The AdHOC study of older adults’ adherence to medication in 11 countries

BACKGROUND: Compared with the resources expended developing, evaluating and making clinical decisions about prescribing medication, we know little about what determines whether people take it. Older adults are prescribed more medication than any other group. Poor adherence is a common reason for nonresponse to medication. OBJECTIVES: To investigate cross-nationally the impact of demographic, psychiatric (including cognitive), physical health, behavioural and medication factors on adherence to medication in older adults. METHODS: Researchers interviewed 3881 people over 65 who receive home care services using a structured interview at participants’ places of residence in eleven countries. The main outcome measure was the percentage participants not adherent to medication. RESULTS: 12.5% (n= 456) of people reported they were not fully adherent to medication. Non-adherence was predicted by problem drinking (OR=3.6), not having a doctor review medication (OR=3.3), dementia (OR=1.4 for every one point increase in impairment), good physical health (OR=1.2), resisting care (OR=2.1) being married (OR=2.3) and living in the Czech Republic (OR=4.7) or Germany (OR=1.4). CONCLUSION: People, who screen positive for problem drinking and with dementia, often undiagnosed are less likely to adhere to medication. Therefore doctors should consider dementia and problem drinking when prescribing for older adults. Interventions to improve adherence in older adults might be more effective if 4 targeted at these groups. It is possible that medication review enhances adherence, by improving the patient-doctor relationship, or by emphasising the relevance of medications

Resultat af Forsøg, foretagne paa Lykkenssæde i Fyen, med den af Professor Claubrn anbefalede Hørrødningsmethode.

Resultat af Forsøg, foretagne paa Lykkenssæde i Fyen, med den af Professor Claubrn anbefalede Hørrødningsmethode

A prototypical model for tensional wrinkling in thin sheets

The buckling and wrinkling of thin films has recently seen a surge of interest among physicists, biologists, mathematicians and engineers. This has been triggered by the growing interest in developing technologies at ever decreasing scales and the resulting necessity to control the mechanics of tiny structures, as well as by the realization that morphogenetic processes, such as the tissue-shaping instabilities occurring in animal epithelia or plant leaves, often emerge from mechanical instabilities of cell sheets. While the most basic buckling instability of uniaxially compressed plates was understood by Euler more than 200 years ago, recent experiments on nanometrically thin (ultrathin) films have shown significant deviations from predictions of standard buckling theory. Motivated by this puzzle, we introduce here a theoretical model that allows for a systematic analysis of wrinkling in sheets far from their instability threshold. We focus on the simplest extension of Euler buckling that exhibits wrinkles of finite length - a sheet under axisymmetric tensile loads. This geometry, whose first study is attributed to Lam´e, allows us to construct\ud a phase diagram that demonstrates the dramatic variation of wrinkling patterns from near-threshold to far-from-threshold conditions. Theoretical arguments and comparison to experiments show that for thin sheets the far-from-threshold regime is expected to emerge under extremely small compressive loads, emphasizing the relevance of our analysis for nanomechanics applications

Liquid Transport Due to Light Scattering

Using experiments and theory, we show that light scattering by inhomogeneities in the index of refraction of a fluid can drive a large-scale flow. The experiment uses a near-critical, phase-separated liquid, which experiences large fluctuations in its index of refraction. A laser beam traversing the liquid produces a large-scale deformation of the interface and can cause a liquid jet to form. We demonstrate that the deformation is produced by a scattering-induced flow by obtaining good agreements between the measured deformations and those calculated assuming this mechanism.Comment: 4 pages, 5 figures, submitted to Physical Review Letters v2: Edited based on comments from referee

Unintended weight loss in the elderly living at home: the aged in homecare project (Adhoc)

Objective: To describe associations between unintended weight loss (UWL) and characteristics of nutritional status. Design: A comparative cross-sectional assessment study at 11 sites in Europe. The target population was a stratified random sample of 4,455 recipients of home care (405 in each random sample from 11 urban areas) aged 65 years and older. Measurements: the Resident Assessment Instrument for Home Care, version 2.0. Epidemiological and medical characteristics of clients and service utilisation were recorded in a standardized, comparative manner. UWL was defined as information of 5% or more weight loss in the last 30 days (or 10% or more in the last 180 days). Results: The final sample consisted of 4,010 persons; 74% were female. The mean ages were 80.9 ± 7.5 years (males) and 82.8 ± 7.3 years (females). No associations were found between single diagnoses and UWL, except for cancer. Cancer patients were excluded from further analyses. Persons with a Cognitive Performance Scale value (CPS) > 3 (impaired) had increased risk of UWL (OR = 2.0) compared with those scoring < 3 (less impaired). Only in the oldest group did we find a significant association between UWL and reduction in ADL and IADL functions, comparing those who scored 3 or less with those who scored more than 3 (disabled). A binary logistic regression model explained 26% of UWL: less than one meal/day, reduced appetite, malnutrition, reduced social activity, experiencing a flare-up of a recurrent or chronic problem, and hospitalisation were important indicators. Conclusion: We recommend a regular comprehensive assessment in home care to identify clients with potential risk factors for weight loss and malnutrition, in particular those discharged from hospital, and those with physical dependency or cognitive problems. This study may provide incentives to create tailored preventive strategies

