Effectiveness of interventions aimed at improving physical and psychological outcomes of fall-related injuries in people with dementia: a narrative systematic review

Background: The annual prevalence of falls in people with dementia ranges from 47 to 90%. Falls are a common reason for hospital admission in people with dementia, and there is limited research evidence regarding the care pathways experienced by this population. In addition to immediate management of an injury, prevention of further falls is likely to be an important part of any successful intervention. This review aims to assess the effectiveness of interventions for improving the physical and psychological wellbeing of people with dementia who have sustained a fall-related injury. Methods: Systematic review methodologies were employed utilising searches across multiple databases (MEDLINE, CENTRAL, Health Management Information Consortium, EMBASE, CINAHL, Web of Science, Allied and Complementary Medicine Database, and Physiotherapy Evidence Database (PEDro)) and citation chaining. Studies including people with a known diagnosis of dementia living in the community and who present at health services with a fall, with or without injury, were included. Outcomes of interest included mobility, recurrent falls, activities of daily living, length of hospital stay, and post-discharge residence. Results were independently reviewed and quality assessed by two researchers, and data extracted using a customised form. A narrative synthesis was performed due to heterogeneity of the included studies. Results: Seven studies were included. Interventions clustered into three broad categories: multidisciplinary in-hospital post-surgical geriatric assessment; pharmaceuticals; and multifactorial assessment. Multidisciplinary care and early mobilisation showed short-term improvements for some outcomes. Only an annual administration of zoledronic acid showed long-term reduction in recurrent falls. Conclusions: Due to high heterogeneity across the studies, definitive conclusions could not be reached. Most post-fall interventions were not aimed at patients with dementia and have shown little efficacy regardless of cognitive status. Minor improvements to some quality of life indicators were shown, but these were generally not statistically significant. Conclusions were also limited due to most studies addressing hip fracture; the interventions provided for this type of injury may not be suitable for other types of fractures or soft tissue injuries, or for use in primary care

Climate change and agricultural adaptation in Sri Lanka: a review

Climate change is inevitable and will continue into the next century. Since the agricultural sector in Sri Lanka is one of the most vulnerable to climate change, a thorough understanding of climate transition is critical for formulating effective adaptation strategies. This paper provides an overview of the status of climate change and adaptation in the agricultural sector in Sri Lanka. The review clearly indicates that climate change is taking place in Sri Lanka in terms of rainfall variability and an increase in climate extremes and warming. A number of planned and reactive adaptation responses stemming from policy and farm-level decisions are reported. These adaptation efforts were fragmented and lacked a coherent connection to the national development policies and strategies. Research efforts are needed to develop and identify adaptation approaches and practices that are feasible for smallholder farmers, particularly in the dry zone where paddy and other food crops are predominately cultivated. To achieve the envisaged growth in the agricultural sector, rigorous efforts are necessary to mainstream climate change adaptation into national development policies and ensure that they are implemented at national, regional and local levels

Moments of inertia, nucleon axial-vector coupling, the {\bf 8}, {\bf 10}, 10ˉ\bar{\bf 10} and 273/2{\bf 27}_{3/2} mass spectrums and the higher SU(3)_f representation mass splittings in the Skyrme model

The broad importance of a recent experimental discovery of pentaquarks requires more theoretical insight into the structure of higher representation multiplets. The nucleon axial-vector coupling, moments of inertia, the {\bf 8}, {\bf 10}, $\bar{\bf 10}$, and ${\bf 27}_{3/2}$ absolute mass spectra and the higher SU(3)$_f$ representation mass splittings for the multiplets ${\bf 8}$, ${\bf 10}$, $\bar{\bf 10}$, ${\bf 27}$, ${\bf 35}$, $\bar{\bf 35}$, and $\bf 64$ are computed in the framework of the minimal ${\rm SU(3)_f}$ extended Skyrme model by using only one free parameter, i.e., the Skyrme charge $e$. The analysis presented in this paper represents simple and clear theoretical estimates, obtained without using any experimental results for higher ($\bar{\bf 10}$,...) multiplets. The obtained results are in good agreement with other chiral soliton model approaches that more extensively use experimental results as inputs.Comment: 22 pages, 12 figures, 9 tables, version accepted in JHE

