MEDICATION CHANGES & RECOMMENDATIONS IN A CLINICAL GERONTOLOGY SERVICE

The purpose of this prospective study was to assess medication changes instituted during geriatric assessment and to determine compliance with medication recommendations three months post-discharge. Additional information to be studied included physicians' opinions of a Clinical Gerontology Service (CGS) discharge summary and the impact of the addition of a pharmacist-prepared medication discharge summary. Patients who underwent geriatric assessment had their medication regimens assessed on admission, discharge, and three months post-discharge. As an intervention, a pharmacist-prepared medication discharge section was added to the multidisciplinary discharge summary. A questionnaire was used to determine referring and primary care physicians' opinions of the CGS discharge summary. A total of 104 patients (two patients with readmissions, therefore 106 study cases) participated. The mean age of the study population was 80.6 (SD=6.8) years. Patients were admitted on an average of 5.5 (SD=3.3) total medications. They were discharged on an average of 4.3 (SD=2.3) and were again on an average of 5.5 (SD=2.9) total medications by three months post-discharge. There were no significant differences in scheduled medication costs between admission, discharge, and follow-up. Numerous drug additions, discontinuations, dose and administration interval changes occurred during and after assessment. There were also many changes in the choice of therapeutic agents prescribed. A number of variables were identified which were significantly correlated with the number of medication changes which occurred. The overall response rate for the questionnaires was 67.5%. For two of the three CGS study sites, physicians reported that discharge summaries were not received within a desirable time period. The overall quality of the discharge summary and the quality of the medication information provided received median rank scores of 4 (on a five point Likert scale labelled as 1=poor and 5=excellent). Physicians rated as "very important" the inclusion of information in discharge summaries about discharge medications along with their therapeutic rationale, changes in dose and reasons for this change, medications discontinued and reasons for the discontinuations, and medications added and reasons for the additions. The pharmacy discharge summary had no significant impact on decreasing medication numbers, costs, or changes between discharge and follow-up. Because the control group may have been sicker (possible selection bias), it was not possible to determine if polypharmacy occurred less frequently in intervention patients, or whether the more favorable questionnaire responses from physicians of these patients were actually due to the presence of the pharmacy discharge summary

Transnational education in Malaysia: does it prepare graduates for a globalized world?

The establishment of higher educational hubs in Malaysia and Singapore has spurred the growth of transnational education offerings in Asia, and attracted foreign higher education providers to set up branch campuses in these countries. In this paper we ask whether transnational education as practiced in Malaysia has a particular contribution to one aspect of the student experience – preparing graduates for an increasingly globalized world (Urry 2002). We considered the contribution that internationalisation of curriculum and the international experience of students and staff bring to the development of graduate capabilities suited to a globalized world. The opportunities that transnational education bring to the learning experiences of students were studied. The paper reports on an empirical study conducted in Australia and on transnational campuses in Malaysia to illustrate the extent to which current educational practice equips students to operate beyond national boundaries and suggest what needs to happen in order to realize the potential of transnational education for preparing students to operate in a globalized environment

Using attachment theory to illuminate consumers’ tensions between their sense of self and goal-pursuits in relationships

Consumers face tensions in deciding which goal to pursue, who to be and which self to present in daily life. Yet we know little about these tensions consumers experience as they respond to distinct interpersonal contexts (e.g., perceived support, trust, conflict and sense of belongingness). To this end, we explore the consumption deliberations that consumers undertake for self-presenting when faced with varying interpersonal encounters. We used interview data with women aged 19-62 and Rabinovich and Kacen’s (2013) qualitative coding methodology to examine interpersonal patterns of self-presentation. During the data analysis, attachment theory emerged as important in illuminating the tensions participants experienced in pursuing 4 types of goal-pursuit (intimacy, prevention, performance and authenticity) aided by their consumption choices for self-presenting in specific interpersonal contexts. Our findings show intrapsychic and interpersonal influences are not non-interacting entities, but rather need to be studied in conjunction when examining how people create desired social images/identities

Emerging MRI techniques for molecular and functional phenotyping of the diseased heart

