To test the hypotheses that older community dwelling men taking non-enzyme-inducing antiepileptic drugs (NEIAEDs) and those taking enzyme-inducing antiepileptic drugs (EIAEDs) have increased rates of ...hip bone loss.
We ascertained antiepileptic drug (AED) use (interviewer-administered questionnaire with verification of use by containers) and measured hip bone mineral density (BMD) (using dual energy x-ray absorptiometry) at baseline and an average of 4.6 years later in a cohort of 4,222 older community-dwelling men enrolled in the Osteoporotic Fractures in Men study. Men were categorized as nonusers (no AED use at either examination, n = 4060), NEIAED user (use of NEIAED only at either examination, n = 100), or EIAED user (use of EIAED only at either examination, n = 62).
After adjustment for multiple potential confounders (age, race, clinic site, health status, pain interfering with work or activity, physical activity, smoking status, alcohol use, total calcium intake, diabetes, chronic kidney disease, vitamin D supplement use, bisphosphonate use, selective serotonin reuptake inhibitor use, inability to rise from a chair, body mass index, and baseline BMD), the average rate of decline in total hip BMD was -0.35%/year among nonusers compared with -0.53%/year among NEIAED users (p = 0.04) and -0.46%/year among EIAED users (p = 0.31). Multivariable adjusted rate of loss was -0.60%/year among men taking NEIAED at both examinations, -0.51%/year among men taking NEIAED at one examination only, and -0.35%/year among nonusers (p for trend = 0.03). Findings were similar at hip subregions.
Use of non-enzyme-inducing antiepileptic drugs was independently associated with increased rates of hip bone loss in this cohort of older community-dwelling men.
Birds exhibit variation in alert and flight behaviours in response to vehicles within and between species, but it is unclear how properties inherent to individuals influence variation in avoidance ...responses over time. We examined individual variation in avoidance behaviours of Brown-headed Cowbirds (Molothrus ater (Boddaert, 1783)) in response to repeated presentation of a simulated vehicle approach in a video playback scenario. We modeled temporal alert and flight behaviours to determine whether overall behavioural variation resulted primarily from variation within individuals (i.e., intraindividual variation) or between individuals (i.e., interindividual variation). We examined reaction norms (individual × treatment day) and whether birds showed plasticity in responses via habituation or sensitization. Repeatability in the response metrics for individuals was low (∼0.22 for alert and flight), indicating that model variation was due primarily to within-individual variation rather than between-individual variation. We observed sensitization in alert responses over time, but no sensitization or habituation in flight responses. Our results indicate that individuals learned to anticipate the vehicle approach but did not vary their escape behaviour, suggesting that alert and flight behaviours might be affected differently by cues associated with oncoming objects or experience with them. We consider our findings in light of the ongoing development of strategies to reduce animal–vehicle collisions.
The relationship between objectively assessed activity, energy expenditure, and the development of functional limitations is unknown.
Energy expenditure and activity levels were measured objectively ...using the multisensor SenseWear Pro Armband worn for greater than or equal to 5 days in 1,983 MrOS men (aged ≥ 78.3 years) free of functional limitations. Validated algorithms calculated energy expenditure; standard cut points defined moderate or greater activity (≥ 3.0 METS); and sedentary behavior (time awake ≤ 1.5 METS). Self-reported functional limitation was determined at the activity assessment and 2.0 years later as inability to perform instrumental activities of daily living (managing money, managing medications, shopping, housework, and meal preparation) and activities of daily living (climb stairs, walk two to three blocks, transfer, or bathe).
Each standard deviation decrease in total energy expenditure (420.6 kcal/day) increased the likelihood of inability to perform an instrumental activity of daily living (multivariate odds ratio mOR: 1.61, 95% CI: 1.30-2.00) or activity of daily living (mOR: 1.35, 95% CI: 1.12-1.63). Each standard deviation decrease in moderate or greater activity (61.1 minutes/day) increased the likelihood of inability to perform an instrumental activity of daily living (mOR: 1.47, 95% CI: 1.22-1.78) or activity of daily living (mOR: 1.36, 95% CI: 1.14-1.61). Each standard deviation increase in minutes of sedentary behavior (105.2 minutes/day) increased the likelihood of inability to perform an instrumental activity of daily living (mOR: 1.20, 95% CI: 1.03-1.40) or activity of daily living (mOR: 1.17, 95% CI: 1.01-1.35).
Older men with lower total energy expenditure, lower moderate activity, or greater sedentary time were more likely to develop a functional limitation.
