Malnutrition in older people - screening and management strategies

Copyright © 2004 Royal Australian College of General Practitioners Copyright to Australian Family Physician. Reproduced with permission. Permission to reproduce must be sought from the publisher, The Royal Australian College of General Practitioners.Background: Malnutrition in older people is not only common, but frequently overlooked. It can result in multiple medical complications, hospitalisation and even death. Objective: This article focusses on the consequences, pathophysiology, diagnosis and management of this clinical syndrome. Discussion: Nonphysiological causes of malnutrition include social, psychological, medical and medication related factors. With vigilance, early screening and the institution of simple therapeutic measures of correcting nonphysiological causes and following dietary guidelines for older people, the adverse effects of malnutrition may be minimised.Renuka Visvanathan; Jonathan W Newbury; Ian Chapma

Optical Polarization of 52 Radio-Loud QSOs and BL Lac Objects

Polarization measurements are presented for 52 radio-loud QSOs and BL Lac objects. For 9 highly polarized (p >3%) AGN, these are the first published polarization measurements. Of these 9, 7 are highly-polarized QSOs (HPQs), one is a BL Lac object and another is a likely BL Lac object. Polarization variability is confirmed for some of these new and previously known highly-polarized AGN. While 6 of the HPQs have flat radio spectra are almost certainly blazars, PKS 1452-217 is probably a new member of the rare class of radio-loud QSOs that show high polarization by scattering, and is therefore important for testing orientation Unified Schemes. In competition for the highest redshift HPQ are the well-observed QSO PKS 0438-43 at z = 2.85, with maximum p = 4.7%, and PKS 0046-315 at z = 2.72, for which we find p = 13%.Comment: 6 pages. Astronomical Journal, in pres

An Old Cluster in NGC 6822

We present spectroscopy of two clusters in the dwarf irregular galaxy NGC 6822. From these we deduce an age for Cluster VII of 11 Gyr and [Fe/H] = -1.95 +/- 0.15 dex. Cluster VII appears to be an analog of the metal-poor galactic globular clusters. Cluster VI is found to be much younger and more metal rich, with an age of approximately 2 Gyr. Its derived metallicity, [Fe/H], of approximately -1.0 dex is comparable to that of the gas seen today in NGC 6822. The existence of a metal-poor old cluster in NGC 6822 rules out models for the chemical evolution of this galaxy with significant prompt initial enhancement. We find that a star formation rate which is constant with time and is within a factor of two of the present star formation rate can reproduce the two points on the age-metallicity relationship for NGC 6822 over the past 10 Gyr defined by these two clusters.Comment: 8 pages; accepted for publication in A

Suppressed star formation in circumnuclear regions in Seyfert galaxies

Feedback from black hole activity is widely believed to play a key role in regulating star formation and black hole growth. A long-standing issue is the relation between the star formation and fueling the supermassive black holes in active galactic nuclei (AGNs). We compile a sample of 57 Seyfert galaxies to tackle this issue. We estimate the surface densities of gas and star formation rates in circumnuclear regions (CNRs). Comparing with the well-known Kennicutt-Schmidt (K-S) law, we find that the star formation rates in CNRs of most Seyfert galaxies are suppressed in this sample. Feedback is suggested to explain the suppressed star formation rates.Comment: 1 color figure and 1 table. ApJ Letters in pres

The association between benzodiazepine use and sleep quality in residential aged care facilities: a cross-sectional study

BACKGROUND: Benzodiazepines are commonly prescribed in residential aged care facilities (RACFs) for their sedative and anxiolytic effects. The objective of this study was to investigate the association between benzodiazepine use and sleep quality in residents of RACFs. METHODS: A cross-sectional study involving 383 participants was conducted in six Australian RACFs. Night-time sleep quality, day-time drowsiness and day-time napping behavior were assessed using a validated questionnaire. Logistic regression was used to compute adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for the association between benzodiazepine use and sleep quality. Covariates included pain, dementia severity, depression, insomnia and other sedative use. RESULTS: Of the 383 residents (mean age 87.5 years, 77.5% female), 96(25.1%) used a benzodiazepine on a regular basis. Residents who used long-acting benzodiazepines on a regular basis had higher night-time sleep quality than non-users (AOR = 4.00, 95%CI 1.06 - 15.15). Residents who used short-acting benzodiazepines on a PRN only basis had longer daytime napping times than non-users (AOR = 1.77, 95%CI 1.01 - 3.08). No benzodiazepine category was associated with day-time drowsiness. CONCLUSIONS: The association between benzodiazepine use and sleep quality is dependent on the half-life and prescribing pattern of the benzodiazepine. Short-acting PRN benzodiazepines were associated with lower night time sleep quality and longer day-time napping compared to long-acting regular benzodiazepines. Longitudinal studies are needed to determine whether these findings reflect channeling of short-acting agents to residents at higher risk of sleep disorders.Lynna Chen, J. Simon Bell, Renuka Visvanathan, Sarah N. Hilmer, Tina Emery, Leonie Robson, Jessica M. Hughes and Edwin C. K. Ta

Perspectives of frailty and frailty screening: Protocol for a collaborative knowledge translation approach and qualitative study of stakeholder understandings and experiences

