Is there an association between low dose aspirin and anemia (without overt bleeding)?: narrative review

<p>Abstract</p> <p>Background</p> <p>Overt bleeding associated with low dose aspirin (LDA) is well-recognized, little attention is given to the possibility of association between LDA and occult bleeding, although this is known to occur in healthy volunteers. LDA is used increasingly in primary and secondary prevention of a number of medical conditions, many of which are common in older people, as is anemia. Anemia in older people is associated with adverse outcomes including disability, morbidity and mortality. The purpose of this study was to review the evidence that LDA might cause anemia without overt bleeding.</p> <p>Methods</p> <p>An extensive narrative review was carried out. Electronic searching (including database links) and reference lists of reports were used to identify studies reporting on use of aspirin ≤325 mg/day and anemia or change in hemoglobin (Hb) without overt bleeding. Data were extracted from reports of trials, adverse drug reactions (ADRs) and prevalence studies of adults aged ≥18 years, published since 1980.</p> <p>Results</p> <p>There are few relevant data, with considerable heterogeneity among trial designs, duration, and patient characteristics in studies of LDA. In five randomised trials (n = 5879) in (mostly secondary) prevention, the majority of patients were men without peptic ulcer disease aged 50-70 years and no consistent association between LDA and change in Hb was found. In two smaller studies (n = 609) of primary prevention in healthy patients aged ≥70 years, there was a small but statistically significant fall in Hb with LDA. Observational studies, and data from trials in which use of LDA was not a primary focus of the study, were inconclusive.</p> <p>Conclusions</p> <p>It is not clear whether there is an association between LDA and anemia in the absence of overt bleeding, but there may be an association between LDA and fall in Hb in (a subset of) older patients. The available evidence has significant limitations, which are discussed; studies including more older patients, and publication of individual patient data, would help clarify this important matter.</p

Is there evidence for a relationship between cognitive impairment and fatigue after acquired brain injury: a systematic review and meta-analysis

PurposeFatigue is a major symptom of ABI. Greater fatigue is associated with cognitive impairment. Our aim was to systematically review, describe and analyse the literature on the extent of this relationship.MethodsFive databases were searched from inception. Studies were included where: participants had a defined clinical diagnosis of ABI which included TBI, stroke or subarachnoid haemorrhage; a fatigue measure was included; at least one objective cognitive measure was used. Three reviewers individually identified studies and determined quality using the Quality Assessment Tool for Observational Cohort and Cross-sectional Studies.ResultsSixteen of the 412 identified studies, investigating the relationship between cognitive dysfunction and fatigue, comprising a total of 1,745 participants, were included. Quality ranged from fair to good. Meta-analysis found fatigue was significantly associated with an overall pattern of cognitive slowing on tasks of sustained attention. A narrative synthesis found weak associations with fatigue and information processing, attention, memory and executive function.ConclusionAnalysis found sustained attentional performance had stronger associations with fatigue after ABI. Whereas, weak associations were found between fatigue and information processing, attention and to some extent memory and executive function. More focused research on specific cognitive domains is needed to understand the mechanisms of fatigue.Implications for RehabilitationCognitive dysfunction is associated with higher fatigue levels after stroke, traumatic brain injury or subarachnoid haemorrhage.Management of cognitive dysfunction may improve fatigue and participation in meaningful activities after stroke, traumatic brain injury or subarachnoid haemorrhage.Intervention strategies that reduce cognitive load during everyday activities (e.g., grading the burden on attentional resources), may potentially be effective in managing post-ABI fatigue.Agreement on core measures could facilitate integration of findings into clinical practice

Reframing governance possibilities for urban biodiversity conservation through systemic co-inquiry

