Posttraumatic Stress Symptomatology in Aging Combat Veterans: The Direct and Buffering Effects of Stress and Social Support

AbstractThe literature has reported that some older veterans are still distressed by memories of traumatic experiences decades after wartime military service. Recent research has suggested that posttraumatic stress symptoms may appear or reappear during late life in survivors of past trauma and that stress associated with age-related changes may intensify this phenomenon. This dissertation research examined the relationship between past combat exposure and posttraumatic stress symptomatology in community-dwelling veterans of World War II and the Korean War. The risk factor of perceived stress and the protective factor of perceived social support were examined for their potential to exacerbate or mitigate this relationship. The study also investigated the effect of past combat exposure and the role of the moderating variables on health-related quality of life. A secondary aim of the research was to assess the direct effect of perceived stress and perceived social support on the outcome variables.The results indicated that past combat exposure was positively associated with experiencing posttraumatic stress symptoms in World War II and Korean War veterans. Perceived stress was found to significantly exacerbate this relationship. Direct effect relationships were found between perceived stress and both posttraumatic stress symptomatology and health-related quality of life. The mean number of posttraumatic stress symptoms experienced by participants at the symptomatic level was five. The most frequent symptom experienced was sleep disturbance, the second was becoming upset at reminders of the traumatic experience. Increased levels of posttraumatic stress symptoms were found in veterans who were not married, living in an urban area, and diagnosed with depression

THEMES OF POWE:R AND TRUST IN EDI RELATIONSHIPS

The findings reported in this research focus on the role of power and trust in adopting and using Electronic Data Interchange (EDI). EDI refers to the use of computer networks to exchange standardized business transactions (e. g., purchase orders) between customers and suppliers. As of December, 1992, there were 161 transaiction sets approved for publication by the American National Standards Institute X. 12 Committee, which is responsible for developing EDI standards in the U.S. The effective use of EDI requires expenditures in the computing and networking infrastructures of participating firms, as well as investments in managerial resources required to facilitate the redesign of information processing procedures and roles. Moreover, current and potential coordination benefits associated with EDI may be related to access methods and data exchange regarded as sensitive. For these reasons, some firms may resist using EDI. Resistance by some market partners has negative economic implications for firms that use EDI: until all partners are EDI partners, redundant information processing systems must be supported. Our investigation sought to provide evidence of the role of power in influencing partners to adopt EDI and the role of trust in information exchange. Data were collected from both telephone interviews and written questionnaires among suppliers of a major chemical company and a large office supply firm. Measures of dependence, power, and level of trust were adopted from items in a previous study (Saunders and Clark 1991). Preliminary analysis shows that among firms adopting EDI, dependence is highly correlated with exercised power (r=.60, p \u3c .01), which is consistent with the findings reported by Prekumar, Ramamurthy, and Nilakanta (1992). More interestingly, perceptions of a continuing relationship are positively related to trust (r=.63, p \u3c .05), and trust is positively related to information sharing (r=.60, p \u3c .05). These findings provide preliminary support for the recommendation that effective EDI implementation, which requires the opportunity for greater information sharing, must be based on trust. The corollary is that when trust is not developed, effective use of EDI, and thus the opportunity for greater coordination benefits, are less likely. More long term relationships with specific market partners are more likely to provide the context for greater information sharing. These preliminary findings suggest that EDI used by customer and supplier firms may more likely support electronic hierarchies (i.e., inter-organizational relationships with specific markets partners), rather than electronic markets (i.e., relationships based on short term opportunities)

Influence of pregnancy on gene expression in rabbit articular cartilage

AbstractObjective: Articular cartilage is known to be influenced by estrogen and the pregnancy-associated hormone, relaxin,in vitro. Such observations have raised the possibility that articular cartilage in females may be subjected to unique regulatory influences by such hormonesin vivo. The purpose of this study was to evaluate mRNA levels for several relevant molecules in the articular cartilage of pregnant and non-pregnant rabbits.Design: Total RNA was extracted from New Zealand White rabbit knee articular cartilage using the TRIspin method. The total RNA was reverse transcribed and analysed by the sensitive molecular technique of semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR) using rabbit specific primer sets.Results: Total RNA yield from articular cartilage from primigravida rabbits was reduced to 65% of age-matched control values (P=0.0003); however the yield from multiparous animals was not significantly depressed. In both cases, DNA yields were not affected by pregnancy. There was a general tendency for depressed mRNA levels for most genes investigated in cartilage from pregnant animals. Articular cartilage from multiparous rabbits showed a significant decrease in mRNA levels for relevant molecules such as type II collagen, biglycan, collagenase and tissue inhibitors of metalloproteinases (TIMP)-1, as well as necrosis factor-α (TNF-α), inducible nitric oxide synthase (iNOS) and cyclo-oxygenase 2 (COX-2). Transcripts for collagenase and lumican were significantly lower in cartilage from primigravida rabbits. Transforming growth factor β1 (TGF-β1) transcript levels were significantly decreased in both pregnant groups. In contrast, basic fibroblast growth factor (bFGF) and insulin-like growth factor-2 (IGF-2) mRNA levels were significantly decreased in cartilage from primigravida rabbits, whereas transcripts for these molecules were upregulated in the cartilage of multiparous rabbits.Conclusions: The present study demonstrates that regulation of RNA levels in articular cartilage during pregnancy is complex and is influenced by the parity and/or the skeletal maturity of the animals

