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Large rivers play an important role in transferring water and all of its constituents, including carbon in its various forms, from the land to the ocean, but the seasonal and inter-annual variations in these riverine flows remain unclear. Satellite Earth observation datasets and reanalysis products can now be used to observe synoptic-scale spatial and temporal variations in the carbonate system within large river outflows. Here, we present the University of Exeter (UNEXE) Satellite Oceanographic Datasets for Acidification (OceanSODA) dataset (OceanSODA-UNEXE) time series, a dataset of the full carbonate system in the surface water outflows of the Amazon (2010–2020) and Congo (2002–2016) rivers. Optimal empirical approaches were used to generate gridded total alkalinity (TA) and dissolved inorganic carbon (DIC) fields in the outflow regions. These combinations were determined by equitably evaluating all combinations of algorithms and inputs against a reference matchup database of in situ observations. Gridded TA and DIC along with gridded temperature and salinity data enable the calculation of the full carbonate system in the surface ocean (which includes pH and the partial pressure of carbon dioxide, pCO2). The algorithm evaluation constitutes a Type-A uncertainty evaluation for TA and DIC, in which model, input and sampling uncertainties are considered. Total combined uncertainties for TA and DIC were propagated through the carbonate system calculation, allowing all variables to be provided with an associated uncertainty estimate. In the Amazon outflow, the total combined uncertainty for TA was 36 µmolkg-1 (weighted root-mean-squared difference, RMSD, of 35 µmolkg-1 and weighted bias of 8 µmolkg-1 for n = 82), whereas it was 44 µmolkg-1 for DIC (weighted RMSD of 44 µmolkg-1 and weighted bias of - 6 µmolkg-1 for n = 70). The spatially averaged propagated combined uncertainties for the pCO2 and pH were 85 µatm and 0.08, respectively, where the pH uncertainty was relative to an average pH of 8.19. In the Congo outflow, the combined uncertainty for TA was identified as 29 µmolkg-1 (weighted RMSD of 28 µmolkg-1 and weighted bias of 6 µmolkg-1 for n = 102), whereas it was 40 µmolkg-1 for DIC (weighted RMSD of 37 µmolkg-1 and weighted bias of - 16 µmolkg-1 for n = 77). The spatially averaged propagated combined uncertainties for pCO2 and pH were 74 µatm and 0.08, respectively, where the pH uncertainty was relative to an average pH of 8.21. The combined uncertainties in TA and DIC in the Amazon and Congo outflows are lower than the natural variability within their respective regions, allowing the time-varying regional variability to be evaluated. Potential uses of these data would be the assessment of the spatial and temporal flow of carbon from the Amazon and Congo rivers into the Atlantic and the assessment of the riverine-driven carbonate system variations experienced by tropical reefs within the outflow regions. The data presented in this work are available at 10.1594/PANGAEA.946888 (Sims et al., 2023). [ABSTRACT FROM AUTHOR]

Large rivers play an important role in transferring water and all of its constituents including carbon in its various forms from the land to the ocean, but the seasonal and inter-annual variations in these riverine flows remain unclear. Satellite Earth observation datasets and reanalysis products can now be used to observe synoptic-scale spatial and temporal variations in the carbonate system within large river outflows. Here we present the OceanSODA-UNEXE time series, a dataset of the full carbonate system in the surface water outflows of the Amazon (2010-2020) and Congo Rivers (2002-2016). Optimal empirical approaches were used to generate gridded Total alkalinity (TA) and dissolved inorganic carbon (DIC) fields in the outflow regions. These combinations were determined by equitably evaluating all combinations of algorithms and inputs against a matchup database of in situ observations. Gridded TA and DIC along with gridded temperature and salinity data enable the calculation of the full carbonate system in the surface ocean. The algorithm evaluation constitutes a Type A uncertainty evaluation for TA and DIC where model, input and sampling uncertainties are considered. Total combined uncertainties for TA and DIC were propagated through the carbonate system calculation allowing all variables to be provided with an associated uncertainty estimate. In the Amazon outflow, the total combined uncertainty for TA was identified as 36 µmol kg-1 (weighted RMSD 35 µmol kg-1 and weighted bias 8 µmol kg-1 for n=82) and for DIC was 44 µmol kg-1 (weighted RMSD 44 µmol kg-1 and weighted bias -6 µmol kg-1 for n=70). The spatially averaged propagated uncertainties for the partial pressure of carbon dioxide (pCO2) and pH are 85 µatm and 0.08 respectively, where the pH uncertainty is relative to an average pH of 8.19. In the Congo outflow, the combined uncertainty for TA was identified as 29 µmol kg-1 (weighted RMSD 28 µmol kg-1 and weighted bias 6 µmol kg-1 for n=102) and for DIC was 40 µmol kg-1 (weighted RMSD 37 µmol kg-1and weighted bias -16 µmol kg-1 for n=77). The spatially averaged propagated uncertainties for pCO2 and pH are 74 µatm and 0.08 respectively, where the pH uncertainty is relative to an average pH of 8.21. The combined uncertainties in TA and DIC in the Amazon and Congo outflows are lower than the natural variability their respective regions allowing the time varying regional variability to be evaluated. Potential uses of these data would be for assessing the spatial and temporal flow of carbon from the Amazon and Congo rivers into the Atlantic and for assessing the riverine driven carbonate system variations experienced by tropical reefs within the outflow regions. [ABSTRACT FROM AUTHOR]

