Use of medications with anticholinergic activity and self-reported injurious falls in older community-dwelling adults

Objectives: To assess the association between the use of medications with anticholinergic activity and the subsequent risk of injurious falls in older adults. Design: Prospective, population-based study using data from The Irish Longitudinal Study on Ageing. Setting: Irish population. Participants: Community-dwelling men and women without dementia aged 65 and older (N = 2,696). Measurements: Self-reported injurious falls reported once approximately 2 years after baseline interview. Self-reported regular medication use at baseline interview. Pharmacy dispensing records from the Irish Health Service Executive Primary Care Reimbursement Service in a subset (n = 1,553). Results: Nine percent of men and 17% of women reported injurious falls. In men, the use of medications with definite anticholinergic activity was associated with greater risk of subsequent injurious falls (adjusted relative risk (aRR) = 2.55, 95% confidence interval (CI) = 1.33-4.88), but the risk of having any fall and the number of falls reported were not significantly greater. Greater anticholinergic burden was associated with greater injurious falls risk. No associations were observed for women. Findings were similar using pharmacy dispensing records. The aRR for medications with definite anticholinergic activity dispensed in the month before baseline and subsequent injurious falls in men was 2.53 (95% CI = 1.15-5.54). Conclusion: The regular use of medications with anticholinergic activity is associated with subsequent injurious falls in older men, although falls were self-reported after a 2-year recall and so may have been underreported. Further research is required to validate this finding in men and to consider the effect of duration and dose of anticholinergic medications.

Transgressing community:the case of Muslims in a twenty-first-century British city

This paper draws on ethnographic research carried out in Birmingham, UK – a city significant for its sizeable Muslim population and its iconic role in the history of minority ethnic settlement in Britain – to consider how associations of place and ethnicity work in different ways to inform ideas about ‘Muslim community’ in twenty-first-century Britain. The paper charts happenings around a local event in an area of majority Asian settlement and how representations of the area as a place of Muslim community were used to implicate it in the ‘war on terror’. The paper goes on to show how this sensibility is disrupted by Muslims themselves through alternative engagements with space and ethnicity. The paper argues that these offer a ground for making Muslim community in ways that actively engage with histories and patterns of ethnic settlement in the city rather than being determined by them.

Transgressing community:the case of Muslims in a twenty-first-century British city

This paper draws on ethnographic research carried out in Birmingham, UK - a city significant for its sizeable Muslim population and its iconic role in the history of minority ethnic settlement in Britain - to consider how associations of place and ethnicity work in different ways to inform ideas about 'Muslim community' in twenty-first-century Britain. The paper charts happenings around a local event in an area of majority Asian settlement and how representations of the area as a place of Muslim community were used to implicate it in the 'war on terror'. The paper goes on to show how this sensibility is disrupted by Muslims themselves through alternative engagements with space and ethnicity. The paper argues that these offer a ground for making Muslim community in ways that actively engage with histories and patterns of ethnic settlement in the city rather than being determined by them.

Community formation among Asian Indians in southeast Florida

Nearly one million Asian Indians have immigrated to the United States. Asian Indians are scattered across wide geographic areas. While some have chosen transnationalism, most are taking the traditional route of building ethnic communities. Using what the West has to offer in terms of communication and transportation technologies, they are constructing communities without geographic boundaries, with the extensive use of the automobile and air transportation, cellular phones, FAX machines, commercial delivery services, multi-party conference phones. Also, they are incorporating the American tradition of immigrant associations into an Asian Indian syncretism of community. In the process there emerges an Asian Indian identity and concept of kinship and community. ^

The mathematics anxiety of bilingual community college students

Math anxiety levels and performance outcomes were compared for bilingual and monolingual community college Intermediate Algebra students attending a culturally diverse urban commuter college. Participants (N = 618, 250 men, 368 women; 361 monolingual, 257 bilingual) completed the Abbreviated Math Anxiety Scale (AMAS) and a demographics instrument. Bilingual and monolingual students reported comparable mean AMAS scores (20.6 and 20.7, respectively) and comparable proportions of math anxious individuals (50% and 48%, respectively). Factor analysis of AMAS scores, using principal component analysis by varimax rotation, yielded similar two-factor structures for both populations -- assessment and learning content -- accounting for 65.6% of the trace for bilingual AMAS scores. Statistically significant predictor variables for levels of math anxiety for the bilingual participants included (a) preparatory course enrollment (β = .236, p = .041) with those enrolled in prior preparatory courses scoring higher, (b) education major (β = .285, p = .018) with education majors scoring higher, and (c) business major (β = .252, p = .032) with business majors scoring higher. One statistically significant predictor variable emerged for monolingual students, gender (β = -.085, p = .001) with females ranking higher. Age, income, race, ethnicity, U.S. origin, science or health science majors did not emerge as statistically significant predictor variables for either group.^ Similarities between monolingual and bilingual participants included statistically significant negative linear correlations between AMAS scores and course grades for both bilingual (r = -.178, p = .017) and monolingual participants (r = -.203, p = .001). Differences included a statistically significant linear correlation between AMAS scores and final exam grades for monolingual participants only (r = -.253, p < .0009) despite no statistically significant difference in the strength the linear relationship of the AMAS scores and the final exam scores between groups, z = 1.35, p = .1756.^ The findings show that bilingual and monolingual students report math anxiety similarly and that math anxiety has similar associations with performance measures, despite differences between predictor variables. One of the first studies on the math anxiety of bilingual community college students, the results suggest recommendations for researchers and practitioners.^

