Medication management ability in older patients: Time for a reappraisal

Background. Adhering to drug regimens is a complex and multidimensional task. Elderly patients usually take an average of seven drugs but most fail to adhere to the prescribed regimen. Several performance-based instruments have been developed to assess a patient\u2019s capacity to manage drugs but with inconsistent results. Aims. The aim of the study was to assess the prevalence of impaired medical management capacity in a sample of the oldest old hospitalized elderly patients and the main clinical factors associated with potential unintentional non-adherence. Methods. Forty-six consecutive patients were enrolled in the geriatric transitional care unit of Ospedale Policlinico San Martino, Genoa, Italy. All patients received an abbreviated comprehensive geriatric assessment and a hand grip assessment for sarcopenia. Patients\u2019 medication management ability was assessed by administering the DRUGS tool 48-74 hours before hospital discharge. Results. The results showed a negative correlation between age and total medication management score. A positive correlation was detected between functional status, cognitive status, and medication management score. Hand grip strength < 9 kg correlated with a significant worsening of medical management capacity. In contrast, multiple morbidities and the mean number of drugs were not associated with the medical management score. Conclusions. This preliminary study indicated that drug management capacity mainly relies on frailty markers, such as functional status, sarcopenia, and cognitive performance. Further studies are warranted to identify a subset of medical parameters that can accurately predict impaired medical management ability early, particularly for highly vulnerable elderly patients

vitamin C, aging and Alzheimer's disease

Accumulating evidence in mice models of accelerated senescence indicates a rescuing role of ascorbic acid in premature aging. Supplementation of ascorbic acid appeared to halt cell growth, oxidative stress, telomere attrition, disorganization of chromatin, and excessive secretion of inflammatory factors, and extend lifespan. Interestingly, ascorbic acid (AA) was also found to positively modulate inflamm-aging and immunosenescence, two hallmarks of biological aging. Moreover, ascorbic acid has been shown to epigenetically regulate genome integrity and stability, indicating a key role of targeted nutrition in healthy aging. Growing in vivo evidence supports the role of ascorbic acid in ameliorating factors linked to Alzheimer’s disease (AD) pathogenesis, although evidence in humans yielded equivocal results. The neuroprotective role of ascorbic acid not only relies on the general free radical trapping, but also on the suppression of pro-inflammatory genes, mitigating neuroinflammation, on the chelation of iron, copper, and zinc, and on the suppression of amyloid-beta peptide (Aβ) fibrillogenesis. Epidemiological evidence linking diet, one of the most important modifiable lifestyle factors, and risk of Alzheimer's disease is rapidly increasing. Thus, dietary interventions, as a way to epigenetically modulate the human genome, may play a role in the prevention of AD. The present review is aimed at providing an up to date overview of the main biological mechanisms that are associated with ascorbic acid supplementation/bioavailability in the process of aging and Alzheimer’s disease. In addition, we will address new fields of research and future directions.</jats:p

Magnetic Helicity Generation from the Cosmic Axion Field

The coupling between a primordial magnetic field and the cosmic axion field generates a helical component of the magnetic field around the time in which the axion starts to oscillate. If the energy density of the seed magnetic field is comparable to the energy density of the universe at that time, then the resulting magnetic helicity is about |H_B| \simeq (10^{-20} G)^2 kpc and remains constant after its generation. As a corollary, we find that the standard properties of the oscillating axion remain unchanged even in the presence of very strong magnetic fields.Comment: 6 pages, 2 figures. Accepted for publication in Phys. Rev. D. Minor revisions and new references adde

A compact city for the wealthy? Employment accessibility inequalities between occupational classes in the London metropolitan region 2011

The prevalence of gentrification and housing marketisation processes in many cities points to increasingly wealthy inner-city areas and potentially greater population segregation by income. It is plausible that these trends are contributing to regional accessibility inequalities, though quantitative research testing this link is limited. This paper examines differences in employment accessibility between Standard Occupational Classification groups in the London Metropolitan Region for 2011 for car, transit, bus only and walking modes. Additionally, changes in occupational class populations 2006–2016 are considered, revealing continuing inner-city gentrification. Employment accessibility is calculated using cumulative measures, based on travel times from multi-modal network modelling. The results show that while car accessibility is relatively equal between occupational classes, public transport, bus and walk accessibility have significant inequalities favouring professional classes. Low income groups have lower accessibility for the most affordable bus and walk modes, and inequalities are greater for residents in the wider metropolitan region. Furthermore, professional groups combine accessibility advantages with the highest rates of owner occupation, maximising housing wealth benefits. Lower income groups are exposed to rent increases, though this is offset by social housing, which remains the most prevalent tenure in Inner London for low income classes