Introduction of Medical Emergency Teams in Australia and New Zealand: a multi-centre study

INTRODUCTION: Information about Medical Emergency Teams (METs) in Australia and New Zealand (ANZ) is limited to local studies and a cluster randomised controlled trial (the Medical Emergency Response and Intervention Trial [MERIT]). Thus, we sought to describe the timing of the introduction of METs into ANZ hospitals relative to relevant publications and to assess changes in the incidence and rate of intensive care unit (ICU) admissions due to a ward cardiac arrest (CA) and ICU readmissions. METHODS: We used the Australian and New Zealand Intensive Care Society database to obtain the study data. We related MET introduction to publications about adverse events and MET services. We compared the incidence and rate of readmissions and admitted CAs from wards before and after the introduction of an MET. Finally, we identified hospitals without an MET system which had contributed to the database for at least two years from 2002 to 2005 and measured the incidence of adverse events from the first year of contribution to the second. RESULTS: The MET status was known for 131 of the 172 (76.2%) hospitals that did not participate in the MERIT study. Among these hospitals, 110 (64.1%) had introduced an MET service by 2005. In the 79 hospitals in which the MET commencement date was known, 75% had introduced an MET by May 2002. Of the 110 hospitals in which an MET service was introduced, 24 (21.8%) contributed continuous data in the year before and after the known commencement date. In these hospitals, the mean incidence of CAs admitted to the ICU from the wards changed from 6.33 per year before to 5.04 per year in the year after the MET service began (difference of 1.29 per year, 95% confidence interval [CI] -0.09 to 2.67; P = 0.0244). The incidence of ICU readmissions and the mortality for both ICU-admitted CAs from wards and ICU readmissions did not change. Data were available to calculate the change in ICU admissions due to ward CAs for 16 of 62 (25.8%) hospitals without an MET system. In these hospitals, admissions to the ICU after a ward CA decreased from 5.0 per year in the first year of data contribution to 4.2 per year in the following year (difference of 0.8 per year, 95% CI -0.81 to 3.49; P = 0.3). CONCLUSION: Approximately 60% of hospitals in ANZ with an ICU report having an MET service. Most introduced the MET service early and in association with literature related to adverse events. Although available in only a quarter of hospitals, temporal trends suggest an overall decrease in the incidence of ward CAs admitted to the ICU in MET as well as non-MET hospitals

Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis

INTRODUCTION: Older age is associated with higher prevalence of chronic illness and functional impairment, contributing to an increased rate of hospitalization and admission to intensive care. The primary objective was to evaluate the rate, characteristics and outcomes of very old (age >or= 80 years) patients admitted to intensive care units (ICUs). METHODS: Retrospective analysis of prospectively collected data from the Australian New Zealand Intensive Care Society Adult Patient Database. Data were obtained for 120,123 adult admissions for >or= 24 hours across 57 ICUs from 1 January 2000 to 31 December 2005. RESULTS: A total of 15,640 very old patients (13.0%) were admitted during the study. These patients were more likely to be from a chronic care facility, had greater co-morbid illness, greater illness severity, and were less likely to receive mechanical ventilation. Crude ICU and hospital mortalities were higher (ICU: 12% vs. 8.2%, P /= 80 years was associated with higher ICU and hospital death compared with younger age strata (ICU: odds ratio (OR) = 2.7, 95% confidence interval (CI) = 2.4 to 3.0; hospital: OR = 5.4, 95% CI = 4.9 to 5.9). Factors associated with lower survival included admission from a chronic care facility, co-morbid illness, nonsurgical admission, greater illness severity, mechanical ventilation, and longer stay in the ICU. Those aged >or= 80 years were more likely to be discharged to rehabilitation/long-term care (12.3% vs. 4.9%, OR = 2.7, 95% CI = 2.6 to 2.9). The admission rates of very old patients increased by 5.6% per year. This potentially translates to a 72.4% increase in demand for ICU bed-days by 2015. CONCLUSIONS: The proportion of patients aged >or= 80 years admitted to intensive care in Australia and New Zealand is rapidly increasing. Although these patients have more co-morbid illness, are less likely to be discharged home, and have a greater mortality than younger patients, approximately 80% survive to hospital discharge. These data also imply a potential major increase in demand for ICU bed-days for very old patients within a decade