The Mathematics Anxiety of Bilingual Community College Students

Math anxiety levels and performance outcomes were compared for bilingual and monolingual community college Intermediate Algebra students attending a culturally diverse urban commuter college. Participants (N = 618, 250 men, 368 women; 361 monolingual, 257 bilingual) completed the Abbreviated Math Anxiety Scale (AMAS) and a demographics instrument. Bilingual and monolingual students reported comparable mean AMAS scores (20.6 and 20.7, respectively) and comparable proportions of math anxious individuals (50% and 48%, respectively). Factor analysis of AMAS scores, using principal component analysis by varimax rotation, yielded similar two-factor structures for both populations -- assessment and learning content -- accounting for 65.6% of the trace for bilingual AMAS scores. Statistically significant predictor variables for levels of math anxiety for the bilingual participants included (a) preparatory course enrollment (β = .236, p = .041) with those enrolled in prior preparatory courses scoring higher, (b) education major (β = .285, p = .018) with education majors scoring higher, and (c) business major (β = .252, p = .032) with business majors scoring higher. One statistically significant predictor variable emerged for monolingual students, gender (β = -.085, p = .001) with females ranking higher. Age, income, race, ethnicity, U.S. origin, science or health science majors did not emerge as statistically significant predictor variables for either group. Similarities between monolingual and bilingual participants included statistically significant negative linear correlations between AMAS scores and course grades for both bilingual (r = -.178, p = .017) and monolingual participants (r = -.203, p = .001). Differences included a statistically significant linear correlation between AMAS scores and final exam grades for monolingual participants only (r = -.253, p < .0009) despite no statistically significant difference in the strength the linear relationship of the AMAS scores and the final exam scores between groups, z = 1.35, p = .1756. The findings show that bilingual and monolingual students report math anxiety similarly and that math anxiety has similar associations with performance measures, despite differences between predictor variables. One of the first studies on the math anxiety of bilingual community college students, the results suggest recommendations for researchers and practitioners.

Fossil associations from the middle and upper Eocene strata of the Pamplona Basin and surrounding areas (Navarre, western Pyrenees)

Fossil associations from the middle and upper Eocene (Bartonian and Priabonian) sedimentary succession of the Pamplona Basin are described. This succession was accumulated in the western part of the South Pyrenean peripheral foreland basin and extends from deep-marine turbiditic (Ezkaba Sandstone Formation) to deltaic (Pamplona Marl, Ardanatz Sandstone and Ilundain Marl formations) and marginal marine deposits (Gendulain Formation). The micropalaeontological content is high. It is dominated by foraminifera, and common ostracods and other microfossils are also present. The fossil ichnoasssemblages include at least 23 ichnogenera and 28 ichnospecies indicative of Nereites, Cruziana, Glossifungites and ?Scoyenia-Mermia ichnofacies. Body macrofossils of 78 taxa corresponding to macroforaminifera, sponges, corals, bryozoans, brachiopods, annelids, molluscs, arthropods, echinoderms and vertebrates have been identified. Both the number of ichnotaxa and of species (e. g. bryozoans, molluscs and condrichthyans) may be considerably higher. Body fossil assemblages are comparable to those from the Eocene of the Nord Pyrenean area (Basque Coast), and also to those from the Eocene of the west-central and eastern part of South Pyrenean area (Aragon and Catalonia). At the European scale, the molluscs assemblages seem endemic from the Pyrenean area, although several Tethyan (Italy and Alps) and Northern elements (Paris basin and Normandy) have been recorded. Palaeontological data of studied sedimentary units fit well with the shallowing process that throughout the middle and late Eocene occurs in the area, according to the sedimentological and stratigraphical data.

