Cultivating Responsive Systems for the Care of Acutely and Critically Ill Older Adults

This article examines the importance of creating acute care systems that are responsive to the needs of acutely and critically ill and injured older adults. Four attributes of the responsive system are examined: elasticity, enabling, ease, and equanimity. An analytic literature review provides the basis for recommended practices by responsive professionals in responsive systems. Implications for practice, research, education, and policy are provided

Outcome From Serious Injury in Older Adults

Purpose: The purpose of this paper is to analyze the research published in peer-reviewed journals between 1996 and 2005 that examine factors affecting the physical outcomes of older adults after serious traumatic injury. Organizing Construct: 27 primary research studies published in the last 10 years describe in-hospital and long-term outcomes of serious injury among older adults. Research specific to isolated hip injury, traumatic brain injury and burn trauma was excluded. Methods: An integrative review of research published between January 1996 and January 2005 was carried out to examine the relationship between older age and outcome from severe injury. MEDLINE, BIOSIS previews, CINAHL and PsycINFO databases were searched using the MeSH terms: injury, serious injury, trauma and multiple trauma, and crossed with type, severity, medical/surgical management, complication, outcome, mortality, morbidity, survival, disability, quality of life, functional status, functional recovery, function, and placement. Findings: Older adults experience higher short and long-term mortality when compared to younger adults. The relationship between older age and poorer outcome persists when adjusting for injury severity, number of injuries, comorbidities, and complications. At the same time, injury severity, number of injuries, complications, and gender each independently correlate to increased mortality among older adults. The body of research is limited by over-reliance on retrospective data and heterogeneity in definitional criteria for the older adult population. Conclusions: Additional research is needed to clarify the contributory effect of variables such as psychosocial sequelae and physiologic resilience on injury outcome. The field of geriatric trauma would benefit from further population-based prospective investigation of the determinants of injury outcome in older adults in order to guide interventions and acute care treatment

Measurement of Orbital Decay in the Double Neutron Star Binary PSR B2127+11C

We report the direct measurement of orbital period decay in the double neutron star pulsar system PSR B2127+11C in the globular cluster M15 at the rate of $(-3.95 \pm 0.13) \times 10^{-12}$, consistent with the prediction of general relativity at the $\sim 3$ level. We find the pulsar mass to be $m_p = (1.358 \pm 0.010) M_\odot$ and the companion mass $m_c = (1.354 \pm 0.010) M_\odot$. We also report long-term pulse timing results for the pulsars PSR B2127+11A and PSR B2127+11B, including confirmation of the cluster proper motion.Comment: 12 pages, 4 figures, accepted for publication in ApJ

Re-evaluation of link between interpregnancy interval and adverse birth outcomes: retrospective cohort study matching two intervals per mother

Objective - To re-evaluate the causal effect of interpregnancy interval on adverse birth outcomes, on the basis that previous studies relying on between mother comparisons may have inadequately adjusted for confounding by maternal risk factors. Design - Retrospective cohort study using conditional logistic regression (matching two intervals per mother so each mother acts as her own control) to model the incidence of adverse birth outcomes as a function of interpregnancy interval; additional unconditional logistic regression with adjustment for confounders enabled comparison with the unmatched design of previous studies. Setting - Perth, Western Australia, 1980-2010. Participants - 40 441 mothers who each delivered three liveborn singleton neonates. Main outcome measures - Preterm birth (<37 weeks), small for gestational age birth (<10th centile of birth weight by sex and gestational age), and low birth weight (<2500 g). Results - Within mother analysis of interpregnancy intervals indicated a much weaker effect of short intervals on the odds of preterm birth and low birth weight compared with estimates generated using a traditional between mother analysis. The traditional unmatched design estimated an adjusted odds ratio for an interpregnancy interval of 0-5 months (relative to the reference category of 18-23 months) of 1.41 (95% confidence interval 1.31 to 1.51) for preterm birth, 1.26 (1.15 to 1.37) for low birth weight, and 0.98 (0.92 to 1.06) for small for gestational age birth. In comparison, the matched design showed a much weaker effect of short interpregnancy interval on preterm birth (odds ratio 1.07, 0.86 to 1.34) and low birth weight (1.03, 0.79 to 1.34), and the effect for small for gestational age birth remained small (1.08, 0.87 to 1.34). Both the unmatched and matched models estimated a high odds of small for gestational age birth and low birth weight for long interpregnancy intervals (longer than 59 months), but the estimated effect of long interpregnancy intervals on the odds of preterm birth was much weaker in the matched model than in the unmatched model. Conclusion - This study questions the causal effect of short interpregnancy intervals on adverse birth outcomes and points to the possibility of unmeasured or inadequately specified maternal factors in previous studies

A Survey for Low-Surface-Brightness Galaxies Around M31. I. The Newly Discovered Dwarf Andromeda V

