Potentially Inappropriate Prescribing in Australian Nursing Home Residents with Advanced Dementia: A Substudy of the IDEAL Study

© 2018, Mary Ann Liebert, Inc. Background: Prescribing medications for nursing home residents with advanced dementia should focus on optimizing function and comfort, reducing unnecessary harms and aligning care goals with a palliative approach. Objective: The aim of the study was to estimate the proportion of Australian nursing home residents with advanced dementia receiving potentially inappropriate medications, and identify those most commonly prescribed and factors associated with their use. Design: Data were collected through retrospective audit of medication charts. Setting/Subjects: Two hundred eighteen nursing home residents with advanced dementia from 20 nursing homes participated in a cluster-randomized controlled trial of case conferencing (the IDEAL Study) from June 2013 to December 2014. Measurements: Inappropriate drug use was defined as medications classified as "never appropriate" by the Palliative Excellence in Alzheimer Care Efforts (PEACE) program criteria. Generalized linear mixed models were used to identify variables predicting use of "never" appropriate medications. Results: Over a quarter (n = 65, 30%) of residents received at least one medication classed as "never" appropriate, the most common being lipid-lowering agents (n = 38, 17.4%), antiplatelet agents (n = 18, 8.3%), and acetylcholinesterase inhibitors (n = 16, 7.3%). Residents who had been at the nursing home for ≤10 months (odds ratio [OR] 5.60, 95% confidence interval [CI] 1.74-18.06) and 11-21 months (OR 5.41, 95% CI 1.67-17.75) had significantly greater odds of receiving a never appropriate medication compared with residents who had been at the nursing home for >5 years. Conclusions: Use of potentially inappropriate medications in Australian nursing home residents with advanced dementia is common. A greater understanding of the rationale that underpins prescribing of medications is required

Application of the Nutrition Functional Diversity indicator to assess food system contributions to dietary diversity and sustainable diets of Malawian households

Objective: Dietary diversity is associated with nutrient adequacy and positive health outcomes but indicators to measure diversity have focused primarily on consumption, rather than sustainable provisioning of food. The Nutritional Functional Diversity score was developed by ecologists to describe the contribution of biodiversity to sustainable diets. We have employed this tool to estimate the relative contribution of home production and market purchases in providing nutritional diversity to agricultural households in Malawi and examine how food system provisioning varies by time, space and socio-economic conditions. Design: A secondary analysis of nationally representative household consumption data to test the applicability of the Nutritional Functional Diversity score. Setting: The data were collected between 2010 and 2011 across the country of Malawi. Subjects: Households (n 11 814) from predominantly rural areas of Malawi. Results: Nutritional Functional Diversity varied demographically, geographically and temporally. Nationally, purchased foods contributed more to household nutritional diversity than home produced foods (mean score = 17·5 and 7·8, respectively). Households further from roads and population centres had lower overall diversity (P < 0·01) and accessed relatively more of their diversity from home production than households closer to market centres (P < 0·01). Nutritional diversity was lowest during the growing season when farmers plant and tend crops (P < 0·01). Conclusions: The present analysis demonstrates that the Nutritional Functional Diversity score is an effective indicator for identifying populations with low nutritional diversity and the relative roles that markets, agricultural extension and home production play in achieving nutritional diversity. This information may be used by policy makers to plan agricultural and market-based interventions that support sustainable diets and local food systems

