Potentially inappropriate medication use: the Beers' Criteria used among older adults with depressive symptoms

INTRODUCTION: The ageing population means prescribing for chronic illnesses in older people is expected to rise. Comorbidities and compromised organ function may complicate prescribing and increase medication-related risks. Comorbid depression in older people is highly prevalent and complicates medication prescribing decisions. AIM: To determine the prevalence of potentially inappropriate medication use in a community-dwelling population of older adults with depressive symptoms. METHODS: The medications of 191 community-dwelling older people selected because of depressive symptoms for a randomised trial were reviewed and assessed using the modified version of the Beers' Criteria. The association between inappropriate medication use and various population characteristics was assessed using Chi-square statistics and logistic regression analyses. RESULTS: The mean age was 81 (±4.3) years and 59% were women. The median number of medications used was 6 (range 1-21 medications). The most commonly prescribed potentially inappropriate medications were amitriptyline, dextropropoxyphene, quinine and benzodiazepines. Almost half (49%) of the participants were prescribed at least one potentially inappropriate medication; 29% were considered to suffer significant depressive symptoms (Geriatric Depression Scale ≥5) and no differences were found in the number of inappropriate medications used between those with and without significant depressive symptoms (Chi-square 0.005 p=0.54). DISCUSSION: Potentially inappropriate medication use, as per the modified Beers' Criteria, is very common among community-dwelling older people with depressive symptoms. However, the utility of the Beers' Criteria is lessened by lack of clinical correlation. Ongoing research to examine outcomes related to apparent inappropriate medication use is needed

Modular Equations and Distortion Functions

Modular equations occur in number theory, but it is less known that such equations also occur in the study of deformation properties of quasiconformal mappings. The authors study two important plane quasiconformal distortion functions, obtaining monotonicity and convexity properties, and finding sharp bounds for them. Applications are provided that relate to the quasiconformal Schwarz Lemma and to Schottky's Theorem. These results also yield new bounds for singular values of complete elliptic integrals.Comment: 23 page

Will modifying soil water holding capacity increase the resilience of southern Australian crop-livestock farms to climate change?

Southern Australia is expected to face a warmer and drier climate in near future that will affect the dryland crop-livestock farming enterprises. As soil provides a buffer to store water between rainfall events, a suggested climate adaptation option is to reduce subsoil constraints (physical or chemical) to increase the soil plant available water capacity (PAWC). The considerable costs to modify the subsoil raises a question of how much PAWC needs to be increased and how often the increased PAWC would be advantageous. This research examines the effect of increasing PAWC from 40 to 120 mm in 20 mm increments on wheat and pasture production along a climate transect from 385 to 219 mm mean growing season rainfall during the historic climate and in two potential climate projections for 2030: moderate warming with little changes in rainfall, and more severe warming with declining rainfall. Biophysical simulation models of integrated crop-livestock systems were constructed by linking APSIM (V7.7) to GRAZPLAN using the AusFarm environment (V1.4.12). Locations and projected future climates with higher rainfall gained the most from an increased PAWC. Not only was this evident in an increase in average yields of pasture and wheat but also in the frequency of years when there was a benefit. In higher rainfall conditions a larger PAWC increased wheat yield by at least 10% in 95% of years, compared to only 60% of years in lower rainfall conditions. A larger PAWC was of no benefit in very dry conditions. Overall productivity gains diminished not only as rainfall increased, but also as PAWC increased. Pasture production showed little benefit of PAWC above 60 mm presumably due to shallower roots or rainfall more closely matched to water demand, while wheat yield in a PAWC of 80 mm averaged over 90% of that in a PAWC of 120 mm. Wheat yield was reduced by water stress experienced during the growth cycle with the seasonal distribution of rainfall affecting the severity and timing of water stress and yield components of grain number and grain size. However, wheat grown in soils with higher PAWC had less water stress even under the same rainfall conditions. This was due in part to greater availability of water because of reduced water loss from deep drainage and increased soil water storage between rotations. Modifying PAWC will not counteract an extreme drying trend. In some seasons there will be little benefit of modifying the subsoil because the rainfall pattern is extremely low or is regular and matched to crop and pasture requirements. In other seasons when rainfall is high a larger PAWC will be of benefit as the increased buffering capacity of the soil will assist with carryover of water from a wet run of days to a dry period. Modifying the subsoil raises complex questions of nutrition, engineering and farm management economics. However, simulation modelling using a transect from wetter and drier sites in both current and future climates contributes to discussion on management of climate risk in the coming decades and effective adaptation options for future climates

Effectiveness of Health Education Teachers and School Nurses Teaching Sexually Transmitted Infections/ Human Immunodeficiency Virus Prevention Knowledge and Skills in High School

