Safety assessment of essential medicines for elderly people: a bibliographic survey

Certain medicines are considered potentially inappropriate (PIM) for elderly people as they increase the risk of adverse drug events (ADE) and because safer alternative therapies are available on the market. In this context, in order to identify the instruments that assess the quality of medical prescriptions for elderly and to determine which drugs are considered PIM, a bibliographic survey was conducted in PUBMED, LILACS and PAHO databases, in February and March/2010. The search strategy included the use of health descriptors and a manual search in the references cited by selected papers. During the period of data collection, 15 instruments were identified. In 2012, with the publication of the update of Beers criteria, this instrument was included in the study. We identified 163 PIM of 25 therapeutic classes, of which 125 (76.7%) are marketed in Brazil. Of these, 31 (24.8%) are essential medicines (RENAME 2012), of which 13 have safer therapeutic equivalents and 19 (15.2%) are over-the-counter drugs. Data suggest the need for inclusion of safer alternatives for the elderly in the national list of essential medicines and the pharmaceutical care for early detection of ADE in this age group, in order to contribute to the safe use of medicines.

Distribution of stream macroalgae in the northwest region of Sao Paulo State, southeastern Brazil

Forty-four stream segments were sampled from May to October in 1992 and 1993 in the northwest region of São Paulo State, southeastern Brazil (19 degrees 45'-21 degrees 25'S, 49 degrees 05'-51 degrees 30'S). Thirty-six macroalgal subgeneric taxa were found and Chlorophyta was the dominant algal group (47% species), followed by Cyanophyta (33.5%), Rhodophyta (14%) and Chrysophyta (5.5%). The most widespread species were Stigeoclonium helveticum (25% sites), Batrachospermum delicatulum and Compsopogon coeruleus (20.5%). Distribution was patchy, with species number per sampling site ranging from 0 to six (3.1 +/- 1.7) and correlated positively with species abundance. Species cover ranged from 0 to 61% of the stream bottom (19.1 +/- 19.7%). Most sites (57%) were dominated by one or two macroalgae species. No significant difference was found between the frequency distribution of variables measured for streams and for total macroalgae, but the most widespread species differed for most parameters and occurred over wider ranges of environmental conditions. Mean species number and abundance were close to values found in distinct regions or biomes of North America. Higher conductance and lower oxygen values, as well as rocky substrata, generally constituted the most favourable combination of conditions for the development of macroalgae in the region. The pattern of strong dominance of few species was considered to be typical for stream macroalgal communities in general.

Influence of landscape evolution on the distribution of floristic patterns in northern Amazonia revealed by delta 13C data

The Amazonian lowlands include large patches of open vegetation which contrast sharply with the rainforest, and the origin of these patches has been debated. This study focuses on a large area of open vegetation in northern Brazil, where d13C and, in some instances, C/N analyses of the organic matter preserved in late Quaternary sediments were used to achieve floristic reconstructions over time. The main goal was to determine when the modern open vegetation started to develop in this area. The variability in d13C data derived from nine cores ranges from -32.2 to -19.6 parts per thousand, but with nearly 60% of data above -26.5 parts per thousand. The most enriched values were detected only in ecotone and open vegetated areas. The development of open vegetation communities was asynchronous, varying between estimated ages of 6400 and 3000 cal a BP. This suggests that the origin of the studied patches of open vegetation might be linked to sedimentary dynamics of a late Quaternary megafan system. As sedimentation ended, this vegetation type became established over the megafan surface. In addition, the data presented here show that the presence of C4 plants must be used carefully as a proxy to interpret dry paleoclimatic episodes in Amazonian areas. Copyright (c) 2012 John Wiley & Sons, Ltd.

