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RATIONALE & OBJECTIVE: Traditional risk estimates for atherosclerotic vascular disease (ASVD) and death may not perform optimally in the setting of CKD. We sought to determine whether the addition of measures of inflammation and kidney function to traditional estimation tools improves prediction of these events in a diverse cohort of patients with CKD. STUDY DESIGN: Observational cohort study SETTING & PARTICIPANTS: 2399 Chronic Renal Insufficiency Cohort (CRIC) study participants without history of cardiovascular disease at study entry. PREDICTORS: Baseline plasma levels of biomarkers of inflammation (interleukin (IL)-1β, IL-1RA (IL-1 receptor antagonist), IL-6, tumor necrosis factor (TNF)-α, transforming growth factor β (TGFβ), high sensitivity C-Reactive protein (hs-CRP), fibrinogen, and serum albumin), measures of kidney function (estimated glomerular filtration rate (eGFR) and albuminuria), and the Pooled Cohort Equation Probability (PCEP) estimate. OUTCOMES: Composite of ASVD events (incident myocardial infarction (MI), peripheral arterial disease (PAD), and stroke) and death. ANALYTICAL APPROACH: Cox proportional hazard models adjusted for PCEP estimates, albuminuria, and eGFR. RESULTS: During a median follow-up of 7.3 years, 86, 61, 48, and 323 participants experienced MI, PAD, stroke, or death, respectively. 1-decile greater levels of IL-6 (adjusted Hazard Ratio [aHR], 1.12; 95% CI, 1.08-1.16; p

Compassion fatigue (CF) has been described in various "caring professions," particularly the human medical field. Recently, CF has been identified as a concern in animal care professions, specifically veterinary medicine. Despite the perception that veterinary personnel in animal research are at increased risk of CF, few studies have assessed CF in this population. The cur-rent cross-sectional study aimed to describe the prevalence of both CF and compassion satisfaction (CS) among active-duty veterinary personnel in Department of Defense animal research environments, using the Professional Quality of Life Scale (ProQOL). The ProQOL measures burnout and secondary traumatic stress as representative of compassion fatigue, while also measuring the inverse of CF, or CS. The current study set out to identify factors associated with both CF and CS. Validated scales of measurement were used to assess the frequency of exposures and outcomes of interest, while associations were analyzed using linear regression models. The study found that most survey respondents reported high levels of CS and low levels of BO and STS. Factors associated with higher levels of CF and lower CS included working with NHPs, difficulty working with primary investigators, loneliness, and euthanasia distress. These findings can inform future studies of CF in animal research environments and bolster initiatives to reduce occupational stress by the preventing and mitigating CF.

Robust event detection of low signal-to-noise ratio (SNR) events, such as those characterized as induced or triggered seismicity, remains a challenge. The reason is the relatively small magnitude of the events (usually less than 2 or 3 in Richter scale) and the fact that regional permanent seismic networks can only record the strongest events of a microseismic sequence. Monitoring using temporary installed short-period arrays can fill the gap of missed seismicity but the challenge of detecting weak events in long, continuous records is still present. Further, for low SNR recordings, commonly applied detection algorithms generally require pre-filtering of the data based on a priori knowledge of the background noise. Such knowledge is often not available. We present the NpD (Non-parametric Detection) algorithm, an automated algorithm which detects potential events without the requirement for pre-filtering. Events are detected by calculating the energy contained within small individual time segments of a recording and comparing it to the energy contained within a longer surrounding time window. If the excess energy exceeds a given threshold criterion, which is determined dynamically based on the background noise for that window, then an event is detected. For each time window, to characterize background noise the algorithm uses non-parametric statistics to describe the upper bound of the spectral amplitude. Our approach does not require an assumption of normality within the recordings and hence it is applicable to all datasets. We compare our NpD algorithm with the commonly commercially applied STA/LTA algorithm and another highly efficient algorithm based on Power Spectral Density using a challenging microseismic dataset with poor SNR. For event detection, the NpD algorithm significantly outperforms the STA/LTA and PSD algorithms tested, maximizing the number of detected events whilst minimizing the number of false positives.

A summary of the support given to paramedic students who attended the Manchester Arena bombing in May 2017.

In each issue, the paramedic education team at Edge Hill University focuses on the clinical skills carried out by paramedics on the frontline, highlighting the importance of these skills and how to perform them. Here, Sally Thompson discusses the importance of monitoring blood pressure trends in acutely ill or injured patients

Background In 2008 an end of life care government strategy cited research which showed that people don’t want to spend their last year or last days in hospital but this often occurred due to poorly coordinated crisis driven care. In response to this in 2013 the My Care Choices Register (MCCR) was launched to record end of life care choices for those living in north east Essex with an incurable illness, dementia and frailty. Aims A marketing campaign was commissioned by the North East Essex Health and Wellbeing Alliance in October 2018 with a budget of £50,000 with the aim to: Raise public awareness in north east Essex amongst local people about the MCCR; Enable potentially difficult conversations with loved ones; Enable more people to access the My Care Choices Register. Method An ‘elephant in the room’ campaign, with the elephant representing the conversation about future care including death and dying. The elephant appeared on backs of buses, bus tickets, bus stops, petrol nozzles, pharmacy bags, village publications, pens, mouse mats and key rings. We covered a diverse range of options to ensure we targeted as many people as possible. Segmenting this market was particularly difficult. The key promotional tool was an animation entitled ‘The elephant in the room’. Produced as a modest, yet sophisticated old style cartoon to appeal to all ages. It has the ability to be a ‘white label’ film to be used by other organisations wishing to promote advance care planning. Results 1083 new register entries were created between 1 October 2018 and 31 March 2019, a 22% increase in new entries from the same period in 2017/18. Conclusion A good budget and a simple idea can be very effective in promoting a sensitive and taboo subject, encouraging choice for people living with life limiting illness.

