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Aim: To examine the associations between visceral adipose tissue (VAT) and brain structural measures at midlife and explore how these associations may be affected by age, sex and cardiometabolic factors. Methods: We used abdominal and brain magnetic resonance imaging data from a population‐based cohort of people at midlife in the UK Biobank. Regression modelling was applied to study associations of VAT volume with total brain volume (TBV), grey matter volume (GMV), white matter volume, white matter hyperintensity volume (WMHV) and total hippocampal volume (THV), and whether these associations were altered by age, sex or cardiometabolic factors. Results: Complete data were available for 17 377 participants (mean age 63 years, standard deviation = 12, 53% female). Greater VAT was associated with lower TBV, GMV and THV (P <.001). We found an interaction between VAT and sex on TBV (P <.001), such that the negative association of VAT with TBV was greater in men (β = −2.89, 95% confidence interval [CI] −2.32 to −10.15) than in women (β = −1.32, 95% CI −0.49 to −3.14), with similar findings for GMV. We also found an interaction between VAT and age (but not sex) on WMHV (P <.001). The addition of other cardiometabolic factors or measures of physical activity resulted in little change to the models. Conclusions: VAT volume is associated with poorer brain health in midlife and this relationship is greatest in men and those at younger ages. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Although poor glycemic control is associated with dementia, it is unknown if variability in glycemic control, even in those with optimal glycosylated hemoglobin A1c (HbA1c) levels, increases dementia risk. METHODS: Among 171,964 people with type 2 diabetes, we evaluated the hazard of dementia association with long‐term HbA1c variability using five operationalizations, including standard deviation (SD), adjusting for demographics and comorbidities. RESULTS: The mean baseline age was 61 years (48% women). Greater HbA1c SD was associated with greater dementia hazard (adjusted hazard ratio = 1.15 [95% confidence interval: 1.12, 1.17]). In stratified analyses, higher HbA1c SD quintiles were associated with greater dementia hazard among those with a mean HbA1c < 6% (P = 0.0004) or 6% to 8% (P < 0.0001) but not among those with mean HbA1c ≥ 8% (P = 0.42). DISCUSSION: Greater HbA1c variability is associated with greater dementia risk, even among those with HbA1c concentrations at ideal clinical targets. These findings add to the importance and clinical impact of recommendations to minimize glycemic variability. Highlights: We observed a cohort of 171,964 people with type 2 diabetes (mean age 61 years).This cohort was based in Northern California between 1996 and 2018.We examined the association between glycosylated hemoglobin A1c (HbA1c) variability and dementia risk.Greater HbA1c variability was associated with greater dementia hazard.This was most evident among those with normal–low mean HbA1c concentrations. [ABSTRACT FROM AUTHOR]

Low fitness and obesity at midlife are individually associated with later‐life decline in cognition and health. However, the relationship between profiles of midlife fitness and obesity with midlife cognition is unclear and was examined by this study. Participants from the third follow‐up of the Childhood Determinants of Adult Health study (2014–2019; aged 36–49 years) were assessed for obesity (body mass index [BMI]), cardiorespiratory (physical work capacity) and muscular fitness (isometric grip and leg strength), and these factors were entered into a latent profile analysis. Psychomotor‐attention, learning–working memory and global cognition composites were derived from z‐scores of individual CogState battery tests. Linear regression analyses examined associations between profiles of fitness and obesity with cognition, adjusting for age, sex, education, alcohol and smoking. Using data from 617 participants [44.4 ± 2.6 (mean ± SD) years, 52% female], we identified 5 mutually exclusive profiles of obesity and fitness. Relative to those with the lowest fitness and highest BMI (5% of sample), those with a profile of (1) highest muscular fitness and average BMI (9%), (2) average muscular fitness and BMI (61%) and (3) highest cardiorespiratory fitness (CRF) and below average BMI (7%) all exhibited better global cognition [at least 0.44 (0.12, 0.77) SD, 95% CI] and psychomotor‐attention performance [at least 0.59 (0.27, 0.91) SD, 95% CI]. Compared with low fitness and unhealthy BMI levels, possessing average or high muscular and CRF and a healthy BMI in midlife was associated with better cognitive performance. Enhancing fitness and reducing obesity in midlife could contribute to improved cognitive performance in middle age. Highlights: Profiles containing adults with a combination of low levels of cardiorespiratory and muscular fitness and higher levels of obesity were associated with lower psychomotor‐attention and global cognition at midlife.Possessing average or higher levels of fitness, and lower obesity at midlife, was associated with better cognitive performance at midlife compared to those with lower fitness and unhealthy BMIs.Maintaining fitness and reducing obesity at midlife may contribute to greater cognitive performance at midlife and beyond and reduce the risk of cognitive decline. [ABSTRACT FROM AUTHOR]