OBJECTIVES: To determine whether current use of central nervous system (CNS)‐active medications, including benzodiazepines, antidepressants, anticonvulsants, and narcotics, increases the risk for ...subsequent falls.
DESIGN: Prospective cohort study.
SETTING: Four clinical centers in Baltimore, Maryland; Portland, Oregon; Minneapolis, Minnesota; and the Monongahela Valley, Pennsylvania.
PARTICIPANTS: Eight thousand one hundred twenty‐seven women aged 65 and older participating in the fourth examination of the Study of Osteoporotic Fractures between 1992 and 1994.
MEASUREMENTS: Current use of CNS‐active medications was assessed with an interviewer‐administered questionnaire with verification of use from medication containers. A computerized dictionary was used to categorize type of medication from product brand and generic names. Incident falls were reported every 4 months for 1 year after the fourth examination.
RESULTS: During an average follow‐up of 12 months, 2,241 women (28%) reported falling at least once, including 917 women (11%) who experienced two or more (frequent) falls. Compared with nonusers, women using benzodiazepines (multivariate odds ratio (MOR) = 1.51, 95% confidence interval (CI) = 1.14–2.01), those taking antidepressants (MOR = 1.54, 95% CI = 1.14–2.07), and those using anticonvulsants (MOR = 2.56, 95% CI = 1.49–4.41) were at increased risk of experiencing frequent falls during the subsequent year. We found no evidence of an independent association between narcotic use and falls (MOR = 0.99 for frequent falling, 95% CI = 0.68–1.43). Among benzodiazepine users, both women using short‐acting benzodiazepines (MOR = 1.42, 95% CI = 0.98–2.04) and those using long‐acting benzodiazepines (MOR = 1.56, 95% CI = 1.00–2.43) appeared to be at greater risk of frequent falls than nonusers, although the CIs overlapped 1.0. We found no evidence to suggest that women using selective serotonin‐reuptake inhibitors (MOR = 3.45, 95% CI = 1.89–6.30) had a lower risk of frequent falls than those using tricyclic antidepressants (MOR 1.28, 95% CI = 0.90–1.84).
CONCLUSIONS: Community‐dwelling older women taking CNS‐active medications, including those taking benzodiazepines, antidepressants, and anticonvulsants, are at increased risk of frequent falls. Minimizing use of these CNS‐active medications may decrease risk of future falls. Our results suggest that fall risk in women taking benzodiazepines is at best marginally decreased by use of short‐acting preparations. Similarly, our findings indicate that preferential use of selective serotonin‐reuptake inhibitors is unlikely to reduce fall risk in older women taking antidepressants.
Bird collisions with vehicles cause serious safety, financial and conservation concerns worldwide, but the causes of such collisions are poorly described. We investigated how experience with vehicles ...influenced avian avoidance responses. We trained three groups of vehicle‐naïve rock pigeons Columba livia with 32 near‐miss vehicle approaches over 4 weeks at 60 and 120 km h−1, and also included individuals that heard but did not see the approaches (control group). We subsequently measured flight initiation distance (FID) and whether individuals ‘collided’ with a virtual vehicle directly approaching at 120 or 240 km h−1 using video playback. We found that inexperienced individuals (i.e. the control group) had longer FIDs than experienced birds, although only one of 90 individuals across groups successfully avoided virtual collision. Vehicle approach speed during video playback and the interaction of approach speed and training group did not influence FID. Our results suggest that a habituation‐like effect based on repeated observations of passing vehicles could contribute to ineffective vehicle avoidance responses by birds when collisions are imminent. Novel strategies should be developed to enhance avoidance responses to high‐speed vehicles to minimize bird mortality.
We sought to determine how experience with repeated near‐miss vehicle approaches affected avian avoidance behaviour when a collision was imminent. In contrast to inferences from recent empirical findings, we found that inexperienced birds had longer flight initiation distances in response to direct vehicle approaches than individuals that had repeatedly observed passing, fast‐moving vehicles. Our results suggest that habituation to repeated vehicle exposure could contribute to bird‐vehicle collisions and that novel strategies should be developed to enhance avoidance responses to high‐speed vehicles to minimize bird mortality.
