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Associations between the Drug Burden Index, Potentially Inappropriate Medications and Quality of Life in Residential Aged Care
Get PDF“This is a post-peer-review, pre-copyedit version of an article published in Drugs & Aging. The final authenticated version is available online at: http://dx.doi.org/10.1007/s40266-017-0513-3Background
Inappropriate polypharmacy may negatively impact the quality of life of residents in aged care facilities, but it remains unclear which medications may influence this reduced quality of life.
Objective
The objective of this study was to examine whether the Drug Burden Index and potentially inappropriate medications were associated with quality of life in older adults living in residential care with a high prevalence of cognitive impairment and dementia.
Methods
We conducted cross-sectional analyses of 541 individuals recruited from 17 residential aged care facilities in Australia in the Investigating Services Provided in the Residential Environment for Dementia (INSPIRED) study. Quality of life was measured using the EuroQol Five Dimensions Questionnaire (a measure of generic quality of life) and the Dementia Quality of Life Questionnaire completed by the participant or a proxy.
Results
In the 100 days prior to recruitment, 83.1% of the participants received at least one anticholinergic or sedative medication included in the Drug Burden Index and 73.0% received at least one potentially inappropriate medication according to the Beers Criteria. Multi-level linear models showed there was a significant association between a higher Drug Burden Index and lower quality of life according to the EuroQol Five Dimensions Questionnaire [β (standard error): − 0.034 (0.012), p = 0.006] after adjustment for potential confounding factors. Increasing numbers of potentially inappropriate medications were also associated with lower EuroQol Five Dimensions Questionnaire scores [− 0.030 (0.010), p = 0.003] and Dementia Quality of Life Questionnaire-Self-Report-Utility scores [− 0.020 (0.009), p = 0.029]. Exposure to both Drug Burden Index-associated medications and potentially inappropriate medications was associated with lower Dementia Quality of Life Questionnaire-Self-Report-Utility scores [− 0.034 (0.017), p = 0.049].
Conclusion
Exposure to anticholinergic and sedative medications and potentially inappropriate medications occurred in over three-quarters of a population of older adults in residential care and was associated with a lower quality of life
A new, large-bodied omnivorous bat (Noctilionoidea: Mystacinidae) reveals lost morphological and ecological diversity since the Miocene in New Zealand
Get PDFOpen Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.A new genus and species of fossil bat is described from New Zealand’s only pre-Pleistocene Cenozoic terrestrial fauna, the early Miocene St Bathans Fauna of Central Otago, South Island. Bayesian total evidence phylogenetic analysis places this new Southern Hemisphere taxon among the burrowing bats (mystacinids) of New Zealand and Australia, although its lower dentition also resembles Africa’s endemic sucker-footed bats (myzopodids). As the first new bat genus to be added to New Zealand’s fauna in more than 150 years, it provides new insight into the original diversity of chiropterans in Australasia. It also underscores the significant decline in morphological diversity that has taken place in the highly distinctive, semi-terrestrial bat family Mystacinidae since the Miocene. This bat was relatively large, with an estimated body mass of ~40 g, and its dentition suggests it had an omnivorous diet. Its striking dental autapomorphies, including development of a large hypocone, signal a shift of diet compared with other mystacinids, and may provide evidence of an adaptive radiation in feeding strategy in this group of noctilionoid bats
A database of chlorophyll a in Australian waters
Get PDFOpen Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ The Creative Commons Public Domain Dedication waiver http://creativecommons.org/publicdomain/zero/1.0/ applies to the metadata files made available in this article.Chlorophyll a is the most commonly used indicator of phytoplankton biomass in the marine environment. It is relatively simple and cost effective to measure when compared to phytoplankton abundance and is thus routinely included in many surveys. Here we collate 173, 333 records of chlorophyll a collected since 1965 from Australian waters gathered from researchers on regular coastal monitoring surveys and ocean voyages into a single repository. This dataset includes the chlorophyll a values as measured from samples analysed using spectrophotometry, fluorometry and high performance liquid chromatography (HPLC). The Australian Chlorophyll a database is freely available through the Australian Ocean Data Network portal (https://portal.aodn.org.au/). These data can be used in isolation as an index of phytoplankton biomass or in combination with other data to provide insight into water quality, ecosystem state, and relationships with other trophic levels such as zooplankton or fish
A narrative account of implementation lessons learnt from the dissemination of an up-scaled state-wide child obesity management program in Australia: PEACH™ (Parenting, Eating and Activity for Child Health) Queensland
Get PDFThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: PEACH QLD translated the PEACH Program, designed to manage overweight/obesity in primary school-aged children, from efficacious RCT and small scale community trial to a larger state-wide program. This paper describes the lessons learnt when upscaling to universal health coverage.
Methods: The 6-month, family-focussed program was delivered in Queensland, Australia from 2013 to 2016. Its implementation was planned by researchers who developed the program and conducted the RCT, and experienced project managers and practitioners across the health continuum. The intervention targeted parents as the agents of change and was delivered via parent-only group sessions. Concurrently, children attended fun, non-competitive activity sessions. Sessions were delivered by facilitators who received standardised training and were employed by a range of service providers. Participants were referred by health professionals or self-referred in response to extensive promotion and marketing. A pilot phase and a quality improvement framework were planned to respond to emerging challenges.
