The Relationship Between Fall Rates and Fall Risk Inducing Drugs in Older Adult Patients in the Hospital Setting

The aim of this study was to analyze the risk of falls relative to the use of fall risk inducing drugs (FRIDs) among older adult patients admitted to the hospital setting. Quality improvement of nursing fall risk assessment was of special interest. To analyze this a retroactive review of fall incident reports was conducted in collaboration with the study hospital’s risk manager. Medications were correlated with injuries sustained to identify high risk FRIDs. The selected study population consisted of 166 patients over the age of 65 who fell on the acute care campus of a hospital in the mid-south region of the United States. The results demonstrated no correlation between drug classes and injury sustained from a fall. Anti-hypertensive and cardiovascular medications were found to be involved in the highest number of falls. The study was limited however by a small sample size of nurses who adequately reported fall incidents. Further studies are needed to identify relationships between medications and fall risk. Further studies are also needed to evaluate nurse compliance with incident reporting

Who Benefits from KIPP?

The nation's largest charter management organization is the Knowledge is Power Program (KIPP). KIPP schools are emblematic of the No Excuses approach to public education, a highly standardized and widely replicated charter model that features a long school day, an extended school year, selective teacher hiring, strict behavior norms, and a focus on traditional reading and math skills. No Excuses charter schools are sometimes said to focus on relatively motivated high achievers at the expense of students who are most diffiult to teach, including limited English proficiency (LEP) and special education (SPED) students, as well as students with low baseline achievement levels. We use applicant lotteries to evaluate the impact of KIPP Academy Lynn, a KIPP school in Lynn, Massachusetts that typifies the KIPP approach. Our analysis focuses on special needs students that may be underserved. The results show average achievement gains of 0.36 standard deviations in math and 0.12 standard deviations in reading for each year spent at KIPP Lynn, with the largest gains coming from the LEP, SPED, and low-achievement groups. The average reading gains are driven almost completely by SPED and LEP students, whose reading scores rise by roughly 0.35 standard deviations for each year spent at KIPP Lynn.human capital, charter schools, achievement

The Effects of a Longitudinal Patient Experience on the Enhancement of Empathy in First and Second Year Medical Students

This study examines the effects of a longitudinal patient experience on the enhancement of empathy in first and second year students attending Weill Cornell Medical College (WCMC). The Longitudinal Educational Experience Advancing Patient Partnerships (LEAP) is a new required program at WCMC. Entering Medical students are matched with chronically ill patients whom they will follow throughout medical school. One of the objectives of the LEAP program is to create an experience that will create more empathic medical students. Empathy is an attribute that is considered essential for a strong doctor-patient relationship. With the development of the Jefferson Scale of Empathy (JSE), the measurement of empathy has become increasingly accepted and used in numerous studies. In recent years the ability to teach empathy to medical students has become a more important focus of medical education. The LEAP program is an example of this type of educational intervention. Providing an opportunity for longitudinal patient interactions in the pre-clinical experience may help to facilitate the enhancement of empathy. Using a quasi-experimental model, this study uses the JSE as a pre and post test to determine the effects of LEAP participation on empathy

Structural basis of substrate binding to human facilitative sugar transporters

Human GLUT5 has been heterologously expressed in Xenopus oocytes, allowing examination of its substrate selectivity and basic kinetic parameters. The Km for zero-trans entry of D-fructose by GLUT5 is 22.5 mM, but 2-deoxy-D- glucose is not transported by this isoform. Additionally, transport of fructose is not inhibited by the presence of either deoxyglucose or D-glucose. Analysis of the effects of pH on transport indicate that deoxyglucose is not transported across the pH range. Furthermore, the Km for transport of fructose remains constant under varying pH conditions. The inhibitory effects of fused ring fructose analogues on the fructose transport of GLUT5 have also been determined. Fructose transport by GLUT5- expressing oocytes is not inhibited by the fused pyranose ring analogues, 1,5- anhydromannitol and L-sorbose. However, the fused furanose ring analogue, 2,5 anhydromannitol, does inhibit the transport of fructose by GLUT5 in the same system. GLUT2/GLUT3 chimeras had been constructed previously. Expression of these mutants in Xenopus oocytes has allowed determination of their basic kinetic parameters, with a view to examine the structural basis for differential substrate selectivity between isoforms. Km values for the transport of alternative substrates, fructose and galactose, have been determined for these chimeras, and compared with parameters previously measured for deoxyglucose. All parameters were compared with Km values obtained for native GLUT2 and GLUT3 in the same system. Results indicate that helix 7 participates in fructose recognition by GLUT2, and the equivalent helix in GLUT3 is involved in high affinity deoxyglucose and galactose transport by this isoform. A panel of nineteen GLUT3 mutants had been constructed previously, each incorporating substitution of an individual residue of helix 8 with alanine. These have been expressed in the Xenopus oocyte system, allowing analysis of their basic kinetic properties. The Km value for deoxyglucose entry was determined for each mutant and this compared to that of wild-type GLUT3. Only replacement of asparagine-315 with alanine altered this transport parameter with respect to the wild type value, producing a 4-fold elevation of Km. This residue is polar and may be directly involved in the transport of glucose