Alternative Transportation Energy

Transportation energy issues are moving to the forefront of the public consciousness in the U.S. and particularly California, and gaining increasing attention from legislators and regulators. The three principal concerns motivating interest in transportation energy are urban air quality, oil dependence, and the threat of global warming. Transportation fuels are a principal contributor to each of these. The transportation sector, mostly motor vehicles, contributes roughly half the urban air pollutants, almost one-third of the carbon dioxide, and consumes over 60% of all petroleum

Supplementary Material for: Prevalence and Risk Score for Hypertonic Dehydration Among Community-Dwelling Older Adults: an Analysis of the Bangkok Falls Study

Introduction: Dehydration is associated with morbidity, and many factors affect dehydration in older adults including age and medication use. This study determined the prevalence of hypertonic dehydration (HD) and factors affecting HD in older adults and developed a risk score (a set of consistent weights that assign a numerical value to each risk factor) which are potentially useful in predicting HD among community-dwelling Thai older adults. Methods: Data were obtained from a cohort study of community-dwelling older adults aged ≥60 years in Bangkok, Thailand between October 1, 2019, and September 30, 2021. Current HD was defined as a serum osmolality >300 mOsm/kg. Univariate and multivariate logistic regression analyses were used to identify factors associated with current and impending HD. The risk score for current HD was developed based on the final multiple logistic regression model. Results: A total of 704 participants were included in the final analysis. In this study, 59 (8.4%) participants had current HD and 152 (21.6%) had impending HD. We identified three risk factors for HD in older adults; age ≥ 75 years (adjusted odds ratio (aORs) 2.0, 95% confidence interval [CI]: 1.16-3.46), underlying diabetes mellitus (aORs 3.07, 95%CI: 1.77-5.31) and use of ß-blocker medication (aORs 1.98, 95%CI: 1.04-3.78). The increasing risks of current HD with increasing risk scores were 7.4% for a score of 1, 13.8 % for a score of 2, 19.8% for a score of 3, and 32.8% for a score of 4. Conclusion: One-third of the older adults in this study had current or impending HD. We identified risk factors for HD and created a risk score for HD in one group of community-dwelling older adults. Older adults with risk scores of 1-4 were at 7.4%-32.8% risk for current HD. The clinical utility of this risk score requires further study and external validation

Supplementary Material for: Prevalence and Risk Score for Hypertonic Dehydration Among Community-Dwelling Older Adults: an Analysis of the Bangkok Falls Study

Introduction: Dehydration is associated with morbidity, and many factors affect dehydration in older adults including age and medication use. This study determined the prevalence of hypertonic dehydration (HD) and factors affecting HD in older adults and developed a risk score (a set of consistent weights that assign a numerical value to each risk factor) which are potentially useful in predicting HD among community-dwelling Thai older adults. Methods: Data were obtained from a cohort study of community-dwelling older adults aged ≥60 years in Bangkok, Thailand between October 1, 2019, and September 30, 2021. Current HD was defined as a serum osmolality >300 mOsm/kg. Univariate and multivariate logistic regression analyses were used to identify factors associated with current and impending HD. The risk score for current HD was developed based on the final multiple logistic regression model. Results: A total of 704 participants were included in the final analysis. In this study, 59 (8.4%) participants had current HD and 152 (21.6%) had impending HD. We identified three risk factors for HD in older adults; age ≥ 75 years (adjusted odds ratio (aORs) 2.0, 95% confidence interval [CI]: 1.16-3.46), underlying diabetes mellitus (aORs 3.07, 95%CI: 1.77-5.31) and use of ß-blocker medication (aORs 1.98, 95%CI: 1.04-3.78). The increasing risks of current HD with increasing risk scores were 7.4% for a score of 1, 13.8 % for a score of 2, 19.8% for a score of 3, and 32.8% for a score of 4. Conclusion: One-third of the older adults in this study had current or impending HD. We identified risk factors for HD and created a risk score for HD in one group of community-dwelling older adults. Older adults with risk scores of 1-4 were at 7.4%-32.8% risk for current HD. The clinical utility of this risk score requires further study and external validation

