Impact of medication regimen simplification on medication incidents in residential aged care: Simpler randomized controlled trial

In the SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) cluster-randomized controlled trial, we investigated the impact of a structured medication regimen simplification intervention on medication incidents in residential aged care facilities (RACFs) over a 12-month follow-up. A clinical pharmacist applied the validated 5-step Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE) for 96 of the 99 participating residents in the four intervention RACFs. The 143 participating residents in the comparison RACFs received usual care. Over 12 months, medication incident rates were 95 and 66 per 100 resident-years in the intervention and comparison groups, respectively (adjusted incident rate ratio (IRR) 1.13; 95% confidence interval (CI) 0.53–2.38). The 12-month pre/post incident rate almost halved among participants in the intervention group (adjusted IRR 0.56; 95%CI 0.38–0.80). A significant reduction in 12-month pre/post incident rate was also observed in the comparison group (adjusted IRR 0.67, 95%CI 0.50–0.90). Medication incidents over 12 months were often minor in severity. Declines in 12-month pre/post incident rates were observed in both study arms; however, rates were not significantly different among residents who received and did not receive a one-off structured medication regimen simplification intervention

The role of external broadcasting in a closed political system

This article investigates the role and impact of external broadcasting (radio and television) on a closed political system, through the example of the two post-war German states: the West German Federal Republic of Germany (FRG) and the East German German Democratic Republic (GDR). The aim is to debunk myths about the influence of external broadcasting on the events that led to German reunification in 1990. The study follows a historical approach and discusses what role external media played during the years of a divided Germany. The findings are based on several historical sources, research reports from the 1950s and 1960s and over 100 biographical interviews with former residents of the German Democratic Republic (GDR). The article analyses the impact of external broadcasting on citizens and the political elite in times of crisis as well as during everyday life

Impact of medication regimen simplification on medication administration times and health outcomes in residential aged care: 12 month follow up of the SIMPLER randomized controlled trial

In the SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) cluster-randomized controlled trial, we evaluated the impact of structured medication regimen simplification on medication administration times, falls, hospitalization, and mortality at 8 residential aged care facilities (RACFs) at 12 month follow up. In total, 242 residents taking ≥1 medication regularly were included. Opportunities for simplification among participants at 4 RACFs were identified using the validated Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE). Simplification was possible for 62 of 99 residents in the intervention arm. Significant reductions in the mean number of daily medication administration times were observed at 8 months (-0.38, 95% confidence intervals (CI) -0.69 to -0.07) and 12 months (-0.47, 95%CI -0.84 to -0.09) in the intervention compared to the comparison arm. A higher incidence of falls was observed in the intervention arm (incidence rate ratio (IRR) 2.20, 95%CI 1.33 to 3.63) over 12-months, which was primarily driven by a high falls rate in one intervention RACF and a simultaneous decrease in comparison RACFs. No significant differences in hospitalizations (IRR 1.78, 95%CI 0.57-5.53) or mortality (relative risk 0.81, 95%CI 0.48-1.38) over 12 months were observed. Medication simplification achieves sustained reductions in medication administration times and should be implemented using a structured resident-centered approach that incorporates clinical judgement

Stars made in outflows may populate the stellar halo of the Milky Way

We study stellar-halo formation using six Milky-Way-mass galaxies in FIRE-2 cosmological zoom simulations. We find that 5-40 per cent of the outer (50-300 kpc) stellar halo in each system consists of in-situ stars that were born in outflows from the main galaxy. Outflow stars originate from gas accelerated by superbubble winds, which can be compressed, cool, and form co-moving stars. The majority of these stars remain bound to the halo and fall back with orbital properties similar to the rest of the stellar halo at z = 0. In the outer halo, outflow stars are more spatially homogeneous, metal-rich, and alpha-element-enhanced than the accreted stellar halo. At the solar location, up to ∼10 per cent of our kinematically identified halo stars were born in outflows; the fraction rises to as high as ∼40 per cent for the most metal-rich local halo stars ([Fe/H] >-0.5). Such stars can be retrograde and create features similar to the recently discoveredMilkyWay 'Splash' in phase space.We conclude that theMilkyWay stellar halo could contain local counterparts to stars that are observed to form in molecular outflows in distant galaxies. Searches for such a population may provide a new, near-field approach to constraining feedback and outflow physics. A stellar halo contribution from outflows is a phase-reversal of the classic halo formation scenario of Eggen, Lynden-Bell & Sandange, who suggested that halo stars formed in rapidly infalling gas clouds. Stellar outflows may be observable in direct imaging of external galaxies and could provide a source for metal-rich, extreme-velocity stars in the Milky Way

GeV Gamma-Ray Attenuation and the High-Redshift UV Background

We present new calculations of the evolving UV background out to the epoch of cosmological reionization and make predictions for the amount of GeV gamma-ray attenuation by electron-positron pair production. Our results are based on recent semi-analytic models of galaxy formation, which provide predictions of the dust-extinguished UV radiation field due to starlight, and empirical estimates of the contribution due to quasars. We account for the reprocessing of ionizing photons by the intergalactic medium. We test whether our models can reproduce estimates of the ionizing background at high redshift from flux decrement analysis and proximity effect measurements from quasar spectra, and identify a range of models that can satisfy these constraints. Pair-production against soft diffuse photons leads to a spectral cutoff feature for gamma rays observed between 10 and 100 GeV. This cutoff varies with redshift and the assumed star formation and quasar evolution models. We find only negligible amounts of absorption for gamma rays observed below 10 GeV for any emission redshift. With observations of high-redshift sources in sufficient numbers by the Fermi Gamma-ray Space Telescope and new ground-based instruments it should be possible to constrain the extragalactic background light in the UV and optical portion of the spectrum.Comment: 19 pages, 12 figures, Accepted for publication in MNRAS, this version includes minor correction

Lyman Alpha Blobs as an Observational Signature of Cold Accretion Streams into Galaxies

Recent hydrodynamic simulations of galaxy formation reveal streams of cold (T ~ 1e4 K) gas flowing into the centers of dark matter halos as massive as 1e12-1e13.5 M_sun at redshifts z~1-3. In this paper we show that if > 20% of the gravitational binding energy of the gas is radiated away, then the simulated cold flows are spatially extended Lyman Alpha (Lya) sources with luminosities, Lya line widths, and number densities that are comparable to those of observed Lya blobs. Furthermore, the filamentary structure of the cold flows can explain the wide range of observed Lya blob morphologies. Since the most massive halos form in dense environments, the association of Lya blobs with overdense regions arise naturally. We argue that Lya blobs - even those which are clearly associated with starburst galaxies or quasars - provide direct observational support for the cold accretion mode of galaxies. We discuss various testable predictions of this association.Comment: MNRAS in press. 13 pages, 6 figures. Discussion + references added. Main conclusions unaffecte