This article discusses The Sharlot Hall Museum located in Prescott, Arizona. An overview of the museum's history and program development is presented. Particular focus is given to five major festivals that the museum hosts annually. Details related to the museum's hours of operation, admission rates, and street location are included.

The article focuses on the Sharlot Hall Museum in Prescott, Arizona. The museum was established by poet, historian and conservationist Sharlot Mabridth Hall in 1928. The museum hosts major history and anthropology exhibits within the country. It was reaccredited by the American Association of Museum and has also received the Distinguished Organization Award in 2004 from the Arizona Humanities Council. One of the museum's important mission is research services through its archives and library.

Abstract: Background and purpose: Accurate conformal radiotherapy treatment requires manual delineation of target volumes and organs at risk (OAR) that is both time-consuming and subject to large inter-user variability. One solution is atlas-based automatic segmentation (ABAS) where a priori information is used to delineate various organs of interest. The aim of the present study is to establish the accuracy of one such tool for the head and neck (H&N) using two different evaluation methods. Materials and methods: Two radiotherapy centres were provided with an ABAS tool that was used to outline the brainstem, parotids and mandible on several patients. The results were compared to manual delineations for the first centre (EM1) and reviewed/edited for the second centre (EM2), both of which were deemed as equally valid gold standards. The contours were compared in terms of their volume, sensitivity and specificity with the results being interpreted using the Dice similarity coefficient and a receiver operator characteristic (ROC) curve. Results: Automatic segmentation took typically ∼7min for each patient on a standard PC. The results indicated that the atlas contour volume was generally within ±1SD of each gold standard apart from the parotids for EM1 and brainstem for EM2 that were over- and under-estimated, respectively (within ±2SD). The similarity of the atlas contours with their respective gold standard was satisfactory with an average Dice coefficient for all OAR of 0.68±0.25 for EM1 and 0.82±0.13 for EM2. All data had satisfactory sensitivity and specificity resulting in a favourable position in ROC space. Conclusions: These tests have shown that the ABAS tool exhibits satisfactory sensitivity and specificity for the OAR investigated. There is, however, a systematic over-segmentation of the parotids (EM1) and under-segmentation of the brainstem (EM2) that require careful review and editing in the majority of cases. Such issues have been discussed with the software manufacturer and a revised version is due for release. [Copyright &y& Elsevier]

Background. Stopping driving has significant negative consequences for older adults, but there is no simple, reliable screening tool to predict driving cessation. We sought to determine if self-rated health (SRH) was an independent predictor of driving cessation among older adults. Methods'. Data on SRH (poor, fair, good, very good, or excellent), medical diagnoses, physical performance, visual acuity, driving status, and other relevant covariates were collected from 649 community-dwelling older Alabama drivers during in-home interviews. Using multivariable logistic regression analyses, we estimated the association of SRH with driving cessation 2 years later. Results. Participants had a mean age of 74 years; 43% were women, 41% African American, and 48% rural. Overall, 36% reported poor to fair SRH at baseline, and 11% had stopped driving after 2 years. Compared to 8% of drivers with good to excellent SRH, 17% with poor to fair health stopped driving (adjusted odds ratio [OR], 1.93; 95% confidence interval [CI], 1.09-3.41; p = .025). Lower Short Physical Performance Battery (SPPB) scores (adjusted OR, 0.86; 95% CI, 0.78-0.95; p = .001) and older age (adjusted OR, 1.06 per year; 95% CI, 1.01-1.11: p = .010) were also associated with driving cessation. Receiver operating characteristics curves documented similar predictive discrimination (c statistics) for SRH (0.72), the SPPB (0.70), and a count of comorbidities based on the Charlson Comorbidity Index (0.73). Conclusions. Poor to fair SRH predicted incident driving cessation after 2 years in a cohort of older adults. SRH can be easily obtained during clinic visits to identify at-risk drivers. [ABSTRACT FROM AUTHOR]

