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Background: Due to the aging population of China, the need for palliative care will increase. However, one of the barriers to utilization of palliative care is the traditional belief that talking about death and dying is taboo. Objective: The aim of this study was to examine to what extent older Chinese patients were willing to answer questions about death and dying by asking them about 'fear of death' and their desire to 'use advanced life support when dying.' Design: Survey questionnaire. Setting/Subjects: Convenience sample ( N = 993 hospitalized patients). Results: Only 215 (21.7%; 95% confidence interval [CI] 16.2%-27.1%) and 99 (9.9%; 95% CI 4.1%-15.8%) patients did not answer the questions related to 'fear of death' and 'use of advanced life support when dying,' respectively, while 439 (44.2%; 95% CI 38.7%-49.7%) answered 'yes' and 339 (34.1%; 95% CI 28.7%-39.6%) answered 'no' for 'fear of death' and 382 (38.5%; 95% CI 32.6%-44.3%) answered 'yes' and 512 (51.6%; 95% CI 45.7%-57.4%) answered 'no' for 'use of advanced life support when dying.' In multinomial logistic regression analysis, fear of death was associated with younger age, lowest level of function, and desire to use advanced life support. Conclusions: The majority of older patients were willing to answer the two questions about death and dying. About one-third of patients were not afraid of death, and older patients were less likely to be afraid of death. More than 50% of patients answered that they would not choose advanced life support when dying. More research in this area is needed to help advance palliative care in China. [ABSTRACT FROM AUTHOR]

Delirium is common in acute, postacute, and long-term care settings, and it can be difficult to recognize, especially without deliberate mental status evaluation. Because delirium typically presents with altered arousal and arousal can be assessed within a matter of seconds, routine assessment of arousal offers an efficient means of delirium screening. Nevertheless, impaired arousal often precludes formal assessment of attention and awareness, the cardinal features of delirium per the current Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition . Here we debate the relative merits of “ruling in” as delirious noncomatose patients with impaired arousal (inclusive approach) vs reserving delirium diagnosis to patients in whom diagnostic criteria can be elicited (restrictive approach). Inclusivism provides efficiency and may prevent missing or delaying delirium diagnosis. The restrictive approach challenges the utility of ruling such patients in as delirious and advocates for identifying mental states that directly inform clinical care. Both positions, however, firmly emphasize the value of routine clinical assessment of arousal. [ABSTRACT FROM AUTHOR]

New Findings What is the central question of this study? Alveolar-capillary membrane conductance for nitric oxide (measured as lung diffusion of NO; DLNO) is not thought to be improved with regular exercise training in adult humans. The purpose was to examine the effect of regular exercise training on DLNO in unfit adult women., What is the main finding and its importance? Women performing moderate-intensity physical activity (4-6 metabolic equivalent tasks, or METS, 800 kcal week−1, for 6 weeks) can improve DLNO to a similar extent compared to women performing vigorous-intensity physical activity (>6 METS, 700 kcal week−1, for 6 weeks); however, the magnitude of improvement in DLNO will probably be small and physiologically questionable. This demonstrates that interval training may not provide additional improvements in DLNO compared with moderate-intensity physical activity., The purpose of the study was to determine whether short-term high-intensity aerobic interval training improves resting pulmonary diffusing capacity for nitric oxide (DLNO) and carbon monoxide (DLCO). Twenty-eight sedentary women [mean (SD) age 32 (11) years, body mass index 24.3 (5.7) kg m−2] were randomly assigned to either a self-directed moderate-intensity physical activity ( n = 14) group or a supervised high-intensity aerobic interval training group ( n = 14). The moderate physical activity group and the aerobic interval training group increased weekly physical activity energy expenditure by 800 and 1600 kcal week−1, respectively. After 6 weeks, aerobic capacity increased to a similar exent in both groups (mean improvement 8%, effect size 0.39). The DLNO, but not DLCO, increased to a similar extent in both groups, by 4% or 3.0 (5.7) [95% confidence interval 0.8, 5.2] ml min−1 mmHg−1 m−2 from pre- to post-training (effect size 0.27). There was no correlation between the change in aerobic capacity and the change in DLNO ( P > 0.05) or between the change in aerobic capacity and the change in total weekly physical activity energy expenditure ( P > 0.05). Interval training does not provide additional improvements in DLNO or aerobic capacity compared with self-directed moderate-intensity physical activity (4-6 metabolic equivalent tasks, 800 kcal week−1, for 6 weeks) in unfit women. Despite the slight improvement in both DLNO and aerobic capacity, true meaningful physiological changes in these parameters remain questionable. [ABSTRACT FROM AUTHOR]