Relationship between space distribution of the benthic macroinvertebrates community and trophic state in a Neotropical reservoir (Itupararanga, Brazil)

The purpose of this work was to verify the benthic macroinvertebrates community responses through environmental factors along a headwater tropical reservoir. Samplings were taken with a Van-Veen grab along the reservoir in littoral and profundal regions and in the headwater, next to the dam and the middle of the reservoir. Samples were taken during both wet and dry seasons. Dissolved oxygen concentrations, electric conductivity, temperature and pH near the sediment have been performed in situ, at every sampling station by using a multiprobe and Secchi disc. Total water phosphorus and chlorophyll a concentrations were analyzed to determine the trophic state index. Sediment's organic matter, total phosphorus, nitrogen concentrations and granulometric composition were measured. In order to verify which environmental variables would have more influence over the benthic macroinvertebrates community, a canonical correspondence analysis (CCA) was performed. The total number of recorded taxa was 28. Among them, the family Chironomidae (Diptera) was the richest group (19 taxa). It can be proposed that the benthic macroinvertebrates community may be influenced by environmental conditions such as nutrient and organic matter availability, as well as dissolved oxygen concentration. Macroinvertebrates are adequate bioindicators of water quality due to their sensibility to environmental changes mentioned before. Chironomus sp, Limnodrilus hoffmeisteri and Branchiura sowerbyi comprises a group that can be considered bio-indicators of eutrophic conditions. A second group can be considered as indicator of mesotrophic conditions. The presence of two or more members from that group which comprises Tanytarsini spp, Fissimentum sp, Pelomus sp and Goeldichironomus sp, like predominant taxa, may indicates mesotrophic conditions.

Dynamics of Bora wind over the Adriatic sea: atmospheric water balance and role of air-sea fluxes and orography

The Bora wind is a mesoscale phenomenon which typically affects the Adriatic Sea basin for several days each year, especially during winter. The Bora wind has been studied for its intense outbreak across the Dinaric Alps. The properties of the Bora wind are widely discussed in the literature and scientific papers usually focus on the eastern Adriatic coast where strong turbulence and severe gust intensity are more pronounced. However, the impact of the Bora wind can be significant also over Italy, not only in terms of wind speed instensity. Depending on the synoptic pressure pattern (cyclonic or anticyclonic Bora) and on the season, heavy snowfall, severe storms, storm surges and floods can occur along the Adriatic coast and on the windward flanks of the Apennines. In the present work five Bora cases that occurred in recent years have been selected and their evolution has been simulated with the BOLAM-MOLOCH model set, developed at ISAC-CNR in Bologna. Each case study has been addressed by a control run and by several sensitivity tests, performed with the purpose of better understanding the role played by air-sea latent and sensible heat fluxes. The tests show that the removal of the fluxes induces modifications in the wind approching the coast and a decrease of the total precipitation amount predicted over Italy. In order to assess the role of heat fluxes, further analysis has been carried out: column integrated water vapour fluxes have been computed along the Italian coastline and an atmospheric water balance has been evaluated inside a box volume over the Adriatic Sea. The balance computation shows that, although latent heat flux produces a significant impact on the precipitation field, its contribution to the balance is relatively minor. The most significant and lasting case study, that of February 2012, has been studied in more detail in order to explain the impressive drop in the total precipitation amount simulated in the sensitivity tests with removed heat fluxes with respect to the CNTRL run. In these experiments relative humidity and potential temperature distribution over different cross-sections have been examined. With respect to the CNTRL run a drier and more stable boundary layer, characterised by a more pronounced wind shear at the lower levels, has been observed to establish above the Adriatic Sea. Finally, in order to demonstrate that also the interaction of the Bora flow with the Apennines plays a crucial role, sensitivity tests varying the orography height have been considered. The results of such sensitivity tests indicate that the propagation of the Bora wind over the Adriatic Sea, and in turn its meteorological impact over Italy, is influenced by both the large air-sea heat fluxes and the interaction with the Apennines that decelerate the upstream flow.

Ecological distribution of semi-demersal fishes in space and time on the shelf of Antalya Gulf

In this study we provide a baseline data on semidemersal fish assemblages and biology in a heterogeneous and yet less studied portion of the shelf of Antalya Gulf. The distribution of fish abundance in three transects subjected to different fisheries regulations (fishery vs non fishery areas), and including depths of 10, 25, 75, 125, 200 m, was studied between May 2014 and February 2015 in representative months of winter, spring, summer and autumn seasons. A total of 76 fish species belonging to 40 families was collected and semidemersal species distribution was analyzed in comparison with the whole community. Spatial distribution of fish was driven mainly by depth and two main assemblages were observed: shallow waters (10-25; 75 m) and deep waters (125-200 m). Significant differences among transects were found for the whole community but not for the semidemersal species. Analysis showed that this was due to a strong relation of these species with local environmental characteristics rather than to a different fishing pressure over transects. Firstly all species distribute according to the bathymetrical gradient and secondly to the bottom type structure. Semidemersal species were then found more related to zooplankton and suspended matter availability. The main morphological characteristics, sex and size distribution of the target semidemersal species Spicara smaris (Linnaeus, 1758), Saurida undosquamis (Richardson, 1848), Pagellus acarne (Risso, 1827) were also investigated.