Supplementary Material for: Prevalence and Risk Score for Hypertonic Dehydration Among Community-Dwelling Older Adults: an Analysis of the Bangkok Falls Study

Introduction: Dehydration is associated with morbidity, and many factors affect dehydration in older adults including age and medication use. This study determined the prevalence of hypertonic dehydration (HD) and factors affecting HD in older adults and developed a risk score (a set of consistent weights that assign a numerical value to each risk factor) which are potentially useful in predicting HD among community-dwelling Thai older adults. Methods: Data were obtained from a cohort study of community-dwelling older adults aged ≥60 years in Bangkok, Thailand between October 1, 2019, and September 30, 2021. Current HD was defined as a serum osmolality >300 mOsm/kg. Univariate and multivariate logistic regression analyses were used to identify factors associated with current and impending HD. The risk score for current HD was developed based on the final multiple logistic regression model. Results: A total of 704 participants were included in the final analysis. In this study, 59 (8.4%) participants had current HD and 152 (21.6%) had impending HD. We identified three risk factors for HD in older adults; age ≥ 75 years (adjusted odds ratio (aORs) 2.0, 95% confidence interval [CI]: 1.16-3.46), underlying diabetes mellitus (aORs 3.07, 95%CI: 1.77-5.31) and use of ß-blocker medication (aORs 1.98, 95%CI: 1.04-3.78). The increasing risks of current HD with increasing risk scores were 7.4% for a score of 1, 13.8 % for a score of 2, 19.8% for a score of 3, and 32.8% for a score of 4. Conclusion: One-third of the older adults in this study had current or impending HD. We identified risk factors for HD and created a risk score for HD in one group of community-dwelling older adults. Older adults with risk scores of 1-4 were at 7.4%-32.8% risk for current HD. The clinical utility of this risk score requires further study and external validation

Supplementary Material for: Prevalence and Risk Score for Hypertonic Dehydration Among Community-Dwelling Older Adults: an Analysis of the Bangkok Falls Study

Introduction: Dehydration is associated with morbidity, and many factors affect dehydration in older adults including age and medication use. This study determined the prevalence of hypertonic dehydration (HD) and factors affecting HD in older adults and developed a risk score (a set of consistent weights that assign a numerical value to each risk factor) which are potentially useful in predicting HD among community-dwelling Thai older adults. Methods: Data were obtained from a cohort study of community-dwelling older adults aged ≥60 years in Bangkok, Thailand between October 1, 2019, and September 30, 2021. Current HD was defined as a serum osmolality >300 mOsm/kg. Univariate and multivariate logistic regression analyses were used to identify factors associated with current and impending HD. The risk score for current HD was developed based on the final multiple logistic regression model. Results: A total of 704 participants were included in the final analysis. In this study, 59 (8.4%) participants had current HD and 152 (21.6%) had impending HD. We identified three risk factors for HD in older adults; age ≥ 75 years (adjusted odds ratio (aORs) 2.0, 95% confidence interval [CI]: 1.16-3.46), underlying diabetes mellitus (aORs 3.07, 95%CI: 1.77-5.31) and use of ß-blocker medication (aORs 1.98, 95%CI: 1.04-3.78). The increasing risks of current HD with increasing risk scores were 7.4% for a score of 1, 13.8 % for a score of 2, 19.8% for a score of 3, and 32.8% for a score of 4. Conclusion: One-third of the older adults in this study had current or impending HD. We identified risk factors for HD and created a risk score for HD in one group of community-dwelling older adults. Older adults with risk scores of 1-4 were at 7.4%-32.8% risk for current HD. The clinical utility of this risk score requires further study and external validation