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Victoria, Australia, is developing environmental programs based on local conservation strategies (LCS) by forming local environmental divisions and appointing specialist administration officers at local levels. The LCS program proposes a systemic approach to environmental issues by focussing on the relationship between the area, its ecology and the people. Lack of funding and rigidity in administration impede local environmental programs.

Graeme Small, George Chastellain and the Shaping of Valois Burgundy: Political and Historical Culture at Court in the Fifteenth Century (Woodbridge: Boydell Press; Royal Historical Society Publications, 1997). 302 pp. [...]

Abstract Sarcopenia, defined as a progressive loss of muscle mass and reduced muscle strength and functional capacity, is common among older adults. This study aimed to assess the proportion of people at risk of sarcopenia and probable sarcopenia among Chinese community-dwelling older adults living alone and to identify the associated factors. A total of 390 older adults were included in this study. Sarcopenia and probable sarcopenia were defined according to the criteria of the Asian Working Group for Sarcopenia 2019. Data on socio-demographic characteristics, health status, health behaviours and lifestyle characteristics, nutritional status, physical activity level, and depressive symptoms were collected. The association between these characteristics and sarcopenia risk was analysed using a multivariate ordinal logistic regression. The proportion of subjects at risk of sarcopenia and probable sarcopenia was found to be 57.7% and 30%, respectively. Older age, being malnourished and being at risk of malnutrition were significantly associated with sarcopenia risk. Being educated to secondary level or above, being overweight or obese and higher physical activity level were associated with decreased sarcopenia risk. Our results showed that older adults living alone were at high risk of developing sarcopenia and probable sarcopenia. These results emphasise the urgent need to initiate aggressive screening and holistic lifestyle therapeutic intervention strategies for this high-risk population.

We use 4 yr of Kepler photometry to study the non-eclipsing spectroscopic binary KIC 10080943. We find both components to be γ Doradus/δ Scuti hybrids, which pulsate in both p and g modes.We present an analysis of the g modes, which is complicated by the fact that the two sets of l = 1 modes partially overlap in the frequency spectrum. Nevertheless, it is possible to disentangle them by identifying rotationally split doublets from one component and triplets from the other. The identification is helped by the presence of additive combination frequencies in the spectrum that involve the doublets but not the triplets. The rotational splittings of the multiplets imply core rotation periods of about 11 and 7 d in the two stars. One of the stars also shows evidence of l = 2 modes. [ABSTRACT FROM AUTHOR]

Data indicate that patient outcomes are significantly affected by factors that can be modified through clinical practices, such as vascular access choice, dialysis dose, inter-dialytic weight gain, albumin and hemoglobin levels, and mineral and bone disorders. This article reviews recommended treatment guidelines for these factors and the ways patient outcomes are affected when targets are not achieved. Insights on how nursing practices can positively affect these components of care are also provided. [ABSTRACT FROM AUTHOR]

BACKGROUND: Limited data exist describing vascular access conversions during the first year on dialysis therapy or the effect of converting to and from a catheter on subsequent mortality risk. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: We studied a random sample of incident US hemodialysis patients (initiated long-term dialysis < 30 days before study entry) in the Dialysis Outcomes and Practice Patterns Study (DOPPS; 1996-2004). PREDICTORS: At dialysis therapy initiation, we assessed vascular access type in use (arteriovenous fistula [AVF], arteriovenous graft [AVG], or catheter) and other patient characteristics. We characterized changes in vascular access type (conversions) by using regularly collected functional status information. OUTCOME & MEASUREMENTS: We assessed time to all-cause mortality. We first described conversions, then used time-dependent Cox regression to estimate mortality hazard ratios (HRs) for conversions from a catheter to a permanent vascular access (versus no conversion) and conversions from a permanent vascular access to a catheter (versus no conversion). RESULTS: The study included 4,532 patients; 69.2% were dialyzing with a catheter; 17.6%, with an AVG; and 13.1%, with an AVF. In patients initiating therapy with an AVF or AVG, 22% experienced a conversion (failure), and median times to first failure were 62 and 84 days, respectively. In catheter patients, 59% converted to an AVF/AVG (predominantly AVG [57%]); median times to first conversion were 92 and 66 days, respectively. Conversion to a permanent access was associated with an adjusted mortality HR of 0.69 (95% confidence interval, 0.55 to 0.85). The effect was similar for conversion to an AVF or AVG, and these persisted across demographic groups and facilities with different conversion practices. Conversion from a permanent vascular access to a catheter was associated with an adjusted mortality HR of 1.81 (95% confidence interval, 1.22 to 2.68). LIMITATIONS: Potential for residual confounding because of unmeasured factors influencing decision to convert. CONCLUSION: Vascular access conversions are common in incident patients. Continued efforts to increase early nephrologist referral and permanent vascular access placement may help decrease mortality risk in incident dialysis patients. Copyright © 2009 National Kidney Foundation, Inc. [ABSTRACT FROM AUTHOR]

