legionella pneumonia. We determined the Legionella colonization status of water systems in hospitals to establish whether the results of environmental surveillance correlated with discovery of disease. None of these hospitals had previously experienced endemic hospital-acquired Legionella pneumonia.
Twenty US hospitals in 13 states.
Hospitals performed clinical and environmental surveillance for Legionella from 2000 through 2002. All specimens were shipped to the Special Pathogens Laboratory at the Veterans Affairs Pittsburgh Medical Center.
Legionella pneumophila and Legionella anisa were isolated from 14 (70%) of 20 hospital water systems. Of 676 environmental samples, 198 (29%) were positive for Legionella species. High-level colonization of the water system (30% or more of the distal outlets were positive for L. pneumophila) was demonstrated for 6 (43%) of the 14 hospitals with positive findings. L. pneumophila serogroup 1 was detected in 5 of these 6 hospitals, whereas 1 hospital was colonized with L. pneumophila serogroup 5. A total of 633 patients were evaluated for Legionella pneumonia from 12 (60%) of the 20 hospitals: 377 by urinary antigen testing and 577 by sputum culture. Hospital-acquired Legionella pneumonia was identified in 4 hospitals, all of which were hospitals with L. pneumophila serogroup 1 found in 30% or more of the distal outlets. No cases of disease due to other serogroups or species (L. anisa) were identified.
Environmental monitoring followed by clinical surveillance was successful in uncovering previously unrecognized cases of hospital-acquired Legionella pneumonia.
The potential for development of 2 to 1 atrioventricular conduction in children with prolongation of the QT interval has been previously reported secondary to electrolytic disturbances. We report here a child who developed 2 to 1 atrioventricular conduction with prolongation of the QT interval following treatment with amiodarone for refractory supraventricular tachycardia. We highlight the importance of electrocardiographic monitoring to assess for those at risk of amiodarone toxicity, which may be manifested by prolongation of the QT interval and the simultaneous loss of atrioventricular conduction, and of equal importance the need for prompt conversion to an alternative anti-arrhythmic agent.