Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit.

During an acute medical problem, older people may lose functional independence. ADL scales are used to assess this loss of independence. The simplest and most convenient ADL scale is the Katz Index, which measures six ADL: bathing, dressing, toileting, transferring, continence, and feeding. A lower ADL score indicates greater loss of functional independence. The ADL score prior to the acute medical problem (baseline) is estimated by questioning the patient or the caregivers, and this score is then compared with that on hospital admission. The ADL score should be monitored from hospital admission until discharge to allow early detection of changes in functional independence. Identifying any loss of functional independence before and during hospitalization provides information to caregivers regarding the risk of short-term mortality risk and complications, and the prognosis after hospitalization.

Conserving wildlife amongst the cotton fields. A third of a century of experience at the Nazinga Game Ranch, Burkina Faso.

Established in the early 1970 as a participatory wildlife production area, the Nazinga Game Ranch turned into an island of conservation surrounded by cultivation. We asked ourselves how long-term ungulate trends are affected in a context of continuous human pressure. To find out, we compiled and analysed the data of yearly line-transect counts of mammals carried out since 1985. Results showed that large species such as the elephant (Loxodonta africana) and large antelopes increased or showed stable populations. In contrast, medium and small ungulates showed continuously decreasing trends. During the same period, rainfall, water availability from artificial water points and the crop encroaching outside Nazinga Game Ranch increased. After an initial significant reduction, illegal human signs increased. However, we showed that human signs were positively correlated with the abundance of large ungulates but negatively correlated with the abundance of medium and small ones. In conclusion, this study showed that some isolated mammal populations could be restored and maintained in the long term, in spite of being surrounded by highly cultivated areas.

Comparison of the efficacy and morbidity of flexible ureterorenoscopy for lower pole stones compared with other renal locations.

BACKGROUND AND PURPOSE: Flexible ureterorenoscopy (f-URS) for lower pole stones (LPS) compared with other renal locations can be challenging because of anatomic and technical considerations. We aimed to compare the stone-free rate (SFR) and surgical complication rate with f-URS for LPS vs other renal locations. PATIENTS AND METHODS: We performed a retrospective, single-center study including 371 f-URS for renal stone retrieval performed in our institution between January 2004 and December 2010. Among the 371 procedures included in this analysis, 139 were performed for stones located in a single renal location other than the lower pole (group 1), and 232 for at least one stone located in the lower pole (group 2). We compared the efficacy (SFR) and the morbidity of f-URS between the two groups. The success of the procedure was defined as a complete SFR 6 months after f-URS. RESULTS: Age, sex, history of urolithiasis, body mass index, and preoperative stent placement did not differ between the two groups. No differences in stone characteristics were observed between both groups except stone size under 10 mm that was significantly higher in group 2 (P=0.018). Technical aspects of the procedure did not differ between the groups, except for more frequent use of an access sheath in group 2 (P=0.007). SFR was comparable between groups (P=0.774). The complication rate was similar in both groups, as was the severity of complications. By multivariate analysis, stone size >10 mm (P<0.0001) and multiple stone locations (P=0.001) were associated with f-URS failure, but lower pole location did not impact on SFR. CONCLUSION: In our study, stone location, in particular LPS, did not have any impact on efficacy and morbidity of f-URS. Only multiple locations and stone size >10 mm seemed to significantly decrease the SFR, without impacting morbidity.