We present images and a color-magnitude diagram for And V, a new dwarf spheroidal companion to M31 that was found using a digital filtering technique applied to 1550 square degrees of the second Palomar Sky Survey. And V resolves into stars easily in follow-up 4-m V- and I-band images, from which we deduce a distance of 810 +/- 45 kpc using the tip of the red giant branch method. Within the uncertainties, this distance is identical to the Population II distances for M31 and, combined with a projected separation of 112 kpc, provides strong support for a physical association between the two galaxies. There is no emission from And V detected in H alpha, 1.4 GHz radio continuum, or IRAS bandpasses, and there is no young population seen in the color-magnitude diagram that might suggest that And V is an irregular. Thus, the classification as a new dwarf spheroidal member of the Local Group seems secure. With an extinction-corrected central surface brightness of 25.2 V mag per square arcsec, a mean metal abundance of [Fe/H] approximately -1.5, and no evidence for upper AGB stars, And V resembles And I & III.Comment: Accepted for publication in The Astronomical Journal, November 1998 issue; 4 embedded PostScript figures, 4 JPEG figures; see http://aloe.tuc.noao.edu/jacoby/dwarfs.html for a complete full-resolution PostScript versio

The Nearby Neutron Star RX J0720.4-3125 from Radio to X-rays

We present radio, optical, ultraviolet, and X-ray observations of the isolated, thermally-emitting neutron star RX J0720.4-3125 using the Parkes radio telescope, the Very Large Array, the Hubble Space Telescope, and the Chandra X-ray Observatory. From these data we show that the optical/UV spectrum of RX J0720.4-3125 is not well fit by a Rayleigh-Jeans tail as previously thought, but is instead best fit by either a single non-thermal power-law or a combination of a Rayleigh-Jeans tail and a non-thermal power-law. Taken together with the X-ray spectrum, we find the best model for RX J0720.4-3125 to be two blackbodies plus a power-law, with the cool blackbody implying a radius of 11-13 km at an assumed distance of 300 pc. This is similar to many middle aged (10^{5-6} yr) radio pulsars such as PSR B0656+14, evidence supporting the hypothesis that RX J0720.4-3125 is likely to be an off-beam radio pulsar. The radio data limit the flux at 1.4 GHz to be <0.24 mJy, or a luminosity limit of 4*pi*d^2*F < 3e25*d_300^2 ergs/s, and we see no sign of extended nebulosity, consistent with expectations for a pulsar like RX J0720.4-3125.Comment: 13 pages, 9 figures. Uses emulateapj5.sty and onecolfloat5.sty. Accepted for publication in Ap

An XMM-Newton view of Planetary Nebulae in the Small Magellanic Cloud. The X-ray luminous central star of SMP SMC 22

During an X-ray survey of the Small Magellanic Cloud, carried out with the XMM-Newton satellite, we detected significant soft X-ray emission from the central star of the high-excitation planetary nebula SMP SMC 22. Its very soft spectrum is well fit with a non local thermodynamical equilibrium model atmosphere composed of H, He, C, N, and O, with abundances equal to those inferred from studies of its nebular lines. The derived effective temperature of 1.5x10^5 K is in good agreement with that found from the optical/UV data. The unabsorbed flux in the 0.1-0.5 keV range is about 3x10^{-11} erg cm^-2 s^-1, corresponding to a luminosity of 1.2x10^37 erg/s at the distance of 60 kpc. We also searched for X-ray emission from a large number of SMC planetary nebulae, confirming the previous detection of SMP SMC 25 with a luminosity of (0.2-6)x10^35 erg/s (0.1-1 keV). For the remaining objects that were not detected, we derived flux upper limits corresponding to luminosity values from several tens to hundreds times smaller than that of SMP SMC 22. The exceptionally high X-ray luminosity of SMP SMC 22 is probably due to the high mass of its central star, quickly evolving toward the white dwarf's cooling branch, and to a small intrinsic absorption in the nebula itself.Comment: Accepted for publication on Astronomy and Astrophysic

Recent star formation in the inner Galactic Bulge seen by ISOGAL. I - Classification of bright mid-IR sources in a test field

Context: The stellar populations in the central region of the Galaxy are poorly known because of the high visual extinction and very great source density in this direction. Aims: To use recent infrared surveys for studying the dusty stellar objects in this region. Methods: We analyse the content of a 20x20 arcmin^2 field centred at (l,b)=(-0.27,-0.06) observed at 7 and 15 microns as part of the ISOGAL survey. These ISO observations are more than an order of magnitude better in sensitivity and spatial resolution than the IRAS observations. The sources are cross-associated with other catalogues to identify various types of objects. We then derive criteria to distinguish young objects from post-main sequence stars. Results: We find that a sample of about 50 young stellar objects and ultra-compact HII regions emerges, out of a population of evolved AGB stars. We demonstrate that the sources colours and spatial extents, as they appear in the ISOGAL catalogue, possibly complemented with MSX photometry at 21 microns, can be used to determine whether the ISOGAL sources brighter than 300 mJy at 15 microns (or [15] < 4.5 mag) are young objects or late-type evolved stars.Comment: 15 pages, 12 figures. Accepted for publication in Astronomy and Astrophysic