Use of Medicines by Community Dwelling Elderly in Ontario

OBJECTIVE: Prescription medicine use by the elderly is of growing concern as indicated by a large literature focused on rising costs, patient compliance and the appropriateness of use. However, prescriptions account for only a portion of medicines used by the elderly, who have increasing access to non-prescription medicines and natural health products. The objective of this paper is to describe overall medicine use among the elderly in Ontario. METHODS: Using the National Population Health Survey (1996/97), we describe self-reported use of prescription, non-prescription and alternative medicines among elderly Ontarians aged 65+, and we compare use among four age sub-groups and by gender. Analysis is focused on the prevalence of, and the relative balance of use of different types of medicines. RESULTS: About one quarter of the respondents reported using no prescription or non-prescription medicines in the two days prior to being surveyed; a large majority reported using two or fewer medicines only, and use of non- prescription medicines was reported more often than prescription medicines (56% vs 48%). Use of natural health products by seniors is relatively low, but we observe a trend toward increased use in younger age groups. DISCUSSION: The findings place the consumption of prescription medicines by the elderly into a broader context that reveals that much of medicine use by the elderly involves non-prescribed products. We highlight the need to better understand seniors' decision-making regarding the different types of medicines available, and the financial costs and health risks of the medicine regimes of elderly persons.elderly, medicine-use, prescription medicines, over-the-counter medicines, natural health products, NPHS

Lifting the Veil on Obscured Accretion: Active Galactic Nuclei Number Counts and Survey Strategies for Imaging Hard X-Ray Missions

Finding and characterizing the population of active galactic nuclei (AGNs) that produces the X-ray background (XRB) is necessary to connect the history of accretion to observations of galaxy evolution at longer wavelengths. The year 2012 will see the deployment of the first hard X-ray imaging telescope which, through deep extragalactic surveys, will be able to measure the AGN population at the energies where the XRB peaks (~20-30 keV). Here, we present predictions of AGN number counts in three hard X-ray bandpasses: 6-10 keV, 10-30 keV, and 30-60 keV. Separate predictions are presented for the number counts of Compton thick AGNs, the most heavily obscured active galaxies. The number counts are calculated for five different models of the XRB that differ in the assumed hard X-ray luminosity function, the evolution of the Compton thick AGNs, and the underlying AGN spectral model. The majority of the hard X-ray number counts will be Compton thin AGNs, but there is a greater than tenfold increase in the Compton thick number counts from the 6-10 keV to the 10-30 keV band. The Compton thick population shows enough variation that a hard X-ray number counts measurement will constrain the models. The computed number counts are used to consider various survey strategies for the NuSTAR mission, assuming a total exposure time of 6.2 Ms. We find that multiple surveys will allow a measurement of Compton thick evolution. The predictions presented here should be useful for all future imaging hard X-ray missions

An XMM-Newton observation of Ton S180: Constraints on the continuum emission in ultrasoft Seyfert galaxies

We present an XMM-Newton observation of the bright, narrow-line, ultrasoft Seyfert 1 galaxy Ton S180. The 0.3-10 keV X-ray spectrum is steep and curved, showing a steep slope above 2.5 keV (Gamma ~ 2.3) and a smooth, featureless excess of emission at lower energies. The spectrum can be adequately parameterised using a simple double power-law model. The source is strongly variable over the course of the observation but shows only weak spectral variability, with the fractional variability amplitude remaining approximately constant over more than a decade in energy. The curved continuum shape and weak spectral variability are discussed in terms of various physical models for the soft X-ray excess emission, including reflection off the surface of an ionised accretion disc, inverse-Compton scattering of soft disc photons by thermal electrons, and Comptonisation by electrons with a hybrid thermal/non-thermal distribution. We emphasise the possibility that the strong soft excess may be produced by dissipation of accretion energy in the hot, upper atmosphere of the putative accretion disc.Comment: 9 pages, accepted for publication in MNRA

