Polypharmacy: Misleading, but manageable

The percentage of the population described as elderly is growing, and a higher prevalence of multiple, chronic disease states must be managed concurrently. Healthcare practitioners must appropriately use medication for multiple diseases and avoid risks often associated with multiple medication use such as adverse effects, drug/drug interactions, drug/disease interactions, and inappropriate dosing. The purpose of this study is to identify a consensus definition for polypharmacy and evaluate its prevalence among elderly outpatients. The authors also sought to identify or develop a clinical tool which would assist healthcare practitioners guard against inappropriate drug therapy in elderly patients. The most commonly cited definition was a medication not matching a diagnosis. Inappropriate was part of definitions used frequently. Some definitions placed a numeric value on concurrent medications. Two common definitions (ie, 6 or more medications or a potentially inappropriate medication) were used to evaluate polypharmacy in elderly South Carolinians (n = 1027). Data analysis demonstrates that a significant percentage of this population is prescribed six or more concomitant drugs and/or uses a potentially inappropriate medication. The findings are 29.4% are prescribed 6 or more concurrent drugs, 15.7% are prescribed one or more potentially inappropriate drugs, and 9.3% meet both definitions of polypharmacy used in this study. The authors recommend use of less ambiguous terminology such as hyperpharmacotherapy or multiple medication use. A structured approach to identify and manage inappropriate polypharmacy is suggested and a clinical tool is provided

Distal communication by chimpanzees (Pan troglodytes): evidence for common ground?

van der Goot et al. (2014) proposed that distal, deictic communication indexed the appreciation of the psychological state of a common ground between a signaler and a receiver. In their study, great apes did not signal distally, which they construed as evidence for the human uniqueness of a sense of common ground. This study exposed 166 chimpanzees to food and an experimenter, at an angular displacement, to ask, “Do chimpanzees display distal communication?” Apes were categorized as (a) proximal or (b) distal signalers on each of four trials. The number of chimpanzees who communicated proximally did not statistically differ from the number who signaled distally. Therefore, contrary to the claim by van der Goot et al., apes do communicate distally

Prevention Measures and Management of Unruly Passengers Aboard an Aircraft

Putnik nedoličnog ponašanja definira se kao putnik koji odbija pratiti pravilanormalnog ponašanja unutar zrakoplova ili odbija pratiti upute dane od strane kabinskog osoblja ili zapovjednika zrakoplova, što rezultira ometanjem reda i discipline unutar zrakoplova te narušavanjem sigurnosti unutar zrakoplova. Ovo je definicija putnika nedoličnog ponašanja dana IATA-inim (International Air Transport Association - IATA) smjernicama za prevenciju i postupanje u slučajevima nedoličnog ponašanja putnika u zrakoplovu. Pojavom IATA-inih smjernica, zrakoplovni prijevoznici dobijaju jedinstven dokument uz pomoć kojeg postaje lakše obavljati prevenciju te intervenirati u slučaju incidenta putnika nedoličnog ponašanja u suvremenom dobu zračnog prometa gdje putnici nedoličnog ponašanja mogu predstavljati opasnost ne samo za zrakoplovnu posadu te putnike i imovinu unutarnjega, već i za sam zrakoplov te sigurnost leta. Ovim radom raspravljaju se regulative i praksa zračnih prijevoznika vezani za borbu protiv putnika nedoličnog ponašanja i drugih tipova putnika koji kane, ili su počinili kazneno djelo unutar i izvan zrakoplova, načini identifikacije te načini borbe zračnih prijevoznika, država te zapovjednika zrakoplova protiv akata takvih putnika te konačno smjernice za prevenciju i postupanje s takvim putnicima dane od strane Croatia Airlines te Turkish Airlines i njihova usporedba s onima danim od strane IATA-e.An unruly passenger is defined as a passenger that refuses to follow standard rulesof behaviour aboard an aircraft or refuses to acknowledge and comply to instructions set out by cabin crew or the aircraft commander, which finally results in disruption oforder and discipline aboard aircraft, aswell as the overall disruption of aircraftsecurity. This is the definition of an unruly passenger, given by IATAs (International Air Transport Association - IATA) Guidance on unruly passenger prevention and management. With the release of IATAs guidelines, airlines receive a unique document which they can now use for prevention and intervening in cases of unruly passenger incidents, in a modern air traffic era in which unruly passengers pose a threat not only to aircraft crew, passengers and property, but also to the aircraft itself aswell as the safety of the flight. This paper discusses regulations and practice of airlines regarding combating unruly and other types of passengers which intend to, or have commited a felony inside and outside of the aircraft, ways for airlines, states and aircraft commanders to identify and combat these passengers and finally Croatia Airlines and Turkish Airlines guidelines for prevention and management of unruly passengers and the comparison between these guidelines and the ones given out by IATA

Microbial transformations of selenite by methane-oxidizing bacteria

Abstract Methane oxidizing bacteria are well known for their role in the global methane cycle and their potential for microbial transformation of wide range of hydrocarbon and chlorinated hydrocarbon pollution. Recently, it has also emerged that methane-oxidizing bacteria interact with inorganic pollutants in the environment. Here we report what we believe to be the first study of the interaction of pure strains of methane-oxidizing bacteria with selenite. Results indicate that the commonly used laboratory model strains of methane oxidizing bacteria, Methylococcus capsulatus (Bath) and Methylosinus trichosporium OB3b are both able to reduce the toxic selenite (SeO32-) but not selenate (SeO42-) to red spherical nanoparticulate elemental selenium (Se0), which was characterised via EDX and EXAFS. The cultures also produced volatile selenium-containing species, which suggests that both strains may have an additional activity that can either transform Se0 or selenite into volatile methylated forms of selenium. Transmission electron microscopy (TEM) measurements and experiments with the cell fractions: cytoplasm, cell wall and cell membrane show that the nanoparticles are formed mainly on the cell wall. Collectively these results are promising for the use of methane-oxidizing bacteria for bioremediation or suggest possible uses in the production of selenium nanoparticles for biotechnology

Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort

Although preterm birth less than 37 weeks gestation is the leading cause of neonatal morbidity and mortality in the United States, the majority of data regarding preterm neonatal outcomes come from older studies, and many reports have been limited to only very preterm neonates. Delineation of neonatal outcomes by delivery gestational age is needed to further clarify the continuum of mortality and morbidity frequencies among preterm neonates

Evidence-based Kernels: Fundamental Units of Behavioral Influence

This paper describes evidence-based kernels, fundamental units of behavioral influence that appear to underlie effective prevention and treatment for children, adults, and families. A kernel is a behavior–influence procedure shown through experimental analysis to affect a specific behavior and that is indivisible in the sense that removing any of its components would render it inert. Existing evidence shows that a variety of kernels can influence behavior in context, and some evidence suggests that frequent use or sufficient use of some kernels may produce longer lasting behavioral shifts. The analysis of kernels could contribute to an empirically based theory of behavioral influence, augment existing prevention or treatment efforts, facilitate the dissemination of effective prevention and treatment practices, clarify the active ingredients in existing interventions, and contribute to efficiently developing interventions that are more effective. Kernels involve one or more of the following mechanisms of behavior influence: reinforcement, altering antecedents, changing verbal relational responding, or changing physiological states directly. The paper describes 52 of these kernels, and details practical, theoretical, and research implications, including calling for a national database of kernels that influence human behavior