Background: Efforts to minimize medication risks among older adults include avoidance of potentially inappropriate medications (PIMs). However, most PIMs research has focused on older people in aged or inpatient care, creating an evidence gap for community‐dwelling older adults. To address this gap, we investigated the impact of PIMs use in the ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial cohort. Methods: Analysis included 19,114 community‐dwelling ASPREE participants aged 70+ years (65+ if US minorities) without major cardiovascular disease, cognitive impairment, or significant physical disability. PIMs were defined according to a modified 2019 AGS Beers Criteria. Cox proportional‐hazards regression models were used to estimate the association between baseline PIMs exposure and disability‐free survival, death, incident dementia, disability, and hospitalization, with adjustment for sex, age, country, years of education, frailty, average gait speed, and comorbidities. Results: At baseline, 7396 (39% of the total) participants were prescribed at least one PIM. Compared with those unexposed, participants on a PIM at baseline were at an increased risk of persistent physical disability (adjusted hazard ratio [HR] 1.47, 95% confidence interval [CI] 1.21, 1.80) and hospitalization (adjusted HR 1.26, 95% CI 1.20, 1.32), but had similar rates of disability‐free survival (adjusted HR 1.02; 95% CI 0.93, 1.13) and death (adjusted HR 0.92, 95% CI 0.81, 1.05). These effects did not vary by polypharmacy status in interaction analyses. PIMs exposure was associated with higher risk of disability followed by hospitalization (adjusted HR 1.92, 95% CI 1.25, 2.96) as well as vice versa (adjusted HR 1.54, 95% CI 1.15, 2.05). PPIs, anti‐psychotics and benzodiazepines, were associated with increased risk of disability. Conclusions: PIMs exposure is associated with subsequent increased risk of both incident disability and hospitalization. Increased risk of disability prior to hospitalization suggests that PIMs use may start the disability cascade in healthy older adults. Our findings emphasize the importance of caution when prescribing PIMs to older adults in otherwise good health. [ABSTRACT FROM AUTHOR]

This review provides a qualitative and quantitative analysis of cerebral glucose metabolism in ageing. We undertook a systematic literature review followed by pooled effect size and activation likelihood estimates (ALE) meta‐analyses. Studies were retrieved from PubMed following the PRISMA guidelines. After reviewing 635 records, 21 studies with 22 independent samples (n = 911 participants) were included in the pooled effect size analyses. Eight studies with eleven separate samples (n = 713 participants) were included in the ALE analyses. Pooled effect sizes showed significantly lower cerebral metabolic rates of glucose for older versus younger adults for the whole brain, as well as for the frontal, temporal, parietal, and occipital lobes. Among the sub‐cortical structures, the caudate showed a lower metabolic rate among older adults. In sub‐group analyses controlling for changes in brain volume or partial volume effects, the lower glucose metabolism among older adults in the frontal lobe remained significant, whereas confidence intervals crossed zero for the other lobes and structures. The ALE identified nine clusters of lower glucose metabolism among older adults, ranging from 200 to 2640 mm3. The two largest clusters were in the left and right inferior frontal and superior temporal gyri and the insula. Clusters were also found in the inferior temporal junction, the anterior cingulate and caudate. Taken together, the results are consistent with research showing less efficient glucose metabolism in the ageing brain. The findings are discussed in the context of theories of cognitive ageing and are compared to those found in neurodegenerative disease. [ABSTRACT FROM AUTHOR]

