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Recently, Bizyaev et. al. (2021) conducted the first modeling of rotation curves for 153 ultra-faint, edge-on galaxies using the 3.5 m telescope at the Apache Point Observatory. These models derived high resolution rotation curves for 20 galaxies of various sizes and spiral morphologies, making new estimates of the optical scale lengths. Using the derived models, in this work we make the first fits to the rotation curves using alternative gravity, namely conformal gravity, Modified Newtonian Dynamics (MOND) and more. A robust analysis is shown including the derived rotation curve fits to the alternative gravity models, along with how the models account for empirical phenomena such as the Baryonic Tully Fisher relation and the Radial Acceleration Rule. This data is not only modern, but unique in that certain galaxies are shown to be able to be fit by standard gravity alone without dark matter.

In the last few years, alternative gravity theories have seen increased interest due to the lack of observational evidence of dark matter. Further, new empirical patterns found in rotation curve data such as the Radial Acceleration Rule (RAR) have given new testable features for gravitational theories. In this paper, we revisit two popular surveys of galaxies (Randriamampandry et al 2013 and Bottema et al 2015) which when published were shown to be problematic for alternative gravity. Here, we apply the most recent observational parameters to the surveys and provide fits of Conformal Gravity, MOND as well as the RAR rotation curve formalism and show how these theories can apply to the new findings. We also provide the fits to the RAR and Tully-Fisher relation for each theory and discuss how the RAR may allow for some confining of parameters in the fitting procedure.

During the 2016 International Workshop on Astronomy and Relativistic Astrophysics (IWARA), the question was raised as to if conformal gravity could explain the timely result of McGaugh et. al. 2016 which showed a universal nature found in the centripetal accelerations of spiral galaxies. At the time of the conference, the McGaugh result was only published for two weeks. Since then, the result has become known as the Radial Acceleration Relation (RAR) and has been considered tantamount to a natural law. In this work, we summarize how conformal gravity can explain the Radial Acceleration Rule in a fashion consistent with the findings of the original authors without the need for dark matter., Comment: 5 pages, 5 figures. Submitted to Astronomische Nachrichten (AN), December 5, 2018

The objective of this study was to survey general practitioners (GPs) in Ireland regarding their experience with elder abuse. A random sample of 800 GPs were mailed a survey in March 2010, with a reminder in May 2010, yielding a 24% response rate. The majority, 64.5%, had encountered elder abuse, with 35.5% encountering a case in the previous year. Most were detected during a home visit. Psychological abuse and self-neglect were most common. Most GPs in Ireland have encountered cases of elder abuse, most were willing to get involved beyond medical treatment, and 76% cited a need for more education.

Elder abuse and neglect receives the least attention, when compared with child abuse and intimate partner violence in terms of funding and research, despite significant prevalence with at least 10 % of community elders being victimized in the past year. Abuse results in increased mortality, morbidity, and robs the victim of quality of life. It is imperative for all sectors of society including the elderly, healthcare providers, the public, policymakers, law enforcement, and those in the legal and financial sectors to be educated regarding a role in responding to this societal problem. Much can be learned from successful educational and training programs in the child abuse and intimate partner violence domains. The National Center on Elder abuse and Neglect is rich in educational resources. Efforts to educate the public have been launched by national institutions such as AARP and the popular press—Wall Street Journal, New York Times, and national television programs. Elements of a successful educational or training program include acknowledging the context where the abuse is encountered: clinic, nursing home, or the bank; adapting the program to the participants being educated, recognizing that one size does not fit all, and also sensitivity to cultural and community factors. Educators ideally need to be experts in their field. An interdisciplinary emphasis, which is case-based with adequate time for discussion and debate with follow up for reinforcement, should be emphasized.

