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While previous studies have assessed public opinions for arming teachers in K-12 schools in the United States, comparatively less research has focused on understanding teachers' opinions for such policies and assessed whether and to what extent school- and individual-level factors are associated with differences in support. The current study aims to address these voids in the current body of literature by analyzing self-report data from a large sample of Texas K-12 educators (N = 9,196) to assess relations between theoretical correlates of teacher and staff gun carrying, demographic as well as school characteristics, and support for carrying. A series of logistic regression models reveal that favorable views of an emergency operation plan in a school setting and general negative view of guns in school are associated with lower odds of support. The strength of these associations varies across teacher and school characteristics. The implications of the reported results for K-12 school policy is discussed. [ABSTRACT FROM AUTHOR]

Objectives: An increasing proportion of older people live in Retirement Villages ('villages'). This population cites support for health‐care issues as one reason for relocation to villages. Here, we examine whether relocation to villages is associated with a decline in hospitalisations. Methods: Retrospective, before‐and‐after observational study. Setting: Retirement villages, Auckland, New Zealand. Participants: 466 cognitively intact village residents (336 [72%] female); mean (SD) age at moving to village was 73.9 (7.7) years. Segmented linear regression analysis of an interrupted time‐series design was used. Main outcome measures: all hospitalisations for 18 months pre‐ and postrelocation to village. Secondary outcome: acute hospitalisations during the same time periods. Results: The average hospitalisation rate (per 100 person‐years) was 44.9 (95% confidence interval [CI] = 36.3–55.6) 18–10 months before village relocation, 58.9 (95% CI = 48.3–72.0) 9–1 months before moving, 47.9 (95% CI = 38.8–59.1) 1–9 months after moving and 62.4 (95% CI = 51.2–76.0) 10–18 months after moving. Monthly average hospitalisation rate (per 100 person‐years) increased before relocation to village by an average of 1.2 (95% CI = 0.01–1.57, p =.04) per month from 18 to 1 month before moving, and there was a change in the level of the monthly average hospitalisation rate immediately after relocation (mean difference [MD] = −18.4 per 100 person‐years, 95% CI = −32.8 to −4.1, p =.02). The trend change after village relocation did not differ significantly from that before moving. Conclusions: Although we cannot reliably claim causality, relocation to a retirement village is, for older people, associated with a significant but non‐sustained reduction in hospitalisation. [ABSTRACT FROM AUTHOR]

Introduction. Physical activity (PA) in older people is associated with improved morbidity and mortality outcomes. Increasing numbers of older people are choosing to live in retirement villages, many of which promote themselves as providing opportunities for activity. Aim. To explore the characteristics of PA village residents were undertaking and the associated individual and village factors. Methods. Health, functional and wellbeing information was collected from 577 residents recruited from 34 villages in Auckland, New Zealand, using an International Resident Assessment Instrument and customised survey tools containing items on self-reported PA. Managers from villages completed a survey on village characteristics and facilities. Results. The mean age (s.d.) of village residents was 82 (7) years, and 325 (56%) reporting doing one or more hours of PA in the 3 days prior to assessment. Moderate exercise was performed by 240 (42%) village residents, for a mean (s.d.) of 2.7 (3.4) h per week. The most common activities provided by villages included: bowls/petanque (22, 65%) and exercise classes (22, 65%), and walking was the most common activity undertaken (348, 60%). Factors independently associated with PA included individual factors (gender, fatigue, constipation, self-reported health, number of medications, moving to village for safety and security, utilising village fitness programme, use of the internet, and satisfaction with opportunities to be active) and village-related factors (access to unit, and ownership model). Discussion. PA uptake is determined by many factors at both personal (physical and psychosocial) and environmental levels. Clinicians should focus on individualised PA promotion in those with identified risk factors for low levels of PA. [ABSTRACT FROM AUTHOR]

Chronic pain is common in older people. However, little is known about how pain is experienced in residents of retirement villages ('villages'), and how pain intensity and associations are experienced in relation to characteristics of residents and village living. We thus aimed to examine pain levels, prevalence and associated factors in village residents. The current paper is a cross‐sectional analysis of baseline data from the 'Older People in Retirement Villages' study in Auckland, New Zealand. Between July 2016 and August 2018, 578 village residents were interviewed face‐to‐face by gerontology nurse specialists, using interRAI Community Health Assessment (CHA) and customised survey. We used a validated pain scale and multivariable logistic regression analyses adjusted for pre‐specified confounders. Residents' median age was 82 years; 420 (73%) were female; 270 (47%) exhibited/reported daily pain, and in 11% this was severe. After controlling for confounders, daily pain was positively associated with self‐reported arthritis (OR = 3.88, 95% CI = 2.57–5.87), poor/fair self‐reported health (OR = 3.19, 95% CI = 1.29–7.93), having no health clinic on‐site (OR = 1.76, 95% CI = 1.10–2.83), and minimal fatigue (diminished energy but completes normal day‐to‐day activities) (OR = 1.77, 95% CI = 1.11–2.81). Similar associations were observed for levels of pain. We conclude that levels of pain and prevalence of daily pain are high in village residents. Self‐reported arthritis, self‐reported poor/fair health, no health clinic on‐site and minimal fatigue are all independently associated with a higher risk of daily pain and with levels of pain. This study suggests potential opportunities for villages to better provide on‐site support to decrease prevalence and severity of pain for their residents, and thus potentially increase wellbeing and quality‐of‐life, though as we cannot prove causality, more research is needed. [ABSTRACT FROM AUTHOR]