Predicting continuous amyloid PET values with CSF and plasma Aβ42/Aβ40

INTRODUCTION: Continuous measures of amyloid burden as measured by positron emission tomography (PET) are being used increasingly to stage Alzheimer\u27s disease (AD). This study examined whether cerebrospinal fluid (CSF) and plasma amyloid beta (Aβ)42/Aβ40 could predict continuous values for amyloid PET. METHODS: CSF Aβ42 and Aβ40 were measured with automated immunoassays. Plasma Aβ42 and Aβ40 were measured with an immunoprecipitation-mass spectrometry assay. Amyloid PET was performed with Pittsburgh compound B (PiB). The continuous relationships of CSF and plasma Aβ42/Aβ40 with amyloid PET burden were modeled. RESULTS: Most participants were cognitively normal (427 of 491 [87%]) and the mean age was 69.0 ± 8.8 years. CSF Aβ42/Aβ40 predicted amyloid PET burden until a relatively high level of amyloid accumulation (69.8 Centiloids), whereas plasma Aβ42/Aβ40 predicted amyloid PET burden until a lower level (33.4 Centiloids). DISCUSSION: CSF Aβ42/Aβ40 predicts the continuous level of amyloid plaque burden over a wider range than plasma Aβ42/Aβ40 and may be useful in AD staging. HIGHLIGHTS: Cerebrospinal fluid (CSF) amyloid beta (Aβ)42/Aβ40 predicts continuous amyloid positron emission tomography (PET) values up to a relatively high burden.Plasma Aβ42/Aβ40 is a comparatively dichotomous measure of brain amyloidosis.Models can predict regional amyloid PET burden based on CSF Aβ42/Aβ40.CSF Aβ42/Aβ40 may be useful in staging AD

Environmental monitoring : phase 5 final report (April 2019 - March 2020)

This report presents the results and interpretation for Phase 5 of an integrated environmental monitoring programme that is being undertaken around two proposed shale gas sites in England – Preston New Road, Lancashire and Kirby Misperton, North Yorkshire. The report should be read in conjunction with previous reports freely available through the project website1 . These provide additional background to the project, presentation of earlier results and the rationale for establishment of the different elements of the monitoring programme

Environmental baseline monitoring : Phase III final report (2017-2018)