Galactic rotation curves have proven to be the testing ground for dark matter bounds in spiral galaxies of all morphologies. Dwarf galaxies serve as an increasingly interesting case of rotation curve dynamics due to their typically rising rotation curve as opposed to the flattening curve of large spirals. These galaxies usually vary in galactic structure and mostly terminate at small radial distances. This, coupled with the fact that Cold Dark Matter theories struggle with the universality of galactic rotation curves, allow for exclusive features of alternative gravitational models to be analyzed. Recently, the THINGS (The HI Nearby Galactic Survey) has been extended to include a sample of 25 dwarf galaxies now known as the LITTLE THINGS Survey. Here, we present a thorough application of alternative gravitational models to the LITTLE THINGS survey, specifically focusing on conformal gravity and Modified Newtonian Dynamics. An analysis and discussion of the results of the fitting procedure of the two alternative gravitational models are explored, as well as the resulting rotation curve predictions of each. Further, we show how these two alternative gravitational models account for the recently observed universal trends in centripetal accelerations in spiral galaxies. We posit here that both conformal gravity and MOND can provide an accurate description of the galactic dynamics without the need for dark matter., Comment: 13 Pages, 7 Figures, Accepted in Astrophysical Journal

We continue our study of the application of the conformal gravity theory to galactic rotation curves. Previously we had studied a varied 111 spiral galaxy sample consisting of high surface brightness galaxies, low surface brightness galaxies and dwarf galaxies. With no free parameters other than galactic mass-to-light ratios, we had found that the theory is able to account for the systematics that are observed in the entire set of galactic rotation curves without the need for any dark matter whatsoever. In this paper, we extend our study to an additional set of 27 galaxies of which 25 are dwarf galaxies, and provide updated studies of three additional galaxies that had been in the original sample, and again without dark matter find fully acceptable fits, save only for just a few galaxies that we find to be somewhat troublesome. Our current study brings to 138 the number of rotation curves of galaxies that have been accounted for by the conformal gravity theory. Since one of the primary ingredients in the theory is a universal contribution to galactic motions coming from matter exterior to the galaxies, and thus independent of them, our study reinforces one of the central concepts of the conformal gravity studies, namely that invoking dark matter should be viewed as being nothing more than an attempt to describe global physics contributions in purely local galactic terms.

Self-neglect represents a unique set of challenges to society and, in particular, practitioners in healthcare and social agencies. Despite the fact that self-neglect has been recognized for millennia, our ability to understand, prevent and successfully intervene has hardly improved. Self-neglect seems to particularly affect women, increases mortality and imposes a huge cost on society. Ethical challenges arise for the provider attempting to balance patient autonomy, safety and an approach that emphasizes beneficence, which may violate patient wishes. Given expected demographic trends, an increase in the older population, a decline in social service programs, a decline in the economy and less family support, the incidence of self-neglect is likely to increase; however, there have been few advances in the management of this condition.

Using the linearized Einstein gravitational field equations and the Maxwell field equations it is shown that the plane of polarization of an electromagnetic wave is rotated by the gravitational field created by the electromagnetic radiation of a ring laser. It is further shown that this gravitational Faraday effect shares many of the properties of the standard electromagnetic Faraday effect. An experimental arrangement is then suggested for the observation of this gravitational Faraday effect induced by the ring laser.

Certain cancer patients benefit from chemoradiotherapy that simultaneously applies radiation therapy and chemotherapy to targeted tissue. Infusion pumps administer the chemical agents for chemotherapy. Inadvertently during the treatment, radiation penetrating into the infusion pumps may damage the internal solid state, integrated circuit chips. Such defects may result in inaccurate dosing. Although the manuals for infusion pumps from the manufacturers warn against device use in radiological environments, the devices continue to be used during chemoradiotherapy. Proper shielding of the devices during exposure to radiation could minimize risk of device malfunction. Lead shielding has disadvantages of toxicity, weight, and bulkiness. In this study we have researched and tested potential non-lead composites for shielding. Micro particles of Bismuth (III) oxide (BO) were impregnated into two materials at various percent weights: Polydimethylsiloxane (PDMS) and Polyurethane Elastomer (PU). PDMS/BO samples attenuated X-rays of 52 kVp at 4 mm thickness. PU/BO attenuated X-rays of 52kVp at 3 mm thickness. The addition of BO to industry plastics shows promise toward use as shield to reduce risk of X-ray induced defects for infusion pumps within diagnostic ranges of radiation (1-150kVp). More development and testing are necessary to explore the effectiveness of the material at therapeutic levels (>150kVp) and to expand the potential clinical applications.

