Loss of independence in Katz's ADL ability in connection with an acute hospitalization: early clinical markers in French older people

Background: The preservation of autonomy and the ability of elderly to carry out the basic activities of daily living, beyond the therapeutic care of any pathologies, appears as one of the main objectives of care during hospitalization. Objectives: To identify early clinical markers associated with the loss of independence in elderly people in short stay hospitals. Methods: Among the 1,306 subjects making up the prospective and multicenter SAFEs cohort study (Sujet Agé Fragile: Évolution et suivi—Frail elderly subjects, evaluation and follow-up), 619 medical inpatients, not disabled at baseline and hospitalized through an emergency department were considered. Data used in a multinomial logistic regression were obtained through a comprehensive geriatric assessment (CGA) conducted in the first week of hospitalization. Dependency levels were assessed at baseline, at inclusion and at 30days using Katz's ADL index. Baseline was defined as the dependence level before occurrence of the event motivating hospitalization. To limit the influence of rehabilitation on the level of dependence, only stays shorter than 30days were considered. Results: About 514 patients were eligible, 15 died and 90 were still hospitalized at end point (n=619). Two-thirds of subjects were women, with a mean age of 83. At day 30 162 patients (31%) were not disabled; 61 (12%) were moderately disabled and 291 severely disabled (57%). No socio-demographic variables seemed to influence the day 30 dependence level. Lack of autonomy (odds ratio (OR)=1.9, 95% confidence interval (CI)=1.2-3.6), walking difficulties (OR=2.7, 95% CI=1.3-5.6), fall risk (OR=2.1, 95% CI=1.3-6.8) and malnutrition risk (OR=2.2, 95% CI=1.5-7.6) were found in multifactorial analysis to be clinical markers for loss of independence. Conclusions: Beyond considerations on the designing of preventive policies targeting the populations at risk that have been identified here, the identification of functional factors (lack of autonomy, walking difficulties, risk of falling) suggests above all that consideration needs to be given to the organization per se of the French geriatric hospital care system, and in particular to the relevance of maintaining sector-type segregation between wards for care of acute care and those involved in rehabilitatio

Deep and bottom water export from the Southern Ocean to the Pacific Ocean over the past 38 million years

The application of radiogenic isotopes to the study of Cenozoic circulation patterns in the South Pacific Ocean has been hampered by the fact that records from only equatorial Pacific deep water have been available. We present new Pb and Nd isotope time series for two ferromanganese crusts that grew from equatorial Pacific bottom water (D137-01, “Nova,” 7219 m water depth) and southwest Pacific deep water (63KD, “Tasman,” 1700 m water depth). The crusts were dated using 10Be/9Be ratios combined with constant Co-flux dating and yield time series for the past 38 and 23 Myr, respectively. The surface Nd and Pb isotope distributions are consistent with the present-day circulation pattern, and therefore the new records are considered suitable to reconstruct Eocene through Miocene paleoceanography for the South Pacific. The isotope time series of crusts Nova and Tasman suggest that equatorial Pacific deep water and waters from the Southern Ocean supplied the dissolved trace metals to both sites over the past 38 Myr. Changes in the isotopic composition of crust Nova are interpreted to reflect development of the Antarctic Circumpolar Current and changes in Pacific deep water circulation caused by the build up of the East Antarctic Ice Sheet. The Nd isotopic composition of the shallower water site in the southwest Pacific appears to have been more sensitive to circulation changes resulting from closure of the Indonesian seaway

Radiogenic isotopes: Tracers of past ocean circulation and erosional input

The radiogenic isotope composition of dissolved trace metals in the ocean represents a set of relatively new and not yet fully exploited tracers with a large potential for oceanographic and paleoceanographic research on timescales from the present back to at least 60 Ma. The main topic of this review are those trace metals with oceanic residence times on the order of or shorter than the global mixing time of the ocean (Nd, Pb, Hf, and, in addition, Be). Their isotopic composition in the ocean has varied as a function of changes in paleocirculation, source provenances, style and intensity of weathering on the continents, as well as orogenic processes. The relative importance of these processes for each trace metal is evaluated, which is a prerequisite for reliable interpretation of their time series in terms of changes in paleocirculation or weathering inputs. This analysis of processes includes a discussion of the long-term isotopic evolution of Sr and Os, which are well mixed in the ocean and have thus not been influenced by circulation changes. The radiogenic isotope evolution of those trace metals with intermediate oceanic residence times can be used as paleoceanographic proxies to reconstruct paleocirculation and weathering inputs into the ocean. This is demonstrated by studies from different ocean basins, mainly carried out on ferromanganese crusts, which show that radiogenic trace metal isotopes provide important new insights and can complement results obtained by other well-established paleoceanographic tracers such as carbon isotopes