Objective: To evaluate potential associations of impairments in physical function with motor vehicle crash involvement in older drivers. Methods: Case participantss were randomly selected residents of Mobile County, Alabama, &gte;65 years old who had sustained an at-fault motor vehicle crash in 1996. Similarly selected crash-free controls were frequency matched to cases on gender and age. Self-report data on demographic variables, medical conditions, medications, driving exposure, and function were collected by telephone interviewers. Results: Relative to crash-free subjects, crash-involved drivers were significantly more likely to report difficulty walking 1/4 mile and moving outdoors. Marginally significant associations were observed for trouble carrying a heavy object 100 yards and for the occurrence of falls in the prior year. Increasing numbers of functional limitations were directly related to the odds of crash involvement. Discussion: In comparison to crash-free controls, crash-involved older drivers are more likely to report other mobility-related impairments, possibly including falls. [ABSTRACT FROM AUTHOR]

ABSTRACT: Vitamin D deficiency is relatively common among older persons and those with spinal cord injuries. We report a case of proximal renal tubular acidosis in a 44-year-old quadriplegic nursing home resident who had limited sunlight exposure. Laboratory studies showed a low level of serum bicarbonate, a normal serum anion gap, and a positive urine anion gap. There was no history of diarrhea. Serum calcium and phosphorus levels were 6.9 mg/dL and 3.7 mg/dL, respectively. Proximal renal tubular acidosis due to osteomalacia was suspected, which was confirmed by a low serum 25-hydroxycholecalciferol level (< 5 ng/mL) with an elevated serum parathyroid hormone level. Treatment with vitamin D and a calcium supplement led to normalization of laboratory values. [ABSTRACT FROM AUTHOR]

Provides information on a study which reported on the medical and functional factors associated with vehicle crashes in a group of elderly drivers. Methodology of the study; Results and discussion on the study.

The carbonate chemistry of sea ice is known to play a role in global carbon cycles, but its importance is uncertain in part due to disparities in reported results. Variability in physical and biological drivers is usually invoked to explain differences between studies. In the Canadian Arctic Archipelago, "invisible polynyas" – areas of strong currents, thin ice, and potentially high biological productivity – are examples of extreme spatial variability. We used an invisible polynya as a natural laboratory to study the effects of inferred initial ice formation conditions, ice growth rate, and algal biomass on the distribution of carbonate species by collecting enough cores to perform a statistical comparison between sites located within, and just outside of, a polynya near Iqaluktuttiaq (Cambridge Bay, Nunavut, Canada). At both sites, the uppermost 10 cm ice horizon showed evidence of CO 2 off-gassing, while carbonate distributions in the middle and bottommost 10 cm horizons largely followed the salinity distribution. In the polynya, the upper ice horizon had significantly higher bulk total inorganic carbon (TIC), total alkalinity (TA), and salinity potentially due to freeze-up conditions that favoured frazil ice production. The middle ice horizons were statistically indistinguishable between sites, suggesting that ice growth rate is not an important factor for the carbonate distribution under mid-winter conditions. The thicker (non-polynya) site experienced higher algal biomass, TIC, and TA in the bottom horizon. Carbonate chemistry in the bottom horizon could largely be explained by the salinity distribution, with the strong currents at the polynya site potentially playing a role in desalinization; biology appeared to exert only a minor control, with some evidence that the ice algae community was net heterotrophic. We did see evidence of calcium carbonate precipitation but with little impact on the TIC:TA ratio and little difference between sites. Because differences were constrained to relatively thin layers at the top and bottom, vertically averaged values of TIC, TA, and especially the TIC:TA ratio were not meaningfully different between sites. This provides some justification for using a single bulk value for each parameter when modelling sea ice effects on ocean chemistry at coarse resolution. Exactly what value to use (particularly for the TIC:TA ratio) likely varies by region but could potentially be approximated from knowledge of the source seawater and sea ice salinity. Further insights await a rigorous intercomparison of existing data. [ABSTRACT FROM AUTHOR]

Provides information on a study that estimated the association between diabetes and its complications and at-fault automobile accidents among older drivers. Demographic and driving characteristics of the subject; Medical and visual function characteristics of the subjects; Conclusion.