Results: Implementation challenges included engagement of the health system; participant recruitment; and engagement. A total of 1513 children (1216 families) enrolled, with 1122 children (919 families) in the face-to-face program (105 groups in 50 unique venues) and 391 children (297 families) in PEACH Online. Self-referral generated 68% of enrolments. Unexpected, concurrent and, far-reaching public health system changes contributed to poor program uptake by the sector (only 56 [53%] groups delivered by publicly-funded health organisations) requiring substantial modification of the original implementation plan. Process evaluation during the pilot phase and an ongoing quality improvement framework informed program adaptations that included changing from fortnightly to weekly sessions aligned with school terms, revision of parent materials, modification of eligibility criteria to include healthy weight children and provision of services privately. Comparisons between pilot versus state-wide waves showed comparable prevalence of families not attending any sessions (25% vs 28%) but improved number of sessions attended (median?=?5 vs 7) and completion rates (43% vs 56%).
Conclusions: Translating programs developed in the research context to enable implementation at scale is complex and presents substantial challenges. Planning must ensure there is flexibility to accommodate and proactively manage the system changes that are inevitable over tim
Using hydraulic head, chloride and electrical conductivity data to distinguish between mountain-front and mountain-block recharge to basin aquifers
Get PDFThis work is distributed under the Creative Commons Attribution 4.0 License.Numerous basin aquifers in arid and semi-arid regions of the world derive a significant portion of their recharge from adjacent mountains. Such recharge can effectively occur through either stream infiltration in the mountain-front zone (mountain-front recharge, MFR) or subsurface flow from the mountain (mountain-block recharge, MBR). While a thorough understanding of recharge mechanisms is critical for conceptualizing and managing groundwater systems, distinguishing between MFR and MBR is difficult. We present an approach that uses hydraulic head, chloride and electrical conductivity (EC) data to distinguish between MFR and MBR. These variables are inexpensive to measure, and may be readily available from hydrogeological databases in many cases. Hydraulic heads can provide information on groundwater flow directions and stream–aquifer interactions, while chloride concentrations and EC values can be used to distinguish between different water sources if these have a distinct signature. Such information can provide evidence for the occurrence or absence of MFR and MBR. This approach is tested through application to the Adelaide Plains basin, South Australia. The recharge mechanisms of this basin have long been debated, in part due to difficulties in understanding the hydraulic role of faults. Both hydraulic head and chloride (equivalently, EC) data consistently suggest that streams are gaining in the adjacent Mount Lofty Ranges and losing when entering the basin. Moreover, the data indicate that not only the Quaternary aquifers but also the deeper Tertiary aquifers are recharged through MFR and not MBR. It is expected that this finding will have a significant impact on the management of water resources in the region. This study demonstrates the relevance of using hydraulic head, chloride and EC data to distinguish between MFR and MBR
Estrogen, estrogen receptors, and hepatocellular carcinoma: Are we there yet?
Get PDFOpen-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/A protective role of the sex steroid hormone estrogen in hepatocellular carcinoma (HCC) was suggested a few decades ago according to clinical data showing higher HCC morbidity and mortality among males. Several recent studies further confirmed the anti-cancer effects of estrogen in the liver. However, it remains to be identified how to exploit estrogen signalling within clinical settings for HCC treatment. There are several unresolved issues related to the estrogen pathway in liver cells. The main problems include the absence of a clear understanding of which estrogen receptor (ER) isoform is predominantly expressed in normal and malignant liver cells, the ER isoform expression difference between males and females, and which ER isoform should be targeted when designing HCC therapy. Some of those questions were recently addressed by Iyer and co-authors. The current editorial review critically analyses the study by Iyer et al (WJG, 2017) that investigated the expression of ER subtypes in liver samples collected from patients with a healthy liver, hepatitis C virus cirrhosis, and HCC. ER presence was evaluated in association with gender, intracellular localization, inflammation marker NF-κB, and proliferation-related effector cyclin D1. The study limitations and advantages are discussed in light of recent advances in the HCC and estrogen signalling areas
Homoarginine and inhibition of human arginase activity: kinetic characterization and biological relevance
Get PDFThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.The inhibition of arginase, resulting in higher arginine (ARG) availability for nitric oxide synthesis, may account for the putative protective effect of homoarginine (HOMOARG) against atherosclerosis and cardiovascular disease. However, uncertainty exists regarding the significance of HOMOARG-induced arginase inhibition in vivo. A novel UPLC-MS method, measuring the conversion of ARG to ornithine (ORN), was developed to determine arginase 1 and arginase 2 inhibition by HOMOARG, lysine (LYS), proline (PRO), agmatine (AG), asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), and NG-Monomethyl-L-arginine (L-NMMA). Plasma HOMOARG, ARG and ORN concentrations were further measured in 50 healthy older adults >65 years (27 males and 23 females). HOMOARG inhibited arginase 1 with IC50 and Ki values of 8.14 ± 0.52 mM and 6.1 ± 0.50 mM, and arginase 2 with IC50 and Ki values of 2.52 ± 0.01 mM and 1.73 ± 0.10 mM, respectively. Both arginase isoforms retained 90% activity vs. control when physiological HOMOARG concentrations (1–10 µM) were used. In partial correlation analysis, plasma HOMOARG was not associated with ARG (P = 0.38) or ARG/ORN ratio (P = 0.73) in older adults. Our results suggest that arginase inhibition is unlikely to play a significant role in the reported cardio-protective effects of HOMOARG
