Understanding Antipsychotic Drug Use in the Nursing Home Setting

Introduction: The increasing prevalence of antipsychotic medication use in residents of nursing homes (NH) in the absence of psychiatric diagnoses is concerning. To address these concerns, it is essential to explore how these medications are being prescribed and managed in the NH setting. Our objectives were to understand the decision-making process that influences prescribing and factors that trigger administration of antipsychotic medications to residents with dementia in NHs and to explore why residents remain on antipsychotic medications over an extended period of time. Methods: Interviews with prescribers, caregivers, and family members, on-site observations in study facilities, and review of NH resident medical records. Facilities were selected to obtain a diverse sample of NHs. Results: 204 NH residents with dementia in 26 facilities distributed across five selected Centers for Medicaid and Medicare Services regions were included. Problematic behaviors were the dominant reasons offered as influencing prescribing of antipsychotic medications. Providers indicated that they chose an antipsychotic, rather than another drug class, because they believed that antipsychotic medications were more likely to be effective. There was no standard approach to taper attempts. Family members identified a lack of communication as a barrier to their involvement in decision-making. Conclusions: There is widespread perception that antipsychotic medications are effective and beneficial in managing problematic behaviors in NH residents with dementia. Little attention is given to planning for antipsychotic tapering or discontinuation. There may be opportunities to involve family members more fully in decision-making around the use of antipsychotic medications

Effect of moisture on leaf litter decomposition and its contribution to soil respiration in a temperate forest

The degree to which increased soil respiration rates following wetting is caused by plant (autotrophic) versus microbial (heterotrophic) processes, is still largely uninvestigated. Incubation studies suggest microbial processes play a role but it remains unclear whether there is a stimulation of the microbial population as a whole or an increase in the importance of specific substrates that become available with wetting of the soil. We took advantage of an ongoing manipulation of leaf litter <sup>14</sup>C contents at the Oak Ridge Reservation, Oak Ridge, Tennessee, to (1) determine the degree to which an increase in soil respiration rates that accompanied wetting of litter and soil, following a short period of drought, could be explained by heterotrophic contributions; and (2) investigate the potential causes of increased heterotrophic respiration in incubated litter and 0–5 cm mineral soil. The contribution of leaf litter decomposition increased from 6 ± 3 mg C m<sup>−2</sup> hr<sup>−1</sup> during a transient drought, to 63 ± 18 mg C m<sup>−2</sup> hr<sup>−1</sup> immediately after water addition, corresponding to an increase in the contribution to soil respiration from 5 ± 2% to 37 ± 8%. The increased relative contribution was sufficient to explain all of the observed increase in soil respiration for this one wetting event in the late growing season. Temperature (13°C versus 25°C) and moisture (dry versus field capacity) conditions did not change the relative contributions of different decomposition substrates in incubations, suggesting that more slowly cycling C has at least the same sensitivity to decomposition as faster cycling organic C at the temperature and moisture conditions studied

Effects of two neuromuscular training programs on running biomechanics with load carriage: a study protocol for a randomised controlled trial

Background In recent years, athletes have ventured into ultra-endurance and adventure racing events, which tests their ability to race, navigate, and survive. These events often require race participants to carry some form of load, to bear equipment for navigation and survival purposes. Previous studies have reported specific alterations in biomechanics when running with load which potentially influence running performance and injury risk. We hypothesize that a biomechanically informed neuromuscular training program would optimize running mechanics during load carriage to a greater extent than a generic strength training program. Methods This will be a two group, parallel randomized controlled trial design, with single assessor blinding. Thirty healthy runners will be recruited to participate in a six weeks neuromuscular training program. Participants will be randomized into either a generic training group, or a biomechanically informed training group. Primary outcomes include self-determined running velocity with a 20 % body weight load, jump power, hopping leg stiffness, knee extensor and triceps-surae strength. Secondary outcomes include running kinetics and kinematics. Assessments will occur at baseline and post-training. Discussion To our knowledge, no training programs are available that specifically targets a runner’s ability to carry load while running. This will provide sport scientists and coaches with a foundation to base their exercise prescription on

Predicting transformational and transactional leadership behaviors from individual thinking and behaving preferences

