Discriminating Groups

A group G is termed discriminating if every group separated by G is discriminated by G. In this paper we answer several questions concerning discrimination which arose from [2]. We prove that a finitely generated equationally Noetherian group G is discriminating if and only if the quasivariety generated by G is the minimal universal class containing G. Among other results, we show that the non-abelian free nilpotent groups are non-discriminating. Finally we list some open problems concerning discriminating groups

Hospital Discharge Instructions: Comprehension and Compliance Among Older Adults

BACKGROUND: Little is known regarding the prevalence or risk factors for non-comprehension and non-compliance with discharge instructions among older adults. OBJECTIVE: To quantify the prevalence and identify patient characteristics associated with non-comprehension and non-compliance with discharge instructions. RESEARCH DESIGN: Prospective cohort study SUBJECTS: 450 adults aged ≥65 admitted to medical and surgical units of a tertiary care facility and meeting inclusion criteria. MEASURES: We collected information on demographics, psycho-social factors, discharge diagnoses, and medications using surveys and patient medical records. Domains within discharge instructions included medications, follow-up appointments, diet, and exercise. At 5 days post-discharge, we assessed comprehension by asking patients about their discharge instructions and compared responses to written instructions from medical charts. We assessed compliance among patients who understood their instructions. RESULTS: Prevalence of non-comprehension was 5% for follow-up appointments, 27% for medications, 48% for exercise and 50% for diet recommendations. Age was associated with non-comprehension of medication (odds ratio (OR) 1.07; 95% confidence interval (CI) 1.04, 1.120) and follow-up appointment (OR 1.08; 95% CI 1.00, 1.17) instructions. Male sex was associated with non-comprehension of diet instructions (OR 1.91; 95%CI 1.10, 3.31). Social isolation was associated with non-comprehension of exercise instructions (OR 9.42; 95%CI 1.50, 59.11) Depression was associated with non-compliance with medication (OR 2.29; 95% CI 1.02, 5.10) and diet instructions (OR 3.30; 95% CI 1.24, 8.83). CONCLUSIONS: Non-comprehension of discharge instructions among older adults is prevalent, multi-factorial, and varies by domain.Keywords: Older adults, Comprehension, Hospital discharge instructions, ComplianceKeywords: Older adults, Comprehension, Hospital discharge instructions, Complianc

Depressive Symptoms and Hospital Readmission in Older Adults

BACKGROUND: Identifying patients at high risk of hospital readmission may facilitate interventions to improve care. Depressive symptoms are prevalent among hospitalized older adults and may provide a target for these interventions if associated with readmission. The aim of this study was to quantify the risk of 30-day unplanned hospital readmission among adults age ≥ 65 with depressive symptoms. DESIGN AND SETTING: Prospective cohort study of adults aged ≥ 65 admitted to the University of Maryland Medical Center between 7/1/11 and 8/9/12. PARTICIPANTS: 750 patients aged ≥ 65 admitted to the general medical and surgical units and followed for 31 days following hospital discharge. MEASUREMENTS: Primary exposure was depressive symptoms at admission, defined as ≥ 6 on the 15-item Geriatric Depression Scale. Primary outcome was unplanned 30-day hospital readmission, defined as an unscheduled overnight stay at any inpatient facility not occurring in the emergency department. RESULTS: Prevalence of depressive symptoms was 19% and incidence of 30-day unplanned hospital readmission was 19%. Depressive symptoms were not significantly associated with hospital readmission (Relative Risk (RR) 1.20; 95% Confidence Interval(CI) 0.83, 1.72). Age, Charlson Comorbidity Index score, and ≥ 2 hospitalizations within the past 6 months were significant predictors of unplanned 30-day hospital readmission. CONCLUSION: Although not associated with hospital readmission in our study, depressive symptoms are associated with other poor outcomes and may be under-diagnosed among hospitalized older adults. Hospitals interested in reducing readmission should focus on older patients with more comorbid illness and recent hospitalizations.This is the publisher’s final pdf. The published article is copyrighted by the author(s) and published by John Wiley & Sons Ltd. The published article can be found at: http://onlinelibrary.wiley.com/journal/10.1111/%28ISSN%291532-5415.Keywords: Depressive Symptoms, Older Adults, Hospital Readmissio

Informed consent for MRI and fMRI research: Analysis of a sample of Canadian consent documents

