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The review aimed to identify factors influencing opioid prescribing as regular pain-management medication for older people.
Chronic pain occurs in 45%–85% of older people, but appears to be under-recognised and under-treated. However, strong opiate prescribing is more prevalent in older people, increasing at the fastest rate in this age group.
This review included all study types, published 1990–2017, which focused on opioid prescribing for pain management among older adults. Arksey and O’Malley’s framework was used to scope the literature. PubMed, EBSCO Host, the UK Drug Database, and Google Scholar were searched. Data extraction, carried out by two researchers, included factors explaining opioid prescribing patterns and prescribing trends.
A total of 613 papers were identified and 53 were included in the final review consisting of 35 research papers, 10 opinion pieces and 8 grey literature sources. Factors associated with prescribing patterns were categorised according to whether they were patient-related, prescriber-driven, or system-driven. Patient factors included age, gender, race, and cognition; prescriber factors included attitudes towards opioids and judgements about ‘normal’ pain; and policy/system factors related to the changing policy landscape over the last three decades, particularly in the USA.
A large number of context-dependent factors appeared to influence opioid prescribing for chronic pain management in older adults, but the findings were inconsistent. There is a gap in the literature relating to the UK healthcare system; the prescriber and the patient perspective; and within the context of multi-morbidity and treatment burden.
OBJECTIVES/SPECIFIC AIMS: Explore perceptions of Flint stakeholders on the water crisis regarding trust and the capacity of faith and community-based organizations providing public health services to address community needs. Analyze the community’s voice shared at (1) 17 key community communications (community/congressional meetings and events), and (2) during 9 focus group sessions, in which residents, faith-based leadership and other stakeholders discuss issues and concerns on the Flint Water Crisis, and recommend ways to address them. Develop a framework that defines core theories, concepts and strategies recommended by the community to help rebuild trust and the quality of life in Flint, Michigan, and support other communities experiencing environmental stress. METHODS/STUDY POPULATION: Study population: faith-based leaders, seniors, youth, Hispanic/Latino and African American stakeholders, and others experiencing inequities in the city of Flint. Convene 9 focus group sessions (recorded and transcribed) to learn community perceptions on trust and ways to address it. Validate accuracy of the transcriptions with community consultants to reconcile any inaccurate information. Through a community engaged research (CEnR) process, review and analyze qualitative data from the 9 focus group sessions, and quantitative data from 2 surveys documenting (1) demographic backgrounds of focus group participants, and (2) their perceptions on trust and mistrust. Prepare a codebook to qualitatively analyze the focus group data summarizing community input on trust, mistrust, changes in service delivery among community and faith-based organizations, and ways to re-build trust in the city of Flint. Transcribe the community’s voice shared during 17 key events, identified by a team of community-academic stakeholders (i.e., UM Flint water course, congressional and community events, etc.), in which residents and other stakeholders discuss issues and concerns on the Flint Water Crisis, and recommend ways to address it. Qualitatively analyze the transcriptions, using a CEnR process to prepare a codebook on key themes from the community’s voice shared at these events, and recommendations on ways to address it. Compare and contrast findings between the two codebooks developed from (1) the focus group data and (2) qualitative analysis of community voice during public meetings and events. Synthesize this information into a framework of core theories, concepts and rebuilding strategies for Flint, Michigan. RESULTS/ANTICIPATED RESULTS: It is important to note many undocumented immigrant populations in Flint fear deportation and other consequences, hampering their ability to obtain service and provide community voice. Through our purposive sampling approach, we will hear from community voices not often included in narratives (i.e., seniors, youth, Hispanic/Latino residents). The presentation will present findings documenting levels of trust and mistrust in the city of Flint; and a framework of recommendations, core theories and concepts on ways to reduce, rebuild and eliminate stress that will be helpful to other communities experiencing distress. DISCUSSION/SIGNIFICANCE OF IMPACT: To our knowledge, levels of trust and mistrust in Flint have not been documented thus far. We will compare and contrast common themes presented by the community at public meetings and events with themes presented in our focus group effort on trust. Faith and community-based providers were among the first responders to the Flint Water Crisis. The effort will also share perceptions on changes in public health service delivery, and observations on preparedness for these roles that occurred among community and faith-based providers. Finally, the effort will (1) support the design of a research agenda, (2) define a framework of core theories, concepts and recommendations developed by the community to help rebuild trust in Flint, Michigan; and (3) support other communities addressing environmental distress.
Stars in low-mass dwarf galaxies show a larger range in their chemical properties than those in the Milky Way halo. The slower star formation efficiency make dwarf galaxies ideal systems for testing nucleosynthetic yields. Not only are alpha-poor stars found at lower metallicities, and a higher fraction of carbon-enhanced stars, but we are also finding stars in dwarf galaxies that appear to be iron-rich. These are compared with yields from a variety of supernova predictions.