Objectives To examine evidence of the efficacy of antipsychotics in the treatment of delirium in older hospitalized adults. Design Systematic literature review. Setting Hospital. Participants Older adults with delirium. Measurements The MEDLINE (January 1980-December 2010) and Cochrane Databases were searched using the keywords 'delirium' and 'antipsychotics.' References of review articles were reviewed to identify additional studies. Study selection criteria included prospective design, more than 10 participants (in treatment arms), mean age 60 and older, standardized criteria for diagnosing delirium, and validated delirium rating scales for reporting outcomes. Results Thirteen articles met selection criteria: six single-agent and seven comparison studies. Of these, eight (62%) had fewer than 25 participants in treatment arms, 10 (77%) recruited participants from psychiatry referrals, and eight (62%) did not clearly describe their screening methods. All single-agent studies were open-label studies. Of the comparison studies, five (71%) used randomization, but only one of these (a placebo-controlled study) used adequate allocation concealment methods, and only one other study (comparing two antipsychotics) described a double-blind method in detail. In the only placebo-controlled study (which was stopped early), no statistically significant differences in mean delirium severity scores were found at individual time points (Days 2, 3, 4, 7, 10). The other 12 studies reported improvements in delirium severity or resolution of delirium based on cutoff scores of the scales, but it is not clear from any of these studies what the natural course of delirium would have been without use of antipsychotics. Conclusion Because of severe methodological limitations, the studies in this review do not support the use of antipsychotics in the treatment of delirium in older hospitalized adults. Additional well-designed randomized placebo-controlled trials are needed. [ABSTRACT FROM AUTHOR]

Delirium is associated with several negative outcomes and is not always preventable. Current practices for the management of older hospitalized adults with delirium, such as one-on-one sitters, antipsychotic medications, and physical restraints, have limited effectiveness or potential health risks. An alternative management model, called the Delirium Room ( DR), is a four-bed patient room (within an Acute Care for Elders ( ACE) Unit) that provides 24-hour nursing care, emphasizes nonpharmacological approaches, and is completely free of physical restraints. This article is based on 13 years of experience at two hospitals. The authors have found that a restraint-free environment can be achieved; 'tolerate, anticipate, and don't agitate' (the T- A- DA method) are the core principles of the nonpharmacological approach that go beyond the traditional strategies of management (such as reorientation); based on observational data, it appears that negative outcomes associated with delirium, such as loss of function, longer hospital stay, and greater mortality, can be decreased to levels seen in individuals without delirium; and based on limited data, it appears that the rate of falls is at least not higher in the DR than in the ACE unit overall. The limitations of the DR model include lack of randomized controlled trials and the inability to determine which component of the model provides its benefits. [ABSTRACT FROM AUTHOR]

Objectives To examine evidence of the efficacy of antipsychotics in the treatment of delirium in older hospitalized adults. Design Systematic literature review. Setting Hospital. Participants Older adults with delirium. Measurements The MEDLINE (January 1980-December 2010) and Cochrane Databases were searched using the keywords 'delirium' and 'antipsychotics.' References of review articles were reviewed to identify additional studies. Study selection criteria included prospective design, more than 10 participants (in treatment arms), mean age 60 and older, standardized criteria for diagnosing delirium, and validated delirium rating scales for reporting outcomes. Results Thirteen articles met selection criteria: six single-agent and seven comparison studies. Of these, eight (62%) had fewer than 25 participants in treatment arms, 10 (77%) recruited participants from psychiatry referrals, and eight (62%) did not clearly describe their screening methods. All single-agent studies were open-label studies. Of the comparison studies, five (71%) used randomization, but only one of these (a placebo-controlled study) used adequate allocation concealment methods, and only one other study (comparing two antipsychotics) described a double-blind method in detail. In the only placebo-controlled study (which was stopped early), no statistically significant differences in mean delirium severity scores were found at individual time points (Days 2, 3, 4, 7, 10). The other 12 studies reported improvements in delirium severity or resolution of delirium based on cutoff scores of the scales, but it is not clear from any of these studies what the natural course of delirium would have been without use of antipsychotics. Conclusion Because of severe methodological limitations, the studies in this review do not support the use of antipsychotics in the treatment of delirium in older hospitalized adults. Additional well-designed randomized placebo-controlled trials are needed. [ABSTRACT FROM AUTHOR]