The literature on large‐scale resting‐state functional brain networks across the adult lifespan was systematically reviewed. Studies published between 1986 and July 2021 were retrieved from PubMed. After reviewing 2938 records, 144 studies were included. Results on 11 network measures were summarized and assessed for certainty of the evidence using a modified GRADE method. The evidence provides high certainty that older adults display reduced within‐network and increased between‐network functional connectivity. Older adults also show lower segregation, modularity, efficiency and hub function, and decreased lateralization and a posterior to anterior shift at rest. Higher‐order functional networks reliably showed age differences, whereas primary sensory and motor networks showed more variable results. The inflection point for network changes is often the third or fourth decade of life. Age effects were found with moderate certainty for within‐ and between‐network altered patterns and speed of dynamic connectivity. Research on within‐subject bold variability and connectivity using glucose uptake provides low certainty of age differences but warrants further study. Taken together, these age‐related changes may contribute to the cognitive decline often seen in older adults. Although the literature on large‐scale, resting state functional networks in aging has been reviewed previously, we offer the first systematic qualitative and quantitative synthesis of the evidence. The novel synthesis stems from the adoption of PRISMA method and the breadth of network measures reviewed. The review offers a contemporary summary of the strength of the evidence, theoretical implications, and recommendations for further research. [ABSTRACT FROM AUTHOR]

Objective: To explore older persons’ perceptions of the impact of COVID-19 restrictions on participating in community activities after discharge from inpatient rehabilitation. Methods: Mixed-methods study design. Participants were older adults who were discharged home following inpatient rehabilitation. Interviews were conducted with 70 participants, with a variety of diagnoses, 8 weeks after discharge from inpatient rehabilitation. Frequency of participation in domestic, leisure/work and outdoor activities was measured using the Frenchay Activities Index (FAI). Qualitative analysis was completed using qualitative content analysis and triangulated with FAI scores. Results: In all, 70 older adults (mean age: 73.0 years, SD: 9.9; 59% female) participated in the study. The overarching theme was that participants felt socially isolated following discharge from rehabilitation, with COVID-19 restrictions increasing perceptions of social isolation and complicating their return to participating in community activities. The four categories informing the overarching theme were as follows: physical health was the primary limitation to participation in community activities; COVID-19 restrictions limited participation in social activities and centre-based physical rehabilitation; low uptake of videoconferencing to facilitate socialisation and rehabilitation; and reduced incidental physical activity. Mean FAI score was 21.2 (SD 7.8), indicating that participants were moderately active. Participants most commonly performed domestic activities (mean: 10.0, SD: 4.1), followed by outdoor activities (mean: 6.6, SD: 3.5) and leisure/work activities (mean: 4.5, SD: 2.5). Conclusions: COVID-19 restrictions exacerbated perceptions of social isolation and the limitations already imposed by poor physical health after discharge from rehabilitation. The findings highlight the need for rehabilitation that addresses the psychological and social dimensions of community reintegration. [ABSTRACT FROM AUTHOR]