GPs’ and community pharmacists’ opinions on medication management at transitions of care in Ireland

Objective. The aim of this study was to survey GPs and community pharmacists (CPs) in Ireland regarding current practices of medication management, specifically medication reconciliation, communication between health care providers and medication errors as patients transition in care.
Methods. A national cross-sectional survey was distributed electronically to 2364 GPs, 311 GP Registrars and 2382 CPs. Multivariable associations comparing GPs to CPs were generated and content analysis of free text responses was undertaken.
Results. There was an overall response rate of 17.7% (897 respondents—554 GPs/Registrars and 343 CPs). More than 90% of GPs and CPs were positive about the effects of medication reconciliation on medication safety and adherence. Sixty per cent of GPs reported having no formal system of medication reconciliation. Communication between GPs and CPs was identified as good/very good by >90% of GPs and CPs. The majority (>80%) of both groups could clearly recall prescribing errors, following a transition of care, they had witnessed in the previous 6 months. Free text content analysis corroborated the positive relationship between GPs and CPs, a frustration with secondary care communication, with many examples given of prescribing errors.
Conclusions. While there is enthusiasm for the benefits of medication reconciliation there are limited formal structures in primary care to support it. Challenges in relation to systems that support inter-professional communication and reduce medication errors are features of the primary/secondary care transition. There is a need for an improved medication management system. Future research should focus on the identified barriers in implementing medication reconciliation and systems that can improve it.

Shame, Dissociation, and Complex PTSD Symptoms in Traumatized Psychiatric and Control Groups: Direct and Indirect Associations With Relationship Distress

Objectives: Elevated shame and dissociation are common in dissociative identity disorder (DID) and chronic posttraumatic stress disorder (PTSD) and are part of the constellation of symptoms defined as complex PTSD. Previous work examined the relationship between shame, dissociation, and complex PTSD and whether they are associated with intimate relationship anxiety, relationship depression, and fear of relationships. This study investigated these variables in traumatized clinical samples and a nonclinical community group.

Method: Participants were drawn from the DID (n = 20), conflict-related chronic PTSD (n = 65), and nonclinical (n = 125) populations and completed questionnaires assessing the variables of interest. A model examining the direct impact of shame and dissociation on relationship functioning, and their indirect effect via complex PTSD symptoms, was tested through path analysis.

Results: The DID sample reported significantly higher dissociation, shame, complex PTSD symptom severity, relationship anxiety, relationship depression, and fear of relationships than the other two samples. Support was found for the proposed model, with shame directly affecting relationship anxiety and fear of relationships, and pathological dissociation directly affecting relationship anxiety and relationship depression. The indirect effect of shame and dissociation via complex PTSD symptom severity was evident on all relationship variables.

Conclusion: Shame and pathological dissociation are important for not only the effect they have on the development of other complex PTSD symptoms, but also their direct and indirect effects on distress associated with relationships.

CURB-65 and Other Markers of Illness Severity in Community-Acquired Pneumonia Among HIV-Positive Patients

As the relative burden of community-acquired bacterial pneumonia among HIV-positive patients increases, adequate prediction of case severity on presentation is crucial. We sought to determine what characteristics measurable on presentation are predictive of worse outcomes. We studied all admissions for community-acquired bacterial pneumonia over one year at a tertiary centre. Patient demographics, comorbidities, HIV-specific markers and CURB-65 scores on Emergency Department presentation were reviewed. Outcomes of interest included mortality, bacteraemia, intensive care unit admission and orotracheal intubation. A total of 396 patients were included: 49 HIV-positive and 347 HIV-negative. Mean CURB-65 score was 1.3 for HIV-positive and 2.2 for HIV-negative patients (p < 0.0001), its predictive value for mortality being maintained in both groups (p = 0.03 and p < 0.001, respectively). Adjusting for CURB-65 scores, HIV infection by itself was only associated with bacteraemia (adjusted odds ratio [AOR] 7.1, 95% CI [2.6-19.5]). Patients with < 200 CD4 cells/µL presented similar CURB-65 adjusted mortality (aOR 1.7, 95% CI [0.2-15.2]), but higher risk of intensive care unit admission (aOR 5.7, 95% CI [1.5-22.0]) and orotracheal intubation (aOR 9.1, 95% CI [2.2-37.1]), compared to HIV-negative patients. These two associations were not observed in the > 200 CD4 cells/µL subgroup (aOR 2.2, 95% CI [0.7-7.6] and aOR 0.8, 95% CI [0.1-6.5], respectively). Antiretroviral therapy and viral load suppression were not associated with different outcomes (p > 0.05). High CURB-65 scores and CD4 counts < 200 cells/µL were both associated with worse outcomes. Severity assessment scales and CD4 counts may both be helpful in predicting severity in HIV-positive patients presenting with community-acquired bacterial pneumonia.