Delirium is associated with several negative outcomes and is not always preventable. Current practices for the management of older hospitalized adults with delirium, such as one-on-one sitters, antipsychotic medications, and physical restraints, have limited effectiveness or potential health risks. An alternative management model, called the Delirium Room ( DR), is a four-bed patient room (within an Acute Care for Elders ( ACE) Unit) that provides 24-hour nursing care, emphasizes nonpharmacological approaches, and is completely free of physical restraints. This article is based on 13 years of experience at two hospitals. The authors have found that a restraint-free environment can be achieved; 'tolerate, anticipate, and don't agitate' (the T- A- DA method) are the core principles of the nonpharmacological approach that go beyond the traditional strategies of management (such as reorientation); based on observational data, it appears that negative outcomes associated with delirium, such as loss of function, longer hospital stay, and greater mortality, can be decreased to levels seen in individuals without delirium; and based on limited data, it appears that the rate of falls is at least not higher in the DR than in the ACE unit overall. The limitations of the DR model include lack of randomized controlled trials and the inability to determine which component of the model provides its benefits. [ABSTRACT FROM AUTHOR]

Background. Little is known about mortality among nonagenarians after an earthquake. Methods. Using secondary data analyses from the 2005 study called the Project of Longevity and Aging in Dujiangyan(n = 870), 1-year mortality rates were compared among a pre-earthquake group and a post-earthquake group of nonagenarians. All participants were from Dujiangyan, 50 km from the epicenter of the May 12, 2008 earthquake, in China. The pre-earthquake group was a subset of the 870 Project of Longevity and Aging in Dujiangyan participants, ages 93–95 years at the beginning of “Time Frame 1” (July 2005 through June 2006; n = 228). The post-earthquake group was a different subset of the 870 Project of Longevity and Aging in Dujiangyan participants, ages 93–95 years and alive at the beginning of Time Frame 2 (July 2008 through June 2009; n = 235). Time Frame 2 excluded a 7-week period following the earthquake in order to account for deaths due to trauma. Pre-earthquake health assessment data from the 2005 Project of Longevity and Aging in Dujiangyan study were used to calculate unadjusted/adjusted hazard ratios (HRs) for mortality. Results. One-year mortality rates were 8.3% (19/228) and 16.2% (38/235) in the pre-earthquake group and the post-earthquake group, respectively (p =.01). In unadjusted analyses, only “being in the post-earthquake group” was associated with death (HR = 2.04; 95% confidence interval [CI], 1.17–3.53; p = .011). In the multivariable Cox regression model, being in the post-earthquake group continued to be the strongest risk factor associated with mortality (HR = 2.47; 95% CI, 1.39–4.40; p = .002). Other significant risk factors included impaired cognition (HR = 1.97; 95% CI, 1.10–3.53; p = .024), serum albumin (HR = 0.90; 95% CI, 0.82–0.98; p < .015), and serum triglycerides (HR = 1.51; 95% CI, 1.15–1.99; p = .003). Conclusion. The May 12, 2008 earthquake in Wenchuan, China, was associated with a twofold increase in the 1-year mortality among a group of nonagenarians who lived nearby. [ABSTRACT FROM PUBLISHER]