Objectives: As people age, they are more likely to require support to maintain activities of daily living. Referral for formal assessment of need (assessed using the ‘international Resident Assessment Instrument’ [interRAI]) is the first step to access publicly funded services in Aotearoa New Zealand (NZ). It is unclear whether ethnic access inequities present in other areas of the NZ health system occur in this referral process. This exploratory research aimed to explore ethnic variation in referrals for interRAI assessment, and associated factors. Methods: A retrospective cohort study of all new referrals for aged care services for those 55-plus, received in 2018 by Waitematā District Health Board (WDHB), was conducted. The primary outcome was referral outcome (assessment and no assessment). Secondary outcomes included time from referral to assessment, reason for referral, mortality and, in the assessed cohort, assessment outcome. Results: New referrals (n = 3263) were ethnically representative of the general older adult population in WDHB. Māori were younger and more likely to be referred for higher-level care needs than non-Māori, non-Pasifika (NMNP) (p = 0.03). There was no significant difference in referral outcome, time to assessment or mortality between ethnicities. NMNP were more likely to access lower-level care services than Māori or Pasifika older adults (p = 0.002). Conclusions: Ethnicity was not associated with aged care service assessment access once people were referred for publicly funded services, nor was it associated with time to assessment or mortality in this exploratory study. Māori had higher care needs than NMNP at the time of referral. [ABSTRACT FROM AUTHOR]

Objective: Juvenile idiopathic arthritis (JIA) is the most common chronic immune‐mediated joint disease among children and encompasses a heterogeneous group of immune‐mediated joint disorders classified into 7 subtypes according to clinical presentation. However, phenotype overlap and biologic evidence suggest a shared mechanistic basis between subtypes. This study was undertaken to systematically investigate shared genetic underpinnings of JIA subtypes. Methods: We performed a heterogeneity‐sensitive genome‐wide association study encompassing a total of 1,245 JIA cases (classified into 7 subtypes) and 9,250 controls, followed by fine‐mapping of candidate causal variants at each genome‐wide significant locus, functional annotation, and pathway and network analysis. We further identified candidate drug targets and drug repurposing opportunities by in silico analyses. Results: In addition to the major histocompatibility complex locus, we identified 15 genome‐wide significant loci shared between at least 2 JIA subtypes, including 10 novel loci. Functional annotation indicated that candidate genes at these loci were expressed in diverse immune cell types. Conclusion: This study identified novel genetic loci shared by JIA subtypes. Our findings identified candidate mechanisms underlying JIA subtypes and candidate targets with drug repurposing opportunities for JIA treatment. [ABSTRACT FROM AUTHOR]

Background: To study healthcare utilization and trajectories, and associated factors, in older adults in retirement villages (RVs), also known as continuing care retirement communities. Methods: Prospective cohort study of 578 cognitively intact residents from 34 RVs in Auckland, New Zealand (NZ). Measurement: InterRAI‐Community Health Assessment (includes core items that may trigger functional supplement (FS) completion in those with higher needs, and generates clinical assessment protocols (CAPs) in those with potential unmet needs). Outcomes: time to acute hospitalization, long‐term care (LTC), and death during average 2.5 years follow‐up. Results: Three hundred seven (53%) residents had acute hospitalizations, 65 (11%) moved to LTC, and 51 (9%) died over a mean of 2.5 years. Factors associated with increased risk of acute hospitalization included CAP‐falls (high risk) triggered, number of comorbidities, not having left RV in 2 weeks prior, moderate/severe hearing impairment, CAP‐cardiorespiratory conditions triggered, acute hospitalization in year prior and age, with significant hazard ratios (HR) ranging between 1.03 and 2.90. Factors associated with reduced risk of hospitalization included other (non‐NZ) European ethnicity (HR 0.73, 95% CI 0.55–0.98, p = 0.04), presence of on‐site clinic (HR 0.62, 95% CI 0.45–0.85, p = 0.003), no influenza vaccination (HR 0.56, 95% CI 0.38–0.83, p = 0.004). Factors associated with LTC transition included FS triggered (HR 3.84, 95% CI 1.92–7.66, p < 0.001), CAP‐instrumental activities of daily living (IADL) (HR 2.62, 95% CI 1.22–5.62, p = 0.01), CAP‐social relationship triggered (HR 2.00, 95% CI 1.13–3.55, p = 0.02), and age (HR 1.13, 95% CI 1.07–1.18 p < 0.001). Factors associated with mortality included number of comorbidities (HR 3.75, 95% CI 1.54–9.10, p = 0.004 for 3–5 comorbidities), CAP‐IADL triggered (HR 3.05, 95% CI 1.30–7.16, p = 0.01), and age (HR 1.11, 95% CI 1.05–1.18, p < 0.001). Conclusion: A large proportion of cognitively intact RV residents are admitted to hospital in mean 2.5 years of follow‐up. Multiple factors were associated with acute hospitalization risk. On‐site clinics were associated with reduced risk and should be considered in RV development. [ABSTRACT FROM AUTHOR]

Background: Retirement villages (RVs), also known as continuing care retirement communities, are an increasingly popular housing choice for older adults. The RV population has significant health needs, possibly representing a group with needs in between community‐dwelling older adults and those in long‐term residential care (LTC). Our previous work shows Gerontology Nurse Specialist (GNS)‐facilitated multidisciplinary team (MDT) interventions may reduce hospitalizations from LTC. This study tested whether a similar intervention reduced hospitalizations in RV residents. Methods: Open‐label randomized controlled trial in which 412 older residents of 33 RVs were randomized (1:1) to an MDT intervention or usual care. Setting: RVs across two District Health Boards in Auckland, New Zealand. Residents were eligible if considered high risk of health/functional decline (triggering ≥3 interRAI Clinical Assessment Protocols or needing special consideration identified by GNS). Intervention: GNS‐facilitated MDT intervention, including geriatrician/nurse practitioner and clinical pharmacist, versus usual care. Primary outcome was time from randomization to first acute hospitalization. Secondary outcomes were rate of acute hospitalizations, LTC admission, and mortality. Twelve residents died before randomization; all others (n = 400: MDT intervention = 199; usual care = 201) were included in intention‐to‐treat analyses. Results: Mean (SD) age was 82.2 (6.9) years, 302 (75.5%) were women, and 378 (94.5%) were European. Over median 1.5 years follow‐up, no difference was found in hazard of acute hospitalization between the MDT intervention (51.8%) and usual care (49.3%) groups (Hazard ratio [HR] = 1.01, 95% CI = 0.77–1.34). No difference was found in the incidence rate of acute hospitalizations between the MDT intervention (0.69 per person‐year) and usual care (0.86 per person‐year) groups (incidence rate ratio = 0.81, 95% CI = 0.59–1.10). Similar results were seen for the proportion of residents with LTC transition (HR = 1.18, 95% CI = 0.65–2.11) and mortality (HR = 0.70, 95% CI = 0.36–1.35). Conclusion: Further studies are needed to assess the effects of other patient‐centered interventions and outcomes with adequate primary care integration. [ABSTRACT FROM AUTHOR]