Looks at whether or not age by itself increases susceptibility to pneumococcal infections separate from the effects of chronic disease. Details of a study that suggests that age has an independent association with risk of pneumococcal infections; Potential impact of this finding on public policy; Studies suggesting clinical effectiveness of pneumococcal vaccine in immunocompetent elderly people; More.

The effectiveness of pneumococcal vaccine in the immunocompetent elderly remains controversial. We report the results of a multicenter, case-control study of 244 controls and 122 patients, aged 55 years and older, hospitalized during a 5-year period with pneumococcal bacteremia, meningitis, or other bacteriologically confirmed pneumococcal infection. Two controls per patient were matched on the basis of admission date, hospital records, and underlying diseases. All subjects were selected without knowledge of immunization status with pneumococcal vaccine, and were excluded if there was evidence for immunosuppression due to disease or iatrogenic causes. The clinical effectiveness of the vaccine was calculated to be 70% (95% confidence intervals [CI], 37% to 86%) in this population, based on a Mantel-Haenszel point estimate of the odds ratio of 0.30 (95% CI, 0.14% to 0.63%; P less than 0.005). The clinical effectiveness of pneumococcal vaccine in preventing pneumococcal infection in the immunocompetent elderly approximates the vaccine's effectiveness in the general immunocompetent population. [ABSTRACT FROM AUTHOR]

The long‐term absorption by the oceans of atmospheric carbon dioxide is leading to the slow decline of ocean pH, a process termed ocean acidification (OA). The Arctic is a challenging region to gather enough data to examine the changes in carbonate chemistry over sufficient scales. However, algorithms that calculate carbonate chemistry parameters from more frequently measured parameters, such as temperature and salinity, can be used to fill in data gaps. Here, these published algorithms were evaluated against in situ measurements using different data input types (data from satellites or in situ re‐analysis climatologies) across the Arctic Ocean. With the lowest uncertainties in the Atlantic influenced Seas (AiS), where re‐analysis inputs achieved total alkalinity estimates with Root Mean Squared Deviation (RMSD) of 21 μmol kg−1 and a bias of 2 μmol kg−1 (n = 162) and dissolved inorganic carbon RMSD of 24 μmol kg−1 and bias of −14 μmol kg−1 (n = 262). AiS results using satellite observation inputs show similar bias but larger RMSD, although due to the shorter time span of available satellite observations, more contemporary in situ data would provide further assessment and improvement. Synoptic‐scale observations of surface water carbonate conditions in the Arctic are now possible to monitor OA, but targeted in situ data collection is needed to enable the full exploitation of satellite observation‐based approaches. Plain Language Summary: The long‐term absorption by the oceans of atmospheric carbon dioxide is leading to the slow decline of ocean pH, a process termed ocean acidification (OA). Sea surface salinity and temperature measurements from satellites or in situ re‐analysis products can be used as input to empirical algorithms to calculate OA parameters. This paper provides a first analysis of published Arctic Ocean empirical algorithms to estimate surface water OA parameters using observation‐based data sets. Results show promise in the Atlantic influenced Seas using both in situ re‐analysis and satellite products, but satellite salinity is relatively recent, and a paucity of in situ data in the satellite salinity era precludes a robust assessment. To fully exploit satellite‐based approaches, efforts need to focus on collecting in situ data while these satellites are overhead and operating in orbit. Key Points: Observation‐based data sets enable synoptic spatio‐temporal assessments of Arctic Ocean carbonate system parametersRe‐analysis and satellite products predict total alkalinity with accuracies of ∼21 μmol kg−1Targeted in situ data collection is needed to fully exploit satellite observations in the Arctic to enable carbonate system monitoring [ABSTRACT FROM AUTHOR]

