Given the rising numbers of older adults in Canada experiencing falls, evidence-based identification of fall risks and plans for prevention across the continuum of care is a significant priority for health care providers. A scoping review was conducted to synthesize published international clinical practice guidelines (CPGs) and recommendations for fall risk screening and assessment in older adults (defined as 65 years of age and older). Of the 22 CPGs, 6 pertained to multiple settings, 9 pertained to community-dwelling older adults only, 2 each pertained to acute care and long-term care settings only, and 3 did not specify setting. Two criteria, prior fall history and gait and balance abnormalities, were applied either independently or sequentially in 19 CPG fall risk screening algorithms. Fall risk assessment components were more varied across CPGs but commonly included: detailed fall history; detailed evaluation of gait, balance, and/or mobility; medication review; vision; and environmental hazards assessment. Despite these similarities, more work is needed to streamline assessment approaches for heterogeneous and complex older adult populations across the care continuum. Support is also needed for sustainable implementation of CPGs in order to improve health outcomes.

Many studies have shown that marijuana can negatively affect the cognitive development of adolescents. For some individuals, marijuana use may also initiate opioid use, dose escalation, and opioid use disorder. States that legalize marijuana should help adolescents through regulation of advertising and availability of marijuana-infused edibles. Such policies may assist in protecting neurodevelopment of the adolescent and young adult brain. The federal government should also remove its prohibition of marijuana sales and use, leaving their regulation to state law-makers.

We present a newly developed 1-D numerical energy-balance and phase transition supraglacial lake model: GlacierLake. GlacierLake incorporates snowfall, in situ snow and ice melt, incoming water from the surrounding catchment, ice lid formation, basal freeze-up and thermal stratification. Snow cover and temperature are varied to test lake development through winter and the maximum lid thickness is recorded. Average wintertime temperatures of −2 to $-30^{\circ }{\rm C}$ and total snowfall of 0 to 3.45 m lead to a range of the maximum lid thickness from 1.2 to 2.8 m after ${\sim }250$ days, with snow cover exerting the dominant control. An initial ice temperature of $-15^{\circ }{\rm C}$ with simulated advection of cold ice from upstream results in 0.6 m of basal freeze-up. This suggests that lakes with water depths above 1.3 to 3.4 m (dependent on winter snowfall and temperature) upon lid formation will persist through winter. These buried lakes can provide a sizeable water store at the start of the melt season, expedite future lake formation and warm underlying ice even in winter.

To detect modest associations of dietary intake with disease risk, observational studies need to be large and control for moderate measurement errors. The reproducibility of dietary intakes of macronutrients, food groups and dietary patterns (vegetarian and Mediterranean) was assessed in adults in the UK Biobank study on up to five occasions using a web-based 24-h dietary assessment (n 211 050), and using short FFQ recorded at baseline (n 502 655) and after 4 years (n 20 346). When the means of two 24-h assessments were used, the intra-class correlation coefficients (ICC) for macronutrients varied from 0·63 for alcohol to 0·36 for polyunsaturated fat. The ICC for food groups also varied from 0·68 for fruit to 0·18 for fish. The ICC for the FFQ varied from 0·66 for meat and fruit to 0·48 for bread and cereals. The reproducibility was higher for vegetarian status (κ > 0·80) than for the Mediterranean dietary pattern (ICC = 0·45). Overall, the reproducibility of pairs of 24-h dietary assessments and single FFQ used in the UK Biobank were comparable with results of previous prospective studies using conventional methods. Analyses of diet–disease relationships need to correct for both measurement error and within-person variability in dietary intake in order to reliably assess any such associations with disease in the UK Biobank.

Stellar coronal mass ejections (CMEs) may play an important role in stellar and planetary evolution, therefore the knowledge on parameter distributions of this energetic activity phenomenon is highly relevant. During the last years several attempts have been made to detect stellar CMEs of late-type main-sequence and pre main-sequence stars from dedicated optical spectroscopic observations. Up to now only a handful of distinct stellar CME detections are known which contradicts the results from stellar CME modelling, which predict higher CME rates. We report on dedicated ongoing and future observational attempts to detect stellar CMEs and discuss the observational results with respect to the results from stellar CME modelling.

We studied neuroinflammation in individuals with late-life, depression, as a risk factor for dementia, using [11C]PK11195 positron emission tomography (PET). Five older participants with major depression and 13 controls underwent PET and multimodal 3T magnetic resonance imaging (MRI), with blood taken to measure C-reactive protein (CRP). We found significantly higher CRP levels in those with late-life depression and raised [11C]PK11195 binding compared with controls in brain regions associated with depression, including subgenual anterior cingulate cortex, and significant hippocampal subfield atrophy in cornu ammonis 1 and subiculum. Our findings suggest neuroinflammation requires further investigation in late-life depression, both as a possible aetiological factor and a potential therapeutic target.

Rockfall ages in tectonically active regions provide information regarding frequency and magnitude of earthquakes. In the hyper-arid environment of the Dead Sea fault (DSF), southern Israel, rockfalls are most probably triggered by earthquakes. We dated rockfalls along the western margin of the DSF using terrestrial cosmogenic nuclides (TCN). At each rockfall site, samples were collected from simultaneously exposed conjugate boulders and cliff surfaces. Such conjugate samples initially had identical pre-fall (“inherited”) TCN concentrations. After boulder detachment, these surfaces were dosed by different production rates due to differences in post-fall shielding and geometry. However, in our study area, pre-rockfall inheritance and post-rockfall production rates of TCN cannot be evaluated. Therefore, we developed a numerical approach and demonstrated a way to overcome the above-mentioned problems. This approach can be applied in other settings where rockfalls cannot be dated by simple exposure dating. Results suggest rockfall ages between 3.6 ± 0.8 and 4.7 ± 0.7 ka. OSL ages of sediment accumulated behind the boulders range between 0.6 ± 0.1 and 3.4 ± 1.4 ka and support the TCN results. Our ages agree with dated earthquakes determined in paleoseismic studies along the entire length of the DSF and support the observation of intensive earthquake activity around 4–5 ka.