The social structure and social learning (SSSL) model for crime and deviance has received an impressive amount of empirical support in the United States and other Western industrialized countries. Comparatively, less research, however, has examined whether the SSSL model offers a viable framework for explaining variation in delinquent behavior in other geographic contexts, particularly, countries that place a stronger emphasis on social control stemming from both formal and religious sources. The current study addresses this void in the literature by examining a sample of youth from Saudi Arabia, a Middle Eastern country that enforces Sharia (a set of laws based in Islamic tradition) and strict gender roles. The association between neighborhood exposure to violence and risk for violent and nonviolent delinquent behavior was examined using structural equation models. Subsequent models were aimed at more closely examining the mediating role of delinquent peer association between neighborhood exposure to violence and violent and nonviolent delinquent behavior. Results indicate that males exposed to neighborhood violence are more likely to engage in violent and nonviolent delinquent behavior, whereas females are more likely to engage in violent, but not nonviolent, delinquent behavior. In line with the SSSL model, delinquent peer association fully mediates the direct effect of neighborhood exposure to violence on delinquent behavior in both males and females. Findings from the current study suggest that the SSSL model may provide a useful framework for explaining individual differences in delinquent behavior in Saudi Arabia. [ABSTRACT FROM AUTHOR]

In 2015, China passed legislation that criminalized domestic violence/child maltreatment and provided protections to victims of child maltreatment. Consistent with the intergenerational transmission of violence, prior cross-national research has demonstrated that the experience of child maltreatment is positively associated with supportive attitudes toward domestic violence. However, research conducted within China among Chinese police cadets has not found a relationship between child maltreatment and attitudes toward dating violence. The goals of the current study were to: 1) provide prevalence estimates of child maltreatment – including if the cadet witnessed domestic violence; 2) examine gender differences in the experience of child maltreatment and attitudes toward domestic violence, and; 3) examine if child maltreatment or witnessing domestic violence were associated with attitudes toward domestic violence. Survey data from 404 police cadets attending Zhejiang Police College in Hangzhou, China were analyzed. The majority of cadets (64.10%) experienced child maltreatment. Close to one in five cadets (19.10%) witnessed domestic violence in their household. Significant differences did not emerge between male and female cadets with regard to child maltreatment or witnessing domestic violence. Male cadets reported more supportive attitudes toward domestic violence than female cadets. Child maltreatment and witnessing domestic violence were not associated with attitudes toward domestic violence. Support was not found for the intergenerational transmission of violence among this sample of Chinese police cadets. Implications for future trainings and research are discussed. [ABSTRACT FROM AUTHOR]

Objectives: To develop and validate a frailty index (FI) from interRAI‐Community Health Assessments (CHA) on older adults in retirement villages (RVs). Methods: This is a cross‐sectional analysis of a current RV research study. A FI was generated using the cumulative deficit model. Health‐care utilisation measures were acute, and all, hospitalisations 12 months before baseline assessment. Associations between FI and hospitalisations were explored using multivariable logistic regression to estimate odds ratio (OR). Results: Of 577 included residents, mean (SD) age was 81 (7) and 419 (73%) were female. Mean (SD) FI was 0.16 (0.09); 260 (45%) were mildly frail, and 108 (19%) moderate‐severely frail. In multivariate‐adjusted analysis, odds of acute hospitalisation for mild (OR = 3.3, P <.001) and moderate‐severely frail (OR = 6.4, P <.001) were significantly higher than fit residents. Higher odds were also observed for all hospitalisations. Conclusion: A considerable proportion of RV residents were moderately‐severely frail. FI was associated with acute and all hospitalisations. [ABSTRACT FROM AUTHOR]

Māori (Indigenous people of New Zealand [NZ]) experience inequitable health outcomes compared to non‐Māori, across the spectrum of clinical care, including those relating to medicines. Internationally, pharmacist‐facilitated medicines review services have been shown to benefit older adults. Despite national policies calling for the increased implementation of these services, NZ data relating to them remain limited, and these services may increase disparities between Māori and non‐Māori. There are currently no medicines review services developed specifically for Māori older adults. The current study aims to elicit stakeholder views of current and potential pharmacist services to help inform the development of a pharmacist‐facilitated medicines review service for community‐dwelling Māori older adults. Kaupapa Māori theory was applied within this qualitative research. Purposive sampling was used to recruit participants who were involved in providing, planning, funding developing or culturally supporting health services in Waitematā District Health Board, Auckland, NZ. Data were collected in semi‐structured interviews and in a focus group and analysed using reflexive thematic analysis. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative research. Eleven participants took part in the research in one focus group (n = 4) and seven semi‐structured interviews, conducted between November 2018 and March 2019. Three main themes were generated: (a) moving out of the shadows – claiming pharmacists' unique role within a healthcare whānau (family); (b) 'give them the power to be able to ask' – upholding the mana (self‐esteem, pride, standing) and autonomy of kaumātua (Māori older adults) and (c) rights versus realities – reimagining pro‐equity Māori health services within the constraints of the colonial health system. The right of Māori to experience equitable health outcomes needs to be included in policy and also operationalised in relation to medicines review services through improved utilisation of pharmacist skills and improving Māori older adults' autonomy and control. [ABSTRACT FROM AUTHOR]

Objective: To describe survival and six‐month outcomes (residence, community supports) in the very old (≥80 years) admitted to intensive care in Waitemata District Health Board, New Zealand. Methods: Hospital records of patients 80 years and over admitted from August 2015 to June 2017 were reviewed. Results: One hundred and seventeen patients were admitted (median age: 83). Standard ICU risk scores predicted survival to hospital discharge. Patients admitted electively were more likely to survive to discharge than emergency ICU/HDU admissions (P =.007). Ninety‐two (79%) survived to hospital discharge, and 84 (72%) survived to 6 months. Eighty‐four were discharged home (91% of survivors), and 79 were living at home at 6 months (94% of survivors). Community supports increased from admission (34, 29%) to 6 months later (34, 43% of community dwellers). Forty‐four (47.8% surviving to discharge) were readmitted within 6 months. Conclusions: Most patients are alive at discharge and 6 months, with a majority requiring no formal supports. [ABSTRACT FROM AUTHOR]

