Use of Benzodiazepines and Z-Drugs in Nursing Home Residents with Dementia:Prevalence and Appropriateness

BACKGROUND: Guidelines worldwide recommend restricted prescription of benzodiazepine receptor agonists (BZRAs), i.e., benzodiazepines and Z-drugs, for the treatment of dementia-associated behavioral and psychological symptoms and insomnia. OBJECTIVE: To assess the prevalence and appropriateness of BZRA use among nursing home residents with dementia. METHODS: This is a post-hoc analysis of BZRA prescriptions from two intervention studies on psychotropic drug use, conducted from 2016 to 2018. It includes 1,111 residents of dementia special care units from 24 Dutch long-term care organizations. We assessed the prevalence of use of continuous and as-needed BZRA prescriptions and their association with registered symptoms. Continuous BZRA prescriptions were evaluated for appropriateness, i.e., whether indication, dosage, duration, and evaluation accorded with guidelines for the treatment of challenging behavior in dementia and sleep disorders. RESULTS: The prevalence of BZRA use is 39.2% (95% CI: 36.3%–42.0%): continuous 22.9%; only as-needed 16.3%. Combinations of preferred BZRAs and appropriate indications occur in 19.0% of continuous anxiolytic prescriptions and 44.8% of hypnotic prescriptions. Frequently registered inappropriate indications are aggression/agitation for anxiolytics (continuous: 75.7%; as-needed: 75.2%) and nighttime agitation for hypnotics (continuous: 40.3%; as-needed: 26.7%). None of the continuous prescriptions with appropriate indications were appropriate for all other items. For most of the prescriptions, duration and time to evaluation exceeded 4 weeks. CONCLUSION: BZRA use in nursing home residents with dementia is highly frequent. A large proportion of prescriptions do not follow the guidelines with regard to indication, exceed the recommended duration and are not evaluated in a timely manner. The discrepancy between evidence-based guidelines and daily practice calls for an exploration of factors maintaining inappropriate use

A field study on Sumatran orang utans (Pongo pygmaeus abelii Lesson 1827) : ecology, behaviour and conservation