Recent advances in cardiac MRI (CMR) capabilities have truly transformed its potential for deep phenotyping of the diseased heart. Long known for its unparalleled soft tissue contrast and excellent depiction of three-dimensional (3D) structure, CMR now boasts a range of unique capabilities for probing disease at the tissue and molecular level. We can look beyond coronary vessel blockages and detect vessel disease not visible on a structural level. We can assess if early fibrotic tissue is being laid down in between viable cardiac muscle cells. We can measure deformation of the heart wall to determine early presentation of stiffening. We can even assess how cardiomyocytes are utilizing energy, where abnormalities are often precursors to overt structural and functional deficits. Finally, with artificial intelligence gaining traction due to the high computing power available today, deep learning has proven itself a viable contender with traditional acceleration techniques for real-time CMR. In this review, we will survey five key emerging MRI techniques that have the potential to transform the CMR clinic and permit early detection and intervention. The emerging areas are: (1) imaging microvascular dysfunction, (2) imaging fibrosis, (3) imaging strain, (4) imaging early metabolic changes, and (5) deep learning for acceleration. Through a concerted effort to develop and translate these areas into the CMR clinic, we are committing ourselves to actualizing early diagnostics for the most intractable heart disease phenotypes

Redditors Revealed: Motivational Factors of the Reddit Community

The purpose of this paper is to examine what motivational factors influence frequency of participation on the social news website Reddit.com, which has evolved from a news aggregator into a thriving virtual community. This study takes the uses and gratifications approach to examine why people participate in this community. A survey was posted to Reddit.com and was completed by 549 users. Multiple Regression analysis was conducted to assess factors (informativeness, socializing/ community building, status-seeking, entertainment) that influence participation. \ \ Findings indicate that uses and gratifications is a valid means by which to examine the motivations and gratification for users of new media, specifically online social media platforms. Findings for motivational factors were consistent with the current literature, with the exception of information seeking as a gratification sought / obtained. Results may be useful for designers of online communities and for scholars to further explore new types of needs and gratifications for those who participate in virtual communities

Accelerated Dynamic Magnetic Resonance Imaging from Spatial-Subspace Reconstructions (SPARS)

Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) ideally requires a high spatial and high temporal resolution, but hardware limitations prevent acquisitions from simultaneously achieving both. Existing image reconstruction techniques can artificially create spatial resolution at a given temporal resolution by estimating data that is not acquired, but, ultimately, spatial details are sacrificed at very high acceleration rates. The purpose of this paper is to introduce the concept of spatial subspace reconstructions (SPARS) and demonstrate its ability to reconstruct high spatial resolution dynamic images from as few as one acquired radial spoke per dynamic frame. Briefly, a low-temporal-high-spatial resolution organization of the acquired raw data is used to estimate a spatial subspace in which the high-temporal-high-spatial ground truth data resides. This subspace is then used to estimate entire images from single k-space spokes. In both simulated and human in-vivo data, the proposed SPARS reconstruction method outperformed standard GRASP and GRASP-Pro reconstruction, providing a shorter reconstruction time and yielding higher accuracy from both a spatial and temporal perspective.Comment: Submitted to Frontiers in Imagin

Blood-pool MRI assessment of myocardial microvascular reactivity

PurposeThe ability to non-invasively image myocardial microvascular dilation and constriction is essential to assessing intact function and dysfunction. Yet, conventional measurements based on blood oxygenation are not specific to changes in blood volume. The purpose of this study was to extend to the heart a blood-pool MRI approach for assessing vasomodulation in the presence of blood gas changes and investigate if sex-related differences exist.MethodsAnimals [five male and five female healthy Sprague Dawley rats (200–500 g)] were intubated, ventilated, and cycled through room air (normoxia) and hypercapnia (10% CO2) in 10-minute cycles after i.v. injection of blood-pool agent Ablavar (0.3 mmol/kg). Pre-contrast T1 maps and T1-weighted 3D CINE were acquired on a 3 Tesla preclinical MRI scanner, followed by repeated 3D CINE every 5 min until the end of the gas regime. Invasive laser Doppler flowmetry of myocardial perfusion was performed to corroborate MRI results.ResultsMyocardial microvascular dilation to hypercapnia and constriction to normoxia were readily visualized on T1 maps. Over 10 min of hypercapnia, female myocardial T1 reduced by 20% (vasodilation), while no significant change was observed in the male myocardium. After return to normoxia, myocardial T1 increased (vasoconstriction) in both sexes (18% in females and 16% in males). Laser Doppler perfusion measurements confirmed vasomodulatory responses observed on MRI.ConclusionBlood-pool MRI is sensitive and specific to vasomodulation in the myocardial microcirculation. Sex-related differences exist in the healthy myocardium in response to mild hypercapnic stimuli