Background: Given Australia’s population ageing and predicted impacts related to health, productivity, equity and enhancing quality of life outcomes for senior Australians, lifelong learning has been identified as a pathway for addressing the risks associated with an ageing population. To date Australian governments have paid little attention to addressing these needs and thus, there is an urgent need for policy development for lifelong learning as a national priority. The purpose of this article is to explore the current lifelong learning context in Australia and to propose a set of factors that are most likely to impact learning in later years. Conclusion: Evidence based policy that understands and incorporates learning opportunities for all citizens is required to meet emerging global challenges. Providing appropriate learning opportunities to seniors is one clear pathway for achieving diverse health, social and economic outcomes.

Objective To investigate the prescription medication use practices of a sample of non-institutionalised older persons and to determine any differences with age (65–74 years versus 75 years and over). Method Data were gathered via 204 detailed in-home interviews, completed between March, 1993, and November, 1995. Respondents were identified through general practitioners (GPs). Practice patterns investigated included routines to assist with remembering when to use regular prescription medication, alterations to prescribed regimens, the borrowing and lending of prescription medication and patterns of prescription medication storage. Setting The study was conducted in Melbourne, Australia. Key findings Most respondents were found to have well-defined routines to assist with remembering when to use their prescription medication and in almost two-thirds of cases this was to use the medication with a meal. Almost a quarter of respondents said that on at least one occasion over the past few years they had intentionally used a lower dose of a medication than was prescribed and slightly less than one in 10 had intentionally used a higher dose. Less than one in 10 respondents admitted to having borrowed prescription medication on at least one occasion; almost double that number had lent medication. Most respondents stored their prescription medication appropriately, usually in the kitchen. Only 10 per cent of respondents were found to have more than three additional packs of the prescription medication they currently used. The hoarding of older medications was not uncommon; 42 per cent had prescription medication they no longer used. No differences in practice patterns were found with age. Conclusion Previous concerns about widespread poor quality use of medicines among non-institutionalised older persons were not generally supported by the findings of this study. However, the problems detected emphasise the need for vigilance. GPs and pharmacists could further promote the quality use of medicines among older persons through closer monitoring and review of prescription medication. Older persons need to be encouraged to discuss medicines and/or doses they feel are in some way inappropriate with their GP or pharmacist. Pharmacies should be promoted as places where unwanted or out-of-date medications can be taken for disposal.

Objectives (1) To explore older persons' opinions about their receipt of prescription drug information from general practitioners (GPs) and pharmacists, (2) to determine the information older persons wish to know about their prescription medication and the information sources they use, (3) to determine the opinions of older persons about prescription medication labels and patient information leaflets, and (4) to determine any significant differences between those aged 65–74 years and those aged 75 years and over. Method Data were gathered via 204 detailed in-home interviews completed between March,1993, and November, 1995. Respondents were identified through GPs. Setting The study was conducted in Melbourne, Australia. Key findings The vast majority of respondents liked to receive verbal counselling from GPs and pharmacists about their prescription medication and the majority were willing to share responsibility for receiving that information. However, a small minority of patients seemed to receive little information from GPs and pharmacists about their prescription medication and had no real perception of a need for information. As might be expected, the item of information most desired by respondents was when and how to use the medication (89 per cent). This was followed by the condition for which the medication was prescribed (76 per cent) and side effects (72 per cent). For 90 per cent of respondents GPs were their greatest prescription drug information source; pharmacists featured highly as a secondary source (57 per cent of respondents). Almost all respondents (92 per cent) thought that the information pharmacists printed on prescription medication labels was adequate although numerous suggestions were advanced for label improvement. Seventy-six per cent of respondents were of the opinion that, when receiving a prescription medication that was new to them, an information leaflet written for the consumer about that medication would be helpful. The 75 and over age group were less enthusiastic about receiving such leaflets than the 65–74 age group (P=0.015). Conclusion Education programmes aimed at improving the quality use of medicines in Australia still need to encourage older persons to actively seek, and health professionals to volunteer, prescription drug information. Patient information leaflets are well accepted by older persons; however, it is important that the information be adequately explained.

Background To compare the efficacy of pregabalin and gabapentin at comparable effective dose levels in patients with refractory partial epilepsy. Methods Eight randomized placebo controlled trials investigating the efficacy of pregabalin (4 studies) and gabapentin (4 studies) over 12 weeks were identified with a systematic literature search. The endpoints of interest were "responder rate" (where response was defined as at least a 50% reduction from baseline in the number of seizures) and "change from baseline in seizure-free days over the last 28 days (SFD)". Results of all trials were analyzed using an indirect comparison approach with placebo as the common comparator. The base-case analysis used the intention-to-treat last observation carried forward method. Two sensitivity analyses were conducted among completer and responder populations. Results The base-case analysis revealed statistically significant differences in response rate in favor of pregabalin 300 mg versus gabapentin 1200 mg (odds ratio, 1.82; 95% confidence interval, 1.02, 3.25) and pregabalin 600 mg versus gabapentin 1800 mg (odds ratio, 2.52; 95% confidence interval, 1.21, 5.27). Both sensitivity analyses supported the findings of the base-case analysis, although statistical significance was not demonstrated. All dose levels of pregabalin (150 mg to 600 mg) were more efficacious than corresponding dosages of gabapentin (900 mg to 2400 mg) in terms of SFD over the last 28 days. Conclusion In patients with refractory partial epilepsy, pregabalin is likely to be more effective than gabapentin at comparable effective doses, based on clinical response and the number of SFD.