GI Bleeding in the Elderly

Purpose: To determine the risk factors contributing to and etiologies of gastrointestinal bleeding in an elderly patient population seen by Southwest Gastroenterology (SWGA) providers. Methods: This study reviews charts of patients with GI bleeding from documented sources between 1/1999 and 3/2006. The cases are gathered retrospectively from the clinical records of SWGA, a 12-person private, single specialty gastroenterology group serving community hospitals. Etiology and risk factors for GI hemorrhages are recorded in an elderly population, defined as patients age 55 and older. Results: GI hemorrhages are identified in 105 patients. The majority (83, 79%) of hemorrhages are upper GI bleeds (UGIB) comparing to 22 (21%) lower GI bleeds (LGIB). In the UGIB group, the most common etiology of bleed is gastric ulcer (29%). We also found 72% of UGIB patients on prescribed anticoagulation medications, including anti-platelet agents or non-steroidal anti-inflammatory drugs (NSAIDs). 20% of these patients are also positive for H. Pylori. Thirty patients in the UGIB group smoke or consume alcohol heavily (consuming more than 3 drinks per day for men and two drinks per day for women) while 2 patients smoke or consume alcohol in the LGIB group. Previous bleeds are common in both groups with 39 (41%) in UGIB and 9 (47%) in LGIB. Co-morbidity is the most common risk factor with 20 (91%) in LGIB and 73 (88%) in UGIB. In the peptic ulcer disease (PUD) bleeds, the majority (77%) are taking NSAIDs, while in the non-PUD bleeds, only 38% are currently on NSAIDs. Overall, there are 2 mortalities resulting from cardiovascular complications of GI bleeding. Conclusion: The etiologies of GI bleeds in this population are comparable to other studies in the literature. The ratio of UGIB to LGIB in this elderly population is also similar to that reported in the literature. The risk factors shown to be most correlated to bleeding are co-morbidities, previous episodes of bleeding, anticoagulation, NSAID use, smoking and alcohol use. NSAID use is significant in PUD bleed patients. This study reinforces that increased knowledge of etiology, incidence and contributing factors of GI bleeding are necessary for physicians to efficiently treat GI bleeds in the elderly population

Crystal Structure of the Sodium Cobaltate Deuterate Superconductor NaxCoO2o4xD2O (x=1/3)

Neutron and x-ray powder diffraction have been used to investigate the crystal structures of a sample of the newly-discovered superconducting sodium cobaltate deuterate compound with composition Na0.31(3)CoO2o1.25(2)D2O and its anhydrous parent compound Na0.61(1)CoO2. The deuterate superconducting compound is formed by coordinating four D2O molecules (two above and two below) to each Na ion in a way that gives Na-O distances nearly equal to those in the parent compound. One deuteron of the D2O molecule is hydrogen bonded to an oxygen atom in the CoO2 plane and the oxygen atom and the second deuteron of each D2O molecule lie approximately in a plane between the Na layer and the CoO2 layers. This coordination of Na by four D2O molecules leads to ordering of the Na ions and D2O molecules. The sample studied here, which has Tc=4.5 K, has a refined composition of Na0.31(3)CoO2o1.25(2)D2O, in agreement with the expected 1:4 ratio of Na to D2O. These results show that the optimal superconducting composition should be viewed as a specific hydrated compound, not a solid solution of Na and D2O (H2O) in NaxCoO2oyD2O. Studies of physical properties vs. Na or D2O composition should be viewed with caution until it is verified that the compound remains in the same phase over the composition range of the study.Comment: 22 pages, 8 figure

Estimating the cost-effectiveness of detecting cases of chronic hepatitis C infection on reception into prison