The large-scale evolution of neodymium isotopic composition in the global modern and Holocene ocean revealed from seawater and archive data

Neodymium isotopic compositions (143Nd/144Nd or εNd) have been used as a tracer of water masses and lithogenic inputs to the ocean. To further evaluate the faithfulness of this tracer, we have updated a global seawater εNd database and combined it with hydrography parameters (temperature, salinity, nutrients and oxygen concentrations), carbon isotopic ratio and radiocarbon of dissolved inorganic carbon. Archive εNd data are also compiled for leachates, foraminiferal tests, deep-sea corals and fish teeth/debris from the Holocene period (< 10,000 years). At water depths ≥ 1500 m, property-property plots show clear correlations between seawater εNd and the other variables, suggesting that large-scale water mass mixing is a primary control of deepwater εNd distribution. At ≥ 200 m, basin-scale seawater T-S-εNd diagrams demonstrate the isotopic evolution of different water masses. Seawater and archive εNd values are compared using property-property plots and T-S-εNd diagrams. Archive values generally agree with corresponding seawater values although they tend to be at the upper limit in the Pacific. Both positive and negative offsets exist in the northern North Atlantic. Applying multiple regression analysis to deep (≥ 1500 m) seawater data, we established empirical equations that predict the main, large-scale, deepwater εNd trends from hydrography parameters. Large offsets from the predicted values are interpreted as a sign of significant local/regional influence. Dominant continental influence on seawater and archive εNd is observed mainly within 1000 km from the continents. Generally, seawater and archive εNd values form gradual latitudinal trend in the Atlantic and Pacific at depths ≥ 600 m, consistent with the idea that Nd isotopes help distinguish between northern/southern sourced water contributions at intermediate and deep water depths

New constraints on the Pb and Nd isotopic evolution of NE Atlantic water masses

Time series of lead (Pb) and neodymium (Nd) isotope compositions were measured on three ferromanganese crusts recording the evolution of NE Atlantic water masses over the past 15 Ma. The crusts are distributed along a depth profile (∼700–4600 m) comprising the present-day depths of Mediterranean Outflow Water and North East Atlantic Deep Water. A pronounced increase of the 206Pb/204Pb in the two deeper crusts starting at ∼4 Ma and a decrease in 143Nd/144Nd in all three crusts took place between ∼6–4 Ma and the present. These patterns are similar to isotope time series in the western North Atlantic basin and are consistent with efficient mixing between the two basins. However, the changes occurred 1–3 Ma earlier in the eastern basin indicating that the northeastern Atlantic led the major change in Pb and Nd isotope composition, probably due to a direct supply of Labrador Seawater via a northern route. The Pb isotope evolution during the Pliocene-Pleistocene can generally be explained by mixing between two end-members corresponding to Mediterranean Outflow Water and North East Atlantic Deep Water, but external sources such as Saharan dust are likely to have played a role as well. The Pb isotope composition of the shallowest crust that grew within the present-day Mediterranean Outflow Water does not show significant Pb isotope changes indicating that it was controlled by the same Pb sources throughout the past 15 Ma

La Iatropathologie médicamenteuse du sujet agé (Revue des Méthodes d'Imputabilité et Conception d'un outil de dépistage)

MONTPELLIER-BU Médecine (341722104) / SudocMONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

LA PRESCRIPTION MEDICAMENTEUSE CHEZ LA PERSONNE AGEE (A PROPOS D'UNE ENQUETE DANS LA REGION NORD-EST EN COLLABORATION AVEC LE SERVICE MEDICAL DE LA CAISSE REGIONALE DE L'ASSURANCE MALADIE DE NANCY)

NANCY1-SCD Medecine (545472101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

La prise en charge thérapeutique du sujet âgé (problèmes posés, pertinence des prescriptions et accidents médicamenteux. Enquête prospective en unité de court séjour)

MONTPELLIER-BU Pharmacie (341722105) / SudocSudocFranceF