Distribution of radiodense contrast medium after perineural injection of the palmar and palmar metacarpal nerves (low 4-point nerve block): an in vivo and ex vivo study in horses

REASONS FOR PERFORMING STUDY: Evidence-based information is limited on distribution of local anaesthetic solution following perineural analgesia of the palmar (Pa) and palmar metacarpal (PaM) nerves in the distal aspect of the metacarpal (Mc) region ('low 4-point nerve block'). OBJECTIVES: To demonstrate the potential distribution of local anaesthetic solution after a low 4-point nerve block using a radiographic contrast model. METHODS: A radiodense contrast medium was injected subcutaneously over the medial or the lateral Pa nerve at the junction of the proximal three-quarters and distal quarter of the Mc region (Pa injection) and over the ipsilateral PaM nerve immediately distal to the distal aspect of the second or fourth Mc bones (PaM injection) in both forelimbs of 10 mature horses free from lameness. Radiographs were obtained 0, 10 and 20 min after injection and analysed subjectively and objectively. Methylene blue and a radiodense contrast medium were injected in 20 cadaver limbs using the same techniques. Radiographs were obtained and the limbs dissected. RESULTS: After 31/40 (77.5%) Pa injections, the pattern of the contrast medium suggested distribution in the neurovascular bundle. There was significant proximal diffusion with time, but the main contrast medium patch never progressed proximal to the mid-Mc region. The radiological appearance of 2 limbs suggested that contrast medium was present in the digital flexor tendon sheath (DFTS). After PaM injections, the contrast medium was distributed diffusely around the injection site in the majority of the limbs. In cadaver limbs, after Pa injections, the contrast medium and the dye were distributed in the neurovascular bundle in 8/20 (40%) limbs and in the DFTS in 6/20 (30%) of limbs. After PaM injections, the contrast and dye were distributed diffusely around the injection site in 9/20 (45%) limbs and showed diffuse and tubular distribution in 11/20 (55%) limbs. CONCLUSIONS AND POTENTIAL RELEVANCE: Proximal diffusion of local anaesthetic solution after a low 4-point nerve block is unlikely to be responsible for decreasing lameness caused by pain in the proximal Mc region. The DFTS may be penetrated inadvertently when performing a low 4-point nerve block.

Calculation of the average travel distance in a low-level picker-to-part system considering any distribution function within the aisles

The estimation of the average travel distance in a low-level picker-to-part order picking system can be done by analytical methods in most cases. Often a uniform distribution of the access frequency over all bin locations is assumed in the storage system. This only applies if the bin location assignment is done randomly. If the access frequency of the articles is considered in the bin location assignment to reduce the average total travel distance of the picker, the access frequency over the bin locations of one aisle can be approximated by an exponential density function or any similar density function. All known calculation methods assume that the average number of orderlines per order is greater than the number of aisles of the storage system. In case of small orders this assumption is often invalid. This paper shows a new approach for calculating the average total travel distance taking into account that the average number of orderlines per order is lower than the total number of aisles in the storage system and the access frequency over the bin locations of an aisle can be approximated by any density function.

Characterization of surface winds over the Iberian Peninsula

This work presents a characterization of the surface wind climatology over the Iberian Peninsula (IP). For this objective, an unprecedented observational database has been developed. The database covers a period of 6years (2002–2007) and consists of hourly wind speed and wind direction data recorded at 514 automatic weather stations. Theoriginal observations underwent a quality control process to remove rough errors from the data set. In the first step, the annual and seasonal mean behaviour of the wind field are presented. This analysis shows the high spatial variability of the wind as a result of its interaction with the main orographic features of the IP. In order to simplify the characterization of the wind, a clustering procedure was applied to group the observational sites with similar temporal wind variability. A total of 20 regions are identified. These regions are strongly related to the main landforms of the IP. The wind behaviour of each region, characterized by the wind rose (WR), annual cycle (AC) and wind speed histogram, is explained as the response of each region to the main circulation types (CTs) affecting the IP. Results indicate that the seasonal variability of the synoptic scale is related with intra-annual variability and modulated by local features in the WRs variability. The wind speed distribution not always fit to a unimodal Weibull distribution consequence of interactions at different atmospheric scales. This work contributes to a deeper understanding of the temporal and spatial variability of surface winds. Taken together, the wind database created, the methodology used and the conclusion extracted are a benchmark for future works based on the wind behaviour.