In recent years, large datasets of in situ marine carbonate system parameters (partial pressure of CO 2 (pCO 2), total alkalinity, dissolved inorganic carbon and pH) have been collated, quality-controlled and made publicly available. These carbonate system datasets have highly variable data density in both space and time, especially in the case of pCO 2 , which is routinely measured at high frequency using underway measuring systems. This variation in data density can create biases when the data are used, for example, for algorithm assessment, favouring datasets or regions with high data density. A common way to overcome data density issues is to bin the data into cells of equal latitude and longitude extent. This leads to bins with spatial areas that are latitude- and projection-dependent (e.g. become smaller and more elongated as the poles are approached). Additionally, as bin boundaries are defined without reference to the spatial distribution of the data or to geographical features, data clusters may be divided sub-optimally (e.g. a bin covering a region with a strong gradient). To overcome these problems and to provide a tool for matching surface in situ data with satellite, model and climatological data, which often have very different spatiotemporal scales both from the in situ data and from each other, a methodology has been created to group in situ data into "regions of interest": spatiotemporal cylinders consisting of circles on the Earth's surface extending over a period of time. These regions of interest are optimally adjusted to contain as many in situ measurements as possible. All surface in situ measurements of the same parameter contained in a region of interest are collated, including estimated uncertainties and regional summary statistics. The same grouping is applied to each of the non-in situ datasets in turn, producing a dataset of coincident matchups that are consistent in space and time. About 35 million in situ data points were matched with data from five satellite sources and five model and reanalysis datasets to produce a global matchup dataset of carbonate system data, consisting of ∼286000 regions of interest spanning 54 years from 1957 to 2020. Each region of interest is 100 km in diameter and 10 d in duration. An example application, the reparameterisation of a global total alkalinity algorithm, is presented. This matchup dataset can be updated as and when in situ and other datasets are updated, and similar datasets at finer spatiotemporal scale can be constructed, for example, to enable regional studies. The matchup dataset provides users with a large multi-parameter carbonate system dataset containing data from different sources, in one consistent, collated and standardised format suitable for model–data intercomparisons and model evaluations. The OceanSODA-MDB data can be downloaded from 10.12770/0dc16d62-05f6-4bbe-9dc4-6d47825a5931 (Land and Piollé, 2022). [ABSTRACT FROM AUTHOR]

In recent years, large datasets of in situ marine carbonate system parameters (partial pressure of CO2 (pCO2), total alkalinity, dissolved inorganic carbon and pH) have been collated, quality controlled and made publicly available. These carbonate system datasets have highly variable data density in both space and time, especially in the case of pCO2, which is routinely measured at high frequency using underway measuring systems. This variation in data density can create biases when the data are used, for example for algorithm assessment, favouring datasets or regions with high data density. A common way to overcome data density issues is to bin the data into cells of equal latitude and longitude extent. This leads to bins with spatial areas that are latitude and projection dependent (e. g. become smaller and more elongated as the poles are approached). Additionally, as bin boundaries are defined without reference to the spatial distribution of the data or to geographical features, data clusters may be divided sub-optimally (e. g. a bin covering a region with a strong gradient). To overcome these problems and to provide a tool for matching surface in situ data with satellite, model and climatological data, which often have very different spatiotemporal scales both from the in situ data and from each other, a methodology has been created to group in situ data into 'regions of interest': spatiotemporal cylinders consisting of circles on the Earth's surface extending over a period of time. These regions of interest are optimally adjusted to contain as many in situ measurements as possible. All surface in situ measurements of the same parameter contained in a region of interest are collated, including estimated uncertainties and regional summary statistics. The same grouping is applied to each of the nonin situ datasets in turn, producing a dataset of coincident matchups that are consistent in space and time. About 35 million in situ data points were matched with data from five satellite sources and five model and re-analysis datasets to produce a global matchup dataset of carbonate system data, consisting of ~286,000 regions of interest spanning 54 years from 1957 to 2020. Each region of interest is 100 km in diameter and 10 days in duration. An example application, the reparameterisation of a global total alkalinity algorithm, is shown. This matchup dataset can be updated as and when in situ and other datasets are updated, and similar datasets at finer spatiotemporal scale can be constructed, for example to enable regional studies. The matchup dataset provides users with a large multi-parameter carbonate system dataset containing data from different sources, in one consistent, collated and standardised format suitable for model-data intercomparisons and model evaluations. The OceanSODA-MDB data can be downloaded from https://doi.org/10.12770/0dc16d62-05f6-4bbe-9dc4-6d47825a5931 (Land and Piollé, 2022). [ABSTRACT FROM AUTHOR]