With the emergence of transformational and transactional leadership study there has been resurgence of interest in the study of leader traits and abilities. The current interest is in those individuals who are able to bring about the transformation of organizations within a rapidly changing environment. The transforming leadership behaviors are different than those studied during the past century of leadership research in that they require visioning, conceptualizing, reframing, articulating, personal advocacy, and purposeful role modeling for employee benefit and growth. This study examined the nature of the relationship between certain thinking and behaving preferences and the demonstration of transactional and transformational leadership behaviors. Utilizing a sample of leaders and their direct reports from the rapidly changing health care industry, the degree of transformative and transactional leadership behaviors was measured by leader and rater forms of the Multifactor Leadership Questionnaire (MLQ). Utilizing the same sample of leaders, the thinking and behaving preferences of these individuals were identified using the Emergenetics\sp{\rm TM} Profile. Multivariate multiple regression was conducted to explore the predictive relationship between the thinking and behaving preferences and the demonstration of transformational and transactional leader behaviors. Results of analyses indicated that the social awareness thinking preference and the behavioral attributes of assertiveness, flexibility, and expressiveness demonstrated predictive ability in the emergence of most transforming leader behaviors as defined by the MLQ

Do free or low-cost antibiotic promotions alter prescription filling habits?

Objective: Because free sample of prescription medications have been shown to influence prescribing habits of physicians, we sought to discern if promotional efforts of a retail pharmacy influenced prescriptions filled in our county after a free antibiotic program was initiated.Methods: Retrospective analysis of prescription antibiotics filled throughout the county was performed. Prescriptions filled during the first 6 months of the year before the program was initiated were compared to prescriptions filled during the first 6 months of the year immediately following initiation of the promotion.Results: A total of 436,372 antibiotic prescriptions were dispensed during that time. The number of antibiotics filled that were included in the promotion increased by 13.4% while the number of antibiotics filled that were excluded from the promotion decreased by 20.4%.Conclusion: These data suggest that the promotional pricing of the antibiotics had a significant impact on the number of prescriptions filled in each category. Because a prescription written does not always equate to a prescription filled, further investigation is needed to confirm the relationship between these promotions and actual prescriber habits

Pictorial review of the pulmonary vasculature: from arteries to veins

Abstract Pathology of the pulmonary vasculature involves an impressive array of both congenital and acquired conditions. While some of these disorders are benign, disruption of the pulmonary vasculature is often incompatible with life, making these conditions critical to identify on imaging. Many reviews of pulmonary vascular pathology approach the pulmonary arteries, pulmonary veins and bronchial arteries as individual topics. The goal of this review is to provide an integrated overview of the high-yield features of all major disorders of the pulmonary vasculature. This approach provides a more cohesive and comprehensive conceptualisation of respiratory pathology. In this review, we present both the salient clinical and imaging features of congenital and acquired disorders of the pulmonary vasculature, to assist the radiologist in identifying pathology and forming a robust differential diagnosis tailored to the presenting patient. Teaching Points • Abnormalities of the pulmonary vasculature are both congenital and acquired. • Pathology of a single pulmonary vascular territory often affects the entire pulmonary vasculature. • Anomalous pulmonary venous flow is named as a function of its location and severity. • Bronchial arteries often undergo dilatation secondary to cardio-respiratory pathology

Femmes de conscience

Femmes de conscience, Aspects du féminisme américain (1848-1875) éclaire les débats qui animent la pensée américaine au XIXe siècle et préparent les grandes actions du XXe. Une équipe de spécialistes s'est réunie autour de Susan Goodman et Daniel Royot afin de mettre en perspective tout un faisceau d'idées. L'unité thématique s'est réalisée sur la condition des femmes et son évolution. Sont ainsi examinées les lignes de force des divers mouvements. L'approche diachronique permet d'évaluer les phases successives des luttes. L'ouvrage traite en outre de la nature du discours féministe et de ses variantes, s'attachant aux voix représentatives en termes de politique, de philosophie et de création littéraire. La question religieuse, le problème du mariage, la cause des femmes noires, les fonctions socio-économiques, le droit de vote font l'objet d'analyses. Polémiques, débats, ruptures, échecs et réussites constituent la trame de ce panorama dont on peut dire qu'il participe d'une problématique inédite, de nature à donner un nouvel élan aux études féministes anglophones

Diverse signaling pathways modulate nuclear receptor recruitment of N-CoR and SMRT complexes

Several lines of evidence indicate that the nuclear receptor corepressor (N-CoR) complex imposes ligand dependence on transcriptional activation by the retinoic acid receptor and mediates the inhibitory effects of estrogen receptor antagonists, such as tamoxifen, suppressing a constitutive N-terminal, Creb-binding protein/coactivator complex-dependent activation domain. Functional interactions between specific receptors and N-CoR or SMRT corepressor complexes are regulated, positively or negatively, by diverse signal transduction pathways. Decreased levels of N-CoR correlate with the acquisition of tamoxifen resistance in a mouse model system for human breast cancer. Our data suggest that N-CoR- and SMRT-containing complexes act as rate-limiting components in the actions of specific nuclear receptors, and that their actions are regulated by multiple signal transduction pathways