Objectives: There is a lack of guidance on how to manage the multiple post‐discharge issues of older people following minimal trauma hip fracture. We developed a geriatrician‐staffed outpatient service for people aged ≥65 years admitted with a hip fracture who were not discharged to a nursing home. We aimed to evaluate the potential benefits of the addition of a dedicated hip fracture follow‐up clinic by measuring the actions performed by such a clinic. Methods: We evaluated the potential benefit of the clinic through a retrospective review of the medical records of all those referred to the clinic over a 2‐year period. Results: A total of 80 people were provided a clinic appointment, with 43 (54%) attending. The median age of clinic attendees was 81 years. A total of 40/43 (93%) of attendees received inpatient rehabilitation in a sub‐acute facility before discharge. At the dedicated outpatient clinic, multiple issues were identified and managed including further fall reduction strategies (n = 12), commencement of anti‐resorptive medications (n = 11) and medication deprescribing (n = 11). Conclusions: We found that the introduction of a dedicated hip fracture outpatient clinic identified and managed a broad range of issues. It is unclear if these needs would have been met by previously existing services. Further work is required to clarify whether managing these issues translates into improved patient outcomes and whether a dedicated clinic is a cost‐effective practice of achieving this. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes is associated with a two‐fold increase in dementia risk. Although glycemic variability is becoming increasingly recognised as contributing to end‐organ damage, less is known about its contribution to dementia risk. We aimed to study the association between HbA1c variability and dementia risk in a large, diverse sample of people in Northern California. Method: Over 209,000 members of a fully integrated health care delivery system with type 2 diabetes aged ≥ 50 years were followed from 1996 to 2018 to obtain repeated measures of HbA1c, dementia diagnoses, and comorbidities. Variability was measured using standard deviation (SD), coefficient of variation, and average real variability. Cox proportional hazards models estimated the association between HbA1c variability in the first 3 years of cohort entry and incident dementia at least 2 years after the end of the exposure period adjusting for age (as timescale) and baseline health conditions. Result: There were a total of 209,703 people in the cohort (mean baseline age 61.0 years (SD = 9.2), 47.5% women) (Table1). Approximately 49.6% of the sample were non‐Latino White. The mean number of HbA1c values available for each participant was 5.8 (SD = 2.3). The mean HbA1c for each participant in the first 3 years was 7.4% (SD = 1.33). Greater HbA1c variability was associated with greater hazard of dementia when measured using SD (aHR = 1.12 [95%CI: 1.10, 1.14]), coefficient of variation (aHR = 2.17 [95%CI: 1.85, 2.55]) (Figure1), or average real variability (aHR = 1.06 [95%CI: 1.06, 1.07]). When stratified by mean HbA1c, we found that ‐ relative to the lowest quintile of variation ‐ increasing variability of SD of HbA1c was associated with greater hazard of dementia in HbA1c categories of <6% (p = 0.0004) and 6 ‐8% (p<0.0001) but not in those with a mean HbA1c ≥8% (p = 0.42). Conclusion: Greater HbA1c variability is associated with greater dementia hazard in those with good glycemic control. The absence of association in less well controlled (HbA1c ≥8%) patients may stem from greater variability including lower risk periods of optimal glycemic control. These results support current clinical recommendations to minimize glycemic variability and extend known benefits to include lowering of dementia risk. [ABSTRACT FROM AUTHOR]

The predictive ability and efficiency of inpatient harm screening tools is unclear. We performed a retrospective analysis of approximately 25 000 people admitted to our hospital in 2019. We found that the discriminatory ability of the harm screening tools was at best moderate and could be attributed to one or two questions that overlapped with each other in the harm they predicted. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to describe the demographics of patients from residential aged care facilities (RACFs) who underwent fixation of hip fracture and to compare 12‐month functional and mortality outcomes for those returning to their RACF with those admitted to a subacute facility (SAF) following their acute hospital stay. Methods: A retrospective review was undertaken of all patients from a RACF with high‐level care needs admitted to Alfred Hospital, Melbourne, for fixation of hip fracture in 2014‐2015. Data including demographic and hospital event details, length of stay (LOS), discharge destination and 12‐month functional outcomes measured by the Glasgow Outcome Scale‐Extended (GOS‐E), were collected. Factors related to discharge destination and outcomes were analysed. Results: Ninety patients from a RACF were included in this study, with 68 patients (76%) returning to their RACF and 22 (24%) admitted to a SAF after acute hospital stay. Those discharged to a SAF had an average LOS at this facility of 20.79 days (SD 8.02). The SAF group also had a longer acute LOS (7 days IQR 5‐10, compared to 6 days IQR 4‐7.5) but there was no difference between groups at 12 months in terms of mortality or function, with 50% of all patients deceased at this time point (n = 40) and the remaining 40 patients (50%) reporting a poor functional outcome. Conclusions: Mobility status during acute and subacute stay, and 12‐month functional and mortality outcomes were similar in both groups irrespective of discharge destination, with the influence of cognition and concomitant medical issues currently unknown. Further research is required to evaluate the efficacy of current hip fracture models of care, the factors that influence clinician discharge planning decision‐making and to interrogate new models of care that support rehabilitation and complex medical management in RACFs. [ABSTRACT FROM AUTHOR]

Objective: To examine the feasibility of developing an in‐reach parenteral iron infusion service to residents of residential aged care facilities (RACFs). Methods: An audit comparing the use of iron infusions in RACFs prior to and following the introduction of an in‐reach iron infusion service. Results: Of the 738 inpatient iron infusions administered to inpatients ≥65 years in the 12 months prior to the in‐reach service, 52 (7%) lived in an RACF, with no significant adverse events reported. After implementation of an in‐reach service, a total of 37 RACF residents received parenteral iron in the first 12 months of the service, with no significant adverse events reported. Conclusion: It is possible to safely provide parenteral iron through an in‐reach service to residents in RACF. Further research is required to identify the person‐level benefits achieved by this service. [ABSTRACT FROM AUTHOR]