Strong evidence for a pan-Arctic expansion of upright shrubs comes from analysis of satellite imagery, historical photographs, vegetation plots, and growth rings. However, there are still uncertainties related to local-scale patterns of shrub growth, resulting interactions among vegetation functional groups, and the relative roles of disturbance and climate as drivers of observed change. Here, we present evidence that widespread and rapid shrub expansion and lichen declines over a 15,000 km area of the western Canadian Arctic have been driven by regional increases in temperature. Using 30 m resolution Landsat satellite imagery and high resolution repeat color-infrared aerial photographs, we show that 85% of the land surface has a positive 1985-2011 trend ( P < 0.05) in NDVI, making this one of the most intensely greening regions in the Arctic. Strong positive trends (>0.03 NDVI/decade) occurred consistently across all landscape positions and most vegetation types. Comparison of 208, 1:2,000 scale vertical air photo pairs from 1980 and 2013 clearly shows that this greening was driven by increased canopy cover of erect dwarf and tall shrubs, with declines in terricolous lichen cover. Disturbances caused by wildfires, exploratory gas wells, and drained lakes all produced strong, yet localized increases in NDVI due to shrub growth. Our analysis also shows that a 4°C winter temperature increase over the past 30 years, leading to warmer soils and enhanced nutrient mineralization provides the best explanation for observed vegetation change. These observations thus provide early corroboration for modeling studies predicting large-scale vegetation shifts in low-Arctic ecosystems from climate change. [ABSTRACT FROM AUTHOR]

To understand the potential roles of various patient and provider factors in the underuse of pneumococcal vaccination in Medicare-eligible older African Americans. The Cardiovascular Health Study. Four U.S. states. Seven hundred ninety-five pairs of community-dwelling Medicare-eligible African-American and white adults aged 65 and older, balanced according to age and sex. Data on self-reported race, receipt of pneumococcal vaccination, and other important sociodemographic and clinical variables were collected at baseline. Participants had a mean age ± standard deviation of 73 ± 6; 63% were female. Pneumococcal vaccination rates were 22% for African Americans and 28% for whites (unadjusted odds ratios (OR) for African Americans=0.75; 95% confidence interval (CI)=0.60-0.94; P=.01). This association remained significant despite adjustment for sociodemographic and clinical confounders, including education, income, chronic obstructive pulmonary disease, and prior pneumonia (OR=0.74, 95% CI=0.56-0.97; P=.03), but the association was no longer significant after additional adjustment for the receipt of influenza vaccination (OR=0.79, 95% CI=0.59-1.06; P=.12). Receipt of influenza vaccination was associated with higher odds of receiving pneumococcal vaccination (unadjusted OR=6.43, 95% CI=5.00-8.28; P<.001), and the association between race and pneumococcal vaccination lost significance when adjusted for influenza vaccination alone (OR=0.81, 95% CI=0.63-1.03; P=.09). The strong association between receipt of influenza and pneumococcal vaccinations suggests that patient and provider attitudes toward vaccination, rather than traditional confounders such as education and income, may help explain the underuse of pneumococcal vaccination in older African Americans. [ABSTRACT FROM AUTHOR]

Objective: To determine the demographic and clinical predictors of in-hospital mortality among hospitalized nursing home (NH) residents. Design: Retrospective analysis of the public-use copies of the 2005–2006 National Hospital Discharge Survey (NHDS) datasets. Setting: Non-federal acute-care, short-stay hospitals in all 50 states and the District of Columbia. Participants: Participants were 1904 and 1752 NH residents, 45 years or older, hospitalized in 2005 and 2006, respectively. Measurements: In-hospital mortality. Methods: A multivariable logistic regression model was developed to determine independent predictors of in-hospital mortality using the 2005 dataset. The model was then applied to the 2006 dataset to determine the generalizability of the predictors. Results: Significant independent predictors of in-hospital mortality in 2005 included age 85 years or older (adjusted odds ratio [OR], 2.53; 95% confidence interval [CI], 1.21–5.30; P=.013), acute respiratory failure (adjusted OR, 5.67; 95% CI, 3.51–9.17; P < .0001), septicemia (adjusted OR, 4.63; 95% CI, 3.08–6.96; P < .0001), and acute renal failure (adjusted OR, 2.11; 95% CI, 1.30–3.41; P=.002). The following baseline characteristics also predicted in-hospital mortality in 2006: age 85 years or older (adjusted OR, 2.45; 95% CI, 1.31–4.59; P=.005), acute respiratory failure (adjusted OR, 7.11; 95% CI, 4.46–11.33; P < .0001), septicemia (adjusted OR, 3.91; 95% CI, 2.64–5.80; P < .0001), and acute renal failure (adjusted OR, 2.75; 95% CI, 1.82–4.15; P < .0001). Chronic morbidities were not associated with in-hospital mortality. Conclusion: Among hospitalized NH residents, age 85 years or older and several acute conditions, but not chronic morbidities, predicted in-hospital mortality. Elderly NH residents at risk of developing these acute conditions may benefit from palliative care. [Copyright &y& Elsevier]