The results of a three year research project on the ecology, behaviour and conservation of the Sumatran orang utan are discussed. The 150 hectares Ketambe study area lie within the boundaries of the Gunung Leuser. reserve in Aceh Tenggara, and consists of mixed rainforest typical of hilly regions.The orang utan's food is irregularly distributed in quantity, space and time within this area. Although the orang utan is frugivorous he also eats leaves, insects, 'bark' and several other less important foods, such as bird's eggs. By far the largest part of the 114 food plants collected is typical primary rainforest growth. Figs make up an important part of the diet, particularly those known as the 'strangling' Ficus spp. As the fruiting seasons of the various strangling fig species are staggered over the whole year, and such trees are often enormous in size, they form particularly suitable food sources. Orang utans appear to have a good topographical knowledge of their 'home range'. There are indications that fig trees bearing ripe fruits are sometimes found by using the flight paths of flocks of hornbills, which also feed on figs. With respect to figs in particular, the orang utan must compete for its food with many other species, notably primates.The study area was regularly used by 22 individually recognized orang utans. Both males and females live in homeranges which overlap considerably and are 2-10 km sq. in extent. The population density of the Ketambe area is considerably higher than that reported for other areas in Indonesia, being approximately 5 individuals per square kilometre. Orang utans live a 'limited gregarious' lifestyle, that is, adult males spend the largest part of their time alone, and avoid encounters with other adult males. The adult females and their offspring stay together for the first 4-5 years of life (the birth interval is at least 3 years.). Adolescent social groups form after the mother-offspring bond becomes weaker. This social phase continues for each individual until either (a) the sexual dimorphistic characteristics of males are clearly distinguishable (at approximately 15 years of age), or (b) the female's first young is born (approximately 10 years of age). Adults also have social moments in their lives. Several individuals in an area can come together to form a 'temporary association' in certain fruit trees. It may be seen from their behaviour that they know each other well and that a network of relationships exist which is partly based on competitive dominance. A peaceful co-existence between adult males however, has not been observed; meetings between adult males had invariably an agonistic character. The sexual behaviour of the orang utan is roughly divisable into: (a) 'raping' of some females by sub-adult males; and (b) cooperative matings, where females often take the intitiative by presenting themselves to, usually, adult males. It appears that only the latter makes an essential contribution to reproduction.The social behaviour of the orang utan is considered and described in detail. Comparison of the behavioural repertoire of this species with that of the (gregarious) chimpanzee shows that the two species are closely related. There are clear differences in social organisation, however, which appear to be mainly of degree, rather than of quality. The social organisation of an animal must be a factor that fits its situational (i.e. environmental) context, but is based on phylogenetic characteristics. Comparison of the habitats of these two apes reveals that they both live in a similar ecological condition with respect to food. The reasons for the exceptional life-style on the part of the orang utan are possibly to be found in the predation pressure the species is exposed to, particularly by man. Man has been present in regions of South-EastAsia since the Pleistocene. It is plausible that the orang utan has been persecuted by man continuously from this time. A comparable influence on the chimpanzee is much more recent. The orang utan is the heaviest arboreal creature and has an exceptional social organisation for a primate. If it may be assumed that high intelligence is a biological outcome of complex group life then, on grounds of intelligence, and from the distinct social organisation and current arboreal life-style it maybe postulated that the orang utan has evolved from a groundliving social ape. This original form was supplanted from its niche by a better adapted ground-living social ape, that is, man. It is possible that a stricly arboreal life style for an animal as heavy as an adult orang utan is not compatible with a social life-style. Moreover, it is likely that refraining from a high degree of sociability and inconspicuousness are the best strategies against human predation.Since one possibility is that the hunting pressure in ancient (and current) times had a great influence on the biology of the orang utan, I have paid particular attention to hunting behaviour in hominids. At present, this form of threat is overshadowed by excessive habitat destruction. Cultivation in connection with the explosive population growth in Indonesia, together with the commercial timber concerns, affect the tropical rainforest ecosystem in such proportions that even reserves are threatened. Despite being protected since 1932, the orang utan is a severely endangered species. Rehabilitation of orang utans is a conservation action directed at reducing the still ongoing hunting pressure. This is despite the fact that there are clear risks in this to the wild population. These risks can be negated by confining rehabilitation projects to areas lacking a wild orang utan population.The orang utan is a component of an intact ecosystem and it is of utmost importance that the emphasis of nature conservation schemes is placed on the totality and balance of the tropical rainforest ecosystem. Every form of commercial exploitation within this ecosystem is incompatible with the proposed goal of preserving the system. The removal of components (e.g. 'selective logging' or 'selective hunting') does real damage to the balance of the system.An orang utan who lives in an exploited forest is in principle of equally small biological value as an orang utan in a zoo; it is a, debatably essential, biological solution that does not correspond to the set of conditions originally operating in its natural selection

“Requests” and “offers” in orangutans and human infants

This paper presents two pilot studies of sharing situations in orangutans and human infants. We report on the communicative behaviors that elicit food transfers, the contingencies associated with gesture selection and the (relative) success in obtaining food. We focus on the sequential unfolding of these interactional projects, on the timing between an initial action and the responsive move, and on the semiotic features that allow a participant to recognize (a) when a request has been produced, (b) when it has been unsuccessful and, (c) in the absence of success, when to pursue it further. We claim that the infrastructure for sequentially organized, cooperative social interaction and the capacity to selectively produce communicative actions predates language evolution and is, at least to some degree, shared with other primates

Dying to help: fatal bystander rescues in Australian coastal environments

Bystanders who drown during a rescue attempt in aquatic waterways are becoming an increasingly important issue within drowning prevention. In the Australian context, the majority of these incidents occur in coastal water ways. This study documents and characterizes bystander rescuer fatalities within Australian coastal waterways that occurred between 1 July 2004 and 30 June 2019 in order to provide suggestions for future public safety interventions involving bystander rescuers. Data was sourced through Surf Life Saving Australia's (SLSA) Coastal Fatality Database, which collates information from multiple sources. Sixty-seven bystander rescuer fatalities in coastal waterways were reported during the 15-year period, an average of 4.5 per year, which is a significant proportion of the five fatalities previously reported across all Australian waterways. The majority of coastal bystander rescuer fatality incidents occurred in the state of New South Wales (49%), at beaches (64%), in regional or remote areas (71%), more than 1 km from the nearest lifesaving service (78%), during summer (45%), in the afternoon (72%), in the presence of rip currents (73%), and did not involve the use of flotation devices to assist rescue (97%). The majority of coastal bystander rescuer victims were Australian residents (88%) born in Australia/Oceania (68%), males (81%), aged between 30-44 years old (36%), visitors to the location (55%), either family (69%) or friends (15%) of the rescuee(s), and were attempting to rescue someone younger than 18 years old (64%). Our results suggest future safety intervention approaches should target males, parents and carers visiting beach locations in regional locations during holiday times and should focus on the importance of flotation devices when enacting a rescue and further educating visitors about the rip current hazard. Future research should examine the psychology of bystander rescue situations and evaluate the effectiveness of different safety intervention approaches

