Effect of Medication on Cognition: Information from a Clinical Sample using a Semi-Flexible Battery of Common Neuropsychological Tests

Prescription medications are widely used, particularly among older adults, with 46% of adults overall and 85% of older adults (65 years old and older) using at least one medication (Martin et al., 2019). Three percent of adults overall and 39% of older adults use 5 or more medications, constituting polypharmacy (Kantor et al., 2015). While there are many medications, as well as polypharmacy, that are known to have cognitive effects, many other widely used medications have been inconsistently associated with changes in cognition. Additionally, the degree of change, independent of effects of a possible underlying neurodegenerative process, is unknown. This is problematic for physicians, specifically neuropsychologists, who are tasked with evaluating cognition and providing differential diagnoses for potential cognitive change. OBJECTIVES: The current study sought to evaluate the effects of medication and polypharmacy on global and domain specific cognitive functioning in a broad clinical sample of adults using a comprehensive battery of neuropsychological tests. METHODS: Seven hundred and fifty archival neuropsychological data files were reviewed for inclusion. Four hundred and ninety-seven cases were ultimately retained for analyses (mean age = 40.75, SD = 14.61, range = 18-80 years). Most of the sample identified as xviii female (52%) and Caucasian (94%). The number of medications used by study participants ranged from 0 to 14 (M = 2.64, SD = 2.50) and 11.3% reported taking 6 or more medications. All participants completed a large flexible battery of common neuropsychological tests, which allowed for calculation of overall test battery performance and cognitive domain specific performances. RESULTS: Two-way Analyses of Covariance analyzed the interaction and main effects of specific medication groups and polypharmacy on global cognitive performance, as measured by the overall test battery mean and intra-individual variability. Significant main effects of analgesics, triptan, polypharmacy on IIV were identified. No significant interaction or main effects were identified for two-way Multivariate Analyses of Covariance evaluating the effects of medication and polypharmacy across nine cognitive domains. CONCLUSIONS: Subjects taking analgesic medications, and medications from the triptans drug class, showed more cognitive variability over the course of a neuropsychological evaluation, compared to those not taking these medications. Additionally, subjects without polypharmacy showed more cognitive variability than those taking more than 5 medications and those who were not taking any medications. Study limitations and clinical implications of these findings are discussed

LibGuiding the way: Improved signposting and student interaction with library electronic resources

This case study describes a project in which significant changes were made to the web presence of subject-specific information by implementing new software. Analyses of the usage of the web pages tell us about student information retrieval and research behaviour and, by appraising the approach to resource access points, we can ensure that students’ experiences match their expectations of quick and easy access to information that does not depend on significant prior experience or knowledge. Students can put energy into finding and using resources, rather than trying to figure out how to access them at the start of this process. Lessons learned from the project will be used to inform future developments, including improved methods of engagement with academic staff to ensure that this type of learning environment best suits the needs of students. Moreover, the implementation of the software will lead to a student experience that is greatly improved

MODERN DRAGONS: THE MYTHOLOGY OF THE JET

The human mind is a remarkable device for summarizing and simplifying data with symbols and myths. Like people of ancient times we use myths to understand the things unfamiliar to us. Considering that technology is often hard to understand, one would expect there to be myths based around it. In this project the myths surrounding the jet aircraft were investigated. Data was collected from pop culture, sketches and interviews. Eventually this was condensed into a triptych of three acrylic paintings

Biologically Inspired Wing Planform Optimization

The goal of this project is to use inspiration acquired from bird flight to optimize the wing planform of micro-air vehicle wings. Micro-air vehicles are used by the military for surveillance and for search and rescue missions by civilian first-responders. These vehicles fly in the same low Reynolds number regime as birds, and have low aspect ratios similar to the pheasants and grouse of the order Galliformes. Conventional analysis is difficult for low Reynolds numbers, prompting use of biologically inspired methods of optimization. Genetic algorithms, which mimic the process of evolution in nature, were used to define wing shapes that were tested in wind tunnel experiments. In these experiments, lift-drag ratios at various angles of attack were measured on scale model micro-air vehicle wings (with variable length feathers) similar in shape to a bird wing. The planform shape of the scale model wing evolved in the wind tunnel flow over successive generations to ultimately produce superior wings with higher lift-drag ratios. The low angle of attack wings were easily optimized into a wing shape different from and potentially more efficient than the oft-used Zimmerman planform. The process was repeated for a higher angle of attack, near stall conditions, which yielded a different wing planform shape. Chord distributions of the optimized low angle of attack wings were found to closely match the same distributions of birds from the order Galliformes. Results from flow visualization studies meant to illuminate possible physics responsible for the higher lift-drag ratios were also investigated

Mass spectrometric studies of the biological fate of platinum-based drugs and selenium supplementation in cancer chemotherapy