Objective: To explore the perceived barriers and enablers to the implementation of the Volunteer Dementia and Delirium© program from the perspective of key stakeholders in a metropolitan hospital network. Methods: Focus groups and interviews with hospital staff, volunteers, patients and caregivers. Deductive analysis was conducted for the Behaviour Change Wheel (COM‐B) domains, and inductive thematic analysis for emerging themes. Results: Utilising the skills and knowledge of volunteers, making the program available to all patients, and recognising that volunteers will improve the care experience for patients were identified as enablers. Threats to volunteer safety, difficulty in defining roles and responsibilities of volunteers, volunteer attrition and availability and supervision of volunteers were perceived as barriers to implementation. Conclusion: To enhance the implementation of the program into a metropolitan setting, strategies addressing the identified barriers and enablers need to be developed. [ABSTRACT FROM AUTHOR]

Objective: To explore the perceived acceptability of the Volunteer Dementia and Delirium Care (VDDC)© program components from the perspective of key stakeholders in a metropolitan health network. Methods: A mixed‐methods design was used. Surveys (nurses) and focus groups and interviews (hospital staff, volunteers, patients and caregivers) were conducted simultaneously. Descriptive statistics were used to profile the survey responses. The framework method was used to analyse the qualitative data. Results: The majority of nurses identified that it is acceptable for volunteers to read to, and converse and play games with patients. Hospital staff perceived risk in volunteers assisting with feeding and mobilisation. Overall participants believed the VDDC was acceptable and would be of benefit to the patients. Conclusion: Key stakeholders have a favourable view of the VDDC© program. Strategies can be developed to address the identified issues, and components of the program may be amended to ensure that implementation is acceptable. [ABSTRACT FROM AUTHOR]

Background: Many hospitals use predictive scores to identify a person's risk of inpatient falls, pressure injury and malnutrition despite evidence of limited predictive accuracy. Aim: To examine whether we could improve predictive accuracy by generating a score combining all components of currently used tools. Methods: We performed a retrospective, cross‐validation study in a single sub‐acute (geriatrics and rehabilitation) hospital, extracting data regarding hospital risk scores, and incidence of falls, pressure injury and malnutrition from January 2014 to June 2016. The sample was randomly halved into training and testing data sets. For each harm outcome, model fit was examined using area under receiver operating characteristic curves (AUC) and proportions of people reclassified based on a combined score were calculated. Secondary analyses explored the predictive performance of individual question‐responses. Results: Data were available for 4487 admissions (median age 83.0 years). A total of 667 (15%) people had at least one fall, 499 (11%) had at least one pressure injury and 20 (0.4%) malnutrition. The currently used tools had, at best, moderate ability to predict risk of harm outcomes (AUC 0.56–0.73). Testing of the combined score models resulted in minimal change in AUC (<5.1%) and did not add value to risk category reclassification. Most of the predictive ability of the currently used tools relied on the performance of two individual question‐responses. Conclusion: Combining scores or reducing to two‐item question‐responses did little to change predictive accuracy. This study highlights the limitations of hospital harm predictive scores and emphasises the importance of rigorous testing of predictive scores. [ABSTRACT FROM AUTHOR]

Gongora, J., Cuddahee, R. E., do Nascimento, F. F., Palgrave, C. J., Lowden, S., Ho, S. Y. W., Simond, D., Damayanti, C. S., White, D. J., Tay, W. T., Randi, E., Klingel, H., Rodrigues-Zarate, C. J., Allen, K., Moran, C. & Larson, G. (2011). Rethinking the evolution of extant sub-Saharan African suids (Suidae, Artiodactyla). - Zoologica Scripta, 40, 327-335. Although African suids have been of scientific interest for over two centuries, their origin, evolution, phylogeography and phylogenetic relationships remain contentious. There has been a long-running debate concerning the evolution of pigs and hogs (Suidae), particularly regarding the phylogenetic relationships among extant Eurasian and African species of the subfamily Suinae. To investigate these issues, we analysed the mitochondrial and nuclear DNA sequences of extant genera of Suidae from Eurasia and Africa. Molecular phylogenetic analyses revealed that all extant sub-Saharan African genera form a monophyletic clade separate from Eurasian suid genera, contradicting previous attempts to resolve the Suidae phylogeny. Two major sub-Saharan African clades were identified, with Hylochoerus and Phacochoerus grouping together as a sister clade to Potamochoerus. In addition, we find that the ancestors of extant African suids may have evolved separately from the ancestors of modern day Sus and Porcula in Eurasia before they colonised Africa. Our results provide a revision of the intergeneric relationships within the family Suidae. [ABSTRACT FROM AUTHOR]