Home care needs of extremely obese elderly european women

Objective: To examine the health and needs of extremely obese women aged over 65 years receiving home care in Europe. Study design: A cross-sectional assessment study based on the Aged in Home Care (AdHOC) project recruited 2974 women aged 65 or over who were receiving home care at 11 sites in European countries. Extreme obesity was defined as ‘Obesity of such a degree as to interfere with normal activities, including respiration’. Main outcome measures: Resident Assessment Instrument for Home Care (RAI-HC version 2.0); Activity of Daily Living Scale; Instrumental Activity of Daily Living Scale; the Minimum Data Set Cognitive Performance Scale; and a health profile. Results: One hundred and twenty women (4.0%) were extremely obese. They were younger than their thinner counterparts, with a median age of 78.3 versus 83.3 years, and they more often had multiple health complaints and needed more help with mobility outside the home. The extremely obese had received home care longer than the non-extremely obese (median 28.7 versus 36.6 months). Extremely obese women also needed more help with personal care than the other group and, due to lower age, they were less cognitively impaired. Conclusions: Extreme obesity is a problem that increasingly affects home care of elderly women

Stable Carbon Isotope Signature of Methane Released From Phytoplankton

Unidad de excelencia María de Maeztu CEX2019-000940-MAquatic ecosystems play an important role in global methane cycling and many field studies have reported methane supersaturation in the oxic surface mixed layer (SML) of the ocean and in the epilimnion of lakes. The origin of methane formed under oxic condition is hotly debated and several pathways have recently been offered to explain the "methane paradox." In this context, stable isotope measurements have been applied to constrain methane sources in supersaturated oxygenated waters. Here we present stable carbon isotope signatures for six widespread marine phytoplankton species, three haptophyte algae and three cyanobacteria, incubated under laboratory conditions. The observed isotopic patterns implicate that methane formed by phytoplankton might be clearly distinguished from methane produced by methanogenic archaea. Comparing results from phytoplankton experiments with isotopic data from field measurements, suggests that algal and cyanobacterial populations may contribute substantially to methane formationobserved in the SML of oceans and lakes

Filtering spin with tunnel-coupled electron wave guides

We show how momentum-resolved tunneling between parallel electron wave guides can be used to observe and exploit lifting of spin degeneracy due to Rashba spin-orbit coupling. A device is proposed that achieves spin filtering without using ferromagnets or the Zeeman effect.Comment: 4 pages, 4 figures, RevTex

Impact of a Viscous Liquid Drop

We simulate the impact of a viscous liquid drop onto a smooth dry solid surface. As in experiments, when ambient air effects are negligible, impact flattens the falling drop without producing a splash. The no-slip boundary condition at the wall produces a boundary layer inside the liquid. Later, the flattening surface of the drop traces out the boundary layer. As a result, the eventual shape of the drop is a "pancake" of uniform thickness except at the rim, where surface tension effects are significant. The thickness of the pancake is simply the height where the drop surface first collides with the boundary layer.Comment: 5 pages, 3 figures, submitted to Physical Review Letter

Laser microfluidics: fluid actuation by light

The development of microfluidic devices is still hindered by the lack of robust fundamental building blocks that constitute any fluidic system. An attractive approach is optical actuation because light field interaction is contactless and dynamically reconfigurable, and solutions have been anticipated through the use of optical forces to manipulate microparticles in flows. Following the concept of an 'optical chip' advanced from the optical actuation of suspensions, we propose in this survey new routes to extend this concept to microfluidic two-phase flows. First, we investigate the destabilization of fluid interfaces by the optical radiation pressure and the formation of liquid jets. We analyze the droplet shedding from the jet tip and the continuous transport in laser-sustained liquid channels. In the second part, we investigate a dissipative light-flow interaction mechanism consisting in heating locally two immiscible fluids to produce thermocapillary stresses along their interface. This opto-capillary coupling is implemented in adequate microchannel geometries to manipulate two-phase flows and propose a contactless optical toolbox including valves, droplet sorters and switches, droplet dividers or droplet mergers. Finally, we discuss radiation pressure and opto-capillary effects in the context of the 'optical chip' where flows, channels and operating functions would all be performed optically on the same device