Background: Adverse outcomes associated with advanced diseases are often exacerbated by polypharmacy.Objectives: The current study investigated an association between exposure to anticholinergic and sedative medicines and falls in community-dwelling older people, after controlling for potential confounders.Methods: We conducted a retrospective cross-sectional study of a continuously recruited national cohort of community-dwelling New Zealanders aged 65 years and over. Participants had an International Resident Assessment Instrument–Home Care (interRAI-HC) assessment between 1 September 2012 and 31 January 2016. InterRAI-HC is a comprehensive, multi-domain, standardised assessment. This study captured 18 variables, including fall frequency, from the interRAI. These data were deterministically matched with the Drug Burden Index (DBI) for each participant, derived from an anonymised national dispensed pharmaceuticals database. DBI groupings were statistically ascertained, and ordinal regression models employed.Results: Overall, there were 71,856 participants, with a mean age of 82.7 years (range 65–106); 43,802 (61.0%) were female, and 63,578 (88.5%) were New Zealand European. In unadjusted and adjusted analyses, DBI groupings were related to falls (p < 0.001). A DBI score > 3 was associated with a 41% increase in falls compared with a DBI score of 0 (p < 0.001). There was a ‘dose-response’ relationship between DBI levels and falls risk.Conclusions: DBI was found to be independently and positively associated with a greater risk of falls in this cohort after adjustment for 18 known confounders. We suggest that the DBI could be a valuable tool for clinicians to use alongside electronic prescribing to help reduce falls in older people. [ABSTRACT FROM AUTHOR]

Objectives. SSc-pulmonary arterial hypertension (SSc-PAH) is associated with worse response to therapy and survival when compared with idiopathic PAH. It is suggested that the vasculopathy in SSc may involve postcapillary pulmonary venules resulting in pulmonary veno-occlusive disease (PVOD). This may underlie the lower gas transfer and worse outcome on therapy. We sought to test whether CT signs of PVOD (CTS-PVOD) were frequent in SSc-PAH and whether they were associated with pulmonary oedema on therapy and worse survival. Methods. CT thorax of 66 SSc patients with precapillary pulmonary hypertension (PH) were blindly scored by two radiologists for CTS-PVOD (≤1 or ≥2). Case note and radiograph review determined the presence of pulmonary oedema on therapy. Results. Fifty-nine patients (89%) had ≤1 CTS-PVOD and only 7 (11%) had ≥2 CTS-PVOD. Pulmonary oedema on therapy was relatively common in those with ≥2 CTS-PVOD. On univariate analysis ≥2 CTS-PVOD were associated with a trend towards worse survival. Conclusion. CTS-PVOD were less frequent in this SSc-PAH cohort than in previous reports but the presence of at least two of these signs is associated with pulmonary oedema on therapy and a trend towards worse survival on univariate analysis. [ABSTRACT FROM AUTHOR]

We aimed to study whether short-duration vibration exercise or football sessions of two different durations acutely changed plasma markers of bone turnover and muscle strain. Inactive premenopausal women (n=56) were randomized to complete a single bout of short (FG15) or long duration (FG60) small sided football or low magnitude whole body vibration training (VIB). Procollagen type 1 amino-terminal propeptide (P1NP) was increased during exercise for FG15 (51.6±23.0 to 56.5±22.5 μg·L−1, mean ± SD, P<0.05) and FG60 (42.6±11.8 to 50.2±12.8 μg·L−1, P<0.05) but not for VIB (38.8±15.1 to 36.6±14.7 μg·L−1, P>0.05). An increase in osteocalcin was observed 48 h after exercise (P<0.05), which did not differ between exercise groups. C-terminal telopeptide of type 1 collagen was not affected by exercise. Blood lactate concentration increased during exercise for FG15 (0.6±0.2 to 3.4±1.2 mM) and FG60 (0.6±0.2 to 3.3±2.0 mM), but not for VIB (0.6±0.2 to 0.8±0.4 mM) (P<0.05). Plasma creatine kinase increased by 55±63% and 137±119% 48 h after FG15 and FG60 (P<0.05), but not after VIB (26±54%, NS). In contrast to the minor elevation in osteocalcin in response to a single session of vibration exercise, both short and longer durations of small sided football acutely increased plasma P1NP, osteocalcin, and creatine kinase. This may contribute to favorable effects of chronic training on musculoskeletal health. [ABSTRACT FROM AUTHOR]

Introduction: global population projections forecast large growth in demand for long-term care (LTC) and acute hospital services for older people. Few studies report changes in hospitalisation rates before and after entry into LTC. This study compares hospitalisation rates 1 year before and after LTC entry. Methods: the Older Persons' Ability Level (OPAL) study was a 2008 census-type survey of LTC facilities in Auckland, New Zealand. OPAL resident hospital admissions and deaths were obtained from routinely collected national databases. Results: all 2,244 residents (66% = female) who entered LTC within 12 months prior to OPAL were included. There were 3,363 hospitalisations, 2,424 in 12 months before and 939 in 12 months after entry, and 364 deaths. In the 6 to 12 months before LTC entry, the hospitalisation rate/100 person-years was 67.3 (95% confidence interval [CI] 62.5-72.1). Weekly rates then rose steeply to over 450/100 person-years in the 6 months immediately before LTC entry. In the 6 months after LTC entry, the rate fell to 49.1 (CI 44.9-53.3; RR 0.73 (CI 0.65-0.82, P < 0.0001)) and decreased further 6 to 12 months after entry to 41.1 (CI 37.1-45.1; rate ratio [RR] 0.61 (CI 0.54-0.69, P< 0.0001)). Conclusions: increased hospitalisations a few months before LTC entry suggest functional and medical instability precipitates LTC entry. New residents utilise hospital beds less frequently than when at home before that unstable period. Further research is needed to determine effective interventions to avoid some hospitalisations and possibly also LTC entry. [ABSTRACT FROM AUTHOR]

