Polypharmacy: Misleading, but manageable

The percentage of the population described as elderly is growing, and a higher prevalence of multiple, chronic disease states must be managed concurrently. Healthcare practitioners must appropriately use medication for multiple diseases and avoid risks often associated with multiple medication use such as adverse effects, drug/drug interactions, drug/disease interactions, and inappropriate dosing. The purpose of this study is to identify a consensus definition for polypharmacy and evaluate its prevalence among elderly outpatients. The authors also sought to identify or develop a clinical tool which would assist healthcare practitioners guard against inappropriate drug therapy in elderly patients. The most commonly cited definition was a medication not matching a diagnosis. Inappropriate was part of definitions used frequently. Some definitions placed a numeric value on concurrent medications. Two common definitions (ie, 6 or more medications or a potentially inappropriate medication) were used to evaluate polypharmacy in elderly South Carolinians (n = 1027). Data analysis demonstrates that a significant percentage of this population is prescribed six or more concomitant drugs and/or uses a potentially inappropriate medication. The findings are 29.4% are prescribed 6 or more concurrent drugs, 15.7% are prescribed one or more potentially inappropriate drugs, and 9.3% meet both definitions of polypharmacy used in this study. The authors recommend use of less ambiguous terminology such as hyperpharmacotherapy or multiple medication use. A structured approach to identify and manage inappropriate polypharmacy is suggested and a clinical tool is provided

Prevention Measures and Management of Unruly Passengers Aboard an Aircraft

Putnik nedoličnog ponašanja definira se kao putnik koji odbija pratiti pravilanormalnog ponašanja unutar zrakoplova ili odbija pratiti upute dane od strane kabinskog osoblja ili zapovjednika zrakoplova, što rezultira ometanjem reda i discipline unutar zrakoplova te narušavanjem sigurnosti unutar zrakoplova. Ovo je definicija putnika nedoličnog ponašanja dana IATA-inim (International Air Transport Association - IATA) smjernicama za prevenciju i postupanje u slučajevima nedoličnog ponašanja putnika u zrakoplovu. Pojavom IATA-inih smjernica, zrakoplovni prijevoznici dobijaju jedinstven dokument uz pomoć kojeg postaje lakše obavljati prevenciju te intervenirati u slučaju incidenta putnika nedoličnog ponašanja u suvremenom dobu zračnog prometa gdje putnici nedoličnog ponašanja mogu predstavljati opasnost ne samo za zrakoplovnu posadu te putnike i imovinu unutarnjega, već i za sam zrakoplov te sigurnost leta. Ovim radom raspravljaju se regulative i praksa zračnih prijevoznika vezani za borbu protiv putnika nedoličnog ponašanja i drugih tipova putnika koji kane, ili su počinili kazneno djelo unutar i izvan zrakoplova, načini identifikacije te načini borbe zračnih prijevoznika, država te zapovjednika zrakoplova protiv akata takvih putnika te konačno smjernice za prevenciju i postupanje s takvim putnicima dane od strane Croatia Airlines te Turkish Airlines i njihova usporedba s onima danim od strane IATA-e.An unruly passenger is defined as a passenger that refuses to follow standard rulesof behaviour aboard an aircraft or refuses to acknowledge and comply to instructions set out by cabin crew or the aircraft commander, which finally results in disruption oforder and discipline aboard aircraft, aswell as the overall disruption of aircraftsecurity. This is the definition of an unruly passenger, given by IATAs (International Air Transport Association - IATA) Guidance on unruly passenger prevention and management. With the release of IATAs guidelines, airlines receive a unique document which they can now use for prevention and intervening in cases of unruly passenger incidents, in a modern air traffic era in which unruly passengers pose a threat not only to aircraft crew, passengers and property, but also to the aircraft itself aswell as the safety of the flight. This paper discusses regulations and practice of airlines regarding combating unruly and other types of passengers which intend to, or have commited a felony inside and outside of the aircraft, ways for airlines, states and aircraft commanders to identify and combat these passengers and finally Croatia Airlines and Turkish Airlines guidelines for prevention and management of unruly passengers and the comparison between these guidelines and the ones given out by IATA

