Fall Risk Screening with Interventions for the Elderly

Background: Falls are an important safety concern among the elderly. A practice change project to decrease falls in the elderly population was implemented in a Patient-Centered Medical Home (PCMH) setting in Oregon with the purpose to determine whether staff was satisfied with the change effort. This endeavor encompassed two other clinics in a broader system which also embraced the change initiative. Methods: An electronic survey was offered to staff over a two week period to assess their satisfaction with the implementation of the tools used to screen the elderly for falls with those at risk receiving appropriate interventions. The Hendrich II was chosen to determine fall risk; the Falls Prevention Action Guide for Providers (FPAGFP) guided implementations for those susceptible to falls. The University of Portland (UP) institutional review board (IRB) approved this project. Results: Of the 20 respondents who completed the surveys, 14 were providers and residents, and 6 were MAs. All staff valued assessing the elderly for fall risk in clinical practice. All but one of the MAs indicated it was easy/very easy to incorporate use of the Hendrich II into their workflow. The majority of the providers indicated the tools were beneficial to help reduce falls in the elderly. No correlation existed between providers who believed in the effectiveness of the use of the FPAGFP to guide their actions to reduce falls and the belief that using the tool took time away from the patient encounter. Conclusion: This practice change project was beneficial in that it identified the majority of elderly at risk for falling and provided strategies for providers to choose to reduce the risk. Analyzing survey results for change endeavors is a helpful step to determine if there are apparent trends in responses. Focused group discussions may aid in the identification of reasons for suboptimal screening and implementation practices with direction provided for ways to improve them. Providers and MAs who are using the tools effectively could be mentors for those who are struggling to implement them into their daily practice

The Effect of AST-120 on Hepatic Metabolism and Transport in Chronic Kidney Disease

Chronic kidney disease (CKD) is characterized by a progressive and irreversible decline in renal function. Patients are at high risk for adverse drug events since they are typically administered multiple medications concurrently and pharmacokinetic changes in the diseased state are relatively unexplored. Recent studies point towards molecules known as uremic toxins for playing a mechanistic role in altering the expression and function of drug metabolizing enzymes and drug transporter proteins. To further investigate this hypothesis an adenine-induced model of CKD was used in male wistar rats. AST-120 was administered to remove uremic toxins in an attempt to recover metabolic enzyme as well as transporter protein function and activity. Animals were injected with rosuvastatin prior to sacrifice as a probe for transporter function. Impaired organic anion transporting polypeptide (OATP) and cytochrome P450 (CYP) function are important to acknowledge in a clinical setting since both of these protein superfamilies have broad substrate specificities. We have shown significant down regulation in CYP2B1 activity and expression in rats (

The amount and effect of V.A. mycorrhizal fungi in Saskatchewan soils

Non-Peer Reviewe

Carbon flow in plant microbial associations

Includes bibliographical references (page 474).Measurement of the distribution of the photosynthesis product in the symbiotic association of a legume, a mycorrhizal fungus, and nitrogen-fixing bacteria showed that the fungus incorporated 1 percent of the photosynthesis product and respired 3 percent. The nodules of a 5-week-old plant utilized 7 to 12 percent of the photosynthesis product. The legume compensated in part for the needs of its microbial partners through increased rates of photosynthesis.Publisher version: http://www.jstor.org/stable/1686536

Outcomes of Patients Referred for Arteriovenous Fistula Construction: A Systematic Review

