Prescribed opioid use is associated with increased all-purpose emergency department visits and hospitalizations in community-dwelling older adults in the United States

BackgroundThe geriatric and health characteristics of older adults make them more susceptible to the effects of opioids than younger groups. The number of older adults in the United States visiting the emergency department (ED) and overusing opioids has increased in recent years. Research examining their relationship is, however, limited.MethodsUsing information from the 2020 National Health Interview Survey (NHIS), we included older adults aged 65 and older. To investigate the relationship between prescribed opioid use and 12-months ED visits and hospitalizations, linear regression and logistic regression models were built while adjusting for age, sex, ethnicity, education, employment, general health status, history of depression, and living arrangement.ResultsOur study population consisted of 8,631 participants (mean age 74.3). Most of them were females (58.3%) and Caucasian (81.6%). About 16% of the participants used prescribed opioids over the past 12 months. Of the participants with prescribed opioid use, 65.1% of them did so to treat chronic pain. The adjusted regression models revealed that prescribed opioid use was independently and positively associated with 12-months ED visits (β = 0.22, 95% confidence interval [CI] 0.18, 0.26) and hospitalizations (Odds ratio [OR] = 3.78, 95% CI 3.29, 4.35). Other risk factors for 12-months ED visits and/or hospitalizations included advanced age, male gender, unemployment/retirement, African American ethnicity, living alone, fair or poor general health status, and history of depression.DiscussionsClinicians should screen older adults at high risk for ED visits and hospitalizations and explore multimodal pain management with them to help them reduce/stop using opioids. These efforts may decrease their chronic pain, opioid use, opioid use-related adverse health outcomes, ED visits, as well as hospitalizations

Table-GPT: Table-tuned GPT for Diverse Table Tasks

Language models, such as GPT-3.5 and ChatGPT, demonstrate remarkable abilities to follow diverse human instructions and perform a wide range of tasks. However, when probing language models using a range of basic table-understanding tasks, we observe that today's language models are still sub-optimal in many table-related tasks, likely because they are pre-trained predominantly on \emph{one-dimensional} natural-language texts, whereas relational tables are \emph{two-dimensional} objects. In this work, we propose a new "\emph{table-tuning}" paradigm, where we continue to train/fine-tune language models like GPT-3.5 and ChatGPT, using diverse table-tasks synthesized from real tables as training data, with the goal of enhancing language models' ability to understand tables and perform table tasks. We show that our resulting Table-GPT models demonstrate (1) better \emph{table-understanding} capabilities, by consistently outperforming the vanilla GPT-3.5 and ChatGPT, on a wide-range of table tasks, including holdout unseen tasks, and (2) strong \emph{generalizability}, in its ability to respond to diverse human instructions to perform new table-tasks, in a manner similar to GPT-3.5 and ChatGPT

The Relationship Between Plasma DPP4 Activity to BDNF Ratio and Mild Cognitive Impairment in Elderly Population With Normal Glucose Tolerance

Objective: Since decreased brain-derived neurotrophic factor (BDNF) and increased dipeptidyl peptidase-4 (DPP4) activity have both been implicated in the pathogenesis of mild cognitive impairment (MCI), the aim of our study was to evaluate the association of MCI with plasma DPP4 activity to BDNF ratio (DBR) in an elderly population with normal glucose tolerance.Methods: We cross-sectionally measured C-reactive protein, interleukin-6, nitrotyrosine, 8-iso-PGF2a, DPP4 activity BDNF and calculated the DBR in a total of 1,066 elderly participants in China. MCI was determined by the Montreal Cognitive Assessment and finally confirmed by neurologists.Results: An inverse correlation was found between DPP4 activity and BDNF (r = -0.456, P < 0.001) and this inverse correlation was partly mediated by nitrotyrosine and 8-iso-PGF2a. Across rising quartiles of DBR, nitrotyrosine, 8-iso-PGF2a, C-reactive protein and interleukin-6 progressively increased, whereas the Montreal Cognitive Assessment score progressively decreased. Subjects in the lowest quartile of BDNF and highest quartiles of DBR and DPP4 activity, had higher MCI risk compared with subjects in the highest quartile of the BDNF and lowest quartiles of DBR and DPP4 activity, respectively (all P < 0.05). The odds ratio for MCI became more pronounced with decreased BDNF and increased DPP4.Conclusion: In conclusion, a negative correlation was found between DPP4 activity and BDNF, and this negative correlation was partly mediated by oxidative stress, not inflammation. The DBR was positively associated with MCI and thus may be used as a novel risk biomarker for MCI in an elderly population with normal glucose tolerance

Low temperature and temperature decline increase acute aortic dissection risk and burden: A nationwide case crossover analysis at hourly level among 40,270 patients.