In recent years, due to the lack of direct observed evidence of cold dark matter, coupled with the shrinking parameter space to search for new dark matter particles, there has been increased interest in Alternative Gravitational theories. This paper, addresses three recent advances in conformal gravity, a fourth order renormalizable metric theory of gravitation originally formulated by Weyl, and later advanced by Mannheim and Kazanas. The first section of the paper applies conformal gravity to the rotation curves of the LITTLE THINGS survey, extending the total number of rotation curves successfully fit by conformal gravity to well over 200 individual data sets without the need for additional dark matter. Further, in this rotation curve study, we show how MOND and conformal gravity compare for each galaxy in the sample. Second, we look at the original Zwicky problem of applying the virial theorem to the Coma cluster in order to get an estimate for the cluster mass. However, instead of using the standard Newtonian potential, here we use the weak field approximation of conformal gravity. We show that in the conformal case we can get a much smaller mass estimate and thus there is no apparent need to include dark matter. We then show that this calculation is in agreement with the observational data from other well studied clusters. Last, we explore the calculation of the deflection of starlight through conformal gravity, as a first step towards applying conformal gravity to gravitaitonal lensing.

SUMMARY Initially described in 1953, the concept of self-neglect is complex. Definitional problems exist because it can be redefined by changes in context. This article examines the epidemiology, etiology, detection, ethical/legal issues, management/intervention, and outcome. Prevention is particularly difficult given the nature of the problem, the poorly understood etiology, and the slow insidious progression of the syndrome before it reaches public attention. This complexity is compounded by the fact that respect for autonomy and personal rights is given paramount importance over paternalism when an intervention at an earlier stage could potentially result in a better outcome.

SUMMARY Self-neglect inevitably poses ethical dilemmas for those involved in providing help. The balance between respect for the autonomy of the victim and the desire to act in a beneficent manner oftentimes results in disagreement and tension. The issue of refusal of treatment and the determination of decisional capacity are explored. Advocacy for the victim in the least intrusive manner is recommended.

SUMMARY Older adults frequently engage in such indirect life-threatening behaviors as extreme lack of self-care, refusal to eat, refusal to take medications, and failure to comply with an understood medical regimen. These behaviors are often classified as non-compliance or passive suicide. Analysis of such phenomena reveals that these actions can represent attempts by the person to gain control of and to ameliorate a negative life situation. A case is presented which demonstrates the ultimate outcome of engagement in such behavior when it is misinterpreted and left untreated. The functions of indirect life-threatening behavior are discussed.

Gravitational theories outside standard general relativity have been drawing increased attention over the past several years, mostly due to the lack of direct observational evidence of dark matter. With some recent very high level dark matter searches continuing, and the parameter space to search decreasing has lead to a new interest in rethinking gravity at the largest of scales. As an alternative gravitational theory, conformal gravity has enjoyed much of the success of Modified Newtonian Dynamics (MOND) in predicting phenomenology, but differs dramatically in its initial construction. In this work, we explore some recent advances in conformal gravity, which help to build the case for support of such an alternative theory. Here, we highlight conformal gravity’s success in fitting new rotation curves, its ability to explain velocity dispersions in clusters, the initial steps towards gravitational lensing and finally, some preliminary work on explaining universal centripetal acceleration trends in galaxies.