Objectives: To define racial similarities and differences in mobility among community-dwelling older adults and to identify predictors of mobility change.Design: Prospective, observational, cohort study.Participants: Nine hundred and five community-dwelling older adults.Measures: Baseline in-home assessments were conducted to assess life-space mobility, sociodemographic variables, disease status, geriatric syndromes, neuropsychological factors, and health behaviors. Disease reports were verified by review of medications, physician questionnaires, or hospital discharge summaries. Telephone interviews defined follow-up life-space mobility at 18 months of follow-up.Results: African Americans had lower baseline life-space (LS-C) than whites (mean 57.0 +/- standard deviation [SD] 24.5 vs. 72.7 +/- SD 22.6; P < .001). This disparity in mobility was accompanied by significant racial differences in socioeconomic and health status. After 18 months of follow-up, African Americans were less likely to show declines in LS-C than whites. Multivariate analyses showed racial differences in the relative importance and strength of the associations between predictors and LS-C change. Age and diabetes were significant predictors of LS-C decline for both African Americans and whites. Transportation difficulty, kidney disease, dementia, and Parkinson's disease were significant for African Americans, while low education, arthritis/gout, stroke, neuropathy, depression, and poor appetite were significant for whites.Conclusions: There are significant disparities in baseline mobility between older African Americans and whites, but declines were more likely in whites. Improving transportation access and diabetes care may be important targets for enhancing mobility and reducing racial disparities in mobility. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine the association between angiotensin-converting enzyme (ACE) inhibitor therapy and survival of older heart failure patients with conditions perceived by physicians as contraindications to ACE inhibitors. SETTING: Hospital. DESIGN: Retrospective follow-up study. PARTICIPANTS: Hospitalized older heart failure patients with systolic blood pressure of 90 mmHg or less, serum creatinine of 2.5 mg/dL or more, serum potassium of 5.5 mmol/L or more, or severe aortic stenosis. MEASUREMENTS: One-year postdischarge mortality (with and without adjustment for various patient and care characteristics). Logistic regression analyses were used to estimate the effect of the perceived contraindications on subsequent use of ACE inhibitors. Using Cox proportional hazards models, crude and adjusted hazard ratios (HRs) of 1-year mortality with 95% confidence intervals (CIs) were estimated for patients discharged on ACE inhibitors and compared with those without. HRs were estimated for all patients and were repeated after stratifying patients based on the presence of perceived contraindications to ACE inhibitor use. RESULTS: Of the 295 subjects, 52 (18%) had conditions perceived as contraindications, 186 (63%) received ACE inhibitors, and 107 (40%) died within 1 year of discharge. Presence of a perceived contraindication was independently associated with underutilization of ACE inhibitors on discharge (adjusted OR = 0.35, 95% CI = 0.17–0.71). ACE inhibitor prescription at discharge was associated with lower 1-year mortality overall (HR = 0.58, 95% CI = 0.40–0.85) and for the groups of patients with (HR = 0.34, 95% CI = 0.14–0.81) and without (HR = 0.66, 95% CI = 0.42–1.02) perceived contraindications. CONCLUSIONS: ACE inhibitor use was associated with a significant survival benefit in this cohort of hospitalized older heart failure patients with perceived contraindications. [ABSTRACT FROM AUTHOR]

Describes a pilot initiative sponsored by the U.S. Veterans Health Administration to improve the health and community tenure of frail older veterans living in rural counties. Features of the Coordination and Advocacy for Rural Elders (CARE) program; Problems identified by the CARE team; Interventions initiated by the CARE team.