Modulation of station rainfall over the western Pacific by the Madden-Julian oscillation

Rainfall data from 140 stations in the PACRAIN network in the tropical western Pacific are analysed to assess the signal due to the Madden-Julian Oscillation (MJO). During northern winter, the station rainfall difference between the wet and dry phases of the MJO is up to 6 mm day-1, compared to the climatological mean value of 12 mm day-1. The anomalies have a strong spatial coherence, with over 80% of the individual point station anomalies having the same sign as the large-scale rainfall anomaly, as determined by the mainly satellite-derived CMAP rainfall product

Older people remain on blood pressure agents despite being hypotensive resulting in increased mortality and hospital admission

Background: the use of antihypertensive medication in older people in order to prevent cardiovascular events is well established. The use of such agents has been encouraged by incentive schemes in the United Kingdom including the Quality and Outcomes Framework. In addition, many guidelines recommend good blood pressure (BP) control in the elderly. However, in older people antihypertensives can cause adverse effects related to hypotension. Aim: the aim of this study was to assess the prevalence of low BP and impact on outcomes, particularly in the presence of antihypertensive treatment, in a primary care population of older people. Design: a retrospective observational cohort study in people over the age of 70 years registered with primary care providers in Kent. Results: a total of 11,167 patients over 70 years old were analysed, 6,373 female (57%). Systolic blood pressure (SBP) was below 120 mmHg in 1,297 people (844 on antihypertensives), below 110 mmHg in 474 (313 on antihypertensives) and below 100 mmHg in 128 (89 on antihypertensives). Hypotension was independently associated with mortality, acute kidney injury and hospital admission. Conclusions: the results demonstrate that low SBP is associated with adverse events, it is possible that the pursuit of BP control at a population level may lead to over-treatment in certain groups of patients. This may result in an increased incidence of adverse events particularly in older people

Deprescribing tool for STOPPFall (screening tool of older persons prescriptions in older adults with high fall risk) items

Background: Health care professionals are often reluctant to deprescribe fall-risk-increasing drugs (FRIDs). Lack of knowledge and skills form a significant barrier. To support clinicians in the management of FRIDs and to facilitate the deprescribing process, a deprescribing tool was developed by a European expert group for STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk) items. Methods: STOPPFall was created using an expert Delphi consensus process in 2019 and in 2020, 24 panellists from EuGMS SIG on Pharmacology and Task and Finish on FRIDs completed deprescribing tool questionnaire. To develop the questionnaire, a Medline literature search was performed. The panellists were asked to indicate for every medication class a possible need for stepwise withdrawal and strategy for withdrawal. They were asked in which situations withdrawal should be performed. Furthermore, panellists were requested to indicate those symptoms patients should be monitored for after deprescribing and a possible need for follow-ups. Results: Practical deprescribing guidance was developed for STOPPFall medication classes. For each medication class, a decision tree algorithm was developed including steps from medication review to symptom monitoring after medication withdrawal. Conclusion: STOPPFall was combined with a practical deprescribing tool designed to optimize medication review. This practical guide can help overcome current reluctance towards deprescribing in clinical practice by providing an up-to-date and straightforward source of expert knowledge

