Facilitative reforms, democratic accountability, social accounting and learning representative initiatives

This article considers critical accountants’ potential contribution to progressive reforms by examining how trade unions transformed workplace accountability relationships and developed social accounts as part of a workplace learning initiative. The article develops and utilizes the concept of facilitative reforms to interpret the advances brought by learning representative initiatives and accompanying changes in broader civil society, workplace relationships and social accounts in the UK and New Zealand. The article finds that the experience of the learning representative initiatives suggests that critical accountants’ support of facilitative reforms may sometimes be a fruitful strategy

The SuperAging Research Initiative: A multisite consortium focused on identifying factors promoting extraordinary cognitive aging

BackgroundThe designation of SuperAger is reserved for individuals age 80+ who have episodic memory capacity that would be considered at least average for those 2-3 decades younger. The presence of such outliers raises questions of fundamental importance to the neurobiology of brain aging. Have these superior memory performers resisted age-related changes, or have they simply started from a much higher baseline? Do they have identifiable peculiarities of genetic background? Is there something special about their brain structure or perhaps their resistance to age-related processes such as neurofibrillary degeneration and amyloid deposition? These are the questions that were initially addressed by the Northwestern SuperAging Project, which identified unique results encompassing cognitive, psychosocial, molecular, and neuropathologic markers that characterize SuperAgers. Obstacles to further progress have been the relative rarity of this phenotype and, consequently, the barriers to racial diversity in the cohort.MethodsTo address these challenges, we established the SuperAging Research Initiative, a multicenter study focused on increased minority representation, to identify behavioral, health, biologic, genetic, environmental, socioeconomic, psychosocial, neuroanatomic, and neuropathologic factors associated with SuperAging.ResultsHere we provide the organizational structure and progress to date of the SuperAging Research Initiative, which includes three Cores (Administrative/Biostatistics, Clinical/Imaging, and Biospecimen/Neuropathology) and two Research Projects. Enrollment (n = 500) is planned across four US Sites located in Illinois, Wisconsin, Michigan, and Georgia, and a Canadian Site in Southwest Ontario, with a focus on enrollment of Black SuperAgers and Cognitively Average Elderly Controls with similar demographics. Project 1 uses state-of-the-art wearable technology to obtain quantitative everyday measurements of life sleep, physical activity, autonomic responsivity, and social engagement to determine whether SuperAgers have relatively preserved physiologic and behavioral ‘complexity’ compared to Controls. Project 2 focuses on transcriptomic, genetic, and protein profiling to examine central and peripheral immune and inflammatory system parameters of SuperAgers.ConclusionsBy identifying factors contributing to superior memory performance in old age, outcomes may help isolate modifiable factors that promote healthspan and perhaps also prevent age-related brain diseases such as Alzheimer’s disease.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/175507/1/alz066407.pd

Protocol for a systematic review and meta-analysis assessing the effectiveness of deprescribing in falls prevention in older people

Introduction One of the known risk factors for fall incidents is the use of specific medications, fall-risk-increasing drugs (FRIDs). However, to date, there is uncertainty related to the effectiveness of deprescribing as a single intervention in falls prevention. Thus, a comprehensive update of the literature focusing on all settings in which older people receive healthcare and all deprescribing interventions is warranted to enhance the current knowledge.Methods and analysis This systematic review protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search was performed in Cochrane Central Register of Controlled Trials, MEDLINE, Embase and PsycINFO (2 November 2020). We will also search in trial registers. We will include randomised controlled trials, in which any deprescribing intervention is compared with usual care and reports falls as an outcome. Both title and abstract screening and full-text screening will be done by two reviewers. The Cochrane Collaboration revised tool of Risk of Bias will be applied to perform risk of bias assessment. We will categorise the results separately for every setting. If a group of sufficiently comparable studies will be identified, we will perform a meta-analysis applying random effects model. We will investigate heterogeneity using a combination of visual inspection of the forest plot along with consideration of the χ2 test and the I2 statistic results. We have prespecified several subgroup and sensitivity analyses.Ethics and dissemination Ethics approval is not applicable for this study since no original data will be collected. The results will be disseminated through peer-reviewed publication and conference presentations. Furthermore, this systematic review will inform the recommendations of working group of polypharmacy and FRIDs of the anticipated World’s Falls Guidelines.PROSPERO registration number CRD42020218231

Medication reviews and deprescribing as a single intervention in falls prevention : a systematic review and meta-analysis

Background: our aim was to assess the effectiveness of medication review and deprescribing interventions as a single intervention in falls prevention. Methods: Design: systematic review and meta-analysis. Data sources: Medline, Embase, Cochrane CENTRAL, PsycINFO until 28 March 2022. Eligibility criteria: randomised controlled trials of older participants comparing any medication review or deprescribing intervention with usual care and reporting falls as an outcome. Study records: title/abstract and full-text screening by two reviewers. Risk of bias: Cochrane Collaboration revised tool. Data synthesis: results reported separately for different settings and sufficiently comparable studies meta-analysed. Results forty-nine heterogeneous studies were included. Community: meta-analyses of medication reviews resulted in a risk ratio (RR) of 1.05 (95% confidence interval, 0.85–1.29, I2 = 0%, 3 studies(s)) for number of fallers, in an RR = 0.95 (0.70–1.27, I2 = 37%, 3 s) for number of injurious fallers and in a rate ratio (RaR) of 0.89 (0.69–1.14, I2 = 0%, 2 s) for injurious falls. Hospital: meta-analyses assessing medication reviews resulted in an RR = 0.97 (0.74–1.28, I2 = 15%, 2 s) and in an RR = 0.50 (0.07–3.50, I2 = 72% %, 2 s) for number of fallers after and during admission, respectively. Long-term care: meta-analyses investigating medication reviews or deprescribing plans resulted in an RR = 0.86 (0.72–1.02, I2 = 0%, 5 s) for number of fallers and in an RaR = 0.93 (0.64–1.35, I2 = 92%, 7 s) for number of falls. Conclusions: the heterogeneity of the interventions precluded us to estimate the exact effect of medication review and deprescribing as a single intervention. For future studies, more comparability is warranted. These interventions should not be implemented as a stand-alone strategy in falls prevention but included in multimodal strategies due to the multifactorial nature of falls. PROSPERO registration number: CRD4202021823