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Older adults with dementia are particularly vulnerable to adverse outcomes resulting from anticholinergic use. We aimed to: (i) Examine the anticholinergic burden of patients with dementia attending a Psychiatry of Later Life (PLL) service (ii) Examine concomitant prescription of acetylcholinesterase inhibitors (AChEIs) and anticholinergics and (iii) Compare the Anticholinergic Cognitive Burden (ACB) scale with a recently published composite list of anticholinergics.
Retrospective chart review of new referrals with a diagnosis of dementia (n = 66) seen by the PLL service, Tallaght University Hospital, Dublin, Ireland, over a consecutive period of 4 months.
The mean ACB score was 2.2 (range = 0–9, SD = 2.1). 37.9% (n = 25) had a clinically significant ACB score (>3) and 42.1% (n = 8) of those taking AChEIs had a clinically significant ACB score. A significantly greater number of medications with anticholinergic activity were identified using the composite list versus the traditional ACB scale (2.3 v.1.5, p = 0.001).
We demonstrated a significant anticholinergic burden amongst patients with dementia attending a specialist PLL service. There was no difference in anticholinergic burden between groups prescribed and not prescribed AChEIs, indicating that these medications are being prescribed without discontinuation of potentially inappropriate medications with anticholinergic activity. The true anticholinergic burden experienced by patients may be underestimated by the use of the ACB score alone, although the clinical significance of this finding is unclear. Calculation of true clinical anticholinergic burden load and its translation to a specific rating scale remains a challenge.
Coinfection with human immunodeficiency virus (HIV) and viral hepatitis is associated with high morbidity and mortality in the absence of clinical management, making identification of these cases crucial. We examined characteristics of HIV and viral hepatitis coinfections by using surveillance data from 15 US states and two cities. Each jurisdiction used an automated deterministic matching method to link surveillance data for persons with reported acute and chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections, to persons reported with HIV infection. Of the 504 398 persons living with diagnosed HIV infection at the end of 2014, 2.0% were coinfected with HBV and 6.7% were coinfected with HCV. Of the 269 884 persons ever reported with HBV, 5.2% were reported with HIV. Of the 1 093 050 persons ever reported with HCV, 4.3% were reported with HIV. A greater proportion of persons coinfected with HIV and HBV were males and blacks/African Americans, compared with those with HIV monoinfection. Persons who inject drugs represented a greater proportion of those coinfected with HIV and HCV, compared with those with HIV monoinfection. Matching HIV and viral hepatitis surveillance data highlights epidemiological characteristics of persons coinfected and can be used to routinely monitor health status and guide state and national public health interventions.
It now appears almost certain that the precursor of SN 1987a was the brighter of the components of Sk-69 202, a blue supergiant, with a precursor mass of perhaps 12-16 solar masses. Prior to the explosion the precursor had a core mass of order six solar masses, and 0.1 to 0.2 solar masses of residual hydrogen envelope. The compact nature of this star can account for many of the odd features of the subsequent light curve and spectral evolution.
An analysis of the light curve and colour evolution shows four distinct epochs, which probably relate to the initial expansion of the fireball and the escape of shock-deposited thermal energy, the hydrogen-rich layers becoming optically thin, the exposure of the helium core, and the increasing transparency of the helium core.
The supernova appeared to be at its maximum on May 10, but is dimmer than a normal Type II because its light is apparently derived from recombinations and the radioactive decay of 56Ni to 56Co to 56Fe rather than by the thermal energy deposited by the passage of the shock.
3D printing is a versatile fabrication method that offers the potential to realize complex 3D devices with metamaterial characteristics in a single process directly from a computer aided design. However, the range of functional devices that might be realized by 3D printing is limited by the current range of materials that are compatible with a given 3D printing process: fused deposition modelling (FDM), which is a widely used 3D printing method, typically employs only common thermoplastics. Here we describe the development of a magnetic feedstock based on polymer-ferrite composite that is compatible with FDM. The feasibility of the technique is demonstrated by the permittivity and permeability measurement of direct printed blocks and the fabrication of a complex 3D diamond-like lattice structure. The development of printable magnetic composites provides increased design freedom for direct realization of devices with graded electromagnetic properties operating at microwave frequencies.
