Geriatric Medicine Leadership of Health Care Transformation: To Be or Not To Be?

Geriatric Medicine is well-suited to inform and lead healthcare system redesign to address the needs of seniors with complex conditions. We posit that geriatricians must urgently consider how to “brand” Geriatric Medicine in a manner that garners active support from those outside the specialty, including how to adapt practice patterns to better meet the needs of patients and of the health-care system

Closing the Osteoporosis Care Gap in Hip Fracture Patients: An Opportunity to Decrease Recurrent Fractures and Hospital Admissions

Background. Falls and hip fractures are an increasing health threat to older people who often never return to independent living. This study examines the management of bone health in an acute care setting following a hip fracture in patients over age 65. Methods. Retrospective chart review of all patients admitted to a tertiary health facility who suffered a recent hip fracture. Results. 420 charts of patients admitted over the course of a year (May 1, 2007–April 31, 2008) were reviewed. Thirty-seven percent of patients were supplemented with calcium on discharge, and 36% were supplemented with vitamin D on discharge. Thirty-one percent were discharged on a bisphosphonate. Conclusion. A significant care gap still exists in how osteoporosis is addressed despite guidelines on optimal management. A call to action is required by use of multifaceted approaches to bridge the gap, ensuring that fracture risk is minimized for the aging population

Concomitant deficits in working memory and fear extinction are functionally dissociated from reduced anxiety in metabotropic glutamate receptor 7-deficient mice

Metabotropic glutamate receptor 7 (mGluR7), a receptor with a distinct brain distribution and a putative role in anxiety, emotional responding, and spatial working memory, could be an interesting therapeutic target for fear and anxiety disorders. mGluR7-deficient (mGluR7 / ) mice showed essentially normal performance in tests for neuromotor and exploratory activity and passive avoidance learning but prominent anxiolytic behavior in two anxiety tests. They showed a delayed learning curve during the acquisition of the hidden-platform water maze, and three interspersed probe trials indicated that mGluR7 / mice were slower to acquire spatial information. Working memory in the water maze task and the radial arm maze was impaired in mGluR7 / mice compared with mGluR7 / . mGluR7 / mice also displayed a higher resistance to extinction of fear-elicited response suppression in a conditioned emotional response protocol. In a non-fear-based water maze protocol, mGluR7 / mice displayed similar delayed extinction. These observed behavioral changes are probably not attributable to changes inAMPAorNMDAreceptor function because expression levels of AMPAand NMDA receptors were unaltered. Extinction of conditioned fear is an active and context-dependent form of inhibitory learning and an experimental model for therapeutic fear reduction. It appears to depend on glutamatergic and higher-level brain functions similar to those involved in spatial working memory but functionally dissociated from those that mediate constitutional responses in anxiety tests

Superhumps: Confronting Theory with Observation

We review the theory and observations related to the ``superhump'' precession of eccentric accretion discs in close binary sytems. We agree with earlier work, although for different reasons, that the discrepancy between observation and dynamical theory implies that the effect of pressure in the disc cannot be neglected. We extend earlier work that investigates this effect to include the correct expression for the radius at which resonant orbits occur. Using analytic expressions for the accretion disc structure, we derive a relationship between the period excess and mass-ratio with the pressure effects included. This is compared to the observed data, recently derived results for detailed integration of the disc equations and the equivalent empirically derived relations and used to predict values for the mass ratio based on measured values of the period excess for 88 systems.Comment: 11 pages, 7 figures, 4 tables, accepted for publication in MNRA

Quality of Dementia Care in the Community: Identifying Key Quality Assurance Components

Background: Primary care-based memory clinics (PCMCs) have been established in several jurisdictions to improve the care for persons with Alzheimer’s disease and related dementias. We sought to identify key quality indicators (QIs), quality improvement mechanisms, and potential barriers and facilitators to the establishment of a quality assurance framework for PCMCs. Methods: We employed a Delphi approach to obtain consensus from PCMC clinicians and specialist physicians on QIs and quality improvement mechanisms. Thirty-eight candidate QIs and 19 potential quality improvement mechanisms were presented to participants in two rounds of electronic Delphi surveys. Written comments were collected and descriptively analyzed. Results:The response rate for the first and second rounds were 21.3% (n = 179) and 12.8% (n = 88), respectively. The majority of respondents were physicians. Fourteen QIs remained after the consensus process. Ten quality improvement mechanisms were selected with those characterized by specialist integration, such as case discussions and mentorships, being ranked highly. Written comments revealed three major themes related to potential barriers and facilitators to quality assurance: 1) perceived importance, 2) collaboration and role clarity, and 3) implementation process.Conclusion:We successfully utilized a consultative process among primary and specialty providers to identify core QIs and quality improvement mechanisms for PCMCs. Identified quality improvement mechanisms highlight desire for multi-modal education. System integration and closer integration between PCMCs and specialists were emphasized as essential for the provision of high-quality dementia care in community settings.Alzheimer Society of Canada, Canadian Institutes of Health Research (CIHR), Schlegel-University of Waterloo-Research Institute for Agin

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Background. Falls and hip fractures are an increasing health threat to older people who often never return to independent living. This study examines the management of bone health in an acute care setting following a hip fracture in patients over age 65. Methods. Retrospective chart review of all patients admitted to a tertiary health facility who suffered a recent hip fracture. Results. 420 charts of patients admitted over the course of a year (May 1, 2007-April 31, 2008 were reviewed. Thirty-seven percent of patients were supplemented with calcium on discharge, and 36% were supplemented with vitamin D on discharge. Thirty-one percent were discharged on a bisphosphonate. Conclusion. A significant care gap still exists in how osteoporosis is addressed despite guidelines on optimal management. A call to action is required by use of multifaceted approaches to bridge the gap, ensuring that fracture risk is minimized for the aging population

Cherenkov Light Imaging - Fundamentals and recent Developments

We review in a historical way the fundamentals of Cherenkov light imaging applied to Ring Imaging Cherenkov Counters. We also point out some of the newer developments in this very active field.Comment: Submitted to special edition of NIMA, Proceedings of RICH201

The retinal hypercircuit: a repeating synaptic interactive motif underlying visual function

The vertebrate retina generates a stack of about a dozen different movies that represent the visual world as dynamic neural images or movies. The stack is embodied as separate strata that span the inner plexiform layer (IPL). At each stratum, ganglion cell dendrites reach up to read out inhibitory interactions between three different amacrine cell classes that shape bipolar-to-ganglion cell transmission. The nexus of these five cell classes represents a functional module, a retinal 'hypercircuit', that is repeated across the surface of each of the dozen strata that span the depth of the IPL. Individual differences in the characteristics of each cell class at each stratum lead to the unique processing characteristics of each neural image throughout the stack. This review shows how the interactions between the morphological and physiological characteristics of each cell class generate many of the known retinal visual functions including motion detection, directional selectivity, local edge detection, looming detection, object motion and looming detection

Superhumps, Magnetic Fields and the Mass-ratio in AM Canum Venaticorum

We show that the observed K-velocities and periodicities of AM CVn can be reconciled given a mass ratio of 0.22 and a secondary star with a modest magnetic field of surface strength of order 1 Tesla. We see that the new mass ratio implies that the secondary is most likely semi-degenerate. The effect of the field on the accretion disc structure is examined. The theory of precessing discs and resonant orbits is generalised to encompass higher order resonances than 3:2 and shown to retain consistency with the new mass ratio.Comment: 6 pages, 4 figures, to appear in Monthly Notices of the Royal Astronomical Societ