<p>Abstract</p> <p>Background</p> <p>Research ethics and the measures deployed to ensure ethical oversight of research (e.g., informed consent forms, ethics review) are vested with extremely important ethical and practical goals. Accordingly, these measures need to function effectively in real-world research and to follow high level standards.</p> <p>Methods</p> <p>We examined approved consent forms for Magnetic Resonance Imaging (MRI) and functional Magnetic Resonance Imaging (fMRI) studies approved by Canadian research ethics boards (REBs).</p> <p>Results</p> <p>We found evidence of variability in consent forms in matters of physical and psychological risk reporting. Approaches used to tackle the emerging issue of incidental findings exposed extensive variability between and within research sites.</p> <p>Conclusion</p> <p>The causes of variability in approved consent forms and studies need to be better understood. However, mounting evidence of administrative and practical hurdles within current ethics governance systems combined with potential sub-optimal provision of information to and protection of research subjects support other calls for more scrutiny of research ethics practices and applicable revisions.</p

Nighttime assaults: using a national emergency department monitoring system to predict occurrence, target prevention and plan services

Background: Emergency department (ED) data have the potential to provide critical intelligence on when violence is most likely to occur and the characteristics of those who suffer the greatest health impacts. We use a national experimental ED monitoring system to examine how it could target violence prevention interventions towards at risk communities and optimise acute responses to calendar, holiday and other celebration-related changes in nighttime assaults. Methods: A cross-sectional examination of nighttime assault presentations (6.01 pm to 6.00 am; n = 330,172) over a three-year period (31st March 2008 to 30th March 2011) to English EDs analysing changes by weekday, month, holidays, major sporting events, and demographics of those presenting. Results: Males are at greater risk of assault presentation (adjusted odds ratio [AOR] 3.14, 95% confidence intervals [CIs] 3.11-3.16; P < 0.001); with male:female ratios increasing on more violent nights. Risks peak at age 18 years. Deprived individuals have greater risks of presenting across all ages (AOR 3.87, 95% CIs 3.82-3.92; P < 0.001). Proportions of assaults from deprived communities increase midweek. Female presentations in affluent areas peak aged 20 years. By age 13, females from deprived communities exceed this peak. Presentations peak on Friday and Saturday nights and the eves of public holidays; the largest peak is on New Year’s Eve. Assaults increase over summer with a nadir in January. Impacts of annual celebrations without holidays vary. Some (Halloween, Guy Fawkes and St Patrick’s nights) see increased assaults while others (St George’s and Valentine’s Day nights) do not. Home nation World Cup football matches are associated with nearly a three times increase in midweek assault presentation. Other football and rugby events examined show no impact. The 2008 Olympics saw assaults fall. The overall calendar model strongly predicts observed presentations (R2 = 0.918; P < 0.001). Conclusions: To date, the role of ED data has focused on helping target nightlife police activity. Its utility is much greater; capable of targeting and evaluating multi-agency life course approaches to violence prevention and optimising frontline resources. National ED data are critical for fully engaging health services in the prevention of violence

Epidemiology of acute poisoning in children presenting to the poisoning treatment center at Ain Shams University in Cairo, Egypt, 2009-2013

Introduction—Pediatric poisonings represent a major and preventable cause of morbidity and mortality throughout the world. Epidemiologic information about poisoning among children in many lower- and middle-income countries is scarce. This study describes the epidemiology of acute poisonings in children presenting to Ain Shams University\u27s Poisoning Treatment Center (ASU-PTC) in Cairo and determines the causative agents and characteristics of acute poisoning in several pediatric age groups. Methods—This retrospective study involved acutely poisoned patients, 0 to 18 years of age, who presented to the ASU-PTC between 1/1/2009 and 12/31/2013. Data were extracted from electronic records maintained by the ASU-PTC. Collected data included demographics, substance of exposure, circumstances of the poisoning, patient disposition, and outcome. Results—During the 5-year study period, 38,470 patients meeting our criteria were treated by the ASU-PTC; 19,987 (52%) were younger than 6 years of age; 4,196 (11%) were 6 to 12 years; and 14,287 (37%) were \u3e12 years. Unintentional poisoning accounted for 68.5% of the ingestions, though among adolescents 84.1% of ingestions were with self-harm intent. In all age groups, the most frequent causative drugs were non-opioid analgesics, antipyretics, and antirheumatics. The most common nonpharmaceutical agents were corrosives in preschool children and pesticides in adolescents. Most patients had no/minor effects (29,174 [75.8%]); hospitalization rates were highest among adolescents. There were 119 deaths (case fatality rate of 0.3), primarily from pesticide ingestion. Conclusion—Poisoning in preschool children is mainly unintentional and commonly due to nonpharmaceutical agents while poisoning in adolescents is mainly intentional (self-harm). Pesticides, mainly organophosphorous compounds and carbamates, were the most frequent agent leading to morbidity and mortality