The current study examined whether adolescent IQ predicted risk for mortality by the age of 32. Analyses of data from the Add Health revealed that IQ was related to mortality risk, such that respondents with relatively lower IQs were significantly more likely to experience early life mortality when compared to respondents with relatively higher IQs. This association remained statistically significant even after controlling for a host of covariates such as race, gender, involvement in violent behaviors, levels of self-control, and poverty. The average IQ of deceased respondents was approximately 95, whereas the average IQ of living respondents was about 100. [ABSTRACT FROM AUTHOR]

ICD Lead Position and Outcome Introduction We aim to compare the acute and long-term success of defibrillation between non-apical and apical ICD lead position. Methods and Results The position of the ventricular lead was recorded by the implanting physician for 2,475 of 2,500 subjects in the Shockless IMPLant Evaluation (SIMPLE) trial, and subjects were grouped accordingly as non-apical or apical. The success of intra-operative defibrillation testing and of subsequent clinical shocks were compared. Propensity scoring was used to adjust for the impact of differences in baseline variables between these groups. There were 541 leads that were implanted at a non-apical position (21.9%). Patients implanted with a non-apical lead had a higher rate of secondary prevention indication. Non-apical location resulted in a lower mean R-wave amplitude (14.0 vs. 15.2, P < 0.001), lower mean pacing impedance (662 ohm vs. 728 ohm, P < 0.001), and higher mean pacing threshold (0.70 V vs. 0.66 V, P = 0.01). Single-coil leads and cardiac resynchronization devices were used more often in non-apical implants. The success of intra-operative defibrillation was similar between propensity score matched groups (89%). Over a mean follow-up of 3 years, there were no significant differences in the yearly rates of appropriate shock (5.5% vs. 5.4%, P = 0.98), failed appropriate first shock (0.9% vs. 1.0%, P = 0.66), or the composite of failed shock or arrhythmic death (2.8% vs. 2.3% P = 0.35) according to lead location. Conclusion We did not detect any reduction in the ICD efficacy at the time of implant or during follow-up in patients receiving a non-apical RV lead. [ABSTRACT FROM AUTHOR]

Background: increasing age is associated with a higher prevalence of atrial fibrillation (AF), and higher risks of stroke and bleeding. We report the effects of apixaban versus acetylsalicylic acid (ASA) in older patients (>75 years and >85 years) compared with younger patients with AF unsuitable for vitamin K antagonists. Methods: AVERROES (Apixaban Versus ASA to Prevent Stroke In AF Patients Who Have Failed or Are Unsuitable for Vitamin K Antagonist Treatment) trial (n = 5,599) included 1,898 patients ≥75 years and 366 patients >85 years. We compared the baseline characteristics and effects of apixaban compared with aspirin on clinical outcomes by age. Results: compared with aspirin, apixaban was more efficacious for preventing strokes and systemic embolism in patients ≥85 years (absolute rate [AR] 1%/year on apixaban versus 7.5%/year on aspirin; hazard ratio [HR] 0.14, 95% confidence interval [CI] 0.02-0.48) compared with younger patients (AR 1.7%/year on apixaban versus 3.4%/year on aspirin; HR 0.50, 95% CI 0.35--0.69) (P-value for interaction = 0.05). Major haemorrhage was higher in patients ≥85 years compared with younger patients but similar with apixaban versus aspirin in both young and older individuals (4.9%/year versus 1.0%/year on aspirin and 4.7%/year versus 1.2%/year on apixaban) with no significant treatment-by-age interaction (P-value = 0.65). Conclusions: older patients with AF are at particularly high risk of stroke if given aspirin and have substantially greater relative and absolute benefits from apixaban compared with younger patients with no greater risk of haemorrhage. Clinical Trial Registration: ClinicalTrials.gov number: NCT00496769. [ABSTRACT FROM AUTHOR]

Background: An integrative multidisciplinary approach is required to elucidate the multiple factors that shape neurodevelopmental trajectories of mental disorders. The Philadelphia Neurodevelopmental Cohort (PNC), funded by the National Institute of Mental Health Grand Opportunity (GO) mechanism of the American Recovery and Reinvestment Act, was designed to characterize clinical and neurobehavioral phenotypes of genotyped youths. Data generated, which are recently available through the NIMH Database of Genotypes and Phenotypes (dbGaP), have garnered considerable interest. We provide an overview of PNC recruitment and clinical assessment methods to allow informed use and interpretation of the PNC resource by the scientific community. We also evaluate the structure of the assessment tools and their criterion validity. Methods: Participants were recruited from a large pool of youths (n = 13,958) previously identified and genotyped at The Children's Hospital of Philadelphia. A comprehensive computerized tool for structured evaluation of psychopathology domains (GOASSESS) was constructed. We administered GOASSESS to all participants and used factor analysis to evaluate its structure. Results: A total of 9,498 youths (aged 8-21; mean age = 14.2; European American = 55.8%; African American = 32.9%; Other = 11.4%) were enrolled. Factor analysis revealed a strong general psychopathology factor, and specific 'anxious-misery', 'fear', and 'behavior' factors. The 'behavior' factor had a small negative correlation (0.21) with overall accuracy of neurocognitive performance, particularly in tests of executive and complex reasoning. Being female had a high association with the 'anxious-misery' and low association with the 'behavior' factors. The psychosis spectrum was also best characterized by a general factor and three specific factors: ideas about 'special abilities/ persecution,' 'unusual thoughts/perceptions', and 'negative/disorganized' symptoms. Conclusions: The PNC assessment mechanism yielded psychopathology data with strong factorial validity in a large diverse community cohort of genotyped youths. Factor scores should be useful for dimensional integration with other modalities (neuroimaging, genomics). Thus, PNC public domain resources can advance understanding of complex interrelationships among genes, cognition, brain, and behavior involved in neurodevelopment of common mental disorders. Keywords: Community cohort, children, adolescents, young adults, psychopathology, mood, anxiety, behavior, psychosis, comorbidity, structure, genomics, neuroimaging, neurocognition, public domain. [ABSTRACT FROM AUTHOR]