Aims: We examined the individual association between body mass index (BMI) and cognitive function among the very elderly. Methods: The present study analyzed data from a survey that was conducted on all residents aged 90 years or more from a district which had 2,311,709 inhabitants in 2005. The subjects were divided into 4 groups according to quartiles of BMI (<16.6, 16.6-18.9, 18.9-21.1 and >21.1), and according to classification criteria of underweight, normal weight, overweight and obesity in BMI (<18.5, 18.5-23.0, 23.0-27.5 and >27.5), respectively. Results: The subjects included in the statistical analysis were 211 men and 427 women. Those in the 3rd quartile of BMI (18.9-21.1) had higher cognitive function scores (p < 0.001) and were less likely to present possible dementia (p = 0.016) than the others. However, there was no difference in cognitive function scores (p = 0.350) or prevalence of possible dementia (p = 0.263) among obesity, overweight, normal weight and underweight groups. Conclusions: Concerning longevity in Chinese, there is an association between BMI and cognitive function. BMI of around 20 (18.9-21.1) is associated with the lowest risk of prevalence of possible dementia and the highest cognitive function scores. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background. Patients with delirium, compared with those without, are at increased risk for loss of function, longer hospital stays, and increased mortality. We studied the effect that an Acute Care of the Elderly Unit, which includes a delirium room, has on patients with delirium. Methods. Retrospective observational study. Charts of 148 patients (≥65 years) admitted to an Acute Care of the Elderly Unit with a delirium room during a 4-month period were reviewed. Delirium on admission (prevalence) was based on physician-performed Confusion Assessment Method; delirium during hospital stay (incidence) was based on nurse-performed Confusion Assessment Method. Patients with delirium were compared with those without delirium regarding change in function between admission and discharge (activities of daily living), hospital length of stay, and mortality. Results. The prevalence of delirium was 16.2% (24/148), and the incidence was 16.1% (20/124). There were no significant differences between delirious and non–delirious patients in demographics or comorbidity scores. A significant interaction effect (p < .001) indicated improved activities of daily living (mean ± SD; scale 0–12) between admission and discharge among delirious patients (4.1 ± 4.6 and 6.1 ± 3.9) compared with non–delirious patients (7.4 ± 4.7 and 6.9 ± 4.5). There were no differences between delirious and non–delirious patients with reference to mean length of stay (6.4 ± 3.1 vs 5.9 ± 3.6 days, respectively; p = .461) and mortality (2 [4.5%] versus 2 [1.9%], respectively; p = .582). Conclusions. Although this study sample was small, the results suggest that an Acute Care of the Elderly Unit with a delirium room may improve function among delirious patients and may equalize other outcomes compared with non–delirious patients. [ABSTRACT FROM PUBLISHER]

Abstract: We present a new approach in the finite element framework to solve singularly perturbed convection–diffusion problems. Standard methods for these problems perform poorly because of the presence of sharp boundary and/or internal layers in the solution. The operator is elliptic within these layers and essentially hyperbolic away from them. In the proposed approach, the test function space is modified and hence fits into the class of Petrov–Galerkin finite element methods. The proposed finite element approach is motivated by, and is similar to, one proposed by Hemker [P.W. Hemker, A numerical study of stiff two-point boundary problems, Mathematical Center Tracts, vol. 80, Mathematisch Centrum, Amsterdam, 1977] for one-dimensional problems which was based on using Green’s functions to motivate appropriate test spaces. For problems in higher dimensions we no longer utilize Green’s functions, but rather we try to capture the solutions of suitably posed discretized dual problems with functions in the test space. The dual problem is posed in such a way that a weighted error at the interelement boundaries is minimized. The dual solution is exponential. Hence, the functions in the test space are exponentially fitted to provide a better approximation to the dual solution. These modified test functions fit into a hierarchical framework resulting in the development of a stable higher-order method. Accurate numerical solutions are obtained on structured and unstructured meshes, and numerical artifacts are confined to the few elements containing the boundary layers. [Copyright &y& Elsevier]