BACKGROUND: Confounding-by-indication is a bias in nonexperimental studies that occurs when outcomes are compared for treated and untreated patients and the treatment or medication dose is related to predictors of the outcome. Two recent publications reported that greater epoetin alfa (EPO) doses were associated with increased mortality rates. We assessed whether confounding-by-indication might account for these results. STUDY DESIGN: We used a retrospective cohort study design. SETTING & PARTICIPANTS: Hemodialysis patients were randomly selected from a large dialysis organization from July 2000 to June 2002 and were required to have completed a 9-month baseline period. PREDICTOR: EPO dose assessed during months 7 to 9 of the baseline period and monthly throughout the follow-up period. Hemoglobin (Hb) was assessed as average value during months 4 to 6 of the baseline period and monthly throughout the follow-up period. All other covariates were assessed during months 1 to 6 of the baseline period. OUTCOME: All-cause mortality during the 1 year of follow-up. Baseline Cox models were fitted with log EPO and Hb with and without adjustment for baseline patient characteristics. Time-dependent models were fitted with time-varying log EPO and Hb and, separately, lagged log EPO and Hb, with adjustment for baseline patient characteristics. RESULTS: 22,955 patients met our inclusion criteria. In the unadjusted model, we observed increased mortality risk with increasing EPO dose (hazard ratio [HR], 1.31 per log unit increase; 95% confidence interval [CI], 1.26 to 1.36). Adjustment for baseline patient characteristics resulted in an appreciably decreased HR (HR, 1.21; 95% CI, 1.15 to 1.28). In the lagged time-dependent analyses, estimates ranged from HR of 0.93 (95% CI, 0.92 to 0.95) to HR of 1.01 (95% CI, 0.99 to 1.03) for the 1- and 2-month lagged models, respectively. LIMITATIONS: This analysis was limited to prevalent hemodialysis patients, and inhospital EPO dosing information was unavailable. CONCLUSIONS: The observed mortality risk estimates associated with EPO dose in nonexperimental studies in dialysis patients may be highly sensitive to the analytic method used. This highlights the complexity of evaluating the association between EPO dose, Hb level, and mortality in these studies. Copyright © 2008 National Kidney Foundation, Inc. [ABSTRACT FROM AUTHOR]

Clinical data have repeatedly shown that the erythropoiesis stimulating agents (ESAs) Epoetin alfa and darbepoetin alfa are safe and efficacious to treat anemia in patients on dialysis when used in accordance with the product label. The safety profile of ESAs has recently been updated based on reports from clinical investigations that studied off-label uses of ESAs at doses designed to raise the Hb to above 13.0 g/dL. This article reviews the recent safety data and the current prescribing recommendations, with an emphasis on the need to follow the guidelines found in the products' package inserts to ensure the safe and efficacious use of these agents. [ABSTRACT FROM AUTHOR]

This paper analyzes a simple model of taxation in a federal system within which policymakers are revenue–maximizing Leviathans and fiscal externalities arise not only horizontally, across the “states,” but also vertically between levels of government. Such an economy is characterized by excessively high taxation in the noncooperative equilibrium. Intensifying horizontal competition, by increasing the number of states, unambiguously increases revenues (contrary to the Leviathan wisdom) but nevertheless enhances consumer welfare (consistent with the Leviathan wisdom). Revenue sharing arrangements between policymakers are shown to be—contrary to the Leviathan wisdom—Pareto improving. [ABSTRACT FROM AUTHOR]

In three unrelated families with transmitted retinoblastoma 43 members were tested for HLA-A, B, C, and DR antigens. On 18 patients, 16 unaffected relatives, and 16 controls, mixed lymphocyte cultures were carried out and the response to mitogens, phytohaemagglutinin, concanavalin A, and pokeweed mitogen examined. There were no associations of retinoblastoma with any HLA antigen. A reduction in T cell function is suggested by the results of the mitogen tests. [ABSTRACT FROM PUBLISHER]

The antiviral nucleoside derivative zidovudine (3'-azido-3'-deoxythymidine) previously has been shown to be an effective antibacterial agent in animals infected with Escherichia coli or Salmonella typhimurium. Since HIV infection can alter the course of human syphilis with serious consequences, it was of interest to determine if the noncultivable spirochaetal agent of syphilis, Treponema pallidum, is susceptible to this compound. The progression of experimental rabbit syphilis over a three week period was unchanged in animals receiving either 50 or 150 mg/kg oral zidovudine daily. In addition, a number of cultivable pathogenic and nonpathogenic spirochaetes were tested for susceptibility to zidovudine in vitro. At a concentration of 100 mg/L, zidovudine had no detectable effect on spirochaete growth, morphology, or motility. Thus it appears that spirochaetes are generally not susceptible to this compound, and that long-term zidovudine therapy will not be of benefit in preventing or controlling syphilis or other spirochaetoses in HIV-infected humans receiving this drug. [ABSTRACT FROM AUTHOR]

Preface 145Introduction 156Morley vs. Montagu 169 [ABSTRACT FROM PUBLISHER]