High-quality environmental baseline monitoring data are being collected in areas around two proposed shale gas sites near Kirby Misperton, North Yorkshire and Little Plumpton Lancashire. Monitoring has now been on-going for over two years and has produced an internationally unique data set that will allow any future changes that arise from industrial activities at either or both shale gas sites to be detected and characterised, as well as providing a significant resource for future research. The monitoring includes: water quality, air quality, seismicity, ground motion, soil gas and radon in air. This report presents the results of monitoring in the Vale of Pickering, within which the Kirby Misperton shale gas site (KM8) is located, for the period April 2017–March 2018. It also includes the results of atmospheric composition measurements made near the Little Plumpton (Preston New Road) site. Earlier results and other monitoring in Lancashire are reported elsewhere and can be accessed from the British Geological Survey’s website1. As well as providing valuable insight into the importance of establishing robust information on the conditions before shale gas operations start, it also highlights the challenges in establishing effective monitoring and producing reliable results. For groundwater, this includes the importance of: developing and flushing newly installed boreholes; the spatial variation in water quality and; the selection of monitoring and measuring techniques. Having two years of data has allowed comparison between years. The preliminary analysis reported here has shown that sample populations were not significantly different between the two years. This is directly relevant to the duration of monitoring required by legislation, with the evidence supporting a baseline monitoring period of at least 12 months before any site operations start. The seismic monitoring network installed for measuring background seismicity has operated successfully throughout the reporting period. All but one station show levels of data completeness over 90% which represents a high-quality dataset. There has been no significant change in recorded noise levels at any of the stations in the network. This combined with instrument performance means the network is capable of detecting seismic events with magnitudes of 0.5 ML or less around Kirby Misperton. The monitoring has detected successfully a number of earthquakes around both the Vale of Pickering and the Fylde peninsula. However, all of these are at some distance from the shale gas sites. The Vale of Pickering network has also detected a number of other seismic events that have been attributed to quarry blasts. The magnitudes of these events range from 0.7 ML to 1.6 ML. We have also developed and applied a new magnitude scale to correct for overestimation of magnitudes at small epicentral distances. This results in a significant reduction of the magnitudes of quarry blasts in the Vale of Pickering by over 0.5 magnitude units in some cases. The variance in the magnitude estimates is also slightly reduced. This issue is critical for correct estimation of the magnitudes of any earthquakes that might be induced by hydraulic fracturing. The greenhouse gas monitoring continues to reinforce the conclusion that a baseline at one location is not applicable to other locations. However, the consistency of the baseline measurements (and baseline variability within each year) at both sites clearly suggests that 12 months of baseline monitoring is sufficient to establish a meaningful climatology to compare with analogous climatologies during the operational lifetime of the shale gas sites. Twelve months of data allow differentiation of local and long-range sources of greenhouse gases. At both sites, local (<10 km) sources dominate the contribution to statistically elevated concentration observations. We conclude that: the consistency of the baseline statistics year-to-year at each site separately, strongly validates the utility of these statistics in future comparative work; repeatability and similarity in both mean and statistical variability at each individual site across both annual periods suggests that 12 months of monitoring is sufficient to characterise the baseline at future sites usefully and; the large differences between the baselines at both sites, due to influence of local sources, demonstrate that careful thought and further work may be required to assess the spatial scale over which baselines can be usefully applicable. The baseline distribution of air pollutants measured at the Lancashire site has been broadly similar in 2017 to previous years, but there have been substantial changes observed at Kirby Misperton. There was a noticeable increase in NOx from Autumn 2017 as the site was prepared for hydraulic fracturing operations to begin. The high level of vehicle movements and operation of equipment during this period led to enhanced local NOx emissions. The equipment was removed after operations were suspended and the NOx concentrations returned to broadly the same concentrations seen previously during the baseline period. This highlights the importance of measuring the whole shale-gas operational cycle for air quality as the preparative operations can have a substantial impact on air pollution. In the Vale of Pickering, 133 households volunteered to have detectors for measuring indoor radon concentrations. The results were consistent with the usual log-normal distribution for indoor radon and reflected the locations of the monitoring with respect to whether they were in Radon Affected Areas or not, i.e. radon levels above 200 Bq/m3 were measured in homes in Malton which confirmed the PHE/BGS classification of this location as a Radon Affected Area. Outdoor radon was also measured. There is no indication of elevated outdoor radon concentrations in either the Pickering or Malton Radon Affected Areas, or elsewhere. Results from an active monitor and passive detectors, placed on the Kirby Misperton well site were in good agreement with the average outdoor radon concentrations for the area around Kirby Misperton. The active monitoring showed significant short-term variations over time. However the annual average was consistent, whichever of the techniques was used. Seasonal variability in baseline soil gas and flux values continues to be observed as well as shorter-term diurnal changes and event-driven variations, for example related to the passage of weather systems. The longer-time-series data and the preliminary geostatistical appraisal of selected data suggest that any emissions related to shale gas operations will be easiest to detect in the autumn when baseline biological activity is lower and the soil remains dry. Saturation of the ground in the winter months precludes free gas measurements. A further component of the study is to characterise ground motion (subsidence and/or uplift) in the study areas using satellite data. The objective being to determine what the current situation is, so that any changes that might be caused by hydraulic fracturing, if it takes place, can be identified. The baseline conditions have previously been reported (Ward et al, 2018) and as now hydraulic fracturing has yet taken place, no further analysis has been carried out during this reporting period

Efficacy of a referral and physical activity program for survivors of prostate cancer [ENGAGE]: Rationale and design for a cluster randomised controlled trial

Background: Despite evidence that physical activity improves the health and well-being of prostate cancer survivors, many men do not engage in sufficient levels of activity. The primary aim of this study (ENGAGE) is to determine the efficacy of a referral and physical activity program among survivors of prostate cancer, in terms of increasing participation in physical activity. Secondary aims are to determine the effects of the physical activity program on psychological well-being, quality of life and objective physical functioning. The influence of individual and environmental mediators on participation in physical activity will also be determined.Methods/Design: This study is a cluster randomised controlled trial. Clinicians of prostate cancer survivors will be randomised into either the intervention or control condition. Clinicians in the intervention condition will refer eligible patients (n = 110) to participate in an exercise program, comprising 12 weeks of supervised exercise sessions and unsupervised physical activity. Clinicians allocated to the control condition will provide usual care to eligible patients (n = 110), which does not involve the recommendation of the physical activity program. Participants will be assessed at baseline, 12 weeks, 6 months, and 12 months on physical activity, quality of life, anxiety, depression, self-efficacy, outcome expectations, goals, and socio-structural factors.Discussion: The findings of this study have implications for clinicians and patients with different cancer types or other chronic health conditions. It will contribute to our understanding on the potential impact of clinicians promoting physical activity to patients and the long term health benefits of participating in physical activity programs.<br /