This article examines the changing demographics of China, with particular attention paid to the effect of the one-child policy in relation to long-term care of older people. It also examines the current state of health care for older people. Long-term stays characterize hospital care. Most geriatric syndromes are less common in hospitalized older people (e.g., delirium, falls), but some (e.g., polypharmacy) are more common. A high volume of patients and brief targeted visits characterize outpatient care. Nursing homes exist in China, but relatively fewer than in the most developed countries. Geriatric departments in university-based hospitals primarily have developed out of a need to care for retired government officials and workers. There are no formal geriatric fellowships or national board certifications in geriatrics Health care is primarily based on fee for service. Not all elderly have healthcare insurance. Although costs of health care and medications are less expensive than in the United States, they are relatively high for lower-and middle-class Chinese and have increased more quickly than has the standard of living in the past 20 years. Family and community support for older people is strong in China. Some older people have one-to-one care from a baomu (literally “protection” ( bao) “mother” ( mu)), a type of live-in maid who also provides care for the older person. Some of the challenges facing China in the care of its aging population are how to increase geriatric research and training, how to care for the uninsured or underinsured, and how to handle the inevitable growth of disabled and frail older people. [ABSTRACT FROM AUTHOR]

Abstract: We develop a method of evaluating element level matrices and vectors associated with p-version finite element computations on tetrahedral meshes with curved boundaries. The procedure uses optimal interpolation formula [Q. Chen, I. Babuška, Approximate optimal points for polynomial interpolation of real functions in an interval and in a triangle, Comput. Methods Appl. Mech. Engrg. 128 (1995) 405–417; Q. Chen, I. Babuška, Approximate optimal polynomial interpolation points in the tetrahedron, Comput. Methods Appl. Mech. Engrg. 137 (1997) 89–94] for non-polynomial portions of integrands followed by exact integration. Exact integrals of product combinations of polynomial interpolants and shape functions are stored so that different integrals may be efficiently evaluated by a table look-up. We present error-analysis for our scheme applied to curvilinear tetrahedral meshes with exact geometric representation of the boundary of the domain as defined in a geometric-modelling system. Numerical results are presented for problems involving the Helmholtz equation. [Copyright &y& Elsevier]

Abstract: We use an artificial viscosity term to stabilize discontinuous Galerkin solutions of hyperbolic conservation laws in the presence of discontinuities. Viscous coefficients are selected to minimize spurious oscillations when a kinematic wave equation is subjected to piecewise constant initial data. The same strategy is used with a local linearization in more complex situations. Several one and two-dimensional flow problems illustrate performance. A shock detection scheme [L. Krivodonova, J. Xin, J.-F. Remacle, N. Chevaugeon, J.E. Flaherty, Shock detection and limiting with discontinuous Galerkin methods for hyperbolic conservation laws, Appl. Numer. Math. 48 (2004) 323–338] further sharpens results near discontinuities. [Copyright &y& Elsevier]

Abstract: Light influences numerous developmental and biochemical processes in fungi. The objectives of this research were to characterize the influence of light on growth and conidiation and associated gene expression in the plant pathogenic ascomycete, Exserohilum turcicum. We found that vegetative growth was more extensive in light/dark cycles than in constant light or darkness as measured by analysis of ergosterol content and genomic DNA. Cultures grown under continuous white light or blue light (∼465–480nm) were developmentally arrested after the formation of conidiophores, whereas those grown in continuous darkness or a light/dark cycle produced mature conidia. Incubation of conidiophore-producing cultures in darkness for a minimum of 2h was necessary and sufficient to initiate synchronous conidiation. To identify genes that are expressed during dark-induced conidiation, we constructed subtractive cDNA libraries from cultures grown under conidiation-permissive and -repressive conditions. From 816 sequenced EST clones in the conidiation-permissive and 310 in the repressive libraries, 12 putative regulatory genes were chosen for expression analysis by quantitative real-time PCR. The majority of those genes reached maximum expression by 2h after initiation of the dark period and then declined to initial levels by 4–24h in darkness. Expression of two dark-induced genes remained elevated after 24h in darkness but was reset to initial levels if cultures were returned to light. This study revealed several genes whose expression increased rapidly after dark induction of conidiation, suggesting that they encode regulators of asexual development in E. turcicum. [Copyright &y& Elsevier]