Background: frail older people living in residential long-term care (LTC) have limited life expectancy. Identifying those with poor prognosis may improve management and facilitate transition to a palliative approach to care. Objective: to develop methods for predicting mortality in LTC. Design: a population-based cohort study. Setting: LTC facilities, Auckland, New Zealand. Subjects: five hundred randomly selected older people in a census-type survey of those living in LTC in 2008. Methods: mortality data were obtained from New Zealand Ministry of Health. Two methods for assessing mortality risk were developed using demographic, functional and health service information: (i) two geriatricians blinded to identifying data and to mortality, independently reviewed survey, medications and pre-survey hospitalisations data, and grouped residents according to perceived risk of death within 12 months; (ii) multivariate logistic regression model used the same survey and medication items as the geriatricians. Results: for the geriatricians' assessment, each quintile of perceived risk was associated with a significant increase in mortality (P < 0.001). Area under the curve (AUC) for both physicians was 0.64. The logistic regression model included age, gender, assistance with feeding and requiring night attention, all variables which are easily available from LTC records. AUC for the model was 0.70, but when validated against the entire OPAL cohort, it was 0.65. When either or both geriatrician and the model together predicted high risk of death, 1-year mortality was >50%. Conclusion: two methods with the potential to identify older people with limited prognosis are described. Use of these methods allowed identification of over half of those who died within 12 months. [ABSTRACT FROM AUTHOR]

Residents of long-term care facilities have highly complex care needs and quality of care is of international concern. Maintaining resident wellness through proactive assessment and early intervention is key to decreasing the need for acute hospitalization. The Residential Aged Care Integration Program ( RACIP) is a quality improvement intervention to support residential aged care staff and includes on-site support, education, clinical coaching, and care coordination provided by gerontology nurse specialists ( GNSs) employed by a large district health board. The effect of the outreach program was evaluated through a randomized comparison of hospitalization 1 year before and after program implementation. The sample included 29 intervention facilities (1,425 residents) and 25 comparison facilities (1,128 residents) receiving usual care. Acute hospitalization rate unexpectedly increased for both groups after program implementation, although the rate of increase was significantly less for the intervention facilities. The hospitalization rate after the intervention increased 59% for the comparison group and 16% for the intervention group (rate ratio ( RR) = 0.73, 95% confidence interval ( CI) = 0.61-0.86, P < .001). Subgroup analysis showed a significantly lower rate change for those admitted for medical reasons for the intervention group (13% increase) than the comparison group (69% increase) ( RR = 0.67, 95% CI = 0.56-0.82, P < .001). Conversely, there was no significant difference in the RR for surgical admissions between the intervention and comparison groups ( RR = 1.0, 95% CI = 0.68-1.46, P = .99). The integration of GNS expertise through the RACIP intervention may be one approach to support staff to provide optimal care and potentially improve resident health. [ABSTRACT FROM AUTHOR]

Aim To describe short-term mortality among residential aged care (RAC) residents in Auckland, New Zealand. Method Prospective follow-up, 6828 residents (median age 86 years, 69.8% women) from census-type survey (10/9/2008); 152 facilities. Mortality data from central sources. Results Eight hundred and sixty-one (12.6%) died by 6 months. Survival related to RAC length of stay before the survey: those resident <1 month (subgroup, n = 380) having 80.0% survival, 1-6 months 83.2% and >6 months 87.4% ( P < 0.0001). In those admitted to private hospital from acute hospital ( n = 104 of the subgroup of 380), 6-month mortality was 36.5% ( P < 0.0001 vs other 'short stayers'). Significant mortality predictors were: private hospital admission from acute hospital (hazard ratio ( HR) = 2.02), unscheduled GP visit during the prior 2 weeks ( HR = 1.90), personal care disability ( HR = 1.90) and acute hospital admission number during the previous 2 years ( ≥3; HR = 5.40). Conclusions RAC mortality (especially post admission) is high. Training and resource in the sector should reflect this. [ABSTRACT FROM AUTHOR]

Background Pulmonary hypertension ( PH) in patients with systemic hypertension and preserved ejection fraction ( PEF) has been described. However, the pathophysiology and consequences are not entirely clear. We sought to distinguish the clinical and anatomic features among hypertensive patients with or without coexistent PH. Methods Echocardiograms and records of hypertensive patients with left ventricular ( LV) hypertrophy and PEF from January 2009 to January 2011 were reviewed. We identified 174 patients, including 36 with PH (calculated pulmonary artery systolic pressure [ PASP] ≥ 35 mmHg), and 138 with normal pulmonary pressures. Results Hypertensive patients with PH were older (76 ± 13 vs. 65 ± 13 years, P < 0.0001), more often female (91, 70%), had lower estimated glomerular filtration rate ( eGFR) (63 ± 44 vs. 88 ± 48 mL/min, P = 0.002), and higher pro-BNP levels (3141 ± 4253 vs. 1219 ± 1900 pg/mL, P = 0.003). PH patients also had larger left atrial areas (23.7 ± 3.8 vs. 20.8 ± 4.6 cm2, P = 0.002), evidence of diastolic dysfunction (i.e., septal E/e′ 17.6 ± 8.6 vs. 12.7 ± 4.4, P = 0.0005), and higher calculated peripheral vascular resistance (PVR) (2.3 ± 1.1 vs. 1.6 ± 0.4, P < 0.0001). Both PVR and septal E/e′ showed strong linear correlation with PASP (P < 0.0001 and P < 0.0001, respectively). Conclusions Hypertension in elderly patients is frequently complicated by LV diastolic dysfunction and secondary PH. These hypertensive patients tended to have reduced renal function and higher pro- BNP. Because of the known morbidity and mortality associated with PH, these observations have potentially important implications for target medical therapy. [ABSTRACT FROM AUTHOR]