Chronic Kidney Disease (CKD) affects 10-16% of the US population and its incidence is rising due to increasing prevalence of associated risk factors. Renal replacement therapy is required to treat late stage CKD and hemodialysis is the preferred modality for many patients. Vascular access is required for hemodialysis and arteriovenous fistulas (AVF) are currently the gold standard. This review intended to collate current knowledge on AVF outcomes regarding both the patient and fistula. Scopus and Medline were utilized to identify relevant literature. Inclusion and exclusion criteria were applied to narrow search results. Among CKD patients, 33.5-77.4% require a central venous catheter (CVC) before dialysis through a fistula. Many patients (33-51%) use a CVC regardless of AVF creation due to fistula immaturity or failure. There are large variations in AVF creation policies internationally; 16% of American hemodialysis patients use a fistula compared to 72% of German patients. Primary patency and primary AVFs' failure ranges from 60-70% and 20-26%, respectively. AVFs reduce morbidity and mortality in CKD. At present, too many patients are receiving hemodialysis through a CVC. Inadequate referral times for AVF creation can lead to fistula immaturity or failure in the intervention. Many countries are lagging behind recommended AVF creation rates published by the Kidney Disease Outcomes Quality Initiative. There is a paucity of literature concerning when a patient should be referred for AVF creation. It is paramount to have better predictive outcome measures and more clarity as to when patients will benefit from an AVF

The Role of Intraindividual Carotid Artery Variation in the Development of Atherosclerotic Carotid Artery Disease: A Literature Review

Carotid artery disease (CAD) is associated with numerous risk factors, including hypertension, hyperlipidemia, hypercholesterolemia, diabetes mellitus, and smoking. These systemic risk factors do not affect the carotid arteries equally in most patients, resulting in asymmetrical bilateral and unilateral CAD. It is unclear if anatomic variations in the carotid arteries predispose an individual to formation of atherosclerotic CAD. We wanted to assess (1) the inter-individual or intra-individual anatomical variations in the carotid arteries and (2) whether anatomical variations predispose the development of atherosclerotic CAD. PubMed and Medline were utilized to identify relevant literature for critical appraisal, summarization and documentation. Inclusion and exclusion criteria were applied to narrow results and articles were critically appraised and analyzed. Evidence suggests that a low outflow/inflow ratio, elevated bifurcation height, and bifurcation angle are associated with increased risk for CAD. Sex and age demonstrated positive correlation with the disease. Additionally, tortuosity and kinking of the carotid arteries may affect the formation of CAD but coiling of the arteries is a natural age-dependent process and does not affect CAD development. This review suggests there are anatomic variations in the carotid arteries that increase the risk of developing carotid artery disease. The most significant risk factors include a low outflow/inflow ratio, increased internal carotid artery tortuosity, elevated bifurcation height, and bifurcation angle

Column Time Warping with Neighborhood Distortion Cost

Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author and do not necessarily reflect the views of the National Science Foundation.The Cornell Laboratory of Ornithology coordinates the eBird Project in which volunteer bird watchers participate in a checklist program. Each time they go bird watching, they fill out a checklist of the number of birds of each species that they saw and upload it to a web site. This information has been used to fit models of the spatial distribution of each species of bird on a daily basis. One model pools data from many years; it provides a summary of the typical timing of bird migration each year. A second model describes the locations of the birds for each year separately. One important problem is to visualize, for each year, whether the birds are “ahead” or “behind” their typical migration timing. To do this, an algorithm was developed for “warping” the spatio-temporal distribution of the birds for a single year so that it matched the average spatio-temporal distribution. The algorithm only solves the problem approximately. The goal of this thesis was to understand the computation complexity of this time warping problem and to relate it to other known algorithms. Our analysis suggests, but does not prove, that the spatio-temporal time warping problem is computationally intractable (NP-Hard). Key Words: Time Warping, Bird Migrations, Migration Analysi

Predictors of repair and effect of gender on treatment of ruptured abdominal aortic aneurysm

AbstractObjectiveThe purpose of this study was to determine factors associated with increased likelihood of patients undergoing surgery to repair ruptured abdominal aortic aneurysms (AAAs). Specifically, we investigated whether men were more likely than women to be selected for surgery after rupture of AAAs.MethodsAll patients with a ruptured AAA who came to a hospital in Ontario between April 1, 1992, and March 31, 2001, were included in this population-based retrospective study. Administrative data were used to identify patients, patient demographic data, and hospital variables.ResultsCrude 30-day mortality for the 3570 patients who came to a hospital with a ruptured AAA was 53.4%. Of the 2602 patients (72.9%) who underwent surgical repair, crude 30-day mortality was 41.0%. Older patients (odds ratio [OR], 0.649 per 5 years of age; P < .0001), with a higher Charlson Comorbidity Index (OR, 0.848; P < .0001), were less likely to undergo AAA repair. Patients treated at high-volume centers (OR, 2.674 per 10 cases; P < .0001) and men (OR, 2.214; P < .0001) were more likely to undergo AAA repair.ConclusionMen are more likely to undergo repair of a ruptured AAA than women are, for reasons that are unclear. Given the large magnitude of the effect, further studies are clearly indicated