Abstract: This paper considers the technologies needed to support the creation of adaptively constructed meshes for general curved three-dimensional domains and outlines one set of solutions for providing them. A brief review of an effective way to integrate mesh generation/adaptation with CAD geometries is given. A set of procedures that support general h-adaptive refinement based on a mesh metric field is given. This is followed by examples that demonstrate the ability of the procedures to adaptively construct anisotropic meshes for flow problems. A procedure for the generation of strongly graded, curved meshes as needed for effective hp-adaptive simulations is also given. [Copyright &y& Elsevier]

Fusarium verticillioides, a pathogen of maize, produces a class of mycotoxins called fumonisins in infected kernels. In this study, a candidate regulatory gene, ZFR1, was identified in an expressed sequence tag library enriched for transcripts expressed by F. verticillioides during fumonisin B1 (FB1) biosynthesis. ZFR1 deletion mutants exhibited normal growth and development on maize kernels, but fumonisin production was reduced to less than 10% of that of the wild-type strain. ZFR1 encodes a putative protein of 705 amino acids with sequence similarity to the Zn(II)2Cys6 binuclear cluster family that are regulators of both primary and secondary metabolism in fungi. Expression of ZFR1 in colonized germ and degermed kernel tissues correlated with FB1 levels. Overexpression of ZFR1 in zfrl mutants restored FB1 production to wild-type levels; however, FB1 was not restored in an fcc1 (Fusarium C-type cyclin) mutant by overexpression of ZFR1. The results of this study indicate that ZFR1 is a positive regulator of FB1 biosynthesis in F. verticillioides and suggest that FCC1 is required for ZFR1 function. [ABSTRACT FROM AUTHOR]

Fusarium verticillioides produces a group of mycotoxins known as fumonisins in maize kernels. Fumonisins are associated with a variety of mycotoxicoses in humans and animals; thus, their presence in food is a considerable safety issue. This study addressed fumonisin B[sub 1] (FB[sub 1]) production in two components of the maize kernel, namely the germ tissues and the degermed kernel. Growth of F. verticillioides was similar in colonized germ tissue and degermed kernels, but FB[sub 1] production was at least five times higher in degermed maize kernels than in germ tissue. Expression of the fumonisin polyketide synthase gene, FUM1, as measured by β-glucuronidase (GUS) and Northern blot analysis, followed the same pattern as FB[sub 1] production. Also correlated to FB[sub 1] was a concomitant drop in pH of the colonized degermed kernels. A time course experiment showed that degermed kernels inoculated with F. verticillioides became acidified over time (from pH 6.4 to 4.7 after 10 days of incubation), whereas colonized germ tissue became alkaline over the same period (from pH 6.5 to 8.5). Because conditions of acidic pH are conducive to FB[sub 1] production and alkaline pH is repressive, the observed correlation between the acidification of degermed kernels and the increase in FB[sub 1] provides one explanation for the observed differences in FB[sub 1] levels. [ABSTRACT FROM AUTHOR]

Fumonisins are a group of mycotoxins that contaminate maize and cause leukoencephalomalacia in equine, pulmonary edema in swine, and promote cancer in mice. Fumonisin biosynthesis in Fusarium verticillioides is repressed by nitrogen and alkaline pH. We cloned a PACC-like gene (PAC1) from F. verticillioides. PACC genes encode the major transcriptional regulators of several pH-responsive pathways in other filamentous fungi. In Northern blot analyses, a PAC1 probe hybridized to a 2.2-kb transcript present in F. verticillioides grown at alkaline pH. A mutant of F. verticillioides with a disrupted PAC1 gene had severely impaired growth at alkaline pH. The mutant produced more fumonisin than the wild type when grown on maize kernels and in a synthetic medium buffered at an acidic pH, 4.5. The mutant, but not the wild type, also produced fumonisin B[sub 1] when mycelia were resuspended in medium buffered at an alkaline pH, 8.4. Transcription of FUM1, a gene involved in fumonisin biosynthesis, was correlated with fumonisin production. We conclude that PAC1 is required for growth at alkaline pH and that Pac1 may have a role as a repressor of fumonisin biosynthesis under alkaline conditions. [ABSTRACT FROM AUTHOR]

Focuses on nonemergent medical transportation (NEMT) services for older persons. Description of the Medicaid transportation system; Major problems related to NEMT; Requirement for progress towards implementing a NEMT for older persons.