A compact city for the wealthy? Employment accessibility inequalities between occupational classes in the London metropolitan region 2011

The prevalence of gentrification and housing marketisation processes in many cities points to increasingly wealthy inner-city areas and potentially greater population segregation by income. It is plausible that these trends are contributing to regional accessibility inequalities, though quantitative research testing this link is limited. This paper examines differences in employment accessibility between Standard Occupational Classification groups in the London Metropolitan Region for 2011 for car, transit, bus only and walking modes. Additionally, changes in occupational class populations 2006–2016 are considered, revealing continuing inner-city gentrification. Employment accessibility is calculated using cumulative measures, based on travel times from multi-modal network modelling. The results show that while car accessibility is relatively equal between occupational classes, public transport, bus and walk accessibility have significant inequalities favouring professional classes. Low income groups have lower accessibility for the most affordable bus and walk modes, and inequalities are greater for residents in the wider metropolitan region. Furthermore, professional groups combine accessibility advantages with the highest rates of owner occupation, maximising housing wealth benefits. Lower income groups are exposed to rent increases, though this is offset by social housing, which remains the most prevalent tenure in Inner London for low income classes

URACHAL CYST: AN UNSPECTED COMPLICATION

The urachus is the remnant of the allantois, which usually becomes obliterated shortly after birth. Urachal remnants due to an incomplete obliteration of different portion of the urachus are rare, but they need to be treated surgically because of their potential for infectious complications and malignant degeneration. We present a case report with an unespected postoperative complication. M.E., a 10 years old boy, came to the Accident and Emergency Department for an acute abdominal pain, without other symptoms, twice in one year. The blood tests, urine sample and voiding cystourethrogram were normal. The ultrasound scan showed a thickened urachal duct. After antibiotic and anti-inflammatory therapy for two weeks, we performed laparoscopic surgery. In the second postoperative day the patient showed abdominal pain and hematuria. An ultrasound scan and a voiding cystourethrogram showed a leak from the dome of bladder. We performed an open surgery to close the defect on the bladder’s dome. The patient was discharged in 10th postoperative day. Now he is healthy. Clinically manifest persistent urachal anomalies are rare, but they carry a risk of recurrent infection and subsequent malignant degeneration. For these reasons the radical excision of the remnant is suggested. Today, due to the large laparoscopic experience, all the reports showed that this technique can be used safely, but we have to pay attention to all steps of the procedure. This case is a paradigmatic situation and it illustrates the importance of a meticulous technique during the excision of urachal remnant. Indeed even if laparoscopic excision could be safe and effective, it is not free of complication

Dilaton Interactions and the Anomalous Breaking of Scale Invariance of the Standard Model

We discuss the main features of dilaton interactions for fundamental and effective dilaton fields. In particular, we elaborate on the various ways in which dilatons can couple to the Standard Model and on the role played by the conformal anomaly as a way to characterize their interactions. In the case of a dilaton derived from a metric compactification (graviscalar), we present the structure of the radiative corrections to its decay into two photons, a photon and a $Z$, two $Z$ gauge bosons and two gluons, together with their renormalization properties. We prove that, in the electroweak sector, the renormalization of the theory is guaranteed only if the Higgs is conformally coupled. For such a dilaton, its coupling to the trace anomaly is quite general, and determines, for instance, an enhancement of its decay rates into two photons and two gluons. We then turn our attention to theories containing a non-gravitational (effective) dilaton, which, in our perturbative analysis, manifests as a pseudo-Nambu Goldstone mode of the dilatation current ($J_D$). The infrared coupling of such a state to the two-photons and to the two-gluons sector, and the corresponding anomaly enhancements of its decay rates in these channels, is critically analyzed.Comment: Revised version, 42 pages, 5 figure

A Note on the Cosmic Evolution of the Axion in a Strong Magnetic Field

It has been pointed out in the literature that in the presence of an external magnetic field the axion mass receives an electromagnetic contribution. We show that if a magnetic field with energy density larger than ~10^{-8} times the energy density of the Universe existed at temperatures of a few GeV, that contribution would be dominant and consequently the cosmic evolution of the axion field would change substantially. In particular, the expected axion relic abundance would be lowered, allowing a small relaxation of the present cosmological bound on the Peccei-Quinn constant.Comment: 2 pages, no figures. Minor changes. References added. Accepted for publication in JCA