Background: Acute aortic dissection (AAD) is a life-threatening cardiovascular emergency with high mortality, so identifying modifiable risk factors of AAD is of great public health significance. The associations of non-optimal temperature and temperature variability with AAD onset and the disease burden have not been fully understood. Methods: We conducted a time-stratified case-crossover study using a nationwide registry dataset from 1,868 hospitals in 313 Chinese cities. Conditional logistic regression and distributed lag models were used to investigate associations of temperature and temperature changes between neighboring days (TCN) with the hourly AAD onset and calculate the attributable fractions. We also evaluated the heterogeneity of the associations. Findings: A total of 40,270 eligible AAD cases were included. The exposure-response curves for temperature and TCN with AAD onset risk were both inverse and approximately linear. The risks were present on the concurrent hour (for temperature) or day (for TCN) and lasted for almost 1 day. The cumulative relative risks of AAD were 1.027 and 1.026 per 1°C lower temperature and temperature decline between neighboring days, respectively. The associations were significant during the non-heating period, but were not present during the heating period in cities with central heating. 23.13% of AAD cases nationwide were attributable to low temperature and 1.58% were attributable to temperature decline from the previous day. Interpretation: This is the largest nationwide study demonstrating robust associations of low temperature and temperature decline with AAD onset. We, for the first time, calculated the corresponding disease burden and further showed that central heating may be a modifier for temperature-related AAD risk and burden. Funding: This work was supported by the National Natural Science Foundation of China (92043301 and 92143301), Shanghai International Science and Technology Partnership Project (No. 21230780200), the Medical Research Council-UK (MR/R013349/1), and the Natural Environment Research Council UK (NE/R009384/1)

Obesity related methylation changes in DNA of peripheral blood leukocytes

<p>Abstract</p> <p>Background</p> <p>Despite evidence linking obesity to impaired immune function, little is known about the specific mechanisms. Because of emerging evidence that immune responses are epigenetically regulated, we hypothesized that DNA methylation changes are involved in obesity induced immune dysfunction and aimed to identify these changes.</p> <p>Method</p> <p>We conducted a genome wide methylation analysis on seven obese cases and seven lean controls aged 14 to 18 years from extreme ends of the obesity distribution and performed further validation of six CpG sites from six genes in 46 obese cases and 46 lean controls aged 14 to 30 years.</p> <p>Results</p> <p>In comparison with the lean controls, we observed one CpG site in the UBASH3A gene showing higher methylation levels and one CpG site in the TRIM3 gene showing lower methylation levels in the obese cases in both the genome wide step (<it>P </it>= 5 × 10^-6and <it>P </it>= 2 × 10^-5for the UBASH3A and the TRIM3 gene respectively) and the validation step (<it>P </it>= 0.008 and <it>P </it>= 0.001 for the UBASH3A and the TRIM3 gene respectively).</p> <p>Conclusions</p> <p>Our results provide evidence that obesity is associated with methylation changes in blood leukocyte DNA. Further studies are warranted to determine the causal direction of this relationship as well as whether such methylation changes can lead to immune dysfunction.</p> <p>See commentary: <url>http://www.biomedcentral.com/1741-7015/8/88/abstract</url></p

Discutindo a educação ambiental no cotidiano escolar: desenvolvimento de projetos na escola formação inicial e continuada de professores

A presente pesquisa buscou discutir como a Educação Ambiental (EA) vem sendo trabalhada, no Ensino Fundamental e como os docentes desta escola compreendem e vem inserindo a EA no cotidiano escolar., em uma escola estadual do município de Tangará da Serra/MT, Brasil. Para tanto, realizou-se entrevistas com os professores que fazem parte de um projeto interdisciplinar de EA na escola pesquisada. Verificou-se que o projeto da escola não vem conseguindo alcançar os objetivos propostos por: desconhecimento do mesmo, pelos professores; formação deficiente dos professores, não entendimento da EA como processo de ensino-aprendizagem, falta de recursos didáticos, planejamento inadequado das atividades. A partir dessa constatação, procurou-se debater a impossibilidade de tratar do tema fora do trabalho interdisciplinar, bem como, e principalmente, a importância de um estudo mais aprofundado de EA, vinculando teoria e prática, tanto na formação docente, como em projetos escolares, a fim de fugir do tradicional vínculo “EA e ecologia, lixo e horta”.Facultad de Humanidades y Ciencias de la Educació

