Emergency department visits and hospitalizations by tube-fed nursing home residents with varying degrees of cognitive impairment: a national study

BACKGROUND: Numerous studies indicate that the use of feeding tubes (FT) in persons with advanced cognitive impairment (CI) does not improve clinical outcomes or survival, and results in higher rates of hospitalization and emergency department (ED) visits. It is not clear, however, whether such risk varies by resident level of CI and whether these ED visits and hospitalizations are potentially preventable. The objective of this study was to determine the rates of ED visits, hospitalizations and potentially preventable ambulatory care sensitive (ACS) ED visits and ACS hospitalizations for long-stay NH residents with FTs at differing levels of CI. METHODS: We linked Centers for Medicare and Medicaid Services inpatient & outpatient administrative claims and beneficiary eligibility data with Minimum Data Set (MDS) resident assessment data for nursing home residents with feeding tubes in a 5% random sample of Medicare beneficiaries residing in US nursing facilities in 2006 (n = 3479). Severity of CI was measured using the Cognitive Performance Scale (CPS) and categorized into 4 groups: None/Mild (CPS = 0-1, MMSE = 22-25), Moderate (CPS = 2-3, MMSE = 15-19), Severe (CPS = 4-5, MMSE = 5-7) and Very Severe (CPS = 6, MMSE = 0-4). ED visits, hospitalizations, ACS ED visits and ACS hospitalizations were ascertained from inpatient and outpatient administrative claims. We estimated the risk ratio of each outcome by CI level using over-dispersed Poisson models accounting for potential confounding factors. RESULTS: Twenty-nine percent of our cohort was considered “comatose” and “without any discernible consciousness”, suggesting that over 20,000 NH residents in the US with feeding tubes are non-interactive. Approximately 25% of NH residents with FTs required an ED visit or hospitalization, with 44% of hospitalizations and 24% of ED visits being potentially preventable or for an ACS condition. Severity of CI had a significant effect on rates of ACS ED visits, but little effect on ACS hospitalizations. CONCLUSIONS: ED visits and hospitalizations are common in cognitively impaired tube-fed nursing home residents and a substantial proportion of ED visits and hospitalizations are potentially preventable due to ACS conditions

Response of macroarthropod assemblages to the loss of hemlock (Tsuga canadensis), a foundation species

In eastern North American forests, eastern hemlock (Tsuga canadensis) is a foundation species. As hemlock is lost from forests due to the invasive hemlock woolly adelgid (Adelges tsugae) and preemptive salvage logging, the structure of assemblages of species associated with hemlock is expected to change. We manipulated hemlock canopy structure at hectare scales to investigate the effects of hemlock death on assemblages of ants, beetles, and spiders in a New England forest. Relative to reference hemlock stands, both in situ death of hemlock and logging and removal of hemlock altered composition and diversity of beetles and spiders, and logging increased the species richness and evenness of ant assemblages. Species composition of ant assemblages in disturbed habitats was non-random relative to the regional species pool, but we found no evidence that interspecific competition shaped the structure of ant, beetle, or spider assemblages, in either manipulated or intact forest stands. Environmental filtering by hemlock appears to maintain low levels of species richness and evenness in forest stands, suggesting that the loss of hemlock due to the hemlock woolly adelgid or human activities will not likely lead to extirpations of ant, beetle, or spider species at local scales

Response of macroarthropod assemblages to the loss of hemlock (Tsuga canadensis), a foundation species

In eastern North American forests, eastern hemlock (Tsuga canadensis) is a foundation species. As hemlock is lost from forests due to the invasive hemlock woolly adelgid (Adelges tsugae) and preemptive salvage logging, the structure of assemblages of species associated with hemlock is expected to change. We manipulated hemlock canopy structure at hectare scales to investigate the effects of hemlock death on assemblages of ants, beetles, and spiders in a New England forest. Relative to reference hemlock stands, both in situ death of hemlock and logging and removal of hemlock altered composition and diversity of beetles and spiders, and logging increased the species richness and evenness of ant assemblages. Species composition of ant assemblages in disturbed habitats was non-random relative to the regional species pool, but we found no evidence that interspecific competition shaped the structure of ant, beetle, or spider assemblages, in either manipulated or intact forest stands. Environmental filtering by hemlock appears to maintain low levels of species richness and evenness in forest stands, suggesting that the loss of hemlock due to the hemlock woolly adelgid or human activities will not likely lead to extirpations of ant, beetle, or spider species at local scales

Response of Macroarthropod Assemblages to the Loss of Hemlock (Tsuga canadensis), a Foundation Species

In eastern North American forests, eastern hemlock (Tsuga canadensis) is a foundation species. As hemlock is lost from forests due to the invasive hemlock woolly adelgid (Adelges tsugae) and pre-emptive salvage logging, the structure of assemblages of species associated with hemlock is expected to change. We manipulated hemlock canopy structure at hectare scales to investigate the effects of hemlock death on assemblages of ants, beetles, and spiders in a New England forest. Relative to reference hemlock stands, both in situ death of hemlock and logging and removal of hemlock altered composition and diversity of beetles and spiders, and logging increased the species richness and evenness of ant assemblages. Species composition of ant assemblages in disturbed habitats was non-random relative to the regional species pool, but we found no evidence that interspecific competition shaped the structure of ant, beetle, or spider assemblages, in either manipulated or intact forest stands. Environmental filtering by hemlock appears to maintain low levels of species richness and evenness in forest stands, suggesting that the loss of hemlock due to the hemlock woolly adelgid or human activities will not likely lead to extirpations of ant, beetle, or spider species at local scales.Organismic and Evolutionary BiologyOther Research Uni