Offers views on continuous quality improvement for older persons. Key role for geriatricians; Importance of careful attention to drug-drug interactions; Outline of the DR IA TROS Mnemonic for geriatricians.

Although multiple models of care exist to prevent the development of delirium in hospitalized patients, models for the management of patients for whom delirium is unpreventable or who already have delirium on admission to the hospital are needed. This article describes the development, management, and economics of a new model of care for patients with delirium, called the Delirium Room (DR). The DR is a specialized 4-bed unit that provides 24-hour intensive nursing care and is completely free of physical restraints. Another important feature of the 4-bed DR is that it is an integral part of a 22-bed acute care for the elderly (ACE) unit. As such, patients in the DR benefit from features of the ACE unit: a change in the physical environment of the medical floor to promote mobility and function and discourage bedrest, comprehensive geriatric care that identifies and addresses problems that can lead to a decline in function, and use of a daily multidisciplinary team meeting. This article also presents descriptive data on a group of delirious patients managed in the DR with the intention of giving baseline data for other ACE units that are considering opening a DR or for future prospective studies in this area. [ABSTRACT FROM AUTHOR]

Describes some computational aspects of the discontinuous Galerkin method (DGM) as its applies to hyperbolic conservation laws. Information on the DGM method; Description of Rayleigh-Taylor instability (RTI); Details of the double discretization of finite-element methods; Applications for adaptive analysis techniques; Problems associated with the selection of an error indicator for the RTI.

For clinicians who are struggling with the complexities of medical decision-making, practice guidelines and evidence-based medicine (EBM) have become increasingly popular and have potential to positively influence the practice of medicine. Nevertheless, they have their limitations. Guidelines are often rigid, based solely on age, and usually do not take into account a patient's comorbidities, life expectancy, and nonmedical preferences. EBM studies may not always include particular patient populations commonly seen by the geriatric clinician (e.g., studies on lipid-lowering agents or antihypertensive drug usually exclude the very old or patients who are frail, demented, or at the end of life). These limitations have made it difficult for geriatric clinicians to use these guidelines because of the need to individualize evaluation and treatment approaches and take into account the varied preferences of their older patients. The purpose of this paper is to present an alternative model of care for geriatric clinicians called The Clinical Glidepaths. The Clinical Glidepaths are outpatient tools intended to assist geriatric clinicians in their decision-making process. They are based on the following principles. (1) Clinicians need guidance concerning many different types of patients, not rigid guidelines based solely on age. (2) EBM should be used but has some limitations of which to be aware. (3) Clinical experience, which emphasizes individual outcomes instead of populations, is an important component of medical decisions. (4) There needs to be room for patient preferences in medical decision-making. (5) An approach to patients based on probable life expectancy and function, instead of age, will be more applicable and useful. (6) Making a useful tool will focus on common problems seen in every day geriatric practices. [ABSTRACT FROM AUTHOR]

We review several properties of the discontinuous Galerkin method for solving hyperbolic systems of conservation laws including basis construction, flux evaluation, solution limiting, adaptivity, and a posteriori error estimation. Regarding error estimation, we show that the leading term of the spatial discretization error using the discontinuous Galerkin method with degree p piecewise polynomials is proportional to a linear combination of orthogonal polynomials on each element of degrees p and p+1. These are Radau polynomials in one dimension. The discretization errors have a stronger superconvergence of order O(h2p+1), where h is a mesh-spacing parameter, at the outflow boundary of each element. These results are used to construct asymptotically correct a posteriori estimates of spatial discretization errors in regions where solutions are smooth.We present the results of applying the discontinuous Galerkin method to unsteady, two-dimensional, compressible, inviscid flow problems. These include adaptive computations of Mach reflection and mixing-instability problems. [Copyright &y& Elsevier]

Editorial. Focuses on the effects of healthy lifestyle habits on compression of morbidity in old age. Health benefits of a group exercise program; Major cause of sarcopenia leading to frailty in males; Risk factors associated with cardiovascular disease.