Ethnic Difference in Atrial Fibrillation Incidence. Introduction: Atrial fibrillation (AF) is suggested to be less common among black and Asian individuals, which could reflect bias in symptom reporting and access to care. In the Asymptomatic AF and Stroke Evaluation in Pacemaker Patients and the AF Reduction Atrial Pacing Trial (ASSERT), patients with hypertension but no history of AF had AF recorded via an implanted pacemaker or defibrillator, thus allowing both symptomatic and asymptomatic AF incidence to be determined without ascertainment bias. Methods and Results: The ASSERT enrolled 2,580 patients in 23 countries in North America, Europe, and Asia. AF was defined as device-recorded AF episodes >190/min, lasting either for >6 minutes or >6 hours in duration. All ethnic groups with >50 patients were enrolled. Ethnic groups studied include Europeans (n = 1900), black Africans (n = 73), Chinese (n = 89), and Japanese (n = 105) patients. Compared to Europeans, black Africans had more risk factors for AF such as heart failure (27.8 vs 14.6%) and diabetes (41.7 vs 26.3%). At 2.5 years follow-up, all 3 non-European races had a lower incidence of AF (8.3%, 10.1%, and 9.5% vs 18.0%, respectively, for AF>6 minutes, P < 0.006). When adjusted for baseline difference, Chinese had a lower incidence of AF > 6 minutes (P < 0.007), and Japanese and black Africans had a lower incidence of AF > 6 hours (P < 0.04 and P = 0.057, respectively). Conclusions: Black Africans, Chinese, and Japanese had lower incidence of AF compared to Europeans. In the case of black Africans, this is despite an increased prevalence of AF risk factors. (J Cardiovasc Electrophysiol, Vol. 24, pp. 381-387, April 2013) [ABSTRACT FROM AUTHOR]

Aim: To describe an international comparison of dependency of long-term care residents. Methods: All Auckland aged care residents were surveyed in 1998 and 2008 using the 'Long-Term Care in Auckland' instrument. A large provider of residential aged care, Bupa-UK, performed a similar but separate functional survey in 2003, again in 2006 (including UK Residential Nursing Home Association facilities), and in 2009 which included Bupa facilities in Spain, New Zealand and Australia. The survey questionnaires were reconciled and functional impairment rates compared. Results: Of almost 90 000 residents, prevalence of dependent mobility ranged from 27 to 47%; chronic confusion, 46 to 75%; and double incontinence, 29 to 49%. Continence trends over time were mixed, chronic confusion increased, and challenging behaviour decreased. Conclusion: Overall functional dependency for residents is high and comparable internationally. Available trends over time indicate increasing resident dependency signifying care required for this population is considerable and possibly increasing. [ABSTRACT FROM AUTHOR]

Comparing ICD Implantation with and Without Intraoperative Defibrillation Testing. Introduction: The need to perform defibrillation testing (DT) at the time of implantable cardioverter defibrillator (ICD) insertion is controversial. In the absence of randomized trials, some regions now perform more than half of ICD implants without DT. Methods: During the last year of enrolment in the Resynchronization for Ambulatory Heart Failure Trial, a substudy randomized patients to ICD implantation with versus without DT. Results: Among 252 patients screened, 145 were enrolled; 75 randomized to DT and 70 to no DT. Patients were similar in terms of age (65.9 ± 9.3 years vs 67.9 ± 8.9 years); LVEF (24.7 ± 4.6% vs 23.6 ± 4.6%), QRS width (154.8 ± 23.5 vs 155.8 ± 23.6 ms), and history of atrial fibrillation (5% vs 6%). All 68 patients in the DT arm tested according to the protocol achieved a successful DT (≤25 J); 96% without requiring any system modification. No patient experienced perioperative stroke, myocardial infarction, heart failure (HF), intubation or unplanned ICU stay. The length of hospital stay was not prolonged in the DT group: 20.2 ± 26.3 hours versus 21.3 ± 23.0 hours, P = 0.79. One patient in the DT arm had a failed appropriate shock and no patient suffered an arrhythmic death. The composite of HF hospitalization or all-cause mortality occurred in 10% of patients in the no-DT arm and 19% of patients in the DT arm (HR = 0.53, 95% CI: 0.21-1.31, P = 0.14). Conclusions: In this randomized trial, perioperative complications, failed appropriate shocks, and arrhythmic death were all uncommon regardless of DT. There was a nonsignificant increase in the risk of death or HF hospitalization with DT. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1313-1316, December 2012) [ABSTRACT FROM AUTHOR]

The DSM-5 proposal indicates that personality disorders (PDs) be defined as collections of maladaptive traits but does not provide a specific diagnostic method. However, researchers have previously suggested that PD constructs can be assessed by comparing individuals’ trait profiles with those prototypic of PDs and evidence from the five-factor model (FFM) suggests that these prototype matching scores converge moderately with traditional PD instruments. The current study investigates the convergence of FFM PD prototypes with interview-assigned PD diagnoses in a sample of 99 homeless individuals. This sample had very high rates of PDs, which extends previous research on samples with more modest prevalence rates. Results indicated that diagnostic agreement between these methods was generally low but consistent with the agreement previously observed between explicit PD measures. Furthermore, trait-based and diagnostic interview scores evinced similar relationships with clinically important indicators such as abuse history and past suicide attempts. These findings demonstrate the validity of prototype methods and suggest their consideration for assessing trait-defined PD types within DSM-5. [ABSTRACT FROM PUBLISHER]

Abstract: Background: Vertebral compression fracture repair aims to relieve pain and improve function by restoring vertebral structure and biomechanics, but is still associated with risks arising from polymethylmethacrylate cement extravasation. The Kiva® Vertebral Compression Fracture Treatment System, a stacked coil implant made of polyetheretherketone and delivered over a guide-wire, is a novel device designed to provide height restoration and mechanical stabilization, while improving cement containment and minimizing disruption of cancellous bone. The objective of this study was to determine whether the Kiva system is as effective as balloon kyphoplasty at restoring mechanical properties in osteoporotic vertebral compression fractures. Methods: Wedge fractures were created in the middle vertebra of fourteen osteoporotic three-vertebra spine segments and then repaired with either the Kiva or kyphoplasty procedure. Height, stiffness and displacement under compression of the spine segments were measured for four conditions: intact, fractured, augmented, and post-cyclic eccentric loading (50,000cycles, 200–500N, 30mm anterior lever arm). Findings: No significant differences were seen between the two procedures for height restoration, stiffness at high or low loads, or displacement under compression. However, the Kiva System required an average of 66% less cement than kyphoplasty to achieve these outcomes (mean 2.6 (SD 0.4) mL v. mean 7.5 (SD 0.8) mL 0; P <0.01). Extravasations and excessive posterior cement flow were also significantly lower with Kiva (0/7 v. 4/7; P <.05). Interpretation: Kiva exhibits similar biomechanical performance to balloon kyphoplasty, but may reduce the risk of extravasation through the containment mechanism of the implant design and by reducing cement volume. [Copyright &y& Elsevier]