from 90 to 104 years, with a mean age of 92 years. PrimaryTHA was performed in 47 patients (48 hips) and revisionTHA in 18 patients.Although 39 of the 65 patients were women, menrepresented a higher percentage than exists in the commu-nity, and 50% of all hip revisions were in men. Because ofthe reduced differential in life expectancy between menand women, more men are likely to require surgery in thefuture. This group had some unusual features in that themean weight of the primary and revision THA group was75 kg and 61 kg, respectively, which is somewhat surpris-ing and perhaps higher than one would expect for this agegroup (1 patient weighed 160 kg). The multiple comorbidconditions were as expected, with hypertension, conges-tive heart failure, and anemia being the most common.Other chronic illnesses were also present. The medianAmerican Society of Anesthesiologists preoperativescore in both groups was 3 on a scale of 1 to 5, denotingthe presence of physiologically important systemic dis-ease. The main reason for surgery in the primary THAgroup was osteoarthritis, whereas prosthetic looseningwas the probable cause of revision THA. The low per-centage of patients who had transient confusion leads oneto infer that individuals with dementia were excludedfrom surgery. The prevalence of dementia in this agegroup is probably at least 50%; thus, at least half of thisage cohort might not have met eligibility criteria for thissurgery. Follow-up data were available for a mean of 3.2years.See also page 285.Previous studies have shown positive outcomes ofTHA in patients older than 80 years compared with acontrol group whose mean age was 61 years.

BACKGROUND there is little consistent data on patterns of reporting of elder abuse in Europe. Between 2002 and 2007, the Irish Health Service Executive developed dedicated structures and staff to support the prevention, detection and management of elder abuse without mandatory reporting. Public awareness campaigns, staff training and management briefings heightened awareness regarding this new service. Central to this process is the development of a national database which could provide useful insights for developing coordinated responses to elder abuse in Europe. OBJECTIVE to report the rate of referrals of elder abuse, patterns of elder abuse and outcomes of interventions related to a dedicated elder abuse service in the absence of mandatory reporting. METHODS data on all referrals were recorded at baseline by a national network of Senior Case Workers dedicated to elder abuse, with follow-up conducted at 6 months and/or case closure. All cases were entered on a central database and tracked through the system. The study design was cross-sectional at two time points. RESULTS of 1,889 referrals, 381 related to self-neglect. Of the remaining 1,508, 67% (n = 1,016) were women. In 40% (n = 603) of cases, there was more than one form of alleged abuse. Over 80% of cases referred related to people living at home. At review 86% (n = 1,300) cases were closed, in 101 client had died, 10% of these clients had declined an intervention. Cases are more likely to be open longer than 6 months if substantiated 36 versus 21% in the closed cases. Consultation with the police occurred in 12% (n = 170) of cases. The majority of clients (84% n = 1,237) had services offered with 74% (n = 1,085) availing of them. Monitoring, home support and counselling were the main interventions. CONCLUSION the number of reported cases of abuse in Ireland indicates an under-reporting of elder abuse. The classification of almost half of the cases as inconclusive is a stimulus to further analysis and research, as well as for revision of classification and follow-up procedures. The provision of services to a wide range of referrals demonstrated a therapeutic added benefit of specialist elder abuse services. The national database on elder abuse referrals provides valuable insight into patterns of elder abuse and the nature of classification and response. The pooling of such data between European states would allow for helpful comparison in building research and services in elder abuse.

Twenty-five years of involvement with elder abuse and neglect has yielded mixed results. The contribution by physicians to elder abuse, in contrast with child abuse, has been very limited. Physicians, despite being in an advantaged position to intervene, lag behind other professionals in reporting. Potential remedies include identification of abuse as a syndrome to allow for reimbursement, increased education and research funding, and a greater advocacy role by physician organizations.