A 49 year hindcast of surface winds over the Iberian Peninsula

The use of hindcast climatic data is quite extended for multiple applications. However, this approach needs the support of a validation process to allow its drawbacks and, therefore, confidence levels to be assessed. In this work, the strategy relies on an hourly wind database resulting from a dynamical downscaling experiment, with a spatial resolution of 10 km, covering the Iberian Peninsula (IP), driven by the ERA40 reanalysis (1959–2001) extended by European Centre for Medium-Range Weather Forecast (ECMWF) analysis (2002–2007) and comprising two main steps. Initially, the skill of the simulation is evaluated comparing the quality-tested observational database (Lorente-Plazas et al., 2014) at local and regional scales. The results show that the model is able to portray the main features of the wind over the IP: annual cycles, wind roses, spatial and temporal variability, as well as the response to different circulation types. In addition, there is a significant added value of the simulation with respect to driving conditions, especially in regions with a complex orography. However, some problems are evident, the major drawback being the systematic overestimation of the wind speed, which is mainly attributed to a missrepresentation of frictional forces. The model skill is also lower along the Mediterranean coast and for the Pyrenees. In a second phase, the high spatio-temporal resolution of the pseudo-real wind database is used to explore the limitations of the observational database. It is shown that missing values do not affect the characterisation of the wind climate over the IP, while the length of the observational period (6 years) is sufficient for most regions, with only a few exceptions. The spatial distribution of the observational sampling schemes should be enhanced to improve the correct assessment of all IP wind regimes, particularly in some mountainous areas.

A community-based assessment of the spatiotemporal distribution of influenza in a U.S.-Mexico border county during the spring 2009 novel H1N1 swine-origin influenza A pandemic

This study retrospectively evaluated the spatial and temporal disease patterns associated with influenza-like illness (ILI), positive rapid influenza antigen detection tests (RIDT), and confirmed H1N1 S-OIV cases reported to the Cameron County Department of Health and Human Services between April 26 and May 13, 2009 using the space-time permutation scan statistic software SaTScan in conjunction with geographical information system (GIS) software ArcGIS 9.3. The rate and age-adjusted relative risk of each influenza measure was calculated and a cluster analysis was conducted to determine the geographic regions with statistically higher incidence of disease. A Poisson distribution model was developed to identify the effect that socioeconomic status, population density, and certain population attributes of a census block-group had on that area's frequency of S-OIV confirmed cases over the entire outbreak. Predominant among the spatiotemporal analyses of ILI, RIDT and S-OIV cases in Cameron County is the consistent pattern of a high concentration of cases along the southern border with Mexico. These findings in conjunction with the slight northward space-time shifts of ILI and RIDT cluster centers highlight the southern border as the primary site for public health interventions. Finally, the community-based multiple regression model revealed that three factors—percentage of the population under age 15, average household size, and the number of high school graduates over age 25—were significantly associated with laboratory-confirmed S-OIV in the Lower Rio Grande Valley. Together, these findings underscore the need for community-based surveillance, improve our understanding of the distribution of the burden of influenza within the community, and have implications for vaccination and community outreach initiatives.^

Distribution of particulate matter and particulate organic carbon in waters of the Caspian Sea

Data on concentrations and distribution of particulate matter in the Caspian Sea obtained during surveys in 1981-1983 with use of modified filtering units have shown that over the major part of the sea concentration of particulate matter does dot exceed 1-2 mg/l. Only in the northern Caspian and in coastal regions concentrations correspond to values measured earlier. Total amount of particulate matter in the Caspian Sea is about of 90 million ton, 19.6% in the Northern Caspian, 28.1% in the Middle Caspian, and 52.3% in the Southern Caspian. Contents of carbon in particulate matter of the Central Caspian reach 30-40%, and over a significant part of the sea - 20%. A correlation has been found between areas of increased carbon contents in particulate matter and in bottom sediments. An important role of biofiltration in enrichment of particulates in organic matter has been noted. From data on carbon contents and an estimate of particulate matter input biogenic portion in particulate matter exceeds 50% for the whole sea.