We examine the role of diffusivity, whether molecular or turbulent, on the steady-state stratification in a ventilated filling box. The buoyancy-driven displacement ventilation model of Linden et al. (J. Fluid Mech., vol. 212, 1990, p. 309) predicts the formation of a two-layer stratification when a single plume is introduced into an enclosure with vents at the top and bottom. The model assumes that diffusion plays no role in the development of the ambient buoyancy stratification: diffusion is a slow process and the entrainment of ambient fluid into the plume from the diffuse interface will act to thin the interface resulting in a near discontinuity of density between the upper and lower layers. This prediction has been corroborated by small-scale salt bath experiments; however, full-scale measurements in ventilated rooms and complementary numerical simulations suggest an interface that is not sharp but rather smeared out over a finite thickness. For a given plume buoyancy flux, as the cross-sectional area of the enclosure increases the volume of fluid that must be entrained by the plume to maintain a sharp interface also increases. Therefore the balance between the diffusive thickening of the interface and plume-driven thinning favours a thicker interface. Conversely, the interface thickness decreases with increasing source buoyancy flux, although the dependence is relatively weak. Our analysis presents two models for predicting the interface thickness as a function of the enclosure height, base area, composite vent area, plume buoyancy flux and buoyancy diffusivity. Model results are compared with interface thickness measurements based on previously reported data. Positive qualitative and quantitative agreement is observed.
Delayed recovery of cognitive function is a well-recognized phenomenon in older patients. The potential for the volatile anaesthetic used to contribute to alterations in postoperative cognitive function in older patients following minor surgical procedures has not been determined. We compared emergence from isoflurane and sevoflurane anaesthesia in older surgical patients undergoing urological procedures of short duration.
Seventy-one patients, 60 yr of age or older, undergoing anaesthesia expected to last less than 60 min for ambulatory surgery, were randomly assigned to receive isoflurane or sevoflurane. A standardized anaesthetic protocol was used, with intravenous fentanyl 1 μg kg−1 and propofol 1.5–2.0 mg kg−1 administered to induce anaesthesia. Anaesthesia was maintained with either sevoflurane or isoflurane in 65% nitrous oxide and oxygen. Early and intermediate recovery times were recorded. The mini mental state examination and digit repetition forwards and backwards were administered at baseline, and at 1, 3 and 6 h postoperatively, to assess cognitive function.
There were no between-group differences in (sevoflurane vs. isoflurane, mean ± standard error of the mean) times to removal of the laryngeal mask airway (7.7 ± 0.6 vs. 7.1 ± 0.4 min), verbal response time (10.1 ± 0.7 vs. 9.9 ± 0.7 min) and orientation (12.1 ± 0.7 vs. 12.1 ± 0.7 min). Intermediate recovery, as measured by time to readiness for discharge from the post anaesthesia care unit (44.9 ± 1.5 vs. 44.3 ± 1.5 min), was similar in the two groups. Postoperative indices of cognitive function and attention were comparably reduced at 1 h, but returned to baseline in both groups at 6 h.
Isoflurane and sevoflurane anaesthesia resulted in similar clinical and neurocognitive recovery profiles in older patients undergoing ambulatory surgical procedures of short duration.
In this paper, we report the electrical and optical characteristics of Si delta-doped AlGaN cladding layers, p-cladding structure optimization and the impact on the efficiency of 340nm AlGaN UV LEDs. Compared to the uniformly doped n-AlGaN layer, adding Si Δ-doping layers reduced the sheet resistance by improving both the Hall mobility and carrier concentration. Increasing the number of Si Δ-doped layers further lowered the sheet resistance without cracking the material. The Δ-doped layers in n-Al0.3Ga0.7N improved the optical properties by enhancing near band edge emission as much as 2-fold relative to deep level emission. Additionally, Δ-doping in n-AlGaN layers had no detrimental effect on the optical transparency of the LEDs. The p-cladding layer was found to have a strong absorption at 340nm. Reducing the p-GaN cap layer from 35nm to 10nm tripled the light emission intensity. By optimizing the n- and p-AlGaN cladding layers, a highly efficient UV LED at 340nm was achieved with 1mW output under 800mA/mm2 DC drive current.