We apply the conformal gravity theory to a sample of 111 spiral galaxies whose rotation curve data points extend well beyond the optical disk. With no free parameters other than galactic mass to light ratios, the theory is able to account for the systematics that is observed in this entire set of rotation curves without the need for any dark matter at all. In previous applications of the theory a central role was played by a universal linear potential term $V(r)=\gamma_0 c^2r/2$ that is generated through the effect of cosmology on individual galaxies, with the coefficient $\gamma_0=3.06\times 10^{-30} {\rm cm}^{-1}$ being of cosmological magnitude. Because the current sample is so big and encompasses some specific galaxies whose data points go out to quite substantial distances from galactic centers, we are able to identify an additional globally induced universal term in the data, a quadratic $V(r)=-\kappa c^2r^2/2$ term that is induced by inhomogeneities in the cosmic background. With $\kappa$ being found to be of magnitude $\kappa=9.54\times 10^{-54} {\rm cm}^{-2}$, through study of the motions of particles contained within galaxies we are thus able to both detect the presence of a global de Sitter-like component and provide a specific value for its strength. Our study suggests that invoking dark matter may be nothing more than an attempt to describe global physics effects such as these in purely local galactic terms., Comment: revtex4, 50 pages, 114 figures. Text expanded

We have made a conformal gravity fit to an available sample of 110 spiral galaxies, and report here on the 20 of those galaxies whose rotation curve data points extend the furthest from galactic centers. We identify the impact on the 20 galaxy data set of a universal de Sitter-like potential term $V(r)=-\kappa c^2r^2/2$ that is induced by inhomogeneities in the cosmic background. This quadratic term accompanies a universal linear potential term $V(r)=\gamma_0c^2r/2$ that is associated with the cosmic background itself. We find that when these two potential terms are taken in conjunction with the contribution generated by the local luminous matter within the galaxies, the conformal theory is able to account for the rotation curve systematics that is observed in the entire 110 galaxy sample, without the need for any dark matter whatsoever. With the two universal coefficients being found to be of global magnitude, viz. $\kappa =9.54\times 10^{-54} {\rm cm}^{-2}$ and $\gamma_0=3.06\times 10^{-30}{\rm cm}^{-1}$, our study suggests that invoking the presence of dark matter may be nothing more than an attempt to describe global effects in purely local galactic terms. With the quadratic potential term having negative sign, galaxies are only able to support bound orbits up to distances of order $\gamma_0/\kappa = 3.21\times 10^{23} {\rm cm}$, with global physics thus imposing a natural limit on the size of galaxies., Comment: Revtex4, 11 pages, 20 figures. Some minor changes made. Results not affected

The conventional method for calculating the dielectric tensor for metamaterial relies on finding a transformation from the physical space containing the medium to a virtual electromagnetic space. Such a transformation exists if, and only if, the space is flat, which greatly restricts the way in which we are able to manipulate light. Furthermore, the transformation medium must not alter the temporal coordinate. Here, we show an alternate method for calculating the dielectric tensor that stems from the light ray trajectory equation derived from the metric. Thus, the process of defining an explicit transformation is circumvented entirely. We show that this method reproduces the correct results for the cylindrical cloaking device, and we use it to derive the material parameters of a device that gives rise to a curved space in which light rays follow closed Keplerian orbits.

We show that the standard perfect fluid paradigm is not necessarily a valid description of a curved space steady state gravitational source. Simply by virtue of not being flat, curved space geometries have to possess intrinsic length scales, and such length scales can affect the fluid structure. For modes of wavelength of order or greater than such scales eikonalized geometrical optics cannot apply and rays are not geodesic. Covariantizing thus entails not only the replacing of flat space functions by covariant ones, but also the introduction of intrinsic scales that were absent in flat space. In principle it is thus unreliable to construct the curved space energy-momentum tensor as the covariant generalization of a geodesic-based flat spacetime energy-momentum tensor. By constructing the partition function as an incoherent average over a complete set of modes of a scalar field propagating in a curved space background, we show that for the specific case of a static, spherically symmetric geometry, the steady state energy-momentum tensor that ensues will in general be of the form $T_{\mu\nu}=(\rho+p)U_{\mu}U_{\nu}+pg_{\mu\nu}+\pi_{\mu\nu}$ where the anisotropic $\pi_{\mu\nu}$ is a symmetric, traceless rank two tensor which obeys $U^{\mu}\pi_{\mu\nu}=0$. Such a $\pi_{\mu\nu}$ type term is absent for an incoherently averaged steady state fluid in a spacetime where there are no intrinsic length scales, and in principle would thus be missed in a covariantizing of a flat spacetime $T_{\mu\nu}$. While the significance of such $\pi_{\mu\nu}$ type terms would need to be evaluated on a case by case basis, through the use of kinetic theory we reassuringly find that the effect of such $\pi_{\mu\nu}$ type terms is small for weak gravity stars where perfect fluid sources are commonly used., Comment: Final version to appear in General Relativity and Gravitation (the final publication is available at http://www.springerlink.com). 29 pages, 1 figure