IAU Commission 29 - Stellar Spectra has been one of the IAU commissions from the onset, until its dissolution at the most recent IAU General Assembly in Honolulu in 2015. This commission belonged to IAU Division G (“Stars and Stellar Physics”), the latter committed with fostering research in stellar astrophysics. Within the general field of stellar astrophysics, stellar spectroscopy plays a key role, as stellar spectra are a powerful tool providing a view into the detailed physical properties of stars and the physical processes occuring within them.
Sex differences in the risk factors, presentation and outcome of cerebral venous sinus thrombosis (CVST) are poorly defined, despite a discrepant prevalence between males and females. The proportion of patients on hormonal therapy who develop CVST varies widely. We describe the clinical features, risk factors and outcome by sex and by hormone-related risk factors among a large cohort of patients.
We reviewed records of 108 consecutive patients with CVST at a tertiary hospital in Calgary between 1999 and 2009. Descriptive statistics were used for between group comparisons (men, women with hormone-related risk factors and women without hormone-related risk factors).
Females made up 62% of patients, half of whom were on systemic hormonal therapy. Men and women without hormonal risk factors were older at onset. Oral contraceptive use was the major risk factor in women (45%) while concurrent mastoiditis was the most common predisposing factor in men (27%). Complications were frequent and overall mortality was 6%. Persisting deficits at discharge were more common in men (54% vs. 35% and 32%, p = 0.036). There was a trend for women with hormone-related risk factors to have less residual focal neurologic deficit than the other groups (5% vs. 15% and 17%, p=0.051).
There are differences between sexes in the presentation, risk factors and outcome of patients with CVST.
As the least massive galaxies we know, dwarf spheroidal galaxies (dSph) allow to probe chemical enrichement on the smallest scales, and perhaps in its simplest expression. Particularly interesting are the issues concerning the efficency with which metals are retained or lost in these shallow potential wells (supernovae feedback), and the effect of this on star formation itself. Another fundamental issue concerns the earliest epochs of star formation: are first stars formed in similar ways and proportions in all halos ? Finally, as the smallest galaxies know, dSph have been suggested to be the surviving cousins of galaxy building blocs that (in λ-CDM) assemble to make larger galaxies. This parenthood would not necessarily hold at all late times, when survivors have lived their own differentiated life, but is expected at least at the earliest epochs.
I review here the chemical abundances of individual stars in the nearest dwarf spheroidal galaxies, that have become available in increasing numbers (sample size and galaxies probed) in the last decade. Special emphasis is given to: a) recent results obtain with FLAMES on VLT, highlighting the power of detailed chemical abundance patterns of large samples of stars to unravel the various evolutionnary paths followed by dSph; b) the oldest and most metal-poor populations in dSph.
The metallicity distribution and abundance ratios of the Galactic bulge are reviewed. Issues raised by different groups in recent work, in particular the high metallicity end, a comparison between the oxygen abundances derived from different indicators, the [OI] 630nm and IR OH lines, and the issue of measuring giants vs. dwarfs, are discussed. Finally, abundances in bulge globular clusters are briefly described.
We show that in a sample of Extremely Metal-Poor (EMP) giants (<[Fe/H]>=−3.1) all the stars with a luminosity higher than logL/L⊙ ≈ 2.6 present the characteristics of a mixing of the surface with the H-burning layer: low abundance of carbon and high abundance of nitrogen. In these “mixed stars” the lithium abundance and the ratio 12C/13C are very low. Some of these stars are also Na or/and Al rich.
The Fornax dSph is an interesting case as it contains five old globular clusters and its field stars, although predominantly of intermediate (3-8 Gyr old) age, cover a wide range of age and metallicity. Detailed abundance analysis is crucial to our understanding of the earliest star formation epoches, where classic CMD analysis fails to provide a unique answer. It also allows us to measure the chemical evolution of the stellar population following tracers of different enrichment mechanisms through time, e.g. SN type II (alpha elements); AGB stars (s-process elements) etc. With our large sample of abundance measurements we will obtain a detailed picture of the evolution of Fornax and of the role played by small galaxies in the building up of larger ones.
As part of a study of the detailed abundance patterns in extremely metal-poor stars, we have compared our samples of giants and dwarfs with two samples of dwarfs measured by different teams. For most elements the abundances are in good agreement, but for C, Na, and Al we show that the atmospheric abundances are different in dwarfs and in giants. For C the difference could be explained by “atmospheric effects” or by the influence of the first dredge-up, but for Na and Al deep mixing inside the stars must be invoked. Until now, such deep mixing has not been observed in metal-poor field stars. An excess scatter in [Mg/Fe] in giants remains unexplained.
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