Chronic kidney disease is a large and growing problem among aging populations. Although progression of chronic kidney disease to end-stage renal disease (ESRD) is a costly and important clinical ...event with substantial morbidity, it appears less frequently in aging people compared with cardiovascular mortality. The measurement of kidney function and management of kidney disease in older individuals remain challenging, partly because the pathophysiologic mechanisms underlying age-related decline in kidney function, the interactions between age and other risk factors in renal progression, and the associations of chronic kidney disease with other comorbidities in older people are understudied and poorly understood. The Association of Specialty Professors, the American Society of Nephrology, the American Geriatrics Society, the National Institute on Aging, and the National Institute of Diabetes and Digestive and Kidney Diseases held a workshop, summarized in this article, to review what is known about chronic kidney disease, identify research gaps and resources available to address them, and identify priority areas for future research. Answers to emerging research questions will support the integration of geriatrics and nephrology and thus improve care for older patients at risk for chronic kidney disease.
Highly active antiretroviral treatment has resulted in dramatically increased life expectancy among patients with HIV infection who are now aging while receiving treatment and are at risk of ...developing chronic diseases associated with advanced age. Similarities between aging and the courses of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome suggest that HIV infection compresses the aging process, perhaps accelerating comorbidities and frailty. In a workshop organized by the Association of Specialty Professors, the Infectious Diseases Society of America, the HIV Medical Association, the National Institute on Aging, and the National Institute on Allergy and Infectious Diseases, researchers in infectious diseases, geriatrics, immunology, and gerontology met to review what is known about HIV infection and aging, to identify research gaps, and to suggest high priority topics for future research. Answers to the questions posed are likely to help prioritize and balance strategies to slow the progression of HIV infection, to address comorbidities and drug toxicity, and to enhance understanding about both HIV infection and aging.
Spontaneous sternoclavicular joint infection (SSCJI) is a rare and poorly understood disease process. This study aims to identify factors guiding effective management strategies for SSCJI by using ...data mining.
An Institutional Review Board-approved retrospective review of patients from 2 large hospitals (2010-2022) was conducted. SSCJI is defined as a joint infection without direct trauma or radiation, direct instrumentation or contiguous spread. An interdisciplinary team consisting of thoracic surgeons, radiologists, infectious disease specialists, orthopaedic surgeons, hospital information experts and systems engineers selected relevant variables. Small set data mining algorithms, utilizing systems engineering, were employed to assess the impact of variables on patient outcomes.
A total of 73 variables were chosen and 54 analysed against 11 different outcomes. Forty-seven patients mean age 51 (22-82); 77% male met criteria. Among them, 34 underwent early joint surgical resection (<14 days), 5 patients received delayed surgical intervention (>14 days) and 8 had antibiotic-only management. The antibiotic-only group had comparable outcomes. Indicators of poor outcomes were soft tissue fluid >4.5 cm, previous SSCJI, moderate/significant bony fragments, HgbA1c >13.9% and moderate/significant bony sclerosis.
This study suggests that targeted antibiotic-only therapy should be considered initially for SSCJI cases while concurrently managing comorbidities. Patients displaying indicators of poor outcomes or no symptomatic improvement after antibiotic-only therapy should be considered for surgical joint resection.
The Republic in Crisis, 1848–1861 analyses the political climate in the years leading up to the American Civil War, offering for students and general readers a clear, chronological account of the ...sectional conflict and the beginning of the Civil War. Emerging from the tumultuous political events of the 1840s and 1850s, the Civil War was caused by the maturing of the North and South's separate, distinctive forms of social organisation and their resulting ideologies. John Ashworth emphasises factors often overlooked in explanations of the war, including the resistance of slaves in the South and the growth of wage labour in the North. Ashworth acquaints readers with modern writings on the period, providing a new interpretation of the American Civil War's causes.
Objectives: This study assessed the effectiveness of clinical education to identify patients with a high risk for violence and to reduce the frequency of violent incidents.