Obscuring Active Galactic Nuclei with Nuclear Starburst Disks

We assess the potential of nuclear starburst disks to obscure the Seyfert-like AGN that dominate the hard X-ray background at z~1. Over 1200 starburst disk models, based on the theory developed by Thompson et al., are calculated for five input parameters: the black hole mass, the radial size of the starburst disk, the dust-to-gas ratio, the efficiency of angular momentum transport in the disk, and the gas fraction at the outer disk radius. We find that a large dust-to-gas ratio, a relatively small starburst disk, a significant gas mass fraction, and efficient angular momentum transport are all important to produce a starburst disk that can potentially obscure an AGN. The typical maximum star-formation rate in the disks is ~10 solar masses per year. Assuming no mass-loss due to outflows, the starburst disks feed gas onto the black hole at rates sufficient to produce hard X-ray luminosities of 10^{43}-10^{44} erg s^{-1}. The starburst disks themselves should be detectable at mid-infrared and radio wavelengths; at z=0.8, the predicted fluxes are ~1 mJy at 24microns and ~10-30 microJy at 1.4GHz. Thus, we predict a large fraction of radio/X-ray matches in future deep radio surveys. The starburst disks should be easily distinguished from AGN in future 100microns surveys by Herschel with expected fluxes of ~5 mJy. Any AGN-obscuring starbursts will be associated with hot dust, independent of AGN heating, resulting in observable signatures for separating galactic and nuclear star-formation. Finally, because of the competition between gas and star-formation, nuclear starbursts will be associated with lower-luminosity AGN. Thus, this phenomenon is a natural explanation for the observed decrease in the fraction of obscured AGN with luminosity.Comment: 13 pages, 12 figures, 3 in color; accepted by Ap

The gastric acid pocket is attenuated in H. pylori infected subjects

Objective Gastric acid secretory capacity in different anatomical regions, including the postprandial acid pocket, was assessed in Helicobacter pylori positive and negative volunteers in a Western population. Design We studied 31 H. pylori positive and 28 H. pylori negative volunteers, matched for age, gender and body mass index. Jumbo biopsies were taken at 11 predetermined locations from the gastro-oesophageal junction and stomach. Combined high-resolution pH metry (12 sensors) and manometry (36 sensors) was performed for 20 min fasted and 90 min postprandially. The squamocolumnar junction was marked with radio-opaque clips and visualised radiologically. Biopsies were scored for inflammation and density of parietal, chief and G cells immunohistochemically. Results Under fasting conditions, the H. pylori positives had less intragastric acidity compared with negatives at all sensors >1.1 cm distal to the peak lower oesophageal sphincter (LES) pressure (p<0.01). Postprandially, intragastric acidity was less in H. pylori positives at sensors 2.2, 3.3 and 4.4 cm distal to the peak LES pressure (p<0.05), but there were no significant differences in more distal sensors. The postprandial acid pocket was thus attenuated in H. pylori positives. The H. pylori positives had a lower density of parietal and chief cells compared with H. pylori negatives in 10 of the 11 gastric locations (p<0.05). 17/31 of the H. pylori positives were CagA-seropositive and showed a more marked reduction in intragastric acidity and increased mucosal inflammation. Conclusions In population volunteers, H. pylori positives have reduced intragastric acidity which most markedly affects the postprandial acid pocket

X-ray Reflection from Inhomogeneous Accretion Disks: II. Emission Line Variability and Implications for Reverberation Mapping

One of the principal scientific objectives of the upcoming Constellation-X mission is to attempt to map the inner regions of accretion disks around black holes in Seyfert galaxies by reverberation mapping of the Fe K fluorescence line. This area of the disk is likely radiation pressure dominated and subject to various dynamical instabilities. Here, we show that density inhomogeneities in the disk atmosphere resulting from the photon bubble instability (PBI) can cause rapid changes in the X-ray reflection features, even when the illuminating flux is constant. Using a simulation of the development of the PBI, we find that, for the disk parameters chosen, the Fe K and O VIII Ly\alpha lines vary on timescales as short as a few hundredths of an orbital time. In response to the changes in accretion disk structure, the Fe K equivalent width (EW) shows variations as large as ~100 eV. The magnitude and direction (positive or negative) of the changes depends on the ionization state of the atmosphere. The largest changes are found when the disk is moderately ionized. The O VIII EW varies by tens of eV, as well as exhibiting plenty of rapid, low-amplitude changes. This effect provides a natural explanation for some observed instances of short timescale Fe K variability which was uncorrelated with the continuum (e.g., Mrk 841). New predictions for Fe K reverberation mapping should be made which include the effects of this accretion disk driven line variability and a variable ionization state. Reflection spectra averaged over the evolution of the instability are well fit by constant density models in the 2-10 keV region.Comment: 20 pages, 3 figures. Accepted by Ap