Now in its Fifth Edition, "Reichel's Care of the Elderly" continues to provide comprehensive, clinical approaches to the whole geriatric patient, geared specifically to the family practitioner. New topics covered in this edition include behavioral disturbances in dementia, driving and the older adult, clinical practice guidelines in the elderly, ethnic diversity, spiritual aspects of aging, healthcare organizations, Alzheimer's disease, end-of-life care, and aging in adults.

A geriatric curriculum model employed in the Family Practice Residency Program at Michigan State University is presented. Development of the two-year Program with longitudinal patient care experienced is described. Evaluation data indicate improvement in resident attitudes toward geriatric patients and the ability to interact effectively within a multidisciplinary team. Paradoxically, residents are critical of the decreased daily involvement of the attending physician which is a necessary consequence of increased involvement of the team, particularly the clinical nurse specialist.

Objectives To identify current pain management practices in the long-term care setting; and, implement and evaluate a comprehensive pain management program in the long-term care setting. Design An interventional pilot study. Setting Community-based long-term care facilities. Methods This study was conducted in two phases. Phase I consisted of interviewing long-term care facility administrators to ascertain current pain management policies and practices. This information was used to develop the Phase II intervention that involved collecting benchmark data, creating or modifying pain policies and procedures, implementing a pain management program and presenting educational programs. Measurements Interviews with long term care administrators; facility and resident demographic data; chart audits for pain assessment and management data; pharmacy audits; telephone surveys. Results Pain management policies and practices were inadequate prior to the study intervention. No facilities had policies or procedures that required ongoing (daily, weekly, etc.) pain assessment. Only one facility had mechanisms in place for measuring the presence or intensity of pain in their non-verbal, cognitively-impaired residents. Following the pain management program intervention, pain assessment significantly increased. and treatment for pain was provided for the vast majority of those indicating pain. All sites had a standardized pain assessment program in place one-year post-study completion. Conclusions Standardized pain management programs are critical to improving pain management in long-term care settings. Improvement in long-term care pain management can be obtained through a comprehensive pain management program that involves staff education, changes in pain policies and procedures, and identifying pain management as a quality indicator.

Galactic rotation curves have proven to be the testing ground for dark matter bounds in galaxies, and our own Milky Way is one of many large spiral galaxies that must follow the same models. Over the last decade, the rotation of the Milky Way galaxy has been studied and extended by many authors. Since the work of conformal gravity has now successfully fit the rotation curves of almost 140 galaxies, we present here the fit to our own Milky Way. However, the Milky Way is not just an ordinary galaxy to append to our list, but instead provides a robust test of a fundamental difference of conformal gravity rotation curves versus standard cold dark matter models. It was shown by Mannheim and O'Brien that in conformal gravity, the presence of a quadratic potential causes the rotation curve to eventually fall off after its flat portion. This effect can currently be seen in only a select few galaxies whose rotation curve is studied well beyond a few multiples of the optical galactic scale length. Due to the recent work of Sofue et al and Kundu et al, the rotation curve of the Milky Way has now been studied to a degree where we can test the predicted fall off in the conformal gravity rotation curve. We find that - like the other galaxies already studied in conformal gravity - we obtain amazing agreement with rotational data and the prediction includes the eventual fall off at large distances from the galactic center.