Comparison of Bending Creep Behavior of Bamboo-based Composites Manufactured by Two Types of Stacking Sequences

The study of viscoelastic and mechano-sorptive creep on bamboo laminated veneer lumber (BLVL) and bamboo/poplar plywood (BPP) is described in this paper. Bending creep tests parallel to the grain were carried out on two bamboo-based composites for a length of 90 days. The specimens measured 500 mm × 20 mm × 12 mm. Based on the experimental data, the creep curves of two boards were evaluated. The results are summarized as follows: (1) the anti-creep property of BLVL was better than that of BPP; (2) two creep curves were successfully approximated using the Burgers model and the power law model. The required experimental term for the creep test to estimate an accurate long-term curve is 2 or 3 years when the power law is used for the estimation; and (3) compared with the creep curve in a constant environment, the creep deformation changed more dramatically under varying environment

Investigation of Enhanced Leaching of Lithium from α-Spodumene Using Hydrofluoric and Sulfuric Acid

An effective method using hydrofluoric and sulfuric acid was proposed to enhance the leaching of lithium from α-spodumene, without calcination that is subjected to 1000 °C for phase transformation. The thermodynamic feasibility of the reactions was firstly verified. Dissolution conditions were tested to maximize the leaching efficiency of lithium and with efficient utilization of hydrofluoric acid (HF) served as evaluation criteria. The results showed that 96% of lithium could be transferred into lixivium with an ore/HF/H2SO4 ratio of 1:3:2 (g/mL/mL), at 100 °C for 3 h. Due to the fact that HF molecules were the main reaction form, the dissolution behaviors were theoretically represented and investigated by dissolution in HF/H2SO4. When combined with chemical elements analyses and characterizations, the results of the dissolution behaviors revealed that α-spodumene and albite were preferentially dissolved over quartz. Insoluble fluoroaluminates, such as AlF3, cryolite (Na3AlF6) and cryolithionite (Na3Li3Al2F12), were generated and might be further partially dissolved by H2SO4. Fluorosilicates, such as K2SiF6, Na2SiF6, or KNaSiF6, were also generated as a part of the insoluble residues. This work provides fundamental insight into the role of HF/H2SO4 played in the dissolution of α-spodumene, and sheds light on a novel and promising process to efficiently extract lithium

A Chinese herbal medicine Ermiao wan reduces serum uric acid level and inhibits liver xanthine dehydrogenase and xanthine oxidase in mice

Ermiao wan, which is composed of phellodendri cortex and atractylodis rhizome, is described as eliminating heat, excreting dampness and anti-edema prescription in traditional Chinese medical literatures including Danxi's Experiences in Medicine and State Pharmacopoeia of People's Republic of China. So it is being used clinically in the treatment of gout and hyperuricemia in China. In the present study, the water extracts of Ermiao wan and phellodendri cortex at 840 and 480 mg/kg/day orally for 7 days were demonstrated to possess in vivo potent hypouricemic effects both in hyperuricemic mice pretreated with oxonate and in normal mice, respectively. In the hyperuricemic animals, the effect of Ermiao wan was equal to that of the reference drug allopurinol (at 10 mg/kg/day orally for 7 days), but in the normal mice, the former was weaker than latter. In addition, both Ermiao wan and phellodendri cortex were found to have in vivo relatively inhibitory effects on mouse liver xanthine dehydrogenase (XDH) and xanthine oxidase (XO) activities at the same dose described above. These inhibitory effects were weaker than that observed for allopurinol. Atractylodis rhizome at 340 mg/kg/day orally for 7 days did not show any effects on the above experiments. These results suggested that atractylodis rhizomes assisted and enhanced the effect of phellodendri cortex on reduction of serum uric acid level in hyperuricemic mice, and hypouricemic effects of Ermiao wan and phellodendri cortex may be achieved by other mechanism partly instead of the XDH and XO inhibition. © 2004 Elsevier Ireland Ltd. All rights reserved