Background In England and Wales where less than 1% of the population are Injecting drug users (IDUs), 97% of HCV reports are attributed to injecting drug use. As over 60% of the IDU population will have been imprisoned by the age of 30 years, prison may provide a good location in which to offer HCV screening and treatment. The aim of this work is to examine the cost effectiveness of a number of alternative HCV case-finding strategies on prison reception Methods A decision analysis model embedded in a model of the flow of IDUs through prison was used to estimate the cost effectiveness of a number of alternative case-finding strategies. The model estimates the average cost of identifying a new case of HCV from the perspective of the health care provider and how these estimates may evolve over time. Results The results suggest that administering verbal screening for a past positive HCV test and for ever having engaged in illicit drug use prior to the administering of ELISA and PCR tests can have a significant impact on the cost effectiveness of HCV case-finding strategies on prison reception; the discounted cost in 2017 being £2,102 per new HCV case detected compared to £3,107 when no verbal screening is employed. Conclusion The work here demonstrates the importance of targeting those individuals that have ever engaged in illicit drug use for HCV testing in prisons, these individuals can then be targeted for future intervention measures such as treatment or monitored to prevent future transmission

Opening the terahertz window on the OSIRIS spectrometer

4 pags., 6 figs. -- QENS/WINS 2014 - 11th International Conference on Quasielastic Neutron Scattering and 6th International Workshop on Inelastic Neutron SpectrometersA cooled and mechanically retractable beryllium filter has been installed and commissioned on the low-energy OSIRIS spectrometer at ISIS. This instrument development extends the energy-transfer range of the spectrometer up to ca. 20 meV (∼ 5 THz), leading to an excellent resolution at THz frequencies and substantial gains in detected flux relative to existing capabilities on the neighbouring IRIS spectrometer. Herein, we provide a concise account of this new capability for high-resolution neutron spectroscopy in the THz domain, as well as outline a number of ongoing and potential scientific opportunities in condensed-matter physics, chemistry, and materials science.The authors gratefully acknowledge the UK Science & Technology Facilities Council for financial support and access to beam time at ISIS

Preparation, structural characterisation and antibacterial properties of Ga-doped sol-gel phosphate-based glass

A sol-gel preparation of Ga-doped phosphate-based glass with potential application in antimicrobial devices has been developed. Samples of composition (CaO)(0.30)(Na2O)(0.20-x) (Ga2O3) (x) (P2O5)(0.50) where x = 0 and 0.03 were prepared, and the structure and properties of the gallium-doped sample compared with those of the sample containing no gallium. Analysis of the P-31 MAS NMR data demonstrated that addition of gallium to the sol-gel reaction increases the connectivity of the phosphate network at the expense of hydroxyl groups. This premise is supported by the results of the elemental analysis, which showed that the gallium-free sample contains significantly more hydrogen and by FTIR spectroscopy, which revealed a higher concentration of -OH groups in that sample. Ga K-edge extended X-ray absorption fine structure and X-ray absorption near-edge structure data revealed that the gallium ions are coordinated by six oxygen atoms. In agreement with the X-ray absorption data, the high-energy XRD results also suggest that the Ga3+ ions are octahedrally coordinated with respect to oxygen. Antimicrobial studies demonstrated that the sample containing Ga3+ ions had significant activity against Staphylococcus aureus compared to the control

An analysis of the quality of experimental design and reliability of results in tribology research

In recent years several high profile projects have questioned the repeatability and validity of scientific research in the fields of psychology and medicine. In general, these studies have shown or estimated that less than 50% of published research findings are true or replicable even when no breaches of ethics are made. This high percentage stems from widespread poor study design; either through the use of underpowered studies or designs that allow the introduction of bias into the results. In this work, we have aimed to assess, for the first time, the prevalence of good study design in the field of tribology. A set of simple criteria for factors such as randomisation, blinding, use of control and repeated tests has been made. These criteria have been used in a mass review of the output of five highly regarded tribology journals for the year 2017. In total 379 papers were reviewed by 26 reviewers, 28% of the total output of the journals selected for 2017. Our results show that the prevalence of these simple aspects of study design is poor. Out of 290 experimental studies, 2.2% used any form of blinding, 3.2% used randomisation of either the tests or the test samples, while none randomised both. 30% repeated experiments 3 or more times and 86% of those who repeated tests used single batches of test materials. 4.4% completed statistical tests on their data. Due to the low prevalence of repeated tests and statistical analysis it is impossible to give a realistic indication of the percentage of the published works that are likely to be false positives, however these results compare poorly to other more well studied fields. Finally, recommendations for improved study design for researchers and group design for research group leaders are given