Survival after ruptured abdominal aortic aneurysm: effect of patient, surgeon, and hospital factors

AbstractObjectiveThe purpose of this study was to determine the effects of patient, surgeon, and hospital factors on survival after repair of ruptured abdominal aortic aneurysm (AAA) and to compare them with risk factors for survival after elective AAA repair. It was hypothesized that patients operated on by high-volume surgeons with subspecialty training would have better outcomes, which might argue for regionalization of AAA surgery.MethodsIn this population-based retrospective cohort study, surgeon billing and administrative data were used to identify all patients who had undergone AAA repair between April 1, 1992, and March 31, 2001, in Ontario, Canada. Demographic information was collected for each patient, as well as numerous variables related to the surgeons and hospitals.ResultsThere were 2601 patients with ruptured AAA repair, with an average 30-day mortality rate of 40.8%. Significant independent predictors of lower survival were older age, female gender, lower patient income quintile, performance of surgery at night or on weekends, repair in larger cities, surgeons with lower annual volume of ruptured AAA operations, and surgeons without vascular or cardiothoracic fellowship training. There were 13,701 patients with elective AAA repair, with an average 30-day mortality rate of 4.5%. Significant independent predictors of lower survival were similar, except gender was not significant, but the Charlson Comorbidity Index was. When the hazard ratios associated with predictive factors were compared, surgeon factors appeared to be more important in ruptured AAA repair, and patient factors appeared more important in elective AAA repair.ConclusionFor elective AAA repair, and even more so for ruptured AAA repair, high-volume surgeons with subspecialty training conferred a significant survival benefit for patients. Although this would seem to argue in favor of regionalization, decisions should await a more complete understanding of the relationship between transfer time, delay in treatment, and outcome

Sapropterin Treatment Prevents Congenital Heart Defects Induced by Pregestational Diabetes Mellitus in Mice.

Background Tetrahydrobiopterin is a cofactor of endothelial NO synthase ( eNOS ), which is critical to embryonic heart development. We aimed to study the effects of sapropterin (Kuvan), an orally active synthetic form of tetrahydrobiopterin on eNOS uncoupling and congenital heart defects ( CHD s) induced by pregestational diabetes mellitus in mice. Methods and Results Adult female mice were induced to pregestational diabetes mellitus by streptozotocin and bred with normal male mice to produce offspring. Pregnant mice were treated with sapropterin or vehicle during gestation. CHD s were identified by histological analysis. Cell proliferation, eNOS dimerization, and reactive oxygen species production were assessed in the fetal heart. Pregestational diabetes mellitus results in a spectrum of CHD s in their offspring. Oral treatment with sapropterin in the diabetic dams significantly decreased the incidence of CHD s from 59% to 27%, and major abnormalities, such as atrioventricular septal defect and double-outlet right ventricle, were absent in the sapropterin-treated group. Lineage tracing reveals that pregestational diabetes mellitus results in decreased commitment of second heart field progenitors to the outflow tract, endocardial cushions, and ventricular myocardium of the fetal heart. Notably, decreased cell proliferation and cardiac transcription factor expression induced by maternal diabetes mellitus were normalized with sapropterin treatment. Furthermore, sapropterin administration in the diabetic dams increased eNOS dimerization and lowered reactive oxygen species levels in the fetal heart. Conclusions Sapropterin treatment in the diabetic mothers improves eNOS coupling, increases cell proliferation, and prevents the development of CHD s in the offspring. Thus, sapropterin may have therapeutic potential in preventing CHD s in pregestational diabetes mellitus