Study of medications use of elderly admitted to acute care hospital

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: The prevalence of diseases increases with age and so does use of medications. Thus illness related to medications use does also become more prevalent. This study aims at evaluating medications of elderly people admitted to an acute care hospital, and demonstrate adverse reactions and quality indicators. Material and methods: This is a study of patients 75 years of age and older admitted acutely to internalmedicine at the Reykjavik Hospital over a three month period in the spring of 1995. All medications and diagnoses were registered and the medical records reviewed. The contribution of adverse medication effects to the admission was assessed. Quality of treatment was evaluated according to evidence based medicine for the diagnoses chosen. The study included 208 individuals, 133 women and 75 men with the mean age of 82.4 years. Results: Mean length of stay for women was 19.9 days and men 15.2 days. Number of drugs on admission and discharge ranged from 0 to 18. The mean number of drugs were for women 5.8 and 6.9 and men 6.6 and 7.7 on admission and discharge, respectively. In 16 cases or 7.7% it was judged that there was a high likelihood of the admission being due to an adverse effect. Potential drug interactions according to a computer software package were not judged to be of clinical importance in any case. Conclusions: Treatment for coronary heart disease, heart failure, osteoporosis, insomnia and long term prednisolon treatment is not completely optimal according to evidence based medicine. The results of this study indicate that treatment could be improved for example with use of clinical guidelines.Tilgangur: Með hækkandi aldri vex algengi sjúkdóma og jafnframt lyfjanotkun. Veikindi sem tengjast lyfjanotkun verða því tíðari meðal aldraðra. Rannsóknin lýsir lyfjanotkun aldraðra á bráðasjúkrahúsi, aukaverkunum og gæðavísum. Efniviður og aðferðir: Þessi rannsókn tekur til allra aldraðra, 75 ára og eldri, sem lögðust inn brátt á lyflækningadeildir Borgarspítalans á þriggja mánaða tímabili vorið 1995. Öll lyf og allar sjúkdómsgreiningar voru skráð og sjúkraskrár yfirfarnar. Lagt var mat á það hvort lyfjanotkun ætti þátt í innlögn. Gæði lyfjameðferðar voru metin meðal annars með tilliti til fyrri og núverandi sjúkdómsgreininga. Niðurstöður: Könnunin náði til 208 einstaklinga, 133 kvenna og 75 karla á aldrinum 75 til 98 ára, meðalaldur 82,4 ár. Meðallegudagar kvennanna voru 19,9 dagar og karlanna 15,2 dagar. Skráður fjöldi lyfja við innskrift var á bilinu 0 til 18 lyf og við útskrift mest 18. Meðalfjöldi lyfja hjá konum við innskrift var 5,8 lyf og við útskrift 6,9. Karlar höfðu 6,6 lyf við innskrift að meðaltali og 7,7 við útskrift. Í 16 tilvikum eða 7,7% voru taldar miklar líkur á að sjúklingur hefði lagst inn vegna aukaverkana lyfja. Engin vísbending um milliverkun samkvæmt tölvuútskrift reyndist hafa klíníska þýðingu að mati höfunda. Ályktanir: Aldraðir sem leggjast inn á bráðasjúkrahús eru á fjölda lyfja og eiga aukaverkanir lyfja nokkurn þátt í innlögnum. Hvað varðar meðferð á kransæðasjúkdómi, hjartabilun, beinþynningu, svefntruflunum og langtímameðferð með sykursterum kom fram að all nokkuð vantar upp á að bestu meðferð, samkvæmt niðurstöðum rannsókna, sé beitt. Niðurstöður rannsóknarinnar, ásamt þeim grófu gæðavísum sem beitt var, benda til að gera megi betur til dæmis með klínískum leiðbeiningum

Regional Analysis of the Magnetization Transfer Ratio of the Brain in Mild Alzheimer Disease and Amnestic Mild Cognitive Impairment

BACKGROUND AND PURPOSE: Manually drawn VOI-based analysis shows a decrease in magnetization transfer ratio in the hippocampus of patients with Alzheimer disease. We investigated with whole-brain voxelwise analysis the regional changes of the magnetization transfer ratio in patients with mild Alzheimer disease and patients with amnestic mild cognitive impairment. MATERIALS AND METHODS: Twenty patients with mild Alzheimer disease, 27 patients with amnestic mild cognitive impairment, and 30 healthy elderly control subjects were examined with high-resolution T1WI and 3-mm-thick magnetization transfer images. Whole-brain voxelwise analysis of magnetization transfer ratio maps was performed by use of Statistical Parametric Mapping 8 software and was supplemented by the analysis of the magnetization transfer ratio in FreeSurfer parcellation-derived VOIs. RESULTS: Voxelwise analysis showed 2 clusters of significantly decreased magnetization transfer ratio in the left hippocampus and amygdala and in the left posterior mesial temporal cortex (fusiform gyrus) of patients with Alzheimer disease as compared with control subjects but no difference between patients with amnestic mild cognitive impairment and either patients with Alzheimer disease or control subjects. VOI analysis showed that the magnetization transfer ratio in the hippocampus and amygdala was significantly lower (bilaterally) in patients with Alzheimer disease when compared with control subjects (ANOVA with Bonferroni correction, at P < .05). Mean magnetization transfer ratio values in the hippocampus and amygdala in patients with amnestic mild cognitive impairment were between those of healthy control subjects and those of patients with mild Alzheimer disease. Support vector machine-based classification demonstrated improved classification performance after inclusion of magnetization transfer ratio-related features, especially between patients with Alzheimer disease versus healthy subjects. CONCLUSIONS: Bilateral but asymmetric decrease of magnetization transfer ratio reflecting microstructural changes of the residual GM is present not only in the hippocampus but also in the amygdala in patients with mild Alzheimer disease