People and their past : is 'community archaeology’ the future?

This thesis looks at how ‘community archaeology’ ideals may influence an inclusive approach to Indigenous heritage management, ensuring Indigenous community power over processes to identify both past and present values of Country. Community archaeology was acclaimed by research archaeologists over a decade ago as a distinctive approach with its own set of practices to incorporate the local community’s perspectives of its past and current associations with place. A core feature of this approach in Australia is the major role the Indigenous community has in decisions about its heritage. Concurrently, considerable concern was being expressed that Indigenous heritage was not sufficiently addressed in environmental impact assessment processes ahead of development. Seen as absent from the process was the inclusion of Indigenous knowledge about both the pre- and post-contact story as well as any scientific advance in understanding an area’s Indigenous history. This research examines these contrasting perspectives seeking to understand the ideals of community archaeology and its potential to value all aspects of Indigenous heritage and so benefit the relevant community. The ideals of community archaeology build on past community collaborations in Australia and also respond to more recent societal recognition of Indigenous rights, reflected in more ethically inclusive planning and heritage statutes. Indigenous communities expressed the view that current systems are still not meeting these policy commitments to give them control over their heritage. This research has examined the on-the-ground reality of heritage work on the outskirts of Canberra and Melbourne. The case studies compare Victorian and ACT heritage management processes across community partnerships with public land managers, and examine how pre-development surveys operate. I conclude that considerable potential for achieving community archaeology ideals exists, and that they are occasionally partially realised, however barriers continue. In essence, the archaeological model persists despite a community archaeology approach requiring a wider set of skills to ensure a comprehensive engagement with an Indigenous community. Other obstacles in the current Indigenous heritage management system include a lack of knowledge and communication about national standards for heritage processes in government agencies and heritage consultants; the administrative framework that can result in inertia or silos between relevant agencies; and funding timeframes that limit possibilities for long-term strategic programs for early identification and management planning for Indigenous heritage. Also, Indigenous communities have varying levels of authority to speak for how their heritage should be managed, yet may not have the resources to do so. This thesis suggests ways to breach these barriers to achieve more inclusive Indigenous heritage management based on community archaeology principles. Policies for a greater acknowledgement of the Indigenous community’s authority to speak for Country; processes that enable and early and comprehensive ‘mapping’ of Country, and long-term resourcing of communities, may have been promised before. In this research I suggest ways to realise such goals.

Bacterial community structure of the marine diatom Haslea ostrearia

The marine diatom Haslea ostrearia produces a water-soluble blue-pigment named marennine of economic interest (e.g. in aquaculture for the greening of oysters). Up to date the studies devoted to ecological conditions under which this microalga develops never took into account the bacterial-H. ostrearia relationships. In this study the bacterial community was analysed by PCR-TTGE before and after H. ostrearia isolation cells recovered from 4 localities, to distinguish the relative part of the biotope and the biocenose and eventually to describe the temporal dynamic of the structure of the bacterial community. The bacterial structure of the phycosphere differed strongly from that of the bulk sediment. The similarity between bacteria recovered from the biofilm and the suspended bacteria did not exceed 10% (vs. > 90% amongst biofilms). The differences in genetic fingerprints, more especially high between two H. ostrearia isolates showed also the highest differences in the bacterial structure as the result of specific metabolomics profiles. The non-targeted metabolomic investigation showed that these profiles were more distinct in case of bacteria-alga associations than for the H. ostrearia monoculture. At the scale of a culture cycle in laboratory conditions, the bacterial community was specific to the growth stage. When H. ostrearia was subcultured for 9 months, a shift in the bacterial structure was shown from 3-months subculturing and the bacterial structure stabilized afterwards (70-86% similarities). A first insight of the relationships between H. ostrearia and its surrounding bacteria was shown for a better understanding of the ecological feature of this diatom.