Celivarone in Atrial Fibrillation/Atrial Flutter. Introduction: Celivarone, a new noniodinated benzofuran derivative pharmacologically related to dronedarone and amiodarone, has been shown to have antiarrhythmic properties at a molecular level. The purpose of the 2 trials presented here (MAIA and CORYFEE) was to assess celivarone efficacy in the maintenance of sinus rhythm postcardioversion and for the conversion of atrial fibrillation (AF)/atrial flutter (AFL). Methods and Results: In the MAIA trial, 673 patients with AF/AFL recently converted to sinus rhythm were randomly assigned to receive 50, 100, 200, or 300 mg once-daily dosing of celivarone; 200 mg daily of amiodarone preceded by a loading dose of 600 mg for 10 days; or placebo. At 3 months' follow up, no significant difference was observed in time to AF/AFL relapse among the various celivarone groups and placebo. However, fewer symptomatic AF/AFL recurrences were observed in the lower-dose celivarone groups (26.6% for celivarone 50 mg [P = 0.022] and 25.2% for celivarone 100 mg [P = 0.018] vs 40.5% for placebo at 90 days). Fewer adverse events were observed with the use of celivarone and placebo than amiodarone. In the CORYFEE study, 150 patients with AF/AFL were randomly assigned to once-daily celivarone dosing of 300 or 600 mg, or placebo, for a 2-day treatment period. There was no significant difference in the rate of spontaneous conversion to sinus rhythm between the treatment and control groups. Conclusions: In these studies, celivarone does not appear to be efficacious in the maintenance of sinus rhythm in AF/AFL patients or for the conversion of AF/AFL patients. (J Cardiovasc Electrophysiol, Vol. 23, pp. 462-472, May 2012) [ABSTRACT FROM AUTHOR]

Studies examining sex-role and psychological reactions to infertility have produced inconsistent findings. It is argued that this is due in part to individuals with different diagnoses having been grouped together rather than analysed as separate sub-sets. Findings are presented from a study investigating sex-role and emotional function in a sample of 128 males and 127 females with undiagnosed primary infertility. The data were collected on the couples' initial visit to a specialist clinic. Masculine men, compared with the other three sex-role types, had the lowest GHQ and state and trait anxiety scores while undifferentiated men obtained the highest trait anxiety scores and the lowest marital adjustment scores. Little difference was observed between sex-role types in women. The results are discussed in relation to previously reported studies. [ABSTRACT FROM AUTHOR]

Introduction: LTC residents have higher hospitalisation rates and longer lengths-of-stay than non-LTC residents (Ingarfield SL,Age & Ageing 2009;38:314-18). Some hospitalisations from LTC appear potentially avoidable (Ingarfield SL,Age & Ageing 2009;38:314-18), and rapid decline may follow acute hospitalisations, hence the importance of preventing unnecessary hospitalisation (OuslanderJG, JAGS 2010;58:627-35.). Considerable literature suggests disease-specific interventions for particular diagnoses (cardiac failure, ischaemic heart disease [IHD], chronic obstructive pulmonary disease [COPD], stroke, pneumonia), impact on LTC care quality and on hospitalisations of older people from the community, but few RCTs show reductions in acute admissions from LTC.Methods: LTC facilities with higher than expected hospitalisations were selected and recruited for a cluster-RCT of facility-based complex generic (non-disease-specific) intervention over nine months. The intervention comprised gerontology nurse specialist (GNS)-led staff education, facility benchmarking, GNS resident review and multidisciplinary (geriatrician, primary-care physician, pharmacist, GNS, facility nurse) discussion of residents selected using standard criteria. In this post-hoc analysis the outcome was rate of acute hospitalisations for the combined endpoint of acute hospitalisation for cardiac failure, IHD, COPD, stroke or pneumonia over 14 months.Results: We recruited 36 facilities with 1998 residents (1408 female; mean age 82.9yrs; 1123:875 intervention:control). Although the intervention did not impact rates of acute hospitalistions or mortality (Connolly MJ, Eur Geriatr Med 2013;4 [(Suppl.1]:S171), it resulted in fewer acute admissions for the combined end point (RR = 0.73, 95%CI = 0.54-0.99; p = 0.04), with no significant difference in rate of other acute admissions.Conclusions: This multidisciplinary, multidimensional intervention had no overall impact on acute hospitalisations or mortality. However, this generic package intervention reduced admissions for common conditions which the literature has shown are impacted by disease-specific strategies to reduce admission, suggesting a potential avenue for further research and clinical application. [ABSTRACT FROM PUBLISHER]

The article focuses a study that was conducted to determine the role of oral anticoagulants in causing gastrointestinal bleeding in patients with venous thrombosis or acute coronary syndrome (ACS). Topics discussed include increased risk of gastrointestinal bleeding in patients receiving rivaroxaban in comparison of standard care, increased risk of bleeding in patients with pulmonary embolism and ACS and largest increase in bleeding in ACS trials where new oral were compared with placebo.

Students who demonstrate the most challenging behaviors are at risk of school failure and are often placed in alternative schools, in which a primary goal is remediating behavioral and academic concerns to facilitate students’ return to their community school. Consistently implemented evidence-based classroom management is necessary toward this goal; yet, many teachers report not having the necessary knowledge or skills to effectively manage behavior in their classroom. Implementation Planning (IP) is a proactive and efficient implementation support that has evidence of being effective when delivered by a consultant during behavioral consultation. The primary aim of this multiple baseline design study was to extend the findings on consultant-mediated IP by evaluating the effect of a self-guided, computer-based version of IP on teacher treatment integrity of classroom management plans. Unlike previous studies of consultant-mediated IP, results from this study indicated a minimal effect across dimensions of teachers’ implementation, and thus also on student disruptions. [ABSTRACT FROM AUTHOR]