Progress towards improving chronologies for marine sediment records.

The North Atlantic has played a key role in abrupt climate changes due to the sensitivity of the Atlantic Meridional Overturning Circulation (AMOC) to the location and strength of deep water formation. It is crucial for modelling future climate change to understand the role of the AMOC in the rapid warming and gradual cooling cycles known as Dansgaard-Oescher (DO) events which are recorded in the Greenland ice cores. However, palaeoceanographic research into DO events has been hampered by the uncertainty in timing due largely to the lack of a precise chronological time frame for marine records. While tephrochronology provides links to the Greenland ice core records at a few points, radiocarbon remains the primary dating method for most marine cores. Due to variations in the atmospheric and oceanic 14C concentration, radiocarbon ages must be calibrated to provide calendric ages. The IntCal Working Group provides a global estimate of ocean 14C ages for calibration of marine radiocarbon dates, but the variability of the surface marine reservoir age in the North Atlantic particularly during Heinrich or DO events, makes calibration uncertain. In addition, the current Marine09 radiocarbon calibration beyond around 15 ka BP is largely based on 'tuning' to the Hulu Cave isotope record, so that the timing of events may not be entirely synchronous with the Greenland ice cores. The use of event-stratigraphy and independent chronological markers such as tephra provide the scope to improve marine radiocarbon reservoir age estimates particularly in the North Atlantic where a number of tephra horizons have been identified in both marine sediments and the Greenland ice cores. Quantification of timescale uncertainties is critical but statistical techniques which can take into account the differential dating between events can improve the precision. Such techniques should make it possible to develop specific marine calibration curves for selected regions.

Any versus long-term prescribing of high risk medications in older people using 2012 Beers Criteria: results from three cross-sectional samples of primary care records for 2003/4, 2007/8 and 2011/12

Background: High risk medications are commonly prescribed to older US patients. Currently, less is known about high risk medication prescribing in other Western Countries, including the UK. We measured trends and correlates of high risk medication prescribing in a subset of the older UK population (community/institutionalized) to inform harm minimization efforts. Methods: Three cross-sectional samples from primary care electronic clinical records (UK Clinical Practice Research Datalink, CPRD) in fiscal years 2003/04, 2007/08 and 2011/12 were taken. This yielded a sample of 13,900 people aged 65 years or over from 504 UK general practices. High risk medications were defined by 2012 Beers Criteria adapted for the UK. Using descriptive statistical methods and regression modelling, prevalence of ‘any’ (drugs prescribed at least once per year) and ‘long-term’ (drugs prescribed all quarters of year) high risk medication prescribing and correlates were determined. Results: While polypharmacy rates have risen sharply, high risk medication prevalence has remained stable across a decade. A third of older (65+) people are exposed to high risk medications, but only half of the total prevalence was long-term (any = 38.4 % [95 % CI: 36.3, 40.5]; long-term = 17.4 % [15.9, 19.9] in 2011/12). Long-term but not any high risk medication exposure was associated with older ages (85 years or over). Women and people with higher polypharmacy burden were at greater risk of exposure; lower socio-economic status was not associated. Ten drugs/drug classes accounted for most of high risk medication prescribing in 2011/12. Conclusions: High risk medication prescribing has not increased over time against a background of increasing polypharmacy in the UK. Half of patients receiving high risk medications do so for less than a year. Reducing or optimising the use of a limited number of drugs could dramatically reduce high risk medications in older people. Further research is needed to investigate why the oldest old and women are at greater risk. Interventions to reduce high risk medications may need to target shorter and long-term use separately.

The TRAVATAN Dosing Aid accurately records when drops are taken.

PURPOSE:

To assess the accuracy of Travatan Dosing Aid recordings.

DESIGN:

Prospective evaluation of drop-recording accuracy.

METHODS:

Physicians and patients used the Dosing Aid, and logs of usage were compared to the data obtained from the Dosing Aid.

RESULTS:

Five physicians and 20 patients participated. Devices used by physicians recorded all drops dispensed. Extra readings were recorded when physicians carried the devices during the day. For patients, 93% of all drops were recorded, with 18 of 20 subjects having over 85% of the drops recorded. Seventy percent of patients would continue using the device.

CONCLUSIONS:

The Dosing Aid accurately recorded most eyedrops administered by patients and physicians. Given recent documentation of widespread under-compliance with medical therapy, the Dosing Aid could be a useful addition to clinical practice and research.

Geochronological database and classification system for age uncertainties in Neotropical pollen records.

The newly updated inventory of palaeoecological research in Latin America offers an important overview of sites available for multi-proxy and multi-site purposes. From the collected literature supporting this inventory, we collected all available age model metadata to create a chronological database of 5116 control points (e.g. 14C, tephra, fission track, OSL, 210Pb) from 1097 pollen records. Based on this literature review, we present a summary of chronological dating and reporting in the Neotropics. Difficulties and recommendations for chronology reporting are discussed. Furthermore, for 234 pollen records in northwest South America, a classification system for age uncertainties is implemented based on chronologies generated with updated calibration curves. With these outcomes age models are produced for those sites without an existing chronology, alternative age models are provided for researchers interested in comparing the effects of different calibration curves and age–depth modelling software, and the importance of uncertainty assessments of chronologies is highlighted. Sample resolution and temporal uncertainty of ages are discussed for different time windows, focusing on events relevant for research on centennial- to millennial-scale climate variability. All age models and developed R scripts are publicly available through figshare, including a manual to use the scripts.