Distribution of benthic and planktic foraminifera in surface sediments of the Indian and Pakistan continental margin, Arabian Sea

During the Indian Ocean Expedition of the German research vessel "Meteor" and the following cruise with the Pakistani fishing vessel "Machhera" in February and March 1965, sediments were sampled from the shelf, continental slope and the Arabian Basin off Pakistan and India. The biostratigraphic studies are based on sedimentary material from 24 sediment cores up to 480 cm long and 100 grab samples. The faunal residues of the > 160 µ fraction (chiefly foraminifera and pteropods) were determined and counted in order to get an idea of the climatic conditions during the Late Quaternary of this region. Biostratigraphic correlations of these Late Quaternary deposits are only possible if the thanatocoenosis of the surface sediments are well known. The analysis of the benthonic foraminiferal populations resulted in the definition of several foraminiferal facies. The following sequence of forarniniferal facies, named after their most characteristic members, can be distinguished from the shelf to the deep-sea: 1. Ammonia-Florilus facies ; 2. Ammonia-Cancris facies; 3. Cassidulina-Cibicides facies; 4. Uvigerina-Cassidulina facies ; 5. Buliminacea facies ; 6. deepwater facies, partly with Bulimina aculeata or with Nonionidae. On the upper continental slope there is a zone extremely poor in benthonic foraminifera. In this water depth the oxygen minimum layer (0.05-0.02 ml/l) of the water column reaches the slope. Almost no connection can be observed between the living and the dead foraminiferal population of the same sample. The regional distribution of the planktonic foraminifera from plankton tows as well as from the surface sediments shows marked differences in the species composition of faunas from different regions within the area of investigation. That depends on oceanographic conditions such as upwelling, dissolution of carbonate at great depths etc. Based on the results of faunal analysis of samples from the recent sea-floor, a biostratigraphic subdivision of the sediments in the cores was established. The following biostratigraphically defined sections could be distinguished from the top of the sediment cores downwards : 1. Relatively cool climatic conditions are reflected by the foraminifera of the uppermost core sections. 2. The next section is characterized by much warmer conditions (Holocene climatic optimum). The C-14 ages of this interval range from 4000 to 10 000 years B.P. according to different authors. C-14 dates on the material investigated do not give reliable clues. 3. Foraminiferal populations adapted to much colder conditions can be observed in the underlying core section. The boundary between the warm climate reflected by the foraminifera of section 2 and the cold climate (section 3) is relatively sharp. It can be correlated from core to core over the whole area investigated. The cold climate sediments of section 3 are underlain by different cool-, warm- and cold-climate sediments which can only be correlated over very short distances. Since it appears certain that the last really cold conditions ended earlier in the Arabian Sea and its vicinity than in Europe it is recommended not to use the European stratigraphic terms for the Quaternary. Because of the lack of reliable absolute sediment ages for the cores no exact sedimentation rates can be given. According to rough estimates, however, the rates are 1-2 cm/1000 years in the deep basin and up to 40 cm/1000 years on the upper continental slope. Sedimentation rates are always larger near the mouth of the Indus-River than off South India at stations of about the same water depth. Planktonic gastropods (mainly pteropods) cannot be used for biostratigraphic purposes in the region under consideration. All of them seem to be displaced from the shelf. Their distribution there is given in.

(Table 1) Contents of chlorophyll a over the Northern Sea Route according to data of field measurements and estimated from MODIS data on measurement days

New maps of mean monthly distribution of chlorophyll and primary production in the Kara Sea were compiled using joint processing of CZCS (1978-1986), SeaWiFS (1998-2005), and MODIS (2002-2006) satellite data and field measurements. The annual primary production of phytoplankton is estimated at 22.3 x 10**6 t C per year or 70 mg C/m**2 per day. Results of calculations of the organic carbon budget in the Kara Sea are presented.