The Lantern Vol. 41, No. 2, Spring 1975

• Awakening • 10:27 • The Box • God\u27s Children • The Blasphemous Bean Beetle Levels Limpidland • First Flight • In April • Butterfly • In the Garden • The Emperor\u27s Pond • The Mob • Date with Destiny • While Awaiting Death • Sweet Jane • Final Thoughtshttps://digitalcommons.ursinus.edu/lantern/1106/thumbnail.jp

The aesthetics of ritual--contested identities and conflicting performances in the Iraqi Shi’a diaspora: Ritual, performance and identity change

What are the processes through which identity change takes place at the individual and collective level? How might a focus on embodied religious performance and ritual contribute to understandings of such identity change? Through an ethnographic analysis of the Muharram rituals of Iraqi Shi’is in London, I take religious rites as a starting point from which to theorise a performative theory of identity change to highlight the role of ritual and performance in shaping changing notions of identity at both the individual and collective level. Such a project necessarily engages both with processes of identity change and with the paradox of identity/difference, particularly the ways in which articulations of subjective identity are ontologically dependent on an external ‘other’. Ultimately, I argue that paying close critical attention to the performative and (re)iterative processes of micro-level identificatory practices allows a more nuanced understanding of the mechanisms through which identity change comes to take effect, both at the level of individual subjectivity and that of collective social belonging

Quantifying the prevalence of frailty in English hospitals

OBJECTIVES: Population ageing has been associated with an increase in comorbid chronic disease, functional dependence, disability and associated higher health care costs. Frailty Syndromes have been proposed as a way to define this group within older persons. We explore whether frailty syndromes are a reliable methodology to quantify clinically significant frailty within hospital settings, and measure trends and geospatial variation using English secondary care data set Hospital Episode Statistics (HES). SETTING: National English Secondary Care Administrative Data HES. PARTICIPANTS: All 50 540 141 patient spells for patients over 65 years admitted to acute provider hospitals in England (January 2005—March 2013) within HES. PRIMARY AND SECONDARY OUTCOME MEASURES: We explore the prevalence of Frailty Syndromes as coded by International Statistical Classification of Diseases, Injuries and Causes of Death (ICD-10) over time, and their geographic distribution across England. We examine national trends for admission spells, inpatient mortality and 30-day readmission. RESULTS: A rising trend of admission spells was noted from January 2005 to March 2013(daily average admissions for month rising from over 2000 to over 4000). The overall prevalence of coded frailty is increasing (64 559 spells in January 2005 to 150 085 spells by Jan 2013). The majority of patients had a single frailty syndrome coded (10.2% vs total burden of 13.9%). Cognitive impairment and falls (including significant fracture) are the most common frailty syndromes coded within HES. Geographic variation in frailty burden was in keeping with known distribution of prevalence of the English elderly population and location of National Health Service (NHS) acute provider sites. Overtime, in-hospital mortality has decreased (>65 years) whereas readmission rates have increased (esp.>85 years). CONCLUSIONS: This study provides a novel methodology to reliably quantify clinically significant frailty. Applications include evaluation of health service improvement over time, risk stratification and optimisation of services

Developing and validating a risk prediction model for acute care based on frailty syndromes

OBJECTIVES: Population ageing may result in increased comorbidity, functional dependence and poor quality of life. Mechanisms and pathophysiology underlying frailty have not been fully elucidated, thus absolute consensus on an operational definition for frailty is lacking. Frailty scores in the acute medical care setting have poor predictive power for clinically relevant outcomes. We explore the utility of frailty syndromes (as recommended by national guidelines) as a risk prediction model for the elderly in the acute care setting. SETTING: English Secondary Care emergency admissions to National Health Service (NHS) acute providers. PARTICIPANTS: There were N=2 099 252 patients over 65 years with emergency admission to NHS acute providers from 01/01/2012 to 31/12/2012 included in the analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: Outcomes investigated include inpatient mortality, 30-day emergency readmission and institutionalisation. We used pseudorandom numbers to split patients into train (60%) and test (40%). Receiver operator characteristic (ROC) curves and ordering the patients by deciles of predicted risk was used to assess model performance. Using English Hospital Episode Statistics (HES) data, we built multivariable logistic regression models with independent variables based on frailty syndromes (10th revision International Statistical Classification of Diseases, Injuries and Causes of Death (ICD-10) coding), demographics and previous hospital utilisation. Patients included were those >65 years with emergency admission to acute provider in England (2012). RESULTS: Frailty syndrome models exhibited ROC scores of 0.624–0.659 for inpatient mortality, 0.63–0.654 for institutionalisation and 0.57–0.63 for 30-day emergency readmission. CONCLUSIONS: Frailty syndromes are a valid predictor of outcomes relevant to acute care. The models predictive power is in keeping with other scores in the literature, but is a simple, clinically relevant and potentially more acceptable measurement for use in the acute care setting. Predictive powers of the score are not sufficient for clinical use

Deprescribing medicines in the acute setting to reduce falls risk

Objectives The objective of this study was to identify medicines that contribute to falls and assess whether review led to deprescribing of potentially inappropriate medication in elderly falls patients Methods Admissions data for elderly patients was examined to identify those whose presenting complaint included a fall. Medication lists were obtained from these patients and inpatient prescribing checked. Patients were followed up until discharge to determine when any medication review took place and whether or not their prescriptions changed as a result. In particular falls-risk medicines were identified from the admission lists, compared to discharge prescriptions and deprescribing detail obtained. Results One or more falls-risk associated medicine was found in 65% of patients aged 70 years and older, admitted following a fall. The mean number of regular medicines on admission was 6.8 per patient and problematic polypharmacy was found in 57%. Medicines review was carried out in 86% of patients and 8.5% of admission medicines were deprescribed. Pharmacist involvement in medicines review led to a significant reduction of falls risk medicines (0.53 per patient, p=0.002) Conclusion Inappropriate prescribing and polypharmacy are found frequently in elderly patients at admission following a fall. Comprehensive medicines reviews should be carried out in all such patients with the objective of deprescribing or reducing doses to minimise risk of harm. Involvement o

A nano-disperse ferritin-core mimetic that efficiently corrects anemia without luminal iron redox activity

AbstractThe 2-5nm Fe(III) oxo-hydroxide core of ferritin is less ordered and readily bioavailable compared to its pure synthetic analogue, ferrihydrite. We report the facile synthesis of tartrate-modified, nano-disperse ferrihydrite of small primary particle size, but with enlarged or strained lattice structure (~2.7Å for the main Bragg peak versus 2.6Å for synthetic ferrihydrite). Analysis indicated that co-precipitation conditions can be achieved for tartrate inclusion into the developing ferrihydrite particles, retarding both growth and crystallization and favoring stabilization of the cross-linked polymeric structure. In murine models, gastrointestinal uptake was independent of luminal Fe(III) reduction to Fe(II) and, yet, absorption was equivalent to that of ferrous sulphate, efficiently correcting the induced anemia. This process may model dietary Fe(III) absorption and potentially provide a side effect-free form of cheap supplemental iron.From the Clinical EditorSmall size tartrate-modified, nano-disperse ferrihydrite was used for efficient gastrointestinal delivery of soluble Fe(III) without the risk for free radical generation in murine models. This method may provide a potentially side effect-free form iron supplementation