Glass Formulation Development for INEEL Sodium-Bearing Waste

Studies were performed to develop and test a glass formulation for immobilization of sodium-bearing waste (SBW). SBW is a high soda, acid high activity waste stored at the INEEL in 10 underground tanks. It was determined in previous studies that SBW?s sulfur content dictates the its loading in borosilicate glasses to be melted by currently assumed processes. If the sulfur content (which is ~4.5 mass% SO3 on a non-volatile oxide basis in SBW) of the melter feed is too high then a molten alkali sulfate containing salt phase accumulates on the melt surface. The avoidance of salt accumulation during the melter process and the maximization of sulfur incorporation into the glass melt were the main focus of this development work. A glass was developed for 20 mass% SBW (on a non-volatile oxide basis), which contained 0.91 mass% SO3, that met all the processing and product quality constraint determined for SBW vitrification at a planned INEEL treatment plant?SBW-22-20. This report summarizes the formulation efforts and presents the data developed on a series of glasses with simulated SBW. Summar

Evidence-based Kernels: Fundamental Units of Behavioral Influence

This paper describes evidence-based kernels, fundamental units of behavioral influence that appear to underlie effective prevention and treatment for children, adults, and families. A kernel is a behavior–influence procedure shown through experimental analysis to affect a specific behavior and that is indivisible in the sense that removing any of its components would render it inert. Existing evidence shows that a variety of kernels can influence behavior in context, and some evidence suggests that frequent use or sufficient use of some kernels may produce longer lasting behavioral shifts. The analysis of kernels could contribute to an empirically based theory of behavioral influence, augment existing prevention or treatment efforts, facilitate the dissemination of effective prevention and treatment practices, clarify the active ingredients in existing interventions, and contribute to efficiently developing interventions that are more effective. Kernels involve one or more of the following mechanisms of behavior influence: reinforcement, altering antecedents, changing verbal relational responding, or changing physiological states directly. The paper describes 52 of these kernels, and details practical, theoretical, and research implications, including calling for a national database of kernels that influence human behavior

Recovery of the Eastern North Pacific Gray Whale: A Case Study

In 1994, the United States government removed the Eastern North Pacific gray whale from the Endangered Species List due to its recovery rather than extinction. This notable action also marked the first removal of a marine mammal from the List due to population recovery since its enactment in 1973. The gray whale case study is well documented, in large part due to the charismatic nature of whales, a deep regard for marine mammal species, multiple federal laws and international treaties involved in their management and recovery, and a series of legal cases involving the Makah tribe in its pursuit to resume cultural subsistence whaling. The events leading up to the gray whale's listing as endangered, the actions taken by both the US and the international community, and some of the events since the species' delisting creates a unique and comprehensive case study that provides space for reflection on the future use of environmental laws to protect and preserve species, including, but certainly not limited to, large cetaceans in the Anthropocene

Communicating ocean and human health connections: An agenda for research and practice

The emergence of ocean and human health (OHH) science as a distinct scholarly discipline has led to increased research outputs from experts in both the natural and social sciences. Formal research on communication strategies, messaging, and campaigns related to OHH science remains limited despite its importance as part of the social processes that can make knowledge actionable. When utilized to communicate visible, local issues for targeting audiences, OHH themes hold the potential to motivate action in pursuit of solutions to environmental challenges, supplementing efforts to address large-scale, abstract, or politicized issues such as ocean acidification or climate change. Probing peer-reviewed literature from relevant areas of study, this review article outlines and reveals associations between society and the quality of coastal and marine ecosystems, as well as key themes, concepts, and findings in OHH science and environmental communication. Recommendations for future work concerning effective ocean and human health science communication are provided, creating a platform for innovative scholarship, evidence-based practice, and novel collaboration across disciplines