Accompanying the unprecedented growth in the older adult population worldwide is an increase in the prevalence of frailty, an age-related clinical state of increased vulnerability to stressor events. This increased vulnerability results in lower social engagement and quality of life, increased dependency, and higher rates of morbidity, health service utilization and mortality. Early identification of frailty is necessary to guide implementation of interventions to prevent associated functional decline. Consensus is lacking on how to clinically recognize and manage frailty. It is unknown how healthcare providers and healthcare consumers understand and perceive frailty, whether or not they regard frailty as a public health concern; and information on the indirect and direct experiences of consumer and healthcare provider groups towards frailty are markedly limited.We will conduct a qualitative study of consumer, practice nurse, general practitioner, emergency department physician, and orthopedic surgeons' perspectives of frailty and frailty screening in metropolitan and non-metropolitan South Australia. We will use tailored combinations of semi-structured interviews and arts-based data collection methods depending on each stakeholder group, followed by inductive and iterative analysis of data using qualitative description.Using stakeholder driven approaches to understanding and addressing frailty and frailty screening in context is critical as the prevalence and burden of frailty is likely to increase worldwide. We will use the findings from the Perceptions of Frailty and Frailty Screening study to inform a context-driven identification, implementation and evaluation of a frailty-screening tool; drive awareness, knowledge, and skills development strategies across stakeholder groups; and guide future efforts to embed emerging knowledge about frailty and its management across diverse South Australian contexts using a collaborative knowledge translation approach. Study findings will help achieve a coordinated frailty and healthy ageing strategy with relevance to other jurisdictions in Australia and abroad, and application of the stakeholder driven approach will help illuminate how its applicability to other jurisdictions.Mandy M. Archibald, Rachel Ambagtsheer, Justin Beilby, Mellick J. Chehade, Tiffany K. Gill, Renuka Visvanathan, and Alison L. Kitso

Precursor Lesions of High-Grade Serous Ovarian Carcinoma: Morphological and Molecular Characteristics

The lack of proven screening tools for early detection and the high mortality of ovarian serous carcinoma (OSC), particularly high grade, have focused attention on identifying putative precursor lesions with distinct morphological and molecular characteristics. The finding of occult invasive and intraepithelial fallopian tube carcinomas in prophylactically removed specimens from asymptomatic high-risk BRCA 1/2-mutation carriers supports the notion of an origin for OSC in the fallopian tube. The intraepithelial carcinomas have been referred to as serous intraepithelial carcinomas (STICs) but our own findings (unpublished data) and recent reports have drawn attention to a spectrum of changes that fall short of STICs that we have designated serous tubal intraepithelial lesions (STILs)

Effects of infliximab on markers of inflammation and bone turnover and associations with bone mineral density in patients with ankylosing spondylitis

Using a micro-extruder a new class of polyurethanes, polyacylurethanes (PAUs), based on poly (epsilon-caprol actone) (PCL) oligomers and terephthaloyl diisocyanate was synthesized. These polymers are anticipated to have potential for biodegradable and/or biomedical applications. Therefore, PAUs were synthesized without the use of any, possibly toxic, catalysts. PCL diols of different molecular mass were used, namely 750, 1000, 1250, 1500, 2000, 3000 and 4000 g/mol. These diols were synthesized by thermal polymerization at 150 degrees C without the use of any catalyst. The PAUs of terephthaloyl diisocyanate were synthesized by reactive extrusion using a micro-extruder of 5 cm 3 at 130 degrees C. The PAUs obtained were characterized using DSC, GPC, DMTA, SAXS and tensile testing. Surprisingly, PAUs based on PCL chains of 750, 1000, 1250 and 1500 g/mol were found to show microphase separation/micro crystallization as proven by SAXS data combined with DSC. This microphase separation creates elastomeric properties as is known from polyurethanes. In the PAUs based on PCL chains of 2000, 3000 and 4000 g/mol part of the PCL was found to crystallize and no evidence of any phase separation of the acylurethane block was found. (c) 2005 Elsevier Ltd. All rights reserved

The star formation properties of disk galaxies: Halpha imaging of galaxies in the Coma supercluster

We present integrated H alpha measurements obtained from imaging observations of 98 late-type galaxies, primarily selected in the Coma supercluster. These data, combined with H alpha photometry from the literature, include a magnitude selected sample of spiral (Sa to Irr) galaxies belonging to the "Great Wall" complete up to mp=15.4, thus composed of galaxies brighter than Mp=-18.8 (H0=100 km Mpc^-1 s^-1). The frequency distribution of the H alpha E.W., determined for the first time from an optically complete sample, is approximately gaussian peaking at E.W. ~25 A. We find that, at the present limiting luminosity, the star formation properties of spiral+Irr galaxies members of the Coma and A1367 clusters do not differ significantly from those of the isolated ones belonging to the Great Wall. The present analysis confirms the well known increase of the current massive star formation rate (SFR) with Hubble type. Moreover perhaps a more fundamental anticorrelation exists between the SFR and the mass of disk galaxies: low-mass spirals and dwarf systems have present SFRs ~50 times higher than giant spirals. This result is consistent with the idea that disk galaxies are coeval, evolve as "closed systems" with exponentially declining SFR and that the mass of their progenitor protogalaxies is the principal parameter governing their evolution. Massive systems having high initial efficiency of collapse, or a short collapse time-scale, have retained little gas to feed the present epoch of star formation. These findings support the conclusions of Gavazzi & Scodeggio (1996) who studyed the color-mass relation of a local galaxy sample and agree with the analysis by Cowie et al. (1996) who traced the star formation history of galaxies up to z>1.Comment: 13 pages (LateX) + 24 figures + 4 tables. To appear in Astronomical Journal, April 1998 issu