Emergence of metapopulations and echo chambers in mobile agents

Multi-agent models often describe populations segregated either in the physical space, i.e. subdivided in metapopulations, or in the ecology of opinions, i.e. partitioned in echo chambers. Here we show how the interplay between homophily and social influence controls the emergence of both kinds of segregation in a simple model of mobile agents, endowed with a continuous opinion variable. In the model, physical proximity determines a progressive convergence of opinions but differing opinions result in agents moving away from each others. This feedback between mobility and social dynamics determines to the onset of a stable dynamical metapopulation scenario where physically separated groups of like-minded individuals interact with each other through the exchange of agents. The further introduction of confirmation bias in social interactions, defined as the tendency of an individual to favor opinions that match his own, leads to the emergence of echo chambers where different opinions can coexist also within the same group. We believe that the model may be of interest to researchers investigating the origin of segregation in the offline and online world

Arnold diffusion for a complete family of perturbations

In this work we illustrate the Arnold diffusion in a concrete example — the a priori unstable Hamiltonian system of 2 + 1/2 degrees of freedom H(p, q, I, f, s) = p2/2+ cos q - 1 + I2/2 + h(q, f, s; e) — proving that for any small periodic perturbation of the form h(q, f, s; e) = e cos q (a00 + a10 cosf + a01 cos s) (a10a01 ¿ 0) there is global instability for the action. For the proof we apply a geometrical mechanism based on the so-called scattering map. This work has the following structure: In the first stage, for a more restricted case (I* ~ p/2µ, µ = a10/a01), we use only one scattering map, with a special property: the existence of simple paths of diffusion called highways. Later, in the general case we combine a scattering map with the inner map (inner dynamics) to prove the more general result (the existence of instability for any µ). The bifurcations of the scattering map are also studied as a function of µ. Finally, we give an estimate for the time of diffusion, and we show that this time is primarily the time spent under the scattering map.Peer ReviewedPostprint (published version

Transfer of energy to high frequencies in the cubic defocusing nonlinear Schrodinger equation

We consider the cubic defocusing nonlinear Schrödinger equation on the two dimensional torus. We exhibit smooth solutions for which the support of the conserved energy moves to higher Fourier modes. This behavior is quantified by the growth of higher Sobolev norms: given any δ[much less-than]1,K [much greater-than] 1, s > 1, we construct smooth initial data u 0 with ||u0||Hs , so that the corresponding time evolution u satisfies u(T)Hs[greater than]K at some time T. This growth occurs despite the Hamiltonian’s bound on ||u(t)||H1 and despite the conservation of the quantity ||u(t)||L2. The proof contains two arguments which may be of interest beyond the particular result described above. The first is a construction of the solution’s frequency support that simplifies the system of ODE’s describing each Fourier mode’s evolution. The second is a construction of solutions to these simpler systems of ODE’s which begin near one invariant manifold and ricochet from arbitrarily small neighborhoods of an arbitrarily large number of other invariant manifolds. The techniques used here are related to but are distinct from those traditionally used to prove Arnold Diffusion in perturbations of Hamiltonian systems

The Brexit Botnet and User-Generated Hyperpartisan News

In this paper we uncover a network of Twitterbots comprising 13,493 accounts that tweeted the U.K. E.U. membership referendum, only to disappear from Twitter shortly after the ballot. We compare active users to this set of political bots with respect to temporal tweeting behavior, the size and speed of retweet cascades, and the composition of their retweet cascades (user-to-bot vs. bot-to-bot) to evidence strategies for bot deployment. Our results move forward the analysis of political bots by showing that Twitterbots can be effective at rapidly generating small to medium-sized cascades; that the retweeted content comprises user-generated hyperpartisan news, which is not strictly fake news, but whose shelf life is remarkably short; and, finally, that a botnet may be organized in specialized tiers or clusters dedicated to replicating either active users or content generated by other bots

Prophets and loss: how "soft facts" on social media influenced the Brexit campaign and social reactions to the murder of Jo Cox MP

This article examines “soft facts” about security issues in the 2016 Brexit referendum campaign. Soft facts arise when information provenance is uncertain, and are forms of malleable and contingent knowledge, such as rumors, conspiracy theories, and propaganda. There is a growing appreciation that digital communications environments are especially conducive to the dissemination of these kinds of information. Informed by empirical data comprising forty‐five thousand nine hundred and fifty‐seven data points collected by monitoring social media before and after the UK Brexit referendum campaign (June 16–October 12, 2016), the analysis examines how and why a series of soft facts concerning Brexit were mobilized. By developing the concept of “digital prophecy,” the article explores how influence is exerted by online prophets who were connecting current events to past grievances, to advance negative predictions about the future. This starts to capture the tradecraft of digital influencing, in ways that move beyond the structural topologies of communication networks. In policy terms, the analysis reminds us of the need to attend not just to how influence is achieved through fake news (e.g., using social media bots to amplify a message), but also why influence is sought in the first place