MEDICATION USE IN A SAMPLE OF COMMUNITY-DWELLING OLDER ADULTS

Objectives: To examine prevalence, changes and persistence of medication-use and potentially inappropriate medication-use at two time points in a sample of 176 participants of a falls-prevention program. Methods: Drug lists were formulated through in-person interviews. The Beers\u27 Criteria were used to categorize medications as potentially inappropriate. Results: Mean age of the sample was 79 (SD=6.3) years (range 47-100 years). Nearly two-thirds took at least one cardiac medication. Over 40% took an antithrombotic medication. One-quarter took a prescription central nervous system medication and about one in ten took an over-the- counter pain medication. At baseline, 17.6% reported the use of at least one inappropriate medication which decreased to 13.6% by the second assessment. Conclusions: This small study demonstrates varied prevalence and persistence among drug classes examined. Use of inappropriate medication decreased, but, since follow-up did not continue past one year, the persistence of these changes after the falls-prevention program ceased is unknown

Ocean ensemble forecasting. Part I: Ensemble Mediterranean winds from a Bayesian hierarchical model

A Bayesian hierarchical model (BHM) is developed to estimate surface vector wind (SVW) fields and associated uncertainties over the Mediterranean Sea. The BHM–SVW incorporates data-stage inputs from analyses and forecasts of the European Centre for Medium-Range Weather Forecasts (ECMWF) and SVW retrievals from the QuikSCAT data record. The process-model stage of the BHM–SVW is based on a Rayleigh friction equation model for surface winds. Dynamical interpretations of posterior distributions of the BHM–SVW parameters are discussed. Ten realizations from the posterior distribution of the BHM–SVW are used to force the data-assimilation step of an experimental ensemble ocean forecast system for the Mediterranean Sea in order to create a set of ensemble initial conditions. The sequential data-assimilation method of the Mediterranean forecast system (MFS) is adapted to the ensemble implementation. Analyses of sample ensemble initial conditions for a single data-assimilation period in MFS are presented to demonstrate the multivariate impact of the BHM–SVW ensemble generation methodology. Ensemble initial-condition spread is quantified by computing standard deviations of ocean state variable fields over the ten ensemble members. The methodological findings in this article are of two kinds. From the perspective of statistical modelling, the process-model development is more closely related tophysicalbalances than inpreviousworkwithmodels for the SVW.Fromthe ocean forecast perspective, the generation of ocean ensemble initial conditions via BHM is shown to be practical for operational implementation in an ensemble ocean forecast system. Phenomenologically, ensemble spread generated via BHM–SVW occurs on ocean mesoscale time- and space-scales, in close association with strong synoptic-scale wind-forcing events. A companion article describes the impacts of the BHM–SVW ensemble method on the ocean forecast in comparisons with more traditional ensemble methods

Ocean ensemble forecasting. Part II: Mediterranean Forecast System response

This article analyzes the ocean forecast response to surface vector wind (SVW) distributions generated by a Bayesian hierarchical model (BHM) developed in Part I of this series. A new method for ocean ensemble forecasting (OEF), the socalled BHM-SVW-OEF, is described. BHM-SVW realizations are used to produce and force perturbations in the ocean state during 14 day analysis and 10 day forecast cycles of the Mediterranean Forecast System (MFS). The BHM-SVW-OEF ocean response spread is amplified at the mesoscales and in the pycnocline of the eddy field. The new method is compared with an ensemble response forced by European Centre for Medium-Range Weather Forecasts (ECMWF) ensemble prediction system (EEPS) surface winds, and with an ensemble forecast started from perturbed initial conditions derived froman ad hoc thermocline intensified random perturbation (TIRP) method. The EEPS-OEF shows spread on basin scales while the TIRP-OEF response is mesoscale-intensified as in the BHM-SVW-OEF response. TIRP-OEF perturbations fill more of the MFS domain, while the BHM-SVW-OEF perturbations are more location-specific, concentrating ensemble spread at the sites where the ocean-model response to uncertainty in the surface wind forcing is largest

Ocean Ensemble Forecasting, Part II: Mediterranean Forecast System Response

This paper analyzes the ocean forecast response to surface vector wind (SVW) distributions generated by a Bayesian Hierarchical Model (BHM) developed in Part I (Milliff et al., 2009). A new method for Ocean Ensemble Forecasting (OEF), so-called BHM-SVW-OEF, is described. BHM-SVW realizations are used to produce and force perturbations in the ocean state during 14-day analysis and 10-day forecast cycles of the Mediterranean Forecast System (MFS). The BHM-SVW-OEF ocean response spread is amplified at the mesoscales and pycnocline of the eddy field. The new method is compared to an ensemble response forced by ECMWF Ensemble Prediction System (EEPS) surface winds, and to an ensemble forecast started from perturbed initial conditions derived from an ad hoc Thermocline Intensified Random Perturbation (TIRP) method. The EEPS-OEF shows spread at the basin scales while the TIRP-OEF response is mesoscale intensified as in the BHM-SVW-OEF response. TIRP-OEF perturbations fill more of the MFS domain while the BHM-SVW-OEF perturbations are more location-specific, concentrating ensemble spread at the sites where the ocean model response to uncertainty in the surface wind forcing is largest. The BHM-SVW-OEF method offers a practical and objective means for producing short-term forecast spread by modeling surface atmospheric forcing uncertainties that have maximum impact at the ocean mesoscales

Improving practice in community-based settings: a randomized trial of supervision – study protocol