Extra-terrestrial nuclear power stations : transportation and operation

Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Nuclear Engineering, 2005.Includes bibliographical references (leaves 111-115).Many challenges exist when considering nuclear power to provide electricity for bases on the Moon or Mars, including launch safety, landing safety, deployment, control, and protecting the astronauts from radiation. Examples from the past provide guidance in these areas but surface operations on another body have never been attempted and rarely studied. This thesis discusses the risks and design considerations for launching, transporting, landing, and operating a nuclear fission reactor on the Moon or Mars. A reference mission and reactor were chosen to facilitate analysis in these areas. Launching a reactor involves meeting environmental and federal regulations. This includes an extensive safety analysis of launch to determine if launch accidents pose a serious risk to the public due to fuel release or inadvertent criticality. The reactor must also be able to survive the launch conditions without damage. Transport mainly involves protecting the reactor from damage from meteoroids. The reactor will then land through propulsive means on the Moon or Mars. Landing a reactor will also require a safety analysis to determine the consequences of a landing accident on the Moon or Mars. On the surface, the reactor must be at a location far enough away from the astronauts to limit radiation exposure to the astronauts from the reactor.(cont.) Interaction from ground control and astronauts will be necessary to initiate startup, shutdown, and to change the power level of the reactor; however, startup and operation of the reactor must be autonomous due to the communications time lag between Earth and the Moon or Mars. These are significant challenges but all are feasible given the technology and experience in nuclear engineering and astronautics that exits today.by Susan Christine Kane.S.M

When should acute nonvenereal conjunctivitis be treated with topical antibiotics?

Children with suspected or culture-proven acute nonvenereal bacterial conjunctivitis should be treated with topical antibiotics, which hastens clinical and microbiological remission and may prevent potentially serious morbidity. In light of recent evidence regarding the self-limiting nature of conjunctivitis in adults and the development of antibiotic resistance, a "wait-and-see"� approach with careful follow-up may be reasonable for adults, but this approach has not been evaluated. (Grade of recommendation: C, based on extrapolation from systematic reviews of specialty clinic trials and cohort studies.

Using an Online Learning Module in a Nursing Program to Improve Knowledge and Skills to Prevent Falls in the Community Dwelling Older Adult Population

Nationally, 28.4% of older adults fall each year. Falls and resulting injury result in decreased mobility, functional impairment, loss of independence, and increased mortality. Utilization of evidence based protocols by providers to identify older adults at risk of falling is limited and rates of participation by older adults in prevention activities is low. Because of nursing’s increasing role in caring for older adults, development of fall prevention education for nursing students would result in increased awareness of the need for fall prevention in community dwelling older adults and increased access of older adults to falls risk assessment. There is a need to extend research to inform teaching and learning strategies for fall prevention. After pretesting, a convenience sample of 52 BSN students and 20 graduate nursing students completed an online education program and performed a falls risk assessment on an older adult before completing a posttest and self-efficacy survey. Data were analyzed using multivariate statistical tests. A qualitative approach was used to investigate a subset of student’s views about relationships between acquiring knowledge, self-efficacy, and skill mastery and their perceptions of barriers and facilitators to incorporating falls risk assessment into practice. Data were analyzed using the constant comparative method to review, code, and categorize data. Results revealed a rise in knowledge and student self-reporting of self-efficacy with falls risk assessment skills. Themes that emerged from semi-structured interviews included nurses are too busy to perform fall risk assessments, the older adult is a barrier, the importance of increasing awareness of falls prevention among nurses, opportunities to address health beliefs of older adults, and need for policies or guidelines. In conclusion, an online program enhanced with opportunity for hands on practice provides an effective environment for learning to use falls risk tools and should be incorporated into nursing education in order to increase older adults’ access to fall risk assessment

Darpp-32 and Its Truncated Variant t-Darpp Have Antagonistic Effects on Breast Cancer Cell Growth and Herceptin Resistance