Design: A before and after ...design with an education intervention.
Setting: Data were gathered from the direct care staff and from records of violent/aggressive incidents which occurred on two adult medical wards at a teaching hospital in Western Australia.
Subjects: Nurses, Assistants in Nursing and Patient Care Assistants working on the study wards participated in the education intervention (n=65) and completed a questionnaire before and after the education. Details of 48 violent/aggressive incidents perpetrated by 21 patients were examined.
Intervention: An education program addressed four key areas (assessment, planning, implementation crisis, post incident). Case studies and in-patient scenarios provided context, immediacy and relevance, and 77% of the staff completed the program.
Main outcome measure: Knowledge, confidence and capability of direct care staff to prevent/manage violent/aggressive incidents were measured. Incident data measured the frequency and recurrence of violence/aggression, and if perpetrators met the high risk criteria.
Results: Post education, knowledge increased significantly (p=0.001, CI 0.256-0.542), the use of verbal de-escalation increased significantly (p=0.011, 1df) and the frequency and recurrence of incidents decreased. All perpetrators met criteria indicating a high risk for violence.
Conclusions: Education and coaching provided by clinical experts resulted in increased knowledge, greater use of verbal de-escalation and less incidents. However, more time/coaching is required to improve the perceived capability of clinical staff to manage these incidents.
A novel field experiment shows that learning activities in pairs with a greater spread in abilities lead to better individual work performance, relative to those in pairs with similar abilities. The ...positive effect of the former is not limited to their performance in peer learning material, but it also spills over to their performance in other areas. The underlying improvement comes from the increased performance of those whose achievements were weak prior to peer learning. This implies that exogenously determining learning partners with different abilities helps improve productivity through knowledge sharing and potential peer effects.
The Weak Government Hypothesis states that government fragmentation leads to higher public deficits and debt. This relation can be explained by government inaction, common pool problems or the ...strategic use of debt that arise in coalition governments. Importantly, whereas government inaction models concentrate on the short-term effects of government fragmentation on indebtedness, common pool and strategic debt models imply that such effects will persist in the long term. We test these hypotheses using a large panel of data on municipal debt in 298 Flemish municipalities (1977–2000). We find that there is no long-run effect from weak governments. However, there is general support for the fact that the number of parties in a coalition has a positive effect on the municipality’s short-term debt levels–in line with government inaction models. Copyright Springer Science + Business Media, Inc. 2005
To date, a relatively limited literature has focused on psychotherapy with people with neurological conditions (Coetzer, 2007), and narrower still a literature that explores the impact upon ...practitioners who specialise in working with this population. This paper aims to reduce the latter deficit.
Competition reduces rent extraction in private-sector firms. In this article, we empirically assess whether it similarly disciplines politicians by evaluating local-level governments' performance in ...Flanders. The results indicate that electoral competition - measured via the number of parties competing in elections - significantly positively affects the productive efficiency of municipal policy. Intertemporal competition - measured as the volatility of election outcomes over time - has a similar, but weaker, positive effect. These beneficial effects are mitigated by the fact that competition may lead to more fragmented governments, which is shown to work against their productive efficiency. Overall, though, the beneficial effects outweigh the unfavourable ones in our sample.
A Geography of Heritage Graham, Brian; Ashworth, G. J.; Tunbridge, J. E.
2000, 2016-04-29
eBook
The concept of heritage relates to the ways in which contemporary society uses the past as a social, political or economic resource. However, heritage is open to interpretation and its value may be ...perceived from differing perspectives - often reflecting divisions in society. Moreover, the schism between the cultural and economic uses of heritage also gives rise to potential conflicts of interest.
Examining these issues in depth, this book is the first sustained attempt to integrate the study of heritage into contemporary human geography. It is structured around three themes: the diversity of use and consumption of heritage as a multi-sold cultural and economic resource; the conflicts and tensions arising from this multiplicity of uses, producers and consumers; and the relationship between heritage and identity at a variety of scales.
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