Gender differences in temporal relationships between gambling urge and cognitions in treatment-seeking adults
Get PDF© 2018 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/
This author accepted manuscript is made available following 12 month embargo from date of publication (April 2018) in accordance with the publisher’s archiving policyMany gambling-specific CBT programs seek to target either gambling-related urge or cognitions or both. However, little is known of the influence of one symptom type on another across time and whether these differ for men and women help-seeking problem gamblers. The aim of this study was threefold: to determine presence of measurement invariance for urge and cognition measures over time; to investigate the effect of baseline urge on end-of-treatment gambling-related cognitions – and the reciprocal relationship; and, identify whether these pathways differ across gender. Self-reported gambling urge (GUS), and gambling-related cognitions (GRCS) data from treatment-seeking problem gamblers prior to and post treatment (N = 223; 62% men) were analyzed with cross-lagged panel models, moderated by gender. Conceptualization of urge and cognitions were found to be temporally stable. There was no significant association between baseline GUS scores and post-treatment GRCS scores, nor the reverse relationship. Putatively, this infers that coexisting urge and gambling-related cognition components of problem gambling operate independently over time. Analyses revealed gambling urge had a significantly stronger tracking correlation across time for men than women when adjusting for cognition paths. This investigation provides early evidence for tailoring CBT in response to sub-population gambling-related characteristics, demonstrated across men and women
The effect of ice slurry ingestion on body temperature and cycling performance in competitive athletes
Get PDF© 2018 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/
This author accepted manuscript is made available following 12 month embargo from date of publication (February 2018) in accordance with the publisher’s archiving policyThe effects of pre cooling on endurance performance are widely known. In contrast, the approach of cooling during endurance exercise in combination with pre-exercise cooling has been poorly understood. The purpose of the present study was to determine whether the effects of precooling and cooling during exercise enhance exercise performance compared to the ingestion of a thermo-neutral beverage (20 °C) or precooling alone in cycling performance. This was an experimental study using a randomised crossover design in which 7 cyclists underwent three trials comprising of 45 min steady state cycling (SS) at 70% VO2 max and a subsequent 10 km time trial (TT) in hot conditions (32 °C, 50% relative humidity). Rectal temperature (Tre), heat storage (HS), heart rate (HR), blood lactate concentration (BLA) and thermal sensation (TS) were measured. The intervention consisted of: (1) ingestion of thermo-neutral beverage before and during SS cycling (TN), (2) ingestion of ice slurry beverage and application of iced towels (precooling) prior to exercise, and then ingestion of thermo-neutral beverage during SS (PRE) and (3) precooling strategy as above plus ice slurry ingestion during SS cycling (PRE + MID). The intake of thermo-neutral or ice slurry beverage (14 g/kg) occurred over 30 min before and every 15 min during SS cycling. There was no significant difference in TT performance between all the conditions (P =0.72). However, PRE and PRE + MID caused a significant decrease in Tre (P < 0.05) from TN during exercise. Accordingly, both precooling and a combination of precooling and mid-cooling during exercise in hot conditions may be a practical and effective way of reducing core temperature. Future studies should investigate longer distance events and timing of ice slurry ingestion
Polydopamine as sizing on carbon fiber surfaces for enhancement of epoxy laminated composites
Get PDF© 2018 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/
This author accepted manuscript is made available following 24 month embargo from date of publication (Feb 2018) in accordance with the publisher’s archiving policyCarbon fiber reinforced polymer (CFRP) laminate normally has plastic dominant crack propagation behavior, inducing potential insecurity in the safety and reliability of structures in practical applications. In this study, we report a simple process to increase the stability of crack growth by using polydopamine (PDA) as sizing on the surface of carbon fiber (CF) fabric. The crack propagation behavior changes from a saw-tooth-shaped curve in neat CFRP laminate to a relatively smooth trending curve in PDA coated CFRP laminate with increased Mode I interlaminar fracture toughness. Enhanced impact strength and interlaminar shear strength of PDA coated CFRP laminates is also observed. A single fiber pull-out experiment and morphological study reveal that, with PDA coating on CF fabrics, cracks tend to fracture through the epoxy matrix rather than between fiber and matrix interfaces. The use of PDA as sizing on the CF contributes to improving the load transfer between the CF and the polymer matrix by enhancing the interfaces between the epoxy and the CF, increasing the friction of the fractured interface, reducing unstable crack growth, and thereby enhancing interfacial fracture toughness and impact performance