Optimal management of urinary tract infections in older people

Urinary tract infections (UTI) occur frequently in older people. Unfortunately, UTI is commonly overdiagnosed and overtreated on the basis of nonspecific clinical signs and symptoms. The diagnosis of a UTI in the older patient requires the presence of new urinary symptoms, with or without systemic symptoms. Urinalysis is commonly used to diagnose infection in this population, however, the evidence for its use is limited. There is overwhelming evidence that asymptomatic bacteriuria should not be treated. Catheter associated urinary tract infection accounts for a significant amount of hospital-associated infection. Indwelling urinary catheters should be avoided where possible and alternatives sought. The use of narrow spectrum antimicrobial agents for urinary tract infection is advocated. Local guidelines are now widely used to reflect local resistance patterns and available agents. Guidelines need to be updated to reflect changes in antimicrobial prescribing and a move from broad to narrow spectrum antimicrobials

Cranberry or trimethoprim for the prevention of recurrent urinary tract infections? A randomized controlled trial in older women

OBJECTIVES: To compare the effectiveness of cranberry extract with low-dose trimethoprim in the prevention of recurrent urinary tract infections (UTIs) in older women.PATIENTS AND METHODS: One hundred and thirty-seven women with two or more antibiotic-treated UTIs in the previous 12 months were randomized to receive either 500 mg of cranberry extract or 100 mg of trimethoprim for 6 months.RESULTS: Thirty-nine of 137 participants (28%) had an antibiotic-treated UTI (25 in the cranberry group and 14 in the trimethoprim group); difference in proportions relative risk 1.616 (95% CI: 0.93, 2.79) P = 0.084. The time to first recurrence of UTI was not significantly different between the groups (P = 0.100). The median time to recurrence of UTI was 84.5 days for the cranberry group and 91 days for the trimethoprim group (U = 166, P = 0.479). There were 17/137 (12%) withdrawals from the study, 6/69 (9%) from the cranberry group and 11/68 (16%) from the trimethoprim group (P = 0.205), with a relative risk of withdrawal from the cranberry group of 0.54 (95% CI: 0.19, 1.37).CONCLUSIONS: Trimethoprim had a very limited advantage over cranberry extract in the prevention of recurrent UTIs in older women and had more adverse effects. Our findings will allow older women with recurrent UTIs to weigh up with their clinicians the inherent attractions of a cheap, natural product like cranberry extract whose use does not carry the risk of antimicrobial resistance or super-infection with Clostridium difficile or fungi.</p

Background light measurements at the DUMAND site

Ambient light intensities at the DUMAND site, west of the island of Hawaii were measured around the one photoelectron level. Throughout the water column between 1,500m and 4,700m, a substantial amount of stimulateable bioluminescence is observed with a ship suspended detector. But non-stimulated bioluminescence level is comparable, or less than, K sup 40 background, when measured with a bottom tethered detector typical of a DUMAND optical module

Data-driven counterfactual evaluation of management outcomes to improve emergency conservation decisions

Monitoring is needed to assess conservation success and improve management, but naïve or simplistic interpretation of monitoring data can lead to poor decisions. We illustrate how to counter this risk by combining decision-support tools and quantitative counterfactual analysis. We analyzed 20 years of egg rescue for tara iti (Sternula nereis davisae) in Aotearoa New Zealand. Survival is lower for rescued eggs; however, only eggs perceived as imminently threatened by predators or weather are rescued, so concluding that rescue is ineffective would be biased. Equally, simply assuming all rescued eggswould have died if left in situ is likely to be simplistic. Instead, we used the monitoring data itself to estimate statistical support for a wide space of uncertain counterfactuals about decisions and fate of rescued eggs. Results suggest under past management, rescuing and leaving eggs would have led to approximately the same overall fledging rate, because of likely imperfect threat assessment and low survival of rescued eggs to fledging. Managers are currently working to improve both parameters. Our approach avoids both naïve interpretation of observed outcomes and simplistic assumptions thatmanagement is always justified, using the same data to obtain unbiased quantitative estimates of counterfactual support

Interventions to prevent non-critical care hospital acquired pneumonia – a systematic review

Background: Hospital-acquired pneumonia is a significant burden to healthcare systems around the world. Although there is a considerable body of evidence on prevention of ventilator associated pneumonia, less is known about strategies to prevent hospital-acquired pneumonia in non-critical care settings. Objective: To systematically review the randomised controlled trial evidence for prevention of hospital-acquired pneumonia in non-critical care settings. Methods: We searched EMBASE, CINAHL+, MEDLINE and the Cochrane Library. Seventeen different searches were conducted in parallel through each database. Studies were included if they were randomised controlled trials reporting hospital-acquired pneumonia as an endpoint. Studies were excluded if they were performed in critical care or community settings. All studies published up to the end of December 2014 were considered, with no language restrictions. Data were independently extracted by two authors and the Delphi risk of bias tool was applied to assess trial quality. Results: Five thousand one hundred and one titles were identified across 17 searches. Only two studies were eligible for inclusion in the final review, one from a search of physical therapy interventions and one from a search of enteral feeding. The heterogeneity of the interventions did not permit meta-analysis. One trial suggested possible benefits to early mobilisation; the other trial suggested no benefit or harm from early enteral feeding via nasogastric tube. Both trials enrolled patients with acute stroke. No trials in non-stroke, non-critical care populations were eligible for inclusion in the review. Conclusions: There is currently insufficient trial evidence on preventing non-critical care hospital-acquired pneumonia to make recommendations on practice.</p

Social, environmental and psychological factors associated with objective physical activity levels in the over 65s

