The management of diabetes in the elderly

It appears inevitable that with increased longevity, the management of the elderly diabetic will place even greater demands on hospital services. It seems reasonable to adopt a more liberal attitude to the regulation of control of diabetes in the elderly than in younger patients. However, the view that diabetes in the elderly is always mild can be dangerously misleading. A significant number of elderly diabetics develop ketoacidosis or other serious forms of metabolic disturbance, and in these patients the mortality is high. Cardiovascular disease and peripheral vascular disease are major problems in the elderly, the former being the main cause of death. For best results, it is desirable that management of diabetes not be isolated from management of other, coexisting disorders, but rather that it be considered as part of the overall patient problem. As Malins pointed out, we should think in terms of diabetics rather than diabetes.     

Interviewer specificity in seminaturalistic interviews.

Attempted to replicate earlier findings by B. Pope and A. W. Siegman (see PA, Vol. 39:13386, and Vol. 40:509) that there is an inverse relationship between interviewer specificity and both interviewee productivity and uncertainty, through the use of more naturalistic interviewers. 24 18-40 yr. old psychiatric inpatients were interviewed 3 times in a low specificity, high specificity, and an uncontrolled interview. Previous findings were supported. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Detection and time course of cocaine N-oxide and other cocaine metabolites in human plasma by liquid chromatography/tandem mass spectrometry

Gas chromatography/mass spectrometry (GC/MS) is often used for detection and measurement of cocaine metabolites in biological specimens. However, cocaine N-oxide, a recently identified metabolite of cocaine, is thermally degraded when introduced into a GC/MS. The major degradation products are cocaine and norcocaine. When cocaine N-oxide was measured in rat plasma using liquid chromatography in combination with electrospray ionization-mass spectrometry (LC/ESI-MS), the cocaine N-oxide concentrations in the rat plasma were reported to be as high as 30% of the cocaine concentrations. However, in our study involving LC/ESI-MS/MS analysis of plasma collected from human subjects following administration of oral cocaine, we determined that the concentrations of cocaine N-oxide relative to the cocaine concentrations never exceeded 3%. This suggests that determination of cocaine concentration in human plasma by GC/MS analysis will not significantly distort the actual cocaine concentrations due to thermal conversion of cocaine N-oxide to cocaine. In the work reported here, we compared results obtained using GC/MS, LC/ESI-MS/MS, and liquid chromatography/atmospheric pressure chemical ionization-tandem mass spectrometry (LC/APCI-MS/MS) to determine thermal degradation of cocaine N-oxide. LC/ ESI-MS/MS was selected to determine cocaine, benzoylecgonine, and cocaine N-oxide, and LC/APCI-MS/MS was selected to determine ecgonine methyl ester and norcocaine in plasma collected from three human subjects participating in a clinical study. The resulting time course data provide additional information into kinetic interrelationships between cocaine N-oxidation and cocaine hydrolysis.     

Using an improvement model to reduce adverse drug events in VA facilities

BACKGROUND: Adverse drug events cause significant morbidity and mortality in health care. Many adverse drug events are due to medication errors and are preventable. In 1999 and 2000 the Patient Safety Center of Inquiry collaborated with the Institute for Healthcare Improvement (IHI) to implement a quality improvement (QI) project designed to reduce medication errors within the Veterans Administration system. METHODS: During a 6- to 9-month period, interdisciplinary teams that want to achieve much higher levels of performance work on a common aim, under the guidance of faculty, and come together for three 2-day educational and planning sessions. Between these sessions, teams implement some of the suggested changes, measure the results of those changes, and report back to the larger group. RESULTS: During the formal project, teams collected allergy information on more than 20,000 veterans and averted 1,833 medication errors that had the potential to cause adverse events. At 6-month follow-up, the majority of teams remained intact, continued to collect data, and maintained their gains, approximately doubling the results obtained during the formal project. Half of the teams expanded their efforts to other settings, and one-third of the teams expanded beyond their original topics. Returns on investment in the QI effort were substantial. CONCLUSIONS: The results suggest that gains made in organized QI efforts can be maintained for 6 months without additional external support or coaching if team structure and leadership support remain intact. Facilitators of QI efforts should focus on teams that are having difficulty learning new techniques. Finally, this effort appeared to generate cost savings.     