O'Connell PJ, Hawthorne WJ, Simond D, Chapman JR, Chen Y, Patel AT, Walters SN, Burgess J, Weston L, Stokes RA, Moran C, Allen R. Genetic and functional evaluation of the level of inbreeding of the Westran pig: a herd with potential for use in xenotransplantation. Xenotransplantation 2005.© Blackwell Munksgaard, 2005The Westran pig has been purposely inbred for use in xenotransplantation. The herd originated in the wild from a limited gene pool and has been inbred by repeated full-sib matings for nine generations.The aim of this study was to evaluate the level of inbreeding by functional assays, such as bi-directional MLR and reciprocal skin grafts between herd members, and by genetic analysis using highly polymorphic genetic markers to calculate the level of inbreeding.The MLR between herd members were non-reactive whereas there was a prompt response to third party pig lymphocytes, indicative of a normal immune responsiveness in Westran pigs but isogenicity of the major histocompatibility complex. Skin grafts between male siblings or female sibling skin grafts on male recipients showed prolonged survival but with few exceptions did not survive beyond 100 days suggesting that by the fifth generation the Westran herd was still mismatched at minor histocompatibility antigens. This level of functional inbreeding was confirmed by microsatellite analysis of highly polymorphic markers, which showed that 52 of 53 chromosomally dispersed markers were fixed by the ninth generation. This level of fixation was consistent with 19 to 20 generations of full-sibling inbreeding. The calculated inbreeding coefficient at generation 10 was 0.98159.This analysis confirms that the Westran pig is highly inbred and we propose that analysis of chromosomally dispersed highly polymorphic markers is an accurate and reproducible method for assessing the level of inbreeding of a pig herd. [ABSTRACT FROM AUTHOR]

Lee J-H, Simond D, Hawthorne WJ, Walters SN, Patel AT, Smith DM, O'Connell PJ, Moran C. Characterization of the swine major histocompatibility complex alleles at eight loci in Westran pigs. Xenotransplantation 2005.© Blackwell Munksgaard, 2005Pigs are an important large animal model for transplantation and a potential source of xenografts. Swine leukocyte antigen (SLA) molecules are strong mediators of alloreactive and xenoreactive immune responses. We have characterized the SLA alleles of a new pig line bred for transplantation research, the Westran (Westmead Hospital transplantation) pig, described in a companion paper.Three sixth generation inbred Westran pigs and a Large White pig control were used to assess SLA alleles. We examined theSLA-1,SLA-3,SLA-6,SLA-2,DQA1,DQB1,DRA1andDRB1loci using reverse transcription-polymerase chain reaction and sequencing-based method.All of the Westran pigs had a single allele at each locus, except for theSLA-1locus. Typing of theSLA-1locus in additional animals indicated that this is most likely the result of a duplication of theSLA-1locus rather than heterozygosity. The lack of SLA heterozygosity is consistent with the previous finding of low microsatellite marker heterozygosity and is the result of both the recent deliberate inbreeding of these pigs and their derivation from a feral stock from Kangaroo Island, South Australia, established by the release of a single pair in 1803.After comparing DNA and protein sequences of the Westran SLA alleles with published GenBank SLA sequences, the SLA class I alleles found in the Westran pigs were all novel, while the SLA-DR andDQB1alleles have been previously described in other pig breeds. Characterization of the SLA alleles in the Westran pigs has identified novel alleles and will be useful for designing protocols for modulation of immune responses to allografts and xenografts. [ABSTRACT FROM AUTHOR]

The author reflects on the new policy for the publication of obituaries in "Animal Genetics." The author mentions that a proposal was made to the Executive Committee that the Obituary Note section in the journal should be devoted with a limited and normally very small amount of space which will include the name and date of the person's death. The author states that the discussions on the policy development was added with a particular element of poignancy.