Новые языковые реальности употребления претерита в немецком гипотаксисе

Целью статьи являются обобщение и теоретическое обоснование нового употребления претерита в относительном значении в конкретных видах придаточных предложений с презенсом в главном предложении. В статье анализируются коннотативные нюансы относительного значения претерита, регулярность замены префекта-пассива и перфекта именного составного сказуемого с глаголом "sein" на претеритальные формы в гипотаксисе, а также особое место претерита в системе немецких временных форм.Метою статті є узагальнення та теоретичне обґрунтування нового вживання претериту у релятивному значенні у конкретних видах сурядно-підрядних речень з презентом у сурядному реченні. У статті подано аналіз конототивні нюанси претериту і регулярність зміни перфекту пасиву та іменного присудка з дієсловом "sein" на претеритальні форми у гіпотаксису, а також особливе місце претериту у системі німецьких часових форм.The article aims at generalization and theoretical Explanation of modern preterit usage in relative meaning in certain types of clauses, with the Present tense in the main clause. The article deals with the analysis of connotative component meanings of the relative preterit and the regularity of substitution of preterit forms in hypotaxes for the passive perfect tense and the perfect form of the nominal compound predicate with the verb 'sein' as well as the specificity of preterit in the system of German tenses

Communicating product user reviews and ratings in interfaces for e-commerce: a multimodal approach

This paper describes a comparative empirical evaluation study that uses multimodal presentations to communicate review messages in an e-commerce platform. Previous studies demonstrate the effective use of multimodality in different problem domains (e.g. e-learning). In this paper, multimodality and expressive avatars are used to communicate information related to product reviews messages. The data of the reviews was opportunistically collected from Facebook and Twitter. Two independent groups of users were used to evaluate two different presentations of reviews and ratings using as a basis an experimental e- commerce platform. The control group used a text-based with emojis presentation and the experimental group used a multimodal approach based on expressive avatars. Three parameters of usability were measured. These were efficiency, effectiveness, user satisfaction, and user preference. The result showed that the two approaches performed similarly. These findings provide a basis for further experiments in which text, emojis and expressive avatars can be combine to communicate a larger volume of reviews and ratings

Animated molecular dynamics simulations of hydrated caesium-smectite interlayers

Computer animation of center of mass coordinates obtained from 800 ps molecular dynamics simulations of Cs-smectite hydrates (1/3 and 2/3 water monolayers) provided information concerning the structure and dynamics of the interlayer region that could not be obtained through traditional simulation analysis methods. Cs(+ )formed inner sphere complexes with the mineral surface, and could be seen to jump from one attracting location near a layer charge site to the next, while water molecules were observed to migrate from the hydration shell of one ion to that of another. Neighboring ions maintained a partial hydration shell by sharing water molecules, such that a single water molecule hydrated two ions simultaneously for hundreds of picoseconds. Cs-montmorillonite hydrates featured the largest extent of this sharing interaction, because interlayer ions were able to inhabit positions near surface cavities as well as at their edges, close to oxygen triads. The greater positional freedom of Cs(+ )within the montmorillonite interlayer, a result of structural hydroxyl orientation and low tetrahedral charge, promoted the optimization of distances between cations and water molecules required for water sharing. Preference of Cs(+ )for locations near oxygen triads was observed within interlayer beidellite and hectorite. Water molecules also could be seen to interact directly with the mineral surface, entering its surface cavities to approach attracting charge sites and structural hydroxyls. With increasing water content, water molecules exhibited increased frequency and duration of both cavity habitation and water sharing interactions. Competition between Cs(+ )and water molecules for surface sites was evident. These important cooperative and competitive features of interlayer molecular behavior were uniquely revealed by animation of an otherwise highly complex simulation output