Identification of novel proteins associated with yeast snR30 small nucleolar RNA

H/ACA small nucleolar RNPs (snoRNPs) that guide pseudouridylation reactions are comprised of one small nucleolar RNA (snoRNA) and four common proteins (Cbf5, Gar1, Nhp2 and Nop10). Unlike other H/ACA snoRNPs, snR30 is essential for the early processing reactions that lead to the production of 18S ribosomal RNA in the yeast Saccharomyces cerevisiae. To determine whether snR30 RNP contains specific proteins that contribute to its unique functional properties, we devised an affinity purification strategy using TAP-tagged Gar1 and an RNA aptamer inserted in snR30 snoRNA to selectively purify the RNP. Northern blotting and pCp labeling experiments showed that S1-tagged snR30 snoRNA can be selectively purified with streptavidin beads. Protein analysis revealed that aptamer-tagged snR30 RNA was associated with the four H/ACA proteins and a number of additional proteins: Nop6, ribosomal proteins S9 and S18 and histones H2B and H4. Using antibodies raised against Nop6 we show that endogenous Nop6 localizes to the nucleolus and that it cosediments with snR30 snoRNA in sucrose density gradients. We demonstrate through primer extension experiments that snR30 snoRNA is required for cleavages at site A0, A1 and A2, and that the absence of Nop6 decreases the efficiency of cleavage at site A2. Finally, electron microscopy analyses of chromatin spreads from cells depleted of snR30 snoRNA show that it is required for SSU processome assembly

STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk): a Delphi study by the EuGMS Task and Finish Group on Fall-Risk-Increasing Drugs.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadBackground: Healthcare professionals are often reluctant to deprescribe fall-risk-increasing drugs (FRIDs). Lack of knowledge and skills form a significant barrier and furthermore, there is no consensus on which medications are considered as FRIDs despite several systematic reviews. To support clinicians in the management of FRIDs and to facilitate the deprescribing process, STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk) and a deprescribing tool were developed by a European expert group. Methods: STOPPFall was created by two facilitators based on evidence from recent meta-analyses and national fall prevention guidelines in Europe. Twenty-four panellists chose their level of agreement on a Likert scale with the items in the STOPPFall in three Delphi panel rounds. A threshold of 70% was selected for consensus a priori. The panellists were asked whether some agents are more fall-risk-increasing than others within the same pharmacological class. In an additional questionnaire, panellists were asked in which cases deprescribing of FRIDs should be considered and how it should be performed. Results: The panellists agreed on 14 medication classes to be included in the STOPPFall. They were mostly psychotropic medications. The panellists indicated 18 differences between pharmacological subclasses with regard to fall-risk-increasing properties. Practical deprescribing guidance was developed for STOPPFall medication classes. Conclusion: STOPPFall was created using an expert Delphi consensus process and combined with a practical deprescribing tool designed to optimise medication review. The effectiveness of these tools in falls prevention should be further evaluated in intervention studies. Keywords: accidental falls; adverse effects; aged; deprescribing; fall-risk-increasing drugs; older people.Amsterdam Public Health Aging and Later Life Innovation Price and Clementine Brigitta Maria Dalderup fund Amsterdam University fun

Recuperative Care: an example of partnership care which works for patients

Purpose – The purpose of this paper is to evaluate the role of Recuperative Care after hospital discharge. Design/methodology/approach – Acombined qualitative and quantitative study. The quantitative study was a concurrent, parallel, geographically controlled trial of Recuperative Care versus standard NHShospital rehabilitation. Recuperative Care is rehabilitation in a residential care home with no on-site medical or nursing staff. A daily programme of exercises and activities to improve independence is provided by two in-house occupational therapists. The primary outcome measures were discharge destination, domicile 3 and 12 months post-discharge and mortality. A purposefully selected sample of 20 recuperative care patients was interviewed after discharge. Findings – There was a small difference of borderline significance in initial discharge destination (slightly more patients were discharged home from recuperative care than from Hospital). However, at 3 months and 12 months there was no significant difference between the groups. A logistic regression analysis suggested the main determinant of outcome was cognitive function. There was no significant difference in mortality between the groups. The qualitative data demonstrated Recuperative Care to be a highly-rated, positive and sometimes life-changing experience for patients. The interview data illustrate the aspects of care and characteristics which were beneficial. Practical implications – Recuperative care is a model of partnership working which has potential to free-up hospital beds while benefitting patients. Originality/value – The presentation of the qualitative data aims to highlight those aspects of Recuperative Care which seemed beneficial from a clinical perspective

Key concepts in historical geography

[No abstract available

Key concepts in historical geography

[No abstract available]peer-reviewe