Landmark survival as an end-point for trials in critically ill patients – comparison of alternative durations of follow-up: an exploratory analysis

Introduction Interventional ICU trials have followed up patients for variable duration. However, the optimal duration of follow-up for the determination of mortality endpoint in such trials is uncertain. We aimed to determine the most logical and practical mortality end-point in clinical trials of critically ill patients. Methods We performed a retrospective analysis of prospectively collected data involving 369 patients with one of the three specific diagnoses (i) Sepsis (ii) Community acquired pneumonia (iii) Non operative trauma admitted to the Royal Perth Hospital ICU, a large teaching hospital in Western Australia (WA cohort). Their in-hospital and post discharge survival outcome was assessed by linkage to the WA Death Registry. A validation cohort involving 4609 patients admitted during same time period with identical diagnoses from 55 ICUs across Australia (CORE cohort) was used to compare the patient characteristics and in-hospital survival to look at the Australia-wide applicability of the long term survival data from the WA cohort. Results The long term outcome data of the WA cohort indicate that mortality reached a plateau at 90 days after ICU admission particularly for sepsis and pneumonia. Mortality after hospital discharge before 90 days was not uncommon in these two groups. Severity of acute illness as measured by the total number of organ failures or acute physiology score was the main predictor of 90-day mortality. The adjusted in-hospital survival for the WA cohort was not significantly different from that of the CORE cohort in all three diagnostic groups; sepsis (P = 0.19), community acquired pneumonia (P = 0.86), non-operative trauma (P = 0.47). Conclusions A minimum of 90 days follow-up is necessary to fully capture the mortality effect of sepsis and community acquired pneumonia. A shorter period of follow-up time may be sufficient for non-operative trauma

The Power of Feminist Judgments?

Recent years have seen the advent of two feminist judgment-writing projects, the Women’s Court of Canada, and the Feminist Judgments Project in England. This article analyses these projects in light of Carol Smart’s feminist critique of law and legal reform and her proposed feminist strategies in Feminism and the Power of Law (1989). At the same time, it reflects on Smart’s arguments 20 years after their first publication and considers the extent to which feminist judgment-writing projects may reinforce or trouble her conclusions. It argues that both of these results are discernible—that while some of Smart’s contentions have proved to be unsustainable, others remain salient and have both inspired and hold important cautions for feminist judgment-writing projects

The impact of early hypoglycemia and blood glucose variability on outcome in critical illness

INTRODUCTION: In critical illness, the association of hypoglycemia, blood glucose (BG) variability and outcome are not well understood. We describe the incidence, clinical factors and outcomes associated with an early hypoglycemia and BG variability in critically ill patients. METHODS: Retrospective interrogation of prospectively collected data from the Australia New Zealand Intensive Care Society Adult Patient Database on 66184 adult admissions to 24 intensive care units (ICUs) from 1 January 2000 to 31 December 2005. Primary exposure was hypoglycemia (BG or= 12.0 mmol/L) within 24 hours of admission. Primary outcome was all-cause mortality. RESULTS: The cumulative incidence of hypoglycemia and BG variability were 13.8% (95% confidence interval (CI) = 13.5 to 14.0; n = 9122) and 2.9% (95%CI = 2.8 to 3.0, n = 1913), respectively. Several clinical factors were associated with both hypoglycemia and BG variability including: co-morbid disease (P < 0.001), non-elective admissions (P < 0.001), higher illness severity (P < 0.001), and primary septic diagnosis (P < 0.001). Hypoglycemia was associated with greater odds of adjusted ICU (odds ratio (OR) = 1.41, 95% CI = 1.31 to 1.54) and hospital death (OR = 1.36, 95% CI = 1.27 to 1.46). Hypoglycemia severity was associated with 'dose-response' increases in mortality. BG variability was associated with greater odds of adjusted ICU (1.5, 95% CI = 1.4 to 1.6) and hospital (1.4, 95% CI = 1.3 to 1.5) mortality, when compared with either hypoglycemia only or neither. CONCLUSIONS: In critically ill patients, both early hypoglycemia and early variability in BG are relatively common, and independently portend an increased risk for mortality