Background: Evidence-based treatments for child mental health problems are not consistently available in public mental health settings. Expanding availability requires workforce training. However, research has demonstrated that training alone is not sufficient for changing provider behavior, suggesting that ongoing intervention-specific supervision or consultation is required. Supervision is notably under-investigated, particularly as provided in public mental health. The degree to which supervision in this setting includes ‘gold standard’ supervision elements from efficacy trials (e.g., session review, model fidelity, outcome monitoring, skill-building) is unknown. The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practices and test the impact of systematic implementation of gold standard supervision strategies on treatment fidelity and clinical outcomes. Methods/Design The study has two phases. We will conduct an initial descriptive study (Phase I) of supervision practices within public mental health in Washington State followed by a randomized controlled trial of gold standard supervision strategies (Phase II), with randomization at the clinician level (i.e., supervisors provide both conditions). Study participants will be 35 supervisors and 130 clinicians in community mental health centers. We will enroll one child per clinician in Phase I (N = 130) and three children per clinician in Phase II (N = 390). We use a multi-level mixed within- and between-subjects longitudinal design. Audio recordings of supervision and therapy sessions will be collected and coded throughout both phases. Child outcome data will be collected at the beginning of treatment and at three and six months into treatment. Discussion This study will provide insight into how supervisors can optimally support clinicians delivering evidence-based treatments. Phase I will provide descriptive information, currently unavailable in the literature, about commonly used supervision strategies in community mental health. The Phase II randomized controlled trial of gold standard supervision strategies is, to our knowledge, the first experimental study of gold standard supervision strategies in community mental health and will yield needed information about how to leverage supervision to improve clinician fidelity and client outcomes. Trial registration ClinicalTrials.gov NCT0180026

Better Nonlinear Models from Noisy Data: Attractors with Maximum Likelihood

A new approach to nonlinear modelling is presented which, by incorporating the global behaviour of the model, lifts shortcomings of both least squares and total least squares parameter estimates. Although ubiquitous in practice, a least squares approach is fundamentally flawed in that it assumes independent, normally distributed (IND) forecast errors: nonlinear models will not yield IND errors even if the noise is IND. A new cost function is obtained via the maximum likelihood principle; superior results are illustrated both for small data sets and infinitely long data streams.Comment: RevTex, 11 pages, 4 figure

Structural identification of oxidized acyl-phosphatidylcholines that induce platelet activation

Oxidation of low-density lipoprotein (LDL) generates proinflammatory and prothrombotic mediators that may play a crucial role in cardiovascular and inflammatory diseases. In order to study platelet-activating components of oxidized LDL 1-stearoyl-2-arachidonoyl-sn-glycero-3- phosphocholine, a representative of the major phospholipid species in LDL, the 1-acyl-phosphatidylcholines (PC), was oxidized by CuCl2 and H2O2. After separation by high-performance liquid chromatography, three compounds were detected which induced platelet shape change at low micromolar concentrations. Platelet activation by these compounds was distinct from the pathways stimulated by platelet-activating factor, lysophosphatidic acid, lyso-PC and thromboxane A(2), as evidenced by the use of specific receptor antagonists. Further analyses of the oxidized phospholipids by electrospray ionization mass spectrometry structurally identified them as 1-stearoyl-2-azelaoyl-sn-glycero-3-phosphocholine (m/z 694; SAzPC), 1-stearoyl-2-glutaroyl-snglycero-3- phosphocholine (m/z 638; SGPC), and 1-stearoyl-2-( 5-oxovaleroyl)-sn-glycero-3-phosphocholine (m/z 622; SOVPC). These observations demonstrate that novel 1-acyl-PC which had previously been found to stimulate interaction of monocytes with endothelial cells also induce platelet activation, a central step in acute thrombogenic and atherogenic processes. Copyright (C) 2005 S. Karger AG, Basel

The Advanced LIGO Photon Calibrators

The two interferometers of the Laser Interferometry Gravitaional-wave Observatory (LIGO) recently detected gravitational waves from the mergers of binary black hole systems. Accurate calibration of the output of these detectors was crucial for the observation of these events, and the extraction of parameters of the sources. The principal tools used to calibrate the responses of the second-generation (Advanced) LIGO detectors to gravitational waves are systems based on radiation pressure and referred to as Photon Calibrators. These systems, which were completely redesigned for Advanced LIGO, include several significant upgrades that enable them to meet the calibration requirements of second-generation gravitational wave detectors in the new era of gravitational-wave astronomy. We report on the design, implementation, and operation of these Advanced LIGO Photon Calibrators that are currently providing fiducial displacements on the order of $10^{-18}$ m/$\sqrt{\textrm{Hz}}$ with accuracy and precision of better than 1 %.Comment: 14 pages, 19 figure

What makes you not a Buddhist? : a preliminary mapping of values

This study sets out to establish which Buddhist values contrasted with or were shared by adolescents from a non-Buddhist population. A survey of attitude toward a variety of Buddhist values was fielded in a sample of 352 non-Buddhist schoolchildren aged between 13 and 15 in London. Buddhist values where attitudes were least positive concerned the worth of being a monk/nun or meditating, offering candles & incense on the Buddhist shrine, friendship on Sangha Day, avoiding drinking alcohol, seeing the world as empty or impermanent and Nirvana as the ultimate peace. Buddhist values most closely shared by non-Buddhists concerned the Law of Karma, calming the mind, respecting those deserving of respect, subjectivity of happiness, welfare work, looking after parents in old age and compassion to cuddly animals. Further significant differences of attitude toward Buddhism were found in partial correlations with the independent variables of sex, age and religious affiliation. Correlation patterns paralleled those previously described in theistic religions. Findings are applied to spiritual, moral, social and cultural development and for the teaching of religious to pupils of no faith adherence. The study recommends that quantitative psychometrics employed to conceptualize Buddhist values by discriminant validity in this study could be extended usefully to other aspects of the study of Buddhism, particularly in quest of validity in the conceptualization of Buddhist identity within specifically Buddhist populations