Improved chronological control on the penultimate advance of the Cordilleran Ice Sheet in northwest Canada (the Reid glaciation) is required for a better understanding of late Quaternary palaeoclimatic and palaeoenvironmental change in eastern Beringia. However, reliable dating of glaciation events beyond the last glacial maximum is commonly hindered by a lack of directly dateable material. In this study we (i) provide the first combined minimum and maximum age constraint on the Reid glaciation at Ash Bend, its reference locale in the Stewart River valley, northwestern Canadian Cordillera, using single-grain optically stimulated luminescence dating of quartz; and (ii) compare the timing of the Reid glaciation with other penultimate ice sheet advances in the region with the aim of establishing improved glacial reconstructions in eastern Beringia. We obtain ages of 158±18 ka and 132±18 ka for glaciofluvial sands overlying and underlying the Reid till, respectively. These ages indicate that the Reid advance, at its reference locale, occurred during MIS 6. This precludes an earlier MIS 8 age, and suggests that the Reid advance may have been synchronous with the Delta glaciation of central Alaska, and is likely correlative with the Mirror Creek glaciation in southern Yukon.

Objective: Hematopoietic syndrome (HS) is a clinical diagnosis assigned to people who present with ≥1 new-onset cytopenias in the setting of acute radiation exposure. The World Health Organization convened a panel of experts to evaluate the evidence and develop recommendations for medical countermeasures for the management of HS in a hypothetical scenario involving the hospitalization of 100 to 200 individuals exposed to radiation. The objective of this consultancy was to develop recommendations for treatment of the HS based upon the quality of evidence.

Methods: English-language articles were identified in MEDLINE and PubMed. Reference lists of retrieved articles were distributed to panel members before the meeting and updated during the meeting. Published case series and case reports of individuals with HS, published randomized controlled trials of relevant interventions used to treat nonirradiated individuals, reports of studies in irradiated animals, and prior recommendations of subject matter experts were selected. Studies were extracted using the Grading of Recommendations Assessment Development and Evaluation (GRADE) system. In cases in which data were limited or incomplete, a narrative review of the observations was made. No randomized controlled trials of medical countermeasures have been completed for individuals with radiation-associated HS. The use of GRADE analysis of countermeasures for injury to hematopoietic tissue was restricted by the lack of comparator groups in humans. Reliance on data generated in nonirradiated humans and experimental animals was necessary.

Results: Based upon GRADE analysis and narrative review, a strong recommendation was made for the administration of granulocyte colony-stimulating factor or granulocyte macrophage colony-stimulating factor and a weak recommendation was made for the use of erythropoiesis-stimulating agents or hematopoietic stem cell transplantation.

Conclusions: Assessment of therapeutic interventions for HS in humans exposed to nontherapeutic radiation is difficult because of the limits of the evidence.

(Disaster Med Public Health Preparedness. 2011;5:202-212)

Objectives: The World Health Organization convened a panel of experts to rank the evidence for medical countermeasures for management of acute radiation syndrome (ARS) in a hypothetical scenario involving the hospitalization of 100 to 200 victims. The goal of this panel was to achieve consensus on optimal management of ARS affecting nonhematopoietic organ systems based upon evidence in the published literature.

Methods: English-language articles were identified in MEDLINE and PubMed. Reference lists of retrieved articles were distributed to conferees in advance of and updated during the meeting. Published case series and case reports of ARS, publications of randomized controlled trials of relevant interventions used to treat nonirradiated individuals, reports of studies in irradiated animals, and prior recommendations of subject matter experts were selected. Studies were extracted using the Grading of Recommendations Assessment Development and Evaluation system. In cases in which data were limited or incomplete, a narrative review of the observations was made.

Results: No randomized controlled trials of medical countermeasures have been completed for individuals with ARS. Reports of countermeasures were often incompletely described, making it necessary to rely on data generated in nonirradiated humans and in experimental animals. A strong recommendation is made for the administration of a serotonin-receptor antagonist prophylactically when the suspected exposure is >2 Gy and topical steroids, antibiotics, and antihistamines for radiation burns, ulcers, or blisters; excision and grafting of radiation ulcers or necrosis with intractable pain; provision of supportive care to individuals with neurovascular syndrome; and administration of electrolyte replacement therapy and sedatives to individuals with significant burns, hypovolemia, and/or shock. A strong recommendation is made against the use of systemic steroids in the absence of a specific indication. A weak recommendation is made for the use of fluoroquinolones, bowel decontamination, loperamide, and enteral nutrition, and for selective oropharyngeal/digestive decontamination, blood glucose maintenance, and stress ulcer prophylaxis in critically ill patients.

Conclusions: High-quality studies of therapeutic interventions in humans exposed to nontherapeutic radiation are not available, and because of ethical concerns regarding the conduct of controlled studies in humans, such studies are unlikely to emerge in the near future.

(Disaster Med Public Health Preparedness. 2011;5:183–201)

We review recent developments in ethical pluralism, ethical particularism, Kantian intuitionism, rights theory, and climate change ethics, and show the relevance of these developments in ethical theory to contemporary business ethics. This paper explains why pluralists think that ethical decisions should be guided by multiple standards and why particularists emphasize the crucial role of context in determining sound moral judgments. We explain why Kantian intuitionism emphasizes the discerning power of intuitive reason and seek to integrate that with the comprehensiveness of Kant’s moral framework. And we show how human rights can be grounded in human agency, and explain the connections between human rights and climate change.