Overexpression of EGFR and c-erbB2 causes enhanced cell migration in human breast cancer cells and NIH3T3 fibroblasts

AbstractOverexpression of EGFR and c-erbB2 frequently occurs in human breast cancers, correlating with poor prognosis. Here we show that overexpression of EGFR and c-erbB2 in cell lines increases cell migration, an important step in metastasis formation. The effect of EGFR on migration is dependent on the addition of EGF to the cells. In contrast, c-erbB2 seems to act independently of its ligand in these assays. Overexpression of this receptor is sufficient to induce cell migration. In addition, we investigated the involvement of a number of signal transduction pathways known to be activated by the EGFR. We found that inactivation of MAPKK results in a decreased migration, while inactivation of PI3K increases migration

Inventarisatie Paardenhouderij

ASG heeft voor de beleidslijn van MLV een overzicht gegeven van de aanwezige kennis over de structuur, omvang en organisatiegraad van de paardenhouderij. Naast kengetallen gaat het rapport in op de economische waarde van de paardenhouderij voor de sport, recreatie, handel en slacht in relatie tot de landbouwsectore

Aanbevelingen behorend bij het rapport ' Inventarisatie Paardenhouderij'

Op basis van de in het rapport Inventarisatie Paardenhouderij verzamelde gegevens en ervaringen worden aanbevelingen gedaan. De aanbevelingen zijn opgesplitst in enerzijds meer algemene aanbevelingen voor de nu te volgen strategie en methode en anderzijds meer inhoudelijk toegespitst op bepaalde onderdelen van de paardenhouderi

Kindersekstoeristen: Een literatuurverkenning naar kenmerken, motieven en werkwijzen van (Nederlandse) daders

Child sex tourism is a growing problem and a relatively new challenge for the Dutch national police, which is faced with the task of combatting child sexual abuse by Dutch citizens abroad. Little is known about travelling child sex offenders. In this literature review, information from (international) scientific research, Dutch policy reports, and other documents is analyzed to investigate the characteristics, motives and techniques (modus operandi) of (Dutch) child sex tourists. We conclude that this offender group is not homogeneous, and that different motivations (preferential/situational) and modus operandi (short stay/long stay/online) apply. The diversity of the offender group requires a variety of initiatives which are well-adjusted to the different offender types. The scarcity of research on this topic furthermore illustrates the necessity to gather more intelligence and conduct follow-up research.Criminal Justice: Legitimacy, accountability, and effectivit

Characteristics of aquatic rescues undertaken by bystanders in Australia

An issue of growing importance within the field of drowning prevention is the undertaking of aquatic rescues by bystanders, who sometimes drown in the process. The main objectives of this study were to describe characteristics of bystanders making rescues in different Australian aquatic environments, identify the role of prior water safety training in conducting bystander rescues and provide insights into future public education strategies relating to bystander rescue scenarios. An online survey was disseminated via various social media platforms in 2017 and gathered a total of 243 complete responses. The majority of bystander rescues described took place in coastal waterways (76.5%; n = 186), particularly beaches (n = 67), followed by pools (17.3%; n = 42) and inland waterways (6.2%; n = 15). The majority of respondents were males (64.2%; n = 156) who rescued on average approximately twice as many people in their lifetime (6.5) than female respondents (3.6). Most rescues occurred more than 1 km from lifeguard/lifesaver services (67%; n = 163), but in the presence of others (94.2%; n = 229). The majority of bystander rescuers had water safety training (65.8%; n = 160), self-rated as strong swimmers (68.3%; n = 166), conducted the rescue without help from others (60%; n = 146), did not use a flotation device to assist (63%; n = 153), but were confident in their ability to make the rescue (76.5%; n = 186). However, most considered the situation to be very serious (58%; n = 141) and felt they had saved a life (70.1%; n = 172). With the exception of pools, most bystanders rescued strangers (76.1%; n = 185).While Australia clearly benefits from having a strong water safety culture, there is no clear consensus on the most appropriate actions bystanders should take when confronted with a potential aquatic rescue scenario. In particular, more research is needed to gather information regarding bystander rescues undertaken by those without prior water safety training