BACKGROUND: Herceptin (trastuzumab) is a humanized monoclonal antibody that is approved for the treatment of metastatic breast cancer patients whose tumors overexpress Her2 (erbB2/neu). Up to 70% of Her2-positive breast cancers demonstrate a response to Herceptin-based therapies, but resistance almost inevitably arises within a year of the initial response. To help understand the mechanism of Herceptin resistance, we isolated clonal variants of Her2-positive BT474 human breast cancer cells (BT/Her(R)) that are highly resistant to Herceptin. These cell lines exhibit sustained PI3K/Akt signaling as an essential component of Herceptin-resistant proliferation. Several genes in the protein kinase A (PKA) signaling network have altered expression in BT/Her(R) cells, including PPP1R1B, which encodes a 32 kDa protein known as Darpp-32 and its amino-terminal truncated variant, t-Darpp. The purpose of the current work was to determine the role of Darpp-32 and t-Darpp in Herceptin resistance. METHODOLOGY AND RESULTS: We determined expression of Darpp-32 and t-Darpp in BT/Her(R) cells selected for resistance to Herceptin. Subsequently, cDNAs encoding the two isoforms of Darpp-32 were transfected, separately and together, into Her2-positive SK-Br-3 breast cancer cells. Transfected cells were tested for resistance to Herceptin and Herceptin-mediated dephosphorylation of Akt. DNA binding activity by the cAMP response element binding protein (CREB) was also measured. We found that BT/Her(R) cells overexpressed t-Darpp but not Darpp-32. Moreover, t-Darpp overexpression in SK-Br-3 cells was sufficient for conferring resistance to Herceptin and Herceptin-mediated dephosphorylation of Akt. Darpp-32 co-expression reversed t-Darpp's effects on Herceptin resistance and Akt phosphorylation. t-Darpp overexpression led to increased CREB binding activity, which was also reversible by Darpp-32. CONCLUSIONS: t-Darpp and Darpp-32 appear to have antagonistic effects on Herceptin resistance. We present a unified model by which these effects might be mediated via the PKA regulatory network

Sustaining safe practice: Twenty years on

Abstract This paper examines the ways in which populations at risk of HIV in the developed world have enculturated the knowledges and technologies of both the medical and the social sciences. By revisiting a number of review papers and by reviewing findings from a range of studies, we argue that gay men have appropriated information that has enabled them to sustain safe practices while they have eschewed information that has made maintenance difficult. The paper describes a range of risk reduction strategies and compares the responses of populations at risk of HIV in the years before the advent of highly active antiviral therapy (HAART) with their responses after the introduction of HAART in 1996. We concentrate our argument on the changing responses to HIV risk of gay men, although occasionally illustrate our argument with reference to the responses of injecting drug users. The responses of gay men to risk post-HAART-particularly those who reside in Australia-speak to the adoption of a range of considered strategies, not altogether safe, to reduce harm. We argue that such strategies need to be understood and addressed within a 'new' social public health, that is, a public health that takes what social analysis has to say seriously. The paper examines the differences between the traditional, the 'modern' epidemiological/clinical and the 'new' social or socio-cultural public healths and describes the tensions between the medical and the social science disciplines in their efforts to inform public health. Key concepts provided by social science such as agency (including individual and collective agency), alongside its methodological reflexivity are key to effective public health. The risk avoidance strategies adopted by gay men suggest a way forward by turning our attention to the ways in which medicine is taken in(to) their practice

Who Benefits from KIPP?

The nation's largest charter management organization is the Knowledge is Power Program (KIPP). KIPP schools are emblematic of the No Excuses approach to public education, a highly standardized and widely replicated charter model that features a long school day, an extended school year, selective teacher hiring, strict behavior norms, and emphasizes traditional reading and math skills. No Excuses charter schools are sometimes said to target relatively motivated high achievers at the expense of students who are more difficult to teach, including limited English proficiency (LEP) and special education (SPED) students, as well as students with low baseline achievement levels. We use applicant lotteries to evaluate the impact of KIPP Academy Lynn, a KIPP school in Lynn, Massachusetts that typifies the KIPP approach. Our analysis focuses on special needs students that may be underserved. The results show average achievement gains of 0.36 standard deviations in math and 0.12 standard deviations in reading for each year spent at KIPP Lynn, with the largest gains coming from the LEP, SPED, and low-achievement groups. Average reading gains are driven almost entirely by SPED and LEP students, whose reading scores rise by roughly 0.35 standard deviations for each year spent at KIPP Lynn