The use of sedatives and hypnotics, antidepressants, and benzodiazepines demonstrated a significant association with falls in elderly individuals.

The purpose of this study was to compare force accuracy, force variability and muscle activity during constant isometric contractions at different force levels with and without visual feedback and at different feedback gains. In experiment 1, subjects were instructed to accurately match the target force at 2, 15, 30, 50, and 70% of their maximal isometric force with abduction of the index finger and maintain their force even in the absence of visual feedback. Each trial lasted 22 s and visual feedback was removed from 8–12 to 16–20 s. Each subject performed 6 trials at each target force, half with visual gain of 51.2 pixels/N and the rest with a visual gain of 12.8 pixels/N. Force error was calculated as the root mean square error of the force trace from the target line. Force variability was quantified as the standard deviation and coefficient of variation (CVF) of the force trace. The EMG activity of the agonist (first dorsal interosseus; FDI) was measured with bipolar surface electrodes placed distal to the innervation zone. Independent of visual gain and force level, subjects exhibited lower force error with the visual feedback condition (2.53 ± 2.95 vs. 2.71 ± 2.97 N; P < 0.01); whereas, force variability was lower when visual feedback was removed (CVF: 4.06 ± 3.11 vs. 4.47 ± 3.14, P < 0.01). The EMG activity of the FDI muscle was higher during the visual feedback condition and this difference increased especially at higher force levels (70%: 370 ± 149 vs. 350 ± 143 μV, P < 0.01). Experiment 2 examined whether the findings of experiment 1 were driven by the higher force levels and proximity in the gain of visual feedback. Subjects performed constant isometric contractions with the abduction of the index finger at an absolute force of 2 N, with two distinct feedback gains of 15 and 3,000 pixels/N. In agreement with the findings of experiment 1, subjects exhibited lower force error in the presence of visual feedback especially when the feedback gain was high (0.057 ± 0.03 vs. 0.095 ± 0.05 N). However, force variability was not affected by the vastly distinct feedback gains at this force, which supported and extended the findings from experiment 1. Our findings demonstrate that although removal of visual feedback amplifies force error, it can reduce force variability during constant isometric contractions due to an altered activation of the primary agonist muscle most likely at moderate force levels in young adults.

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BackgroundRecent research published in this journal highlighted the issue of the high content of aluminium in infant formulas. The expectation was that the findings would serve as a catalyst for manufacturers to address a significant problem of these, often necessary, components of infant nutrition. It is critically important that parents and other users have confidence in the safety of infant formulas and that they have reliable information to use in choosing a product with a lower content of aluminium. Herein, we have significantly extended the scope of the previous research and the aluminium content of 30 of the most widely available and often used infant formulas has been measured.MethodsBoth ready-to-drink milks and milk powders were subjected to microwave digestion in the presence of 15.8 M HNO3 and 30% w/v H2O2 and the aluminium content of the digests was measured by TH GFAAS.ResultsBoth ready-to-drink milks and milk powders were contaminated with aluminium. The concentration of aluminium across all milk products ranged from ca 100 to 430 μg/L. The concentration of aluminium in two soya-based milk products was 656 and 756 μg/L. The intake of aluminium from non-soya-based infant formulas varied from ca 100 to 300 μg per day. For soya-based milks it could be as high as 700 μg per day.ConclusionsAll 30 infant formulas were contaminated with aluminium. There was no clear evidence that subsequent to the problem of aluminium being highlighted in a previous publication in this journal that contamination had been addressed and reduced. It is the opinion of the authors that regulatory and other non-voluntary methods are now required to reduce the aluminium content of infant formulas and thereby protect infants from chronic exposure to dietary aluminium.

BackgroundAccurate and timely medication information at the point of discharge is essential for continuity of care. There are scarce data on the clinical significance if poor quality medicines information is passed to the next episode of care. This study aimed to compare the number and clinical significance of medication errors and omission in discharge medicines information, and the timeliness of delivery of this information to community-based health practitioners, between the existing Hospital Discharge Summary (HDS) and a pharmacist prepared Medicines Information Transfer Fax (MITF).MethodThe study used a sample of 80 hospital patients who were at high risk of medication misadventure, and who had a MITF completed in the study period June – October 2009 at a tertiary referral hospital. The medicines information in participating patients’ MITFs was validated against their Discharge Prescriptions (DP). Medicines information in each patient’s HDS was then compared with their validated MITF. An expert clinical panel reviewed identified medication errors and omissions to determine their clinical significance. The time between patient discharge and the dispatching of the MITF and the HDS to each patient’s community-based practitioners was calculated from hospital records.ResultsDPs for 77 of the 80 patients were available for comparison with their MITFs. Medicines information in 71 (92%) of the MITFs matched that of the DP. Comparison of the HDS against the MITF revealed that no HDS was prepared for 16 (21%) patients. Of the remaining 61 patients; 33 (54%), had required medications omitted and 38 (62%) had medication errors in their HDS. The Clinical Panel rated the significance of errors or omissions for 70 patients (16 with no HDS prepared and 54 who’s HDS was inconsistent with the validated MITF). In 17 patients the error or omission was rated as insignificant to minor; 23 minor to moderate; 24 moderate to major and 6 major to catastrophic. 28 (35%) patients had their HDS dispatched to their community-based practitioners within 48 hours post discharge compared to 80 (100%) of MITFs.ConclusionThe MITF is an effective approach for the timely delivery of accurate discharge medicines information to community-based practitioners responsible for the patient’s ongoing care.