The Efficacy of Simulation as a Pedagogy in Facilitating Pre-Service Teachers’ Learning About Emotional Self-Regulation and its Relevance to the Teaching Profession

This study was undertaken in response to the imperative of teacher education courses incorporating National Professional Standards for Teachers, in particular Standard 7, which deals with the professional engagement of teachers (AITSL, 2011). It aimed to evaluate the efficacy of simulation and active recall as a learner-centred pedagogy in facilitating pre-service teachers’ learning about their capacity to self-regulate emotionally and its relevance to the profession. A simulated ‘critical incident’ was used in a lecture to guide students (n=106) to analyse and understand their emotional responses to an altercation between the lecturer and a colleague. The evaluation involved both quantitative and qualitative data collection. The study generated six useful insights associated with the efficacy of simulation pedagogy and revealed convincingly that this pedagogy can engage students actively in learning about the importance of emotional self-regulation in relation to their professional role as a teacher

Individual differences and their measurement: A review of 100 years of research

This article reviews 100 years of research on individual differences and their measurement, with a focus on research published in the Journal of Applied Psychology. We focus on 3 major individual differences domains: (a) knowledge, skill, and ability, including both the cognitive and physical domains; (b) personality, including integrity, emotional intelligence, stable motivational attributes (e.g., achievement motivation, core self-evaluations), and creativity; and (c) vocational interests. For each domain, we describe the evolution of the domain across the years and highlight major theoretical, empirical, and methodological developments, including relationships between individual differences and variables such as job performance, job satisfaction, and career development. We conclude by discussing future directions for individual differences research. Trends in the literature include a growing focus on substantive issues rather than on the measurement of individual differences, a differentiation between constructs and measurement methods, and the use of innovative ways of assessing individual differences, such as simulations, other-reports, and implicit measures

Directly observed antiretroviral therapy: a systematic review and meta-analysis of randomised clinical trials.

BACKGROUND: Directly observed therapy has been recommended to improve adherence for patients with HIV infection who are on highly active antiretroviral therapy, but the benefit and cost-effectiveness of this approach has not been established conclusively. We did a systematic review and meta-analysis of randomised trials of directly observed versus self-administered antiretroviral treatment. METHODS: We did duplicate searches of databases (from inception to July 27, 2009), searchable websites of major HIV conferences (up to July, 2009), and lay publications and websites (March-July, 2009) to identify randomised trials assessing directly observed therapy to promote adherence to antiretroviral therapy in adults. Our primary outcome was virological suppression at study completion. We calculated relative risks (95% CIs), and pooled estimates using a random-effects method. FINDINGS: 12 studies met our inclusion criteria; four of these were done in groups that were judged to be at high risk of poor adherence (drug users and homeless people). Ten studies reported on the primary outcome (n=1862 participants); we calculated a pooled relative risk of 1.04 (95% CI 0.91-1.20, p=0.55), and noted moderate heterogeneity between the studies (I(2)= 53.8%, 95% CI 0-75.7, p=0.0247) for directly observed versus self-administered treatment. INTERPRETATION: Directly observed antiretroviral therapy seems to offer no benefit over self-administered treatment, which calls into question the use of such an approach to support adherence in the general patient population. FUNDING: None

Measuring Controlled-NOT and two-qubit gate operation

Accurate characterisation of two-qubit gates will be critical for any realisation of quantum computation. We discuss a range of measurements aimed at characterising a two-qubit gate, specifically the CNOT gate. These measurements are architecture-independent, and range from simple truth table measurements, to single figure measures such as the fringe visibility, parity, fidelity, and entanglement witnesses, through to whole-state and whole-gate measures achieved respectively via quantum state and process tomography. In doing so, we examine critical differences between classical and quantum gate operation.Comment: 10 pages (two-column). 1 figur

Exploring the limits of ultracold atoms in space

Existing space-based cold atom experiments have demonstrated the utility of microgravity for improvements in observation times and for minimizing the expansion energy and rate of a freely evolving coherent matter wave. In this paper we explore the potential for space-based experiments to extend the limits of ultracold atoms utilizing not just microgravity, but also other aspects of the space environment such as exceptionally good vacuums and extremely cold temperatures. The tantalizing possibility that such experiments may one day be able to probe physics of quantum objects with masses approaching the Planck mass is discussed

Administration of thimerosal-containing vaccines to infant rhesus macaques does not result in autism-like behavior or neuropathology

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder. Some anecdotal reports suggest that ASD is related to exposure to ethyl mercury, in the form of the vaccine preservative, thimerosal, and/or receiving the measles, mumps, rubella (MMR) vaccine. Using infant rhesus macaques receiving thimerosal-containing vaccines (TCVs) following the recommended pediatric vaccine schedules from the 1990s and 2008, we examined behavior, and neuropathology in three brain regions found to exhibit neuropathology in postmortem ASD brains. No neuronal cellular or protein changes in the cerebellum, hippocampus, or amygdala were observed in animals following the 1990s or 2008 vaccine schedules. Analysis of social behavior in juvenile animals indicated that there were no significant differences in negative behaviors between animals in the control and experimental groups. These data indicate that administration of TCVs and/or the MMR vaccine to rhesus macaques does not result in neuropathological abnormalities, or aberrant behaviors, like those observed in ASD