Objective: To assess physical activity levels objectively using accelerometers in community dwelling over 65 s and to examine associations with health, social, environmental and psychological factors. Design: Cross sectional survey. Setting: 17 general practices in Scotland, United Kingdom. Participants: Random sampling of over 65 s registered with the practices in four strata young-old (65–80 years), old-old (over 80 years), more affluent and less affluent groups. Main Outcome Measures: Accelerometry counts of activity per day. Associations between activity and Theory of Planned Behaviour variables, the physical environment, health, wellbeing and demographic variables were examined with multiple regression analysis and multilevel modelling. Results: 547 older people (mean (SD) age 79(8) years, 54% female) were analysed representing 94% of those surveyed. Accelerometry counts were highest in the affluent younger group, followed by the deprived younger group, with lowest levels in the deprived over 80 s group. Multiple regression analysis showed that lower age, higher perceived behavioural control, the physical function subscale of SF-36, and having someone nearby to turn to were all independently associated with higher physical activity levels (R2 = 0.32). In addition, hours of sunshine were independently significantly associated with greater physical activity in a multilevel model. Conclusions: Other than age and hours of sunlight, the variables identified are modifiable, and provide a strong basis for the future development of novel multidimensional interventions aimed at increasing activity participation in later life.Publisher PDFPeer reviewe

Phase mixing of propagating Alfvén waves in a single-fluid partially ionized solar plasma

The phase mixing of Alfvén waves is one of the most promising mechanisms for the heating of the solar atmosphere. The damping of waves in this case requires small transversal scales, relative to the magnetic field direction; this requirement is achieved by considering a transversal inhomogeneity in the equilibrium plasma density profile. Using a single-fluid approximation of a partially ionized chromospheric plasma, we study the effectiveness of the damping of phase-mixed shear Alfvén waves and investigate the effect of varying the ionization degree on the dissipation of waves. Our results show that the dissipation length of shear Alfvén waves strongly depends on the ionization degree of the plasma, but more importantly, in a partially ionized plasma, the damping length of shear Alfvén waves is several orders of magnitude shorter than in the case of a fully ionized plasma, providing evidence that phase mixing could be a large contributor to heating the solar chromosphere. The effectiveness of phase mixing is investigated for various ionization degrees, ranging from very weakly to very strongly ionized plasmas. Our results show that phase-mixed propagating Alfvén waves in a partially ionized plasma with ionization degrees in the range μ = 0.518–0.657, corresponding to heights of 1916–2150 km above the solar surface, can provide sufficient heating to balance chromospheric radiative losses in the quiet Sun

Quantitative data analysis of perceived barriers and motivators to physical activity in stroke survivors

Peer reviewedPublisher PD

Applying a values-based decision process to facilitate co-management of threatened species in Aotearoa New Zealand

Ko koe ki tēnā, ko ahau ki tēnai kīwai o te kete (you at that, and I at this handle of the basket). This Māori (New Zealanders of indigenous descent) saying conveys the principle of cooperation—we achieve more through working together, rather than separately. Despite decades of calls to rectify cultural imbalance in conservation, threatened species management still relies overwhelmingly on ideas from Western science and on top-down implementation. Values-based approaches to decision making can be used to integrate indigenous peoples’ values into species conservation in a more meaningful way. We used such a values-based method, structured decision making, to develop comanagement of pekapeka (Mystacina tuberculata) (short-tailed bat) and tara iti (Sternula nereis davisae) (Fairy Tern) between Māori and Pākehā (New Zealanders of European descent). We implemented this framework in a series of workshops in which facilitated discussions were used to gather expert knowledge to predict outcomes and make management recommendations. For both species, stakeholders clearly stated their values as fundamental objectives from the start, which allowed alternative strategies to be devised that naturally addressed their diverse values, including mātauranga Māori (Māori knowledge and perspectives). On this shared basis, all partners willingly engaged in the process, and decisions were largely agreed to by all. Most expectations of conflicts between values of Western science and Māori culture were unfounded. Where required, positive compromises were made by jointly developing alternative strategies. The values-based process successfully taha wairua taha tangata (brought both worlds together to achieve the objective) through codeveloped recovery strategies. This approach challenges the traditional model of scientists first preparing management plans focused on biological objectives, then consulting indigenous groups for approval. We recommend values-based approaches, such as structured decision making, as powerful methods for development of comanagement conservation plans between different peoples

Magnetohydrodynamic wave modes of solar magnetic flux tubes with an elliptical cross section

The purpose of this paper is to study the behavior of magnetohydrodynamic (MHD) wave modes that propagate in compressible magnetic flux tubes with an elliptical cross section embedded in a magnetic environment. The dispersion relation that describes the behavior of MHD wave modes permitted in an elliptical magnetic flux tube is solved numerically. Distortion of the spatial structure of the purely real eigenmodes from the well-known circular flux tube model has been considered. It has been studied under both photospheric and coronal conditions. It has been shown that (i) solutions in the form of even Mathieu functions are more sensitive to the value of eccentricity than solutions with the form of odd Mathieu functions; (ii) if the ellipticity of the cross section of the magnetic flux tube increases, a sausage mode (m = 0) cannot be easily identified; (iii) even solutions that correspond to the fluting mode (m = 3) can be misinterpreted as a kink mode (m = 1) due to their similarities. In contrast to the fluting modes that are polarized along the major axis and strongly depend on the ellipticity of the magnetic flux tube, the kink and sausage surface modes are practically unaffected by ellipticity. Several examples of the spatial structure of the eigenmodes permitted in the pores and sunspots have been visualized. The solutions obtained in the approximation of cylindrical symmetry are in agreement with previous studies