Platinum-based drugs are an important group of alkylating-like agents which are used in cancer chemotherapy treatment. Cisplatin and oxaliplatin in particular are still commonly used today and are the focus of this thesis. As with most chemotherapy drugs, the efficacy of these drugs are limited by toxicity as well as tumour resistance, and therefore by increasing our understanding of these areas it is hoped to one day achieve personalised chemotherapy. The use of ICP-MS in the study of bio-sciences is still relatively new, however it has the ability to provide robust, fast and accurate methods for the quantification of platinum in biological samples. The research presented here utilised mass spectrometry in the study of the formation of Pt-DNA adducts in the clinical samples, the binding of oxaliplatin to short peptides and the effect of selenium supplementation on oxaliplatin in colorectal cancer cell lines. A comparison in the number of Pt-DNA adducts in saliva and leukocyte samples obtained from patients undergoing Pt-based chemotherapy demonstrated a lack of correlation between the two sample types. Samples were taken pre- and post-treatment and analysed via SF-ICP-MS and significant inter-patient variability was observed as expected. In both leukocyte and saliva samples, not only was Pt from previous chemotherapy cycles observed, but Pt was detected in the DNA in both sample types 1 hour after treatment. However a lack of correlation between platinum levels seen in the blood and saliva, combined with unexpected difficulties obtaining patient adherence to the saliva sampling protocol, indicated that saliva does not at present offer a reliable alternative to leukocytes for this assay. The binding of oxaliplatin to short nitrogen and sulfur rich peptides was investigated. Platinum binding to the peptides was observed and no significant differences in the level of binding were observed between the range of N and S rich peptides studied in this investigation. Partly due to the inability to reproduce biological conditions in this study, oxaliplatin was observed as a whole molecule, and furthermore dimers and multimers were also observed. The effect of selenium supplementation on the total cellular uptake of platinum was investigated in cultured cells via ICP-MS and LA-ICP-MS. It was observed that selenium decreased the amount of Pt taken up by the cancer cells. This was seen in analysis of populations of cells as well as by single cell analysis. Furthermore, while problems were encountered measuring selenium in subcellular experiments, the effect of selenium on the subcellular distribution of platinum as well as the number of Pt-DNA adducts could be determined

Using area health education centers to promote interest in rural practice

Introduction: In the USA, area health education centers (AHECs) work to recruit and educate students to serve in medically underserved communities, primary care, and rural settings. One important aspect of their work is connecting students with rural clinical experiences. Within these experiences, AHECs incorporate a community health/socioeconomic experience within the family medicine clerkship that may not be as prevalent in the standard family medicine clerkship experiences. The purpose of the study was to assess the relationship between AHEC-sponsored family medicine clerkships with a self-reported intent to practice in a rural setting upon graduation. Methods: The study compared third-year medical students with the Indiana University School of Medicine, which participated in AHEC-sponsored family medicine clerkships to the standard family medicine clerkship. Following the 4-week clerkship, students were asked to report their intent to work in a rural setting using a five-point Likert scale. A χ2 test was used to determine the association of AHEC sponsorship, clerkship site location (rural/urban) and intent to practice in a rural setting. Results: The study consisted of 587 students. There was a statistically significant association between self-reported intent and rural clerkship site, χ2 (1, N=587)=6.542, p=0.01. Furthermore, 21.6% (n=25) of students with a rural clerkship experience reported a greater intent compared to 12.3% (n=58) of students with non-rural clerkship experience. Conclusions: The study confirmed a significantly positive association between participation in medical clerkship experiences in a rural primary care setting and the intent to practice in a rural setting upon graduation. The results also support the potential value-added benefits through academic–community partnerships with AHECs, family medical and other primary care specialty clerkship programs may perhaps succeed in increasing student interest in pursuing a practice serving in rural communities upon graduation

From the web to writing: the role of collaboration in providing first year university students with the skills to succeed

In contemporary university environments not only have student populations become more diverse, but also institutions have embraced technological advances to create new facets to the teaching and learning process. The challenges offered by virtual learning as well as the impact of email and e-learning remain largely under-researched both broadly and in relation to first year transition. First year students are now expected to not only acquire the implicit academic discourse in a timely fashion but also master the computing skills so central to contemporary university delivery. Skills central to effective and efficient academic research and writing are often perceived in an atomized and disparate way. The information skills program outlined in this paper seeks to forge connections between the processes involved in locating information and producing essays. Utilising the requisite knowledge of staff from two areas, the objective is to highlight to students how skills required to obtain information in an often virtual environment can further inform assignment preparation. In this way the role of information literacy is negotiated as intrinsic to the essay writing process as opposed to something that is seen as external. The program has been developed in consultation with academic staff to ensure that relevant research topics are demonstrated. The paper will highlight facets of the workshop and explain the reasoning behind its construction and ongoing enhancement, as well as provide justification of the need for such programs within university environments in the light of increasing diverse student populations

The Lonely Scroll: The Impact of Social Media on Loneliness in Introverts and Extroverts

This study examined the impact that social media had on feelings of loneliness in introverts and extroverts. Each participant received a survey based off of the NEO Personality Inventory, the UCLA Loneliness Scale and the Internet Behaviors Scale. The survey aimed to assess the relationship between social media and feelings of loneliness on different personality types. Social Media is a prevalent aspect of modern day culture. Therefore, this study aims to teach individuals how to prevent social media from negatively affecting them. The results supported our hypotheses that both loneliness and internet use, as well as, personality type and loneliness are statistically significant