Which drugs cause preventable admissions to hospital? A systematic review

Aim: Previous systematic reviews have found that drug-related morbidity accounts for 4.3% of preventable hospital admissions. None, however, has identified the drugs most commonly responsible for preventable hospital admissions. The aims of this study were to estimate the percentage of preventable drug-related hospital admissions, the most common drug causes of preventable hospital admissions and the most common underlying causes of preventable drug-related admissions. Methods: Bibliographic databases and reference lists from eligible articles and study authors were the sources for data. Seventeen prospective observational studies reporting the proportion of preventable drug-related hospital admissions, causative drugs and/or the underlying causes of hospital admissions were selected. Included studies used multiple reviewers and/or explicit criteria to assess causality and preventability of hospital admissions. Two investigators abstracted data from all included studies using a purpose-made data extraction form. Results: From 13 papers the median percentage of preventable drug-related admissions to hospital was 3.7% (range 1.4-15.4). From nine papers the majority (51%) of preventable drug-related admissions involved either antiplatelets (16%), diuretics (16%), nonsteroidal anti-inflammatory drugs (11%) or anticoagulants (8%). From five studies the median proportion of preventable drug-related admissions associated with prescribing problems was 30.6% (range 11.1-41.8), with adherence problems 33.3% (range 20.9-41.7) and with monitoring problems 22.2% (range 0-31.3). Conclusions: Four groups of drugs account for more than 50% of the drug groups associated with preventable drug-related hospital admissions. Concentrating interventions on these drug groups could reduce appreciably the number of preventable drug-related admissions to hospital from primary care.

Tropical climates at the Last Glacial Maximum: a new synthesis of terrestrial palaeoclimate data. I. Vegetation, lake-levels and geochemistry.

Palaeodata in synthesis form are needed as benchmarks for the Palaeoclimate Modelling Intercomparison Project (PMIP). Advances since the last synthesis of terrestrial palaeodata from the last glacial maximum (LGM) call for a new evaluation, especially of data from the tropics. Here pollen, plant-macrofossil, lake-level, noble gas (from groundwater) and δ18O (from speleothems) data are compiled for 18±2 ka (14C), 32 °N–33 °S. The reliability of the data was evaluated using explicit criteria and some types of data were re-analysed using consistent methods in order to derive a set of mutually consistent palaeoclimate estimates of mean temperature of the coldest month (MTCO), mean annual temperature (MAT), plant available moisture (PAM) and runoff (P-E). Cold-month temperature (MAT) anomalies from plant data range from −1 to −2 K near sea level in Indonesia and the S Pacific, through −6 to −8 K at many high-elevation sites to −8 to −15 K in S China and the SE USA. MAT anomalies from groundwater or speleothems seem more uniform (−4 to −6 K), but the data are as yet sparse; a clear divergence between MAT and cold-month estimates from the same region is seen only in the SE USA, where cold-air advection is expected to have enhanced cooling in winter. Regression of all cold-month anomalies against site elevation yielded an estimated average cooling of −2.5 to −3 K at modern sea level, increasing to ≈−6 K by 3000 m. However, Neotropical sites showed larger than the average sea-level cooling (−5 to −6 K) and a non-significant elevation effect, whereas W and S Pacific sites showed much less sea-level cooling (−1 K) and a stronger elevation effect. These findings support the inference that tropical sea-surface temperatures (SSTs) were lower than the CLIMAP estimates, but they limit the plausible average tropical sea-surface cooling, and they support the existence of CLIMAP-like geographic patterns in SST anomalies. Trends of PAM and lake levels indicate wet LGM conditions in the W USA, and at the highest elevations, with generally dry conditions elsewhere. These results suggest a colder-than-present ocean surface producing a weaker hydrological cycle, more arid continents, and arguably steeper-than-present terrestrial lapse rates. Such linkages are supported by recent observations on freezing-level height and tropical SSTs; moreover, simulations of “greenhouse” and LGM climates point to several possible feedback processes by which low-level temperature anomalies might be amplified aloft.

Simulating human and environmental exposure from hand-held knapsack pesticide application: Be-WetSpa-Pest, an integrative, spatially explicit modeling approach

This paper presents an integrative and spatially explicit modeling approach for analyzing human and environmental exposure from pesticide application of smallholders in the potato producing Andean region in Colombia. The modeling approach fulfills the following criteria: (i) it includes environmental and human compartments; (ii) it contains a behavioral decision-making model for estimating the effect of policies on pesticide flows to humans and the environment; (iii) it is spatially explicit; and (iv) it is modular and easily expandable to include additional modules, crops or technologies. The model was calibrated and validated for the Vereda La Hoya and was used to explore the effect of different policy measures in the region. The model has moderate data requirements and can be adapted relatively easy to other regions in developing countries with similar conditions.