Preliminary metabolomic approach on the bacterial structure community of Haslea ostrearia

The marine diatom Haslea ostrearia [1] produces a water-soluble blue-pigment named marennine [2] of economic interest. But the lack of knowledge of the ecological conditions, under which this microalga develops in its natural ecosystem, more especially bacteria H. ostrearia interactions, prevents any optimization of its culture in well-controlled conditions. The structure of the bacterial community was analyzed by PCR-TTGE before and after the isolation of H. ostrearia cells recovered from 4 localities, to distinguish the relative part of the biotope and the biocenose and eventually to describe the temporal dynamic of the structure of the bacterial community at two time-scales. The differences in genetic fingerprints, more especially high between two H. ostrearia isolates (HO-R and HO-BM) showed also the highest differences in the bacterial structure [3] as the result of specific metabolomics profiles. The non-targeted metabolomic investigation showed that these profiles were more distinct in case of bacteria-alga associations than for the H. ostrearia monoculture Here we present a Q-TOF LC/MS metabolomic fingerprinting approach [3]: - to investigate differential metabolites of axenic versus non axenic H. ostrearia cultures. - to focus on the specific metabolites of a bacterial surrounding associated with the activation or inhibition of the microalga growing. The Agilent suite of data processing software makes feature finding, statistical analysis, and identification easier. This enables rapid transformation of complex raw data into biologically relevant metabolite information.

CURB-65 and other markers of illness severity in community-acquired pneumonia among HIV-positive patients

Introduction: As the relative burden of community-acquired bacterial pneumonia among HIV-positive patients increases, adequate prediction of case severity on presentation is crucial. We sought to determine what characteristics measurable on presentation are predictive of worse outcomes. Methods: We studied all admissions for community-acquired bacterial pneumonia over 1 year at a tertiary centre. Patient demographics, comorbidities, HIV-specific markers and CURB-65 scores on Emergency Department presentation were reviewed. Outcomes of interest included mortality, bacteraemia, intensive care unit admission and orotracheal intubation. Results: A total of 396 patients were included, 49 HIV positive and 347 HIV negative. Mean CURB-65 score was 1.3 for HIV-positive and 2.2 for HIV-negative patients (p<0.0001), its predictive value for mortality being maintained in both groups (p¼0.03 and p<0.001, respectively). Adjusting for CURB-65 scores, HIV infection by itself was only associated with bacteraemia (adjusted odds ratio 7.1 CI 95% [2.6–19.5]). Patients with<200 CD4 cells/mL presented similar CURB- 65 adjusted mortality (adjusted odds ratio 1.7 CI 95% [0.2–15.2]), but higher risk of intensive care unit admission (adjusted odds ratio 5.7 CI 95% [1.5–22.0]) and orotracheal intubation (adjusted odds ratio 9.1 CI 95% [2.2–37.1]), compared to HIV-negative patients. These two associations were not observed in the>200 CD4 cells/mL subgroup (adjusted odds ratio 2.2 CI 95% [0.7–7.6] and adjusted odds ratio 0.8 CI 95% [0.1–6.5] respectively). Antiretroviral therapy and viral load suppression were not associated with different outcomes (p>0.05). Conclusions: High CURB-65 scores and CD4 counts<200 cells/mL were both associated with worse outcomes. Severity assessment scales and CD4 counts may both be helpful in predicting severity in HIV-positive patients presenting with community-acquired bacterial pneumonia.

Food consumption and risk of malnutrition in community-dwelling very old Spanish adults (≥ 80 years)

Introduction: There are few studies assessing overall diet and food patterns of the oldest population. Objectives: To examine food groups consumption (grams and servings) and their compliance with the dietary guidelines in community-dwelling very old Spanish adults. The relationship with the risk of malnutrition was also studied. Methods: Within the cross-sectional health study of elderly people of Villanueva de la Cañada (Madrid, Spain), in 98 non-institutionalized elders aged ≥ 80 years (66% women) food consumption was calculated from a 24-hour dietary recall and nutritional risk was assessed by Mini Nutritional Assessment (MNA). Statistical significance was evaluated at 95% confidence level (p < 0.05). Results: Men consumed significantly higher amounts of snacks/pickles and alcoholic beverages. The consumption of cereals/grain products (2 servings/day), vegetables (1.5 servings/day) and meat, fish, eggs (1.4 servings/day), was below desirable levels. As nutritional status got worse, fruit consumption was significantly smaller (p = 0.039). Relatively weak but highly significant correlations were found between MNA and oils/fats, fruits and alcoholic beverages. After adjustment for energy intake, oils and fats and fruits associations disappeared whereas a negative association between milk/dairy products and MNA was found. Conclusions: Dietary patterns of the elderly population of Villanueva are departing from the traditional Mediterranean diet and though adequate consumption of fruits, milk/dairy products, oils/fats and sugar/confectionery has been achieved, cereals/grain products, vegetables and the meat,fish,eggs group consumption was below the desirable levels. Deterioration of the nutritional status coincided with a reduction in the consumption of all food groups except for ready meals and milk/dairy products whose consumption increased. Further research on the influence of fruit, milk/dairy products, wine and olive oil consumption on nutritional status is required.