Sustainability intervention mechanisms for managing road freight transport externalities: A systematic literature review

With road freight transport continuing to dominate global freight transport operations, there is increasing pressure on the freight transport industry and its stakeholders to address concerns over its sustainability. This paper adopts a systematic review to examine the academic literature on road freight transport sustainability between 2001 and 2018. Using content and thematic analysis, the paper identifies and categorises sustainability intervention mechanisms providing useful insights on key research applications areas and continental distribution of sustainable road freight transport (SRFT) research. In addition to the six-overarching sustainability intervention mechanism themes identified: decoupling, Information and Communications Technology (ICT), modality, operations, policy, and other, future research can explore the effectiveness of different interventions mechanisms identified in this study to improve sustainable practices across different continents

Radio Synchrotron Emission from Secondary Leptons in the Vicinity of Sgr A*

A point-like source of ~TeV gamma-rays has recently been seen towards the Galactic center by HESS and other air Cerenkov telescopes. In recent work (Ballantyne et al. 2007), we demonstrated that these gamma-rays can be attributed to high-energy protons that (i) are accelerated close to the event horizon of the central black hole, Sgr A*, (ii) diffuse out to ~pc scales, and (iii) finally interact to produce gamma-rays. The same hadronic collision processes will necessarily lead to the creation of electrons and positrons. Here we calculate the synchrotron emissivity of these secondary leptons in the same magnetic field configuration through which the initiating protons have been propagated in our model. We compare this emission with the observed ~GHz radio spectrum of the inner few pc region which we have assembled from archival data and new measurements we have made with the Australia Telescope Compact Array. We find that our model predicts secondary synchrotron emission with a steep slope consistent with the observations but with an overall normalization that is too large by a factor of ~ 2. If we further constrain our theoretical gamma-ray curve to obey the implicit EGRET upper limit on emission from this region we predict radio emission that is consistent with observations, i.e., the hadronic model of gamma ray emission can, simultaneously and without fine-tuning, also explain essentially all the diffuse radio emission detected from the inner few pc of the Galaxy.Comment: 11 pages, 2 figures. Two references missing from published version added and acknowledgements extende

Social-psychological and Structural Factors Influencing the Experience of Chronic Disease: A focus on Individuals with Severe Arthritis

In-depth personal interviews were conducted with 29 men and women with severe arthritis of the hip or knee. All respondents had been identified by medical experts as having demonstrable need for total joint arthroplasty, but in assessment in another study, had stated an unwillingness to consider the procedure. In interviews, we explored 1) current self reported health status and co-morbidities; 2) features and functions of the informal and formal support network; and 3) general orientations to aging, illness and independence, to examine the influence of these on participants' strategies for coping with severe arthritis and their views of treatment options. We present a multi-level model of the social-interactional and social-structural features of lives in which the experience of arthritis and responses to it are contextualized. Interviews reveal a complex set of experiences and responses: participants frequently reject the medicalization of their arthritis; they normalize the experience of functional decline (ie: they modify expectations to fit their capacity), or define it as age normative; they draw on a broad set of previous experiences from the lay health care system as well as from the formal medical care system to define an appropriate strategy of coping for the "here and now". The discussion focuses on the distinction between objectively assessed disease and subjectively experienced illness, and the implications of this distinction for medical practice.illness experience, lay perspectives, social context, decision-making, chronic illness, arthritis