The incidence of idiopathic pulmonary fibrosis (IPF) increases with age. The mechanisms that underlie the age-dependent risk for IPF are unknown. Based on studies that suggest an association of IPF ...and γherpesvirus infection, we infected young (2-3 mo) and old (≥18 mo) C57BL/6 mice with the murine γherpesvirus 68. Acute murine γherpesvirus 68 infection in aging mice resulted in severe pneumonitis and fibrosis compared with young animals. Progressive clinical deterioration and lung fibrosis in the late chronic phase of infection was observed exclusively in old mice with diminution of tidal volume. Infected aging mice showed higher expression of transforming growth factor-β during the acute phase of infection. In addition, aging, infected mice showed elevation of proinflammatory cytokines and the fibrocyte recruitment chemokine, CXCL12, in bronchoalveolar lavage. Analyses of lytic virus infection and virus reactivation indicate that old mice were able to control chronic infection and elicit antivirus immune responses. However, old, infected mice showed a significant increase in apoptotic responses determined by in situ terminal deoxynucleotidyl transferase dUTP nick end labeling assay, levels of caspase-3, and expression of the proapoptotitc molecule, Bcl-2 interacting mediator. Apoptosis of type II lung epithelial cells in aging lungs was accompanied by up-regulation of endoplasmic reticulum stress marker, binding immunoglobulin protein, and splicing of X-box-binding protein 1. These results indicate that the aging lung is more susceptible to injury and fibrosis associated with endoplasmic reticulum stress, apoptosis of type II lung epithelial cells, and activation of profibrotic pathways.
Projecting risks posed to aviation safety by wildlife populations is often overlooked in airport land-use planning. However, the growing dependency on civil aviation for global commerce can require ...increases in capacity at airports which affect land use, wildlife populations, and perspectives on aviation safety. Our objectives were to (1) review legislation that affects airports and surrounding communities relative to managing and reducing wildlife hazards to aviation; (2) identify information gaps and future research needs relative to regulated land uses on and near airports, and the effects on wildlife populations; and (3) demonstrate how information regarding wildlife responses to land-use practices can be incorporated into wildlife-strike risk assessments. We show that guidelines for land-use practices on and near airports with regard to wildlife hazards to aviation can be vague, conflicting, and scientifically ill-supported. We discuss research needs with regard to management of stormwater runoff; wildlife use of agricultural crops and tillage regimens relative to revenue and safety; the role of an airport in the landscape matrix with regard to its effects on wildlife species richness and abundance; and spatial and temporal requirements of wildlife species that use airports, relative to implementing current and novel management techniques. We also encourage the development and maintenance of datasets that will allow realistic assessment of wildlife-strike risk relative to current airport conditions and anticipated changes to capacity. Land uses at airports influence wildlife populations, and understanding and incorporating these effects into planning will reduce risks posed to both aviation safety and wildlife species.
Abstract
Introduction
Poor sleep is common in hospitalized patients, but is not often measured objectively. We gathered subjective and objective sleep data among older adults in an acute-care ...hospital to determine the feasibility of conducting an intervention study to improve sleep among those hospitalized.
Methods
The study setting was an 81-bed community hospital, in rural Tracy, California (January 2016 to November 2017). Inclusion criteria were age ≥60 years and expected duration of stay ≥1 night. Exclusion criteria were severe cognitive impairment, language barrier, or examiner determination of inability to perform study components. Sleep data was collected with 24-hour wrist actigraphy and interviews about pre-hospitalization sleep Pittsburgh Sleep Quality Index (PSQI). Descriptive data was gathered by questionnaire and electronic medical records.
Results
Of 2315 patients screened, 112 were enrolled. Many met the exclusions for cognitive impairment (16%) or language barrier (15%) and 21% refused. The participants were 69 ± 7 years old, 54% female, and 77% white. The median length of stay was 3 days, 11% were discharged to a skilled nursing facility, and 70% had an impairment of instrumental activities of daily living. Self-reported pre-hospitalization sleep disturbance was high: 77% had poor sleep quality (PSQI>5). Actigraphy was well tolerated, with data collection for all nights for 89% of participants. During the interval patients reported trying to sleep at night while admitted, objectively measured sleep fragmentation was high (mean sleep efficiency 68% ± 15%) with average actigraphic total sleep time of 5.6 ± 1.9 hrs. When asked about sleep interruption, the most common reasons were for measurement of vital signs (23%), staff interruption (22%), and blood draws (21%).
Conclusion
Poor subjective sleep prior to hospitalization was high, with high levels of sleep fragmentation and low levels of sleep while admitted. Variability of objective sleep measures was high. Improving modifiable factors in the hospital setting could lead to better sleep quality.
Support (If Any)
The study was funded by the Sutter Tracy Community Hospital Foundation. Thanks to student volunteers from University of California, Davis and hospital staff.
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