BACKGROUND- We examined the differential impact of a well-established human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) curriculum, Be Proud! Be Responsible!, when taught by school nurses and health education classroom teachers within a high school curricula. METHODS- Group-randomized intervention study of 1357 ninth and tenth grade students in 10 schools. Twenty-seven facilitators (6 nurses, 21 teachers) provided programming; nurse-led classrooms were randomly assigned. RESULTS- Students taught by teachers were more likely to report their instructor to be prepared, comfortable with the material, and challenged them to think about their health than students taught by a school nurse. Both groups reported significant improvements in HIV/STI/condom knowledge immediately following the intervention, compared to controls. Yet, those taught by school nurses reported significant and sustained changes (up to 12 months after intervention) in attitudes, beliefs, and efficacy, whereas those taught by health education teachers reported far fewer changes, with sustained improvement in condom knowledge only. CONCLUSIONS- Both classroom teachers and school nurses are effective in conveying reproductive health information to high school students; however, teaching the technical (eg, condom use) and interpersonal (eg, negotiation) skills needed to reduce high-risk sexual behavior may require a unique set of skills and experiences that health education teachers may not typically have

Polynomial diffeomorphisms of C^2, IV: The measure of maximal entropy and laminar currents

This paper concerns the dynamics of polynomial automorphisms of ${\bf C}^2$. One can associate to such an automorphism two currents $\mu^\pm$ and the equilibrium measure $\mu=\mu^+\wedge\mu^-$. In this paper we study some geometric and dynamical properties of these objects. First, we characterize $\mu$ as the unique measure of maximal entropy. Then we show that the measure $\mu$ has a local product structure and that the currents $\mu^\pm$ have a laminar structure. This allows us to deduce information about periodic points and heteroclinic intersections. For example, we prove that the support of $\mu$ coincides with the closure of the set of saddle points. The methods used combine the pluripotential theory with the theory of non-uniformly hyperbolic dynamical systems

Zoonosis emergence linked to agricultural intensification and environmental change

A systematic review was conducted by a multidisciplinary team to analyze qualitatively best available scientific evidence on the effect of agricultural intensification and environmental changes on the risk of zoonoses for which there are epidemiological interactions between wildlife and livestock. The study found several examples in which agricultural intensification and/or environmental change were associated with an increased risk of zoonotic disease emergence, driven by the impact of an expanding human population and changing human behavior on the environment. We conclude that the rate of future zoonotic disease emergence or reemergence will be closely linked to the evolution of the agriculture–environment nexus. However, available research inadequately addresses the complexity and interrelatedness of environmental, biological, economic, and social dimensions of zoonotic pathogen emergence, which significantly limits our ability to predict, prevent, and respond to zoonotic disease emergence

Cardiac and Pulmonary Dosimetric Parameters in Lung Cancer Patients Undergoing Post-Operative Radiation Therapy in the Real-World Setting

Purpose/Objective(s): The recently published Lung ART trial reported increased rates of cardiac and pulmonary toxicity in the post-operative radiation therapy arm. It remains unknown whether the dosimetric parameters reported in Lung ART are representative of real-world practice. The purpose of this study is to examine heart and lung dose exposure in patients receiving post-operative radiation therapy for non-small cell lung cancer (NSCLC) across a statewide consortium. Materials/Methods: From 2012 to 2020, 377 patients at 27 academic and community centers within the Michigan Radiation Oncology Quality Consortium (MROQC) underwent surgical resection followed by post-operative radiation therapy for non-metastatic NSCLC. Demographic and dosimetric data were prospectively collected for these patients. Rates of 3D-CRT and IMRT use were analyzed. Mean heart dose (MHD), heart V5, heart V35, mean lung dose (MLD), lung V20, target volume and minimum dose to 95% PTV were calculated for these patients and the reported dosimetric parameters were stratified by treatment modality. Results: 51% of patients in this cohort had N2 disease at the time of surgery, 18% had a positive margin. 65.8% of patients were treated with IMRT compared to 32.1% treated with 3D-CRT. Average MHD for all patients was 10.3 Gy, mean Heart V5 was 40.3% and mean heart V35 was 12.6%. Average MLD was 11.2 Gy and mean lung V20 was 18.9%. These dosimetric parameters did not significantly differ based on treatment modality, with MHD and MLD 9.9 Gy and 10.1 Gy, respectively, for patients treated with 3D-CRT compared to 10.6 Gy and 11.8 Gy for patients treated with IMRT. Conclusion: Cardiac and lung dosimetric parameters for patients receiving post-operative radiation therapy for NSCLC are similar to the dosimetric characteristics reported in Lung ART. The mean heart and mean lung doses observed are slightly lower (MHD 10.3 Gy, MLD 11.2 Gy) compared to Lung ART (MHD 13 Gy, MLD 13 Gy), possibly owing to increased use of IMRT. These data support application of Lung ART\u27s findings outside of the clinical trial setting