Circadian variation in muscle force output in males using isokinetic, isometric dynamometry: can we observe this in multi-joint movements using the muscleLab force-velocity encoder and are they similar in peak and magnitude?

We have investigated the magnitude of circadian variation in Isokinetic and Isometric strength of the knee extensors and flexors, as well as back squat and bench press performance using the MuscleLab force velocity transducer. Ten resistance-trained males (mean±SD: age 21.5 ± 1.1 years; body mass 78.3 