Caring for the Whole Person: Home care for older people which promotes well-being and choice

This research project explored the factors which make a flexible, person-centred style of service possible. This publication reports the key influences identified, lists the conditions which promote this style of home care, and highlights much information pertinent to developing services in this direction

The Efficacy of Peripheral Opioid Antagonists in Opioid-Induced Constipation and Postoperative Ileus: A Systematic Review of the Literature.

Opioid-induced constipation has a negative impact on quality of life for patients with chronic pain and can affect more than a third of patients. A related but separate entity is postoperative ileus, which is an abnormal pattern of gastrointestinal motility after surgery. Nonselective μ-opioid receptor antagonists reverse constipation and opioid-induced ileus but cross the blood-brain barrier and may reverse analgesia. Peripherally acting μ-opioid receptor antagonists target the μ-opioid receptor without reversing analgesia. Three such agents are US Food and Drug Administration approved. We reviewed the literature for randomized controlled trials that studied the efficacy of alvimopan, methylnaltrexone, and naloxegol in treating either opioid-induced constipation or postoperative ileus. Peripherally acting μ-opioid receptor antagonists may be effective in treating both opioid-induced bowel dysfunction and postoperative ileus, but definitive conclusions are not possible because of study inconsistency and the relatively low quality of evidence. Comparisons of agents are difficult because of heterogeneous end points and no head-to-head studies

Analysis of Time-Independent Consolidation Data

The one-dimensional laboratory consolidation test developed by Terzaghi permits deformation and drainage only in the vertical direction. The stress-strain characteristics of data obtained from this test are normally studied using a semilogarithmic graphical representation, that is, vertical strain or void ratio is plotted as a function of the logarithm of effective stress. Such a representation permits an analysis of the stress history and compressibility characteristics of soils. Knowledge of these material characteristics is of great practical value in the prediction of settlement associated with loading where the effects of lateral consolidation may be neglected

e-Bug Games for Children: Teaching Hygiene and Prudent Antibiotics Use using Web Games

Technology enhanced education has been recently established as a new approach for all stages of education. However, among these new IT media it is computer games playing the central role in delivering education in particular to children and teenagers, however, real world sound evaluation is often given little attention. The EU funded e-Bug project developed web games aimed at children to teach basic principles of pru- dent antibiotics use, hand and respiratory hygiene and aims to reinforces an awareness of microbes, hand and respiratory hygiene among junior and senior school children in 10 countries in Europe. An educational pack implemented in schools across Europe is complemented by Internet web games for two age groups teaching a set of learning objectives (LOs) using a fast and interactive platform game design for junior children and investigate detective games based on PBL principles for senior children. In this paper, we present the design of e-Bug junior and senior games and evaluation results

Characteristic Mechanisms and Outcome of Cardiopulmonary Arrest in Congestive Heart Failure Patients

Recent studies suggest the mechanism of sudden death in congestive heart failure (CHF) patients is less frequently VT/VF than previously believed. In order to further understand the characteristics and mechanisms of death in CHF patients, we evaluated 146 patients who underwent cardiopulmonary resuscitation during hospitalization for congestive heart failure, ischemic heart disease, and noncardiac causes. Clinical characteristics and outcomes are described below:CHF/CardiacnonCHF/CardiacnoncardiacN302690Age63 (49.71)67 (60.72)63 (29.71)Sex (% male)375860Initial Rhythm N(%)VT/VF7 (25)11 (44)24 (27)Asystole6 (21.4)6 (24)33 (37.5)Bradycardia5 (17.9)2 (8)6 (6.8)EMD6 (21.4)1 (4)13 (148)Other4 (14.3)5 (20)12 (136)ROSC21 (70)13 (50)51 (56.7)Survival to D/C1 (3.3)4 (15.4)2 (2.2)Patients with nonCHF/Cardiac disease had a higher ROSC than patients with CHF and noncardiac diseases (p=0.016). In summary, patients with CHF often experience cardiopulmonary arrest with bradycardic or EMD arrests. Although patients with CHF are resuscitated with a high degree of success their in-hospital survival was low. Furthermore, the high rate of bradycardic and EMD arrests may explain the low in-hospital survival rates

TEFRA-Partnership Refunds: Five Steps to Protect a Partner’s Rights

The Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) established a unified procedure for determining the tax treatment of partnership items at the partnership level rather than the partner level. The TEFRA-partnership refund procedures differ from the refund claim procedures that apply to other taxpayers. For a TEFRA partnership, a refund claim is an administrative adjustment request (AAF) and a notice of deficiency is a notice of final partnership administrative adjustment (FPAA). Procedures for the assessment of additional tax attributable to partnership items have received much attention in recent years, but the procedures concerning refunds are complex and full of traps.The tax matters partner (TMP) plays a key role in protecting the partners’ rights, but the TMP’s interests may differ significantly from those of other partners. Because of potential conflicts of interest, an individual partner should not rely entirely on the TMP. This article recommends five steps a taxpayer should take to protect its rights in a TEFRA partnership.First, file an AAR before the IRS issues an FPAA; otherwise, it will be too late. Outside of the TEFRA-partnership context, taxpayers can simply default on a notice of deficiency, pay the resulting assessment, and then file a refund claim. With a TEFRA-partnership, the partners may no longer file an AAR after the IRS issues an FPAA so the only way to pursue a taxpayer-favorable adjustment on other issues is to contest the FPAA in court. Failing to do so will permanently forfeit any such favorable adjustments.Second, review the complex statute of limitations for AARs carefully. There are significant differences between the statute of limitations concerning refund claims and refund suits, outside the TEFRA-partnership context, and the statute of limitations for AARs and related judicial review. Assumptions based on other statutes of limitations could easily result in forfeiting claims. Third, file a separate AAR and do not rely entirely on the AAR filed by the TMP. Individual partners can always contest an FPAA in court, even if the TMP chooses not to, so their rights are protected. But if the IRS disallows an AAR filed by the TMP, only the TMP can file a petition for judicial review and redetermination. Individual partners should consider filing their own AAR and not relying on the TMP’s. The duplicative AAR will likely be rejected but would preserve the partner’s right to judicial review if the TMP’s AAR is disallowed and the TMP does not file a petition in Tax Court.Fourth, consider extending the partner-level statute of limitations for assessments to avoid forfeiting potential refund claims. If the TMP consents to an extension of the statute of limitation for the assessment of tax attributable to partnership items, that will extend the statute of limitations for filing an AAR. If the TMP has not extended the statute of limitations, and an individual partner needs more item to prepare an AAR, the partner may need to extend the partner-level statute of limitations.Fifth, if beyond the statute of limitations for an AAR, consider alternative methods of recovery. For example, the partner may request a discretionary adjustment by the IRS under Section 6230(d). In appropriate circumstances, a partner can seek to apply the statutory mitigation provisions or the judicial doctrine of equitable recoupment.The TEFRA procedures for AARs provide all partners a way to recover overpayments attributable to partnership items. The procedures are complex, however, with many potential pitfalls. Any partner who identifies a potential refund item for the partnership should thoroughly review all of the applicable requirements and carefully assess what it must do to preserve its rights. In particular, a partner may find it beneficial to file its own AAR, or include refund items in a petition for readjustment of an FPAA, in case the TMP cannot or will not act in the partner’s interests. Under some circumstances, it may even be appropriate for a partner to extend its own statute of limitations to protect its interests