Psychosis may pose a greater challenge than cognitive decline for patients with dementia and their caregivers. The nature and frequency of psychotic symptoms varies over the course of illness, but in most patients, these symptoms occur more often in the later stages of disease. Management of psychosis requires a comprehensive nonpharmacologic and pharmacologic approach, including an accurate assessment of symptoms, awareness of the environment in which they occur, and identification of precipitants and how they affect patients and their caregivers. Nonpharmacologic interventions include counseling the caregiver about the nonintentional nature of the psychotic features and offering coping strategies. Approaches for the patient involve behavior modification; appropriate use of sensory intervention; environmental safety; and maintenance of routines such as providing meals, exercise, and sleep on a consistent basis. Pharmacologic treatments should be governed by a "start low, go slow" philosophy; a monosequential approach is recommended, in which a single agent is titrated until the targeted behavior is reduced, side effects become intolerable, or the maximal dosage is achieved. Atypical antipsychotics have the greatest effectiveness and are best tolerated. Second-line medications include typical antipsychotics for short-term therapy; and, less often, anticonvulsants, acetylcholinesterase inhibitors, antidepressants, and anxiolytics. Goals of treatment should include symptom reduction and preservation of quality of life.

Edema is the result of an imbalance in the filtration system between the capillary and interstitial spaces. The kidneys play a key role in regulating extracellular fluid volume by adjusting sodium and water excretion. Major causes of edema include venous obstruction, increased capillary permeability, and increased plasma volume secondary to sodium and water retention. A systematic approach is warranted to determine the underlying diagnosis. Treatment includes sodium restriction, diuretic use, and appropriate management of the underlying disorder. Leg elevation may be helpful in some patients. Loop diuretics often are used alone or in combination. In patients with New York Heart Association class III and IV congestive heart failure, spironolactone has been found to reduce morbidity and mortality rates. In patients with cirrhosis, ascites is treated with paracentesis and spironolactone. Dihydropyridine-induced edema can be treated with an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker. Lymphedema occurs when a protein-rich fluid accumulates in the interstitium. Compression garments and range-of-motion exercises may be helpful in patients with this condition.

Infantile colic can be distressing to parents whose infant is inconsolable during crying episodes. Colic is often defined by the "rule of three": crying for more than three hours per day, for more than three days per week, and for longer than three weeks in an infant who is well-fed and otherwise healthy. The physician's role is to ensure that there is no organic cause for the crying, offer balanced advice on treatments, and provide support to the family. Colic is a diagnosis of exclusion that is made after performing a careful history and physical examination to rule out less common organic causes. Treatment is limited. Feeding changes usually are not advised. Medications available in the United States have not been proved effective in the treatment of colic, and most behavior interventions have not been proved to be more effective than placebo. Families may turn to untested resources for help, and the physician should offer sound advice about these treatments. Above all, parents need reassurance that their baby is healthy and that colic is self-limited with no long-term adverse effects. Physicians should watch for signs of continuing distress in the child and family, particularly in families whose resources are strained already.

Background. This study examines the effects of the Eden Alternative (EA), a systematic introduction of pets, plants, and children into a nursing home, on the quality of life of nursing home residents. Methods. Two nursing homes run by the same organization participated. The study site began implementing the EA in November 1998. The control site continued traditional care. Patient-level data from the Minimum Data Set (MDS), Version 2.0, and aggregate data based on staff reports were used to compare the residents at the two sites in terms of cognition, survival, immune function, functional status, and cost of care after 1 year. Results. After adjusting for baseline differences, follow-up MDS data indicated that the Eden site had significantly greater proportions of residents who had fallen within the past 30 days ( p � .011) and residents who were experiencing nutritional problems ( p � .001). Staff report data indicated that, during the study period, the Eden site had significantly higher rates of residents requiring skilled nursing and hypnotic prescriptions, and more staff terminations and new hires. The control site had significantly higher rates of residents requiring anxiolytic prescriptions. Conclusions. The findings from this study indicate no beneficial effects of the EA in terms of cognition, functional status, survival, infection rate, or cost of care after 1 year. However, qualitative observations at the Eden site indicated that the change was positive for many staff as well as residents, suggesting that it may take longer than a year to demonstrate improvements attributable to the EA.