The effect of nicotine and attention allocation on physiological and self-report measures of induced anxiety in PTSD: A double-blind placebo-controlled trial.

Rates of smoking among populations with psychiatric disorders are more than twice as high as among the general population, yet there are few controlled studies of the mechanisms of this relationship. This trial examined the effect of nicotine by way of cigarette smoking on both self-report and autonomic parameters of anxiety among individuals with PTSD who were also heavy smokers. Half of the participants were randomized to an anxiety-eliciting condition, whereas the other half were assigned to a condition of neutral emotional content. Within each of these conditions, participants were randomized into a nicotine condition (high-yield nicotine cigarette) or a placebo condition (denicotinized cigarette). The final layer of randomization involved assigning participants to either an attention-demanding task or a no task condition. We examined the interactive effects of nicotine and attentional demand on parameters of anxious responding. Nicotine exerted an anxiolytic effect relative to placebo on self-report measures; however, nicotine did not interact with attentional demand in producing this effect. In contrast to the findings on the self-report measures of distress, nicotine enhanced autonomic reactivity to trauma cues, thereby suggesting a decoupling of self-reported anxiety and autonomic arousal associated with responding to trauma-relevant cues. The implications for understanding smoking and psychiatric comorbidity are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Filaments for Incandescent Lamps with Energy Conserving Envelopes

The design considerations for filaments in energy conserving incandescent lamps are described. Such lamps require compact high emissivity filaments to absorb infrared radiation reflected from heat mirrored focusing envelopes. The relationships between the electrical parameters in the radiation returning environment and in the clear surroundings are developed. Efficiency experiments with filaments of various geometries under conditions of radiation return were performed. A highly compact coiled coil filament seems most promising for development. A calculation is presented of the filament emissivity as a function of spacing of the windings in a coil. Measurements of the emissivity as a function of the pitch of a coiled coil filament agree with the calculation.     

Exploring the utility of NOAA AVHRR middle infrared reflectance to monitor the impacts of ENSO-induced drought stress on Sabah rainforests

The ever-wet tropics are under threat from ENSO events and there is a need for a monitoring system to analyse and describe their responses to such events. This letter explores the relative value of using NOAA AVHRR middle infrared (MIR) reflectance data and NDVI data for the monitoring of ENSO-related drought stress of a tropical forest ecosystem in Sabah, Malaysia. Relationships between rainfall and MIR reflectance were examined. Correlation coefficients are generally large and significant (at 0.1 level) while those between rainfall and NDVI were small and insignificant. This letter concludes that there is potential in using MIR reflectance for monitoring the effects of ENSO-induced drought stress on these forests and this has a bearing on how NOAA AVHRR data may be used to further our knowledge on the impacts of ENSO events on tropical forest environments.     

Preparation and moduli of model polymer networks

Polystyrene containing a small number of randomly spaced p-substituted secondary amine groups has been prepared. This polymer has been crosslinked in solution at concentrations in the range 5–20%, by hexamethylene diisocyanate, to form gels. The moduli of these gels were measured and the results compared to theoretical predictions from rubber elasticity theory. The dependence of the moduli on the concentration at which crosslinking takes place has been explained in terms of chemical crosslinks, closed loops and entanglements. The results support a value for the ideal modulus of nkT, where n is the number of crosslinks per cm³.     

Computer protocol and torus maps

We investigate the dynamics of maps and flows which arise from a class of models of closed queueing networks in computer science theory. The network consists of n+/ servers, one of which is a central server with a queue of size n-1. A protocol or scheduling discipline must be specified in this server to define the queueing network. The standard model gives rise to a flow on an n-torus. We consider the service protocols first in-first out (FIFO) and last in-first out (LIFO) in dimension three, for which the state spaces are modifications of a 3-torus. We present a sufficient condition on the time it takes each call to complete one cycle for the FIFO protocol which guarantees that the set of periodic orbits which involve no waiting in the queue is a global attractorfor the associated semi-flow. We also investigate the dynamics for the LIFO service protocol via a return map derived from the associated area preserving flow.