Determines the prevalence, patterns of reporting, and perceived effectiveness of alternative medical therapies (AT) among older white American, African American, and Japanese outpatients. Information on several issues which concern the use of AT; Characteristics of the different groups of patients; Alternative therapies used by patients; Common reasons for the use of alternative therapies; Differences in the use of AT between Japan and the United States.

Focuses on a study which examined the relation between medication use and hospitalization among older home care patients. Methods used; Primary diagnoses of patients in hospitalized and self-care or care of the family groups; Limitations of the study; Discrepancies in the findings.

Of central importance is that our clinical experience and treatment outcome studies to date strongly suggest that coercion is fundamental to addiction treatment and favorable outcomes from therapeutic interventions. Often the alcoholic/drug abuser must be given an opportunity to feel, face, or experience the "consequences" of their alcohol and drug addiction before the denial of their illness can be penetrated and motivation for treatment to recover from addictive illness can be developed. Continued use of alcohol and drugs is an unhealthy and dangerous state for those who are addicted and for others who are affected by their addictive illnesses. Effective therapeutic interventions and long-term recovery are more likely to succeed if avoiding "alternative consequences" are contingent on continued compliance with addiction treatment by those who suffer from addictive illnesses. [ABSTRACT FROM AUTHOR]

Babuška and Yu constructed a posteriori estimates for finite element discretization errors of linear elliptic problems utilizing a dichotomy principal stating that the errors of odd-order approximations arise near element edges as mesh spacing decreases while those of even-order approximations arise in element interiors. We construct similar a posteriori estimates for the spatial errors of finite element method-of-lines solutions of linear parabolic partial differential equations on square-element meshes. Error estimates computed in this manner are proven to be asymptotically correct; thus, they converge in strain energy under mesh refinement at the same rate as the actual errors. [ABSTRACT FROM AUTHOR]

Examines the use of psychiatric services by homeless veterans with mental disorders in the United States. Emergency visits of homeless veterans; Comparison with domiciled veterans with mental disorders; Demographic characteristics.

Presents a mulitvariate study of 148 caregivers of chronically ill older persons, which reports that 22 percent of those caring for a continent senior reported that maintaining continence was a burden, and 75 percent of caregivers of incontinent seniors reported it as burdensome. Methods; Results; Discussion.

Analyzes the relationship between homelessness, gender, and social agencies. Study of 102 homeless individuals; Relationship between mental illness and homelessness; Differences in the perception of social agencies; Implications of findings on service planning for the homeless.

Argues that a broadened conceptualization of stress and alienation which incorporates abusive work relationships has utility for explaining male and female drinking outcomes in both high and low status occupations. Empirical data on the relationship between perceived abusive experiences and drinking outcomes in a cohort of male and female physicians.

Presents the evolution of the author's interest on the general subject of self-disclosures in psychotherapy. Review of literature on the subject with particular attention to intercurrent events in the therapist's life that may affect ongoing therapy; Illustration of varying reactions.

The article presents the authors' views on the standard of care for delirium patients and the idea that delirium intensive care units are a cost-effective method for managing delirium. Articles in this journal by Bourdel-Marchasson and colleagues and by Kiely and colleagues are mentioned. Prevention of and factors contributing to delirium and institutionalization are discussed.

Editorial. Introduces several articles on the quality of life of elderly persons living in nursing homes.

Introduces several articles on pain assessment in elderly patients. Medical personnel responsible for assessing pain; Importance of pain assessment in predicting future disability; Economic aspects of pain evaluation.

Chronic fatigue syndrome is a disabling disorder that has been studied primarily in clinical settings. In the absence of an adequate epidemiological database, cultural stereotypes have influenced the characterization of chronic fatigue syndrome as "the yuppie flu," similar to the 19th century characterization of neurasthenia as a disease of the affluent. The limited epidemiological data available and the overall medical-sociological literature call this assumption into question. Only a community "true" prevalence study that is unbiased by help seeking and access to health care can provide an accurate assessment of the risk factors for and the public health ramifications of this disease. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor regarding the significance of acute care for the elderly delirium units.