Despite decades of effort, biodiversity has not attracted effective political discourse, policies or action to halt its decline. In cities in particular, biodiversity conservation is challenged by short term approaches, separately focusing on biodiversity or community wellbeing rather than on their interconnection, and pervasive beliefs that urban citizenry lack the requisite ethic or skills for conservation action or biodiversity governance. We describe how a systemic co-inquiry in Victoria Australia, conducted by citizen and agency practitioners alongside policy developers and academic researchers, modified understandings, practices, and institutional arrangements (governance) for urban biodiversity conservation. The most impactful outcomes of the early co inquiry period were 1) start-up funding for a network to forge collaborations between community and local government actors that engage urban residents in supporting indigenous biodiversity in their gardens, and 2) empowered co-inquiry members driving the network’s development. These efforts have led to on-going social learning and long-term institutional arrangements for a burgeoning network of municipally based nature stewardship collaborations that are nurturing local human–nature relations. Key challenges include(d): maintaining the co inquiry, paradigms that undervalue urban biodiversity and the role of citizens, organisational inertia, and evaluation measures incommensurate with strengthening person-nature relationships. Our research shows how systemic co-inquiry involving citizen practitioners can surface misleading assumptions around biodiversity stewardship and governance, and help to empower citizen and agency actors to focus on nurturing sustainable human-nature relations in cities

Human-animal elision: a Darwinian universe in George Eliot’s novels

No abstract available

Prevalence of anaemia in older persons: systematic review

<p>Abstract</p> <p>Background</p> <p>Ageing populations will impact on healthcare provision, especially since extra years are not necessarily spent in good health. It is important to identify and understand the significance of common medical problems in older people. Anaemia may be one such problem. We report on the prevalence of anaemia in cohorts of elderly people in the general population. The presence of anaemia is associated with a worse prognosis for both morbidity and mortality.</p> <p>Methods</p> <p>Electronic searching and reference lists of published reports were used to identify studies that reported on prevalence of anaemia in cohorts of at least 100 individuals predominantly aged 65 years and over living in developed countries, together with criteria used to define anaemia. Studies of anaemia prevalence in specific disease groups or published before 1980 were excluded. Prevalence data for the entire cohort, for men and women separately and for different age bands were extracted.</p> <p>Results</p> <p>Forty-five studies contributed data. Thirty-four studies (n = 85,409) used WHO criteria to define anaemia. The weighted mean prevalence was 17% (3–50%) overall, and 12% (3–25%) in studies based in the community (27, n = 69,975), 47% (31–50%) in nursing homes (3, n = 1481), and 40% (40–72%) in hospital admissions (4, n = 13,953). Anaemia prevalence increased with age, was slightly higher in men than women, and was higher in black people than white. Most individuals classified as anaemic using WHO criteria were only mildly anaemic.</p> <p>Conclusion</p> <p>Anaemia, as defined by WHO criteria, is common in older people living in the community and particularly common in nursing home residents and hospital admissions. Predicted demographic changes underline the need to understand more about anaemia in older people.</p

What infant-directed speech tells us about the development of compensation for assimilation

In speech addressed to adults, words are seldom realized in their canonical, or citation, form. For example, the word ‘green’ in the phrase ‘green beans’ can often be realized as ‘greem’ due to English place assimilation, where word-final coronals take on the place of articulation of neighboring velars. In such a situation, adult listeners readily ‘undo’ the assimilatory process and perceive the underlying intended lexical form of ‘greem’ (i.e. they access the lexical representation ‘green’). An interesting developmental question is how children, with their limited lexical knowledge, come to cope with phonologically conditioned connected speech processes such as place assimilation. Here, we begin to address this issue by examining the occurrence of place assimilation in the input to English-learning 18-month-olds. Perceptual and acoustic analyses of elicited speech, as well as analysis of a corpus of spontaneous speech, all converge on the finding that caregivers do not spoon-feed their children canonical tokens of words. Rather, infant-directed speech contains just as many non-canonical realizations of words in place assimilation contexts as adult-directed speech. Implications for models of developmental speech perception are discussed

Impact of cell types and culture methods on the functionality of in vitro liver systems - A review of cell systems for hepatotoxicity assessment.

Xenobiotic safety assessment is an area that impacts a multitude of different industry sectors such as medicinal drugs, agrochemicals, industrial chemicals, cosmetics and environmental contaminants. As such there are a number of well-developed in vitro, in vivo and in silico approaches to evaluate their properties and potential impact on the environment and to humans. Additionally, there is the continual investment in multidisciplinary scientists to explore non-animal surrogate technologies to predict specific toxicological outcomes and to improve our understanding of the biological processes regarding the toxic potential of xenobiotics. Here we provide a concise, critical evaluation of a number of in vitro systems utilised to assess the hepatotoxic potential of xenobiotics