Holocene tidal palaeochannels, Severn Estuary Levels, UK: a search for granulometric and foraminiferal criteria

Holocene tidal palaoechannels, Severn Estuary Levels, UK: a search for granulometric and foraminiferal criteria. Proceedings of the Geologists' Association, 117, 329-344. Grain-size characteristics (by laser granulometry) and foraminiferal assemblages have been established for silts accumulated in five, dissimilar tidal palaeochannels of mid or late Holocene age in the Severn Estuary Levels, representative of muddy tidal systems. For purposes of general comparison, similar data were obtained from a representative active tidal inlet in the area, but all of these channels have been subject to human interference and are not relied upon as a model for environmental interpretation. Although the palaeochannel deposits differ substantially in their bedding characteristics and stratigraphical relationships from the level-bedded salt-marsh platform and mudflat deposits with which they are associated, and although the channel environment is distinctive morphologically and hydraulically, no critical textural differences could be found between the channel deposits and the associated facies. Similarly, no foraminiferal assemblages distinctive of a tidal channel were encountered. Instead, the assemblages compare with those from mudflats and salt-marsh platforms. It is concluded that the sides of the subfossil channels carried some vegetation, as was observed to be the case in the modern inlet. An alternative approach is necessary if concealed palaeochannel deposits are to be recognized in muddy systems from limited numbers of subsurface samples. Although the palaeochannels afforded no characteristic textural signature, they yield transverse grain-size patterns pointing to coastal movements during their evolution. Concave-up trends suggest outward coastal building, whereas convex-up ones point to marsh-edge retreat.

The influence of affective statements on performance on implicit and explicit memory tasks

Consumers are often exposed to brand names presented concurrently with information such as brand claims and warnings, prior to making product choices. As implicit memory has been implicated in the consumer choice process, two experiments were conducted to assess the influence of additional information, namely simple positive and negative statements, on implicit and explicit memory tasks. In Experiment 1, the mere presence of additional statements at study significantly reduced performance on a two-alternatives forced recognition task. However, the same manipulation had no effect on implicit preference judgement task performance. The valence of the accompanying information had no effect on either task. In Experiment 2, using modified implicit and explicit choice tasks, performance on the former was unaffected by statement valence, whereas the latter task was. Hence, positive priming was obtained for brand names previously shown with negative information. The results of the experiments are discussed in relation to both implicit memory and consumer choice.

Implicit learning: Below the subjective threshold?

In this review, we consider three possible criteria by which knowledge might be regarded as implicit or inaccessible: It might be implicit only in the sense that it is difficult to articulate freely, or it might be implicit according to either an objective threshold or a subjective threshold. We evaluate evidence for these criteria in relation to artificial grammar learning, the control of complex systems, and sequence learning, respectively. We argue that the convincing evidence is not yet in, but construing the implicit nature of implicit learning in terms of a subjective threshold is most likely to prove fruitful for future research. Furthermore, the subjective threshold criterion may demarcate qualitatively different types of knowledge. We argue that (1) implicit, rather than explicit, knowledge is often relatively inflexible in transfer to different domains, (2) implicit, rather than explicit, learning occurs when attention is focused on specific items and not underlying rules, and (3) implicit learning and the resulting knowledge are often relatively robust.

Transfer across form and modality in implicit and explicit memory

Three experiments examined transfer across form (words/pictures) and modality (visual/ auditory) in written word, auditory word, and pictorial implicit memory tests, as well as on a free recall task. Experiment 1 showed no significant transfer across form on any of the three implicit memory tests,and an asymmetric pattern of transfer across modality. In contrast, the free recall results revealed a very different picture. Experiment 2 further investigated the asymmetric modality effects obtained for the implicit memory measures by employing articulatory suppression and picture naming to control the generation of phonological codes. Finally, Experiment 3 examined the effects of overt word naming and covert picture labelling on transfer between study and test form. The results of the experiments are discussed in relation to Tulving and Schacter's (1990) Perceptual Representation Systems framework and Roediger's (1990) Transfer Appropriate Processing theory.

Implicit and explicit processes in a second-language learning task

Two experiments examined the learning of a set of Greek pronunciation rules through explicit and implicit modes of rule presentation. Experiment 1 compared the effectiveness of implicit and explicit modes of presentation in two modalities, visual and auditory. Subjects in the explicit or rule group were presented with the rule set, and those in the implicit or natural group were shown a set of Greek words, composed of letters from the rule set, linked to their pronunciations. Subjects learned the Greek words to criterion and were then given a series of tests which aimed to tap different types of knowledge. The results showed an advantage of explicit study of the rules. In addition, an interaction was found between mode of presentation and modality. Explicit instruction was more effective in the visual than in the auditory modality, whereas there was no modality effect for implicit instruction. Experiment 2 examined a possible reason for the advantage of the rule groups by comparing different combinations of explicit and implicit presentation in the study and learning phases. The results suggested that explicit presentation of the rules is only beneficial when it is followed by practice at applying them.

Implicit and explicit knowledge bases in artificial grammar learning

Two experiments examined the claim for distinct implicit and explicit learning modes in the artificial grammar-learning task (Reber, 1967, 1989). Subjects initially attempted to memorize strings of letters generated by a finite-state grammar and then classified new grammatical and nongrammatical strings. Experiment 1 showed that subjects' assessment of isolated parts of strings was sufficient to account for their classification performance but that the rules elicited in free report were not sufficient. Experiment 2 showed that performing a concurrent random number generation task under different priorities interfered with free report and classification performance equally. Furthermore, giving different groups of subjects incidental or intentional learning instructions did not affect classification or free report.