In the present paper the prevalence of obesity (BMI 30 kg/m2) and current physical activity levels in Irish adults have been evaluated. The prevalence of obesity in Irish adults is currently 18 %, with men at 20 % and women at 16 %. A further 47 % of men and 33 % of women are overweight (BMI 25·0–29·9 kg/m2). Since 1990, obesity has more than doubled in men from 8 % to 20 %, and increased from 13 % to 16 % in women. The highest prevalence of obesity (30 %) was found in women aged 51–64 years. Defined waist circumference action levels identified 48 % of the population who are in need of weight management and who also are at a 1·5–4·5 times increased risk of having at least one cardiovascular disease risk factor. Physical activity levels were low overall. Men were more active in work and recreational pursuits than women, but women were more active in household activities. Walking was the most popular recreational pursuit. However, TV viewing occupied most of the leisure time of men and women. Higher levels of activity were associated with a lower BMI and waist circumference. The results indicate the need for sensitive and individualised strategies to promote physical activity and to achieve a healthy weight status.
To describe the current use of nutritional supplements and their contribution to micronutrient intakes in a representative sample of Irish adults, to evaluate the impact of supplement use on the adequacy of micronutrient intakes and to assess the risk to supplement users of exceeding tolerable upper intake levels (UL).
Study design and subjects
Food intake data were collected in 1379 (662 male and 717 female) randomly selected Irish adults aged 18 to 64 years using a 7-day food diary. The current use of nutritional supplements was assessed using a selfadministered questionnaire and respondents entered each supplement as it was consumed into the food diary.
Twenty-three per cent of respondents regularly used nutritional supplements. Twice as many women used supplements as men. The intakes of micronutrients were significantly higher (P < 0.001) in supplement users than in non-users. Micronutrient intakes from food sources were similar in male users and non-users of supplements, but were significantly higher (P < 0.01) in female users, by 3 to 13%, for Fe, Mg, Mn, vitamins C and E and niacin than in non-users. The percentage of female users between 18 and 50 years who had mean Fe intakes below the average requirement (AR) (10 mg) decreased from 50 to 25 when the contribution from supplements was included. The use of supplements reduced the percentage of men who had mean intakes below the AR for Zn from 19 to 13, for riboflavin from 14 to 6 and for vitamin A from 20 to 5, and reduced the percentage of women with intakes below the AR for Ca from 23 to 16 and for riboflavin from 23 to 14. Twenty-one women out of 80 aged between 18 and 50 years, who consumed supplemental folate, achieved the intake of 600 |xg recommended to prevent neural tube defects. Twenty-two per cent of the women who took iron and 15% of the women who took vitamin B$ in supplemental form had mean daily intakes that exceeded that UL for these nutrients. Supplement users did not exceed the UL for the other micronutrients.
Supplementation appears to be beneficial in promoting adequate intakes of some micronutrients, particularly Fe and folate in women aged 18–50 years and vitamin A in men. There appears to be little risk to supplement users of experiencing adverse side effects due to excessive intakes of micronutrients.
A comparative study, using time-resolved and CW photoluminescence spectroscopy, of MOVPE grown InGaN/GaN multiple quantum wells deposited on HVPE GaN/Sapphire at different growth temperatures was undertaken. It was found that the PL linewidth increased and the peak emission energy decreased as the growth temperature was reduced. Moreover, the sample grown at an intermediate growth temperature exhibited total integrated luminescence intensity much greater than the samples grown at higher or lower growth temperatures. A phenomenological carrier recombination dynamics model based on the competition of quantum well-like radative recombination, spatially localized radiative recombination in potential minima and non-radiative recombination through defects is presented to provide an explanation of the observed emission dynamics and efficiency. In this model, the emission efficiency is determined by the relative area of defects and the number density of localized states in the potential minima, both of which are influenced by the growth temperature. Furthermore, the photon energy dependent lifetimes are well fitted with this model by assuming a Gaussian shape localized states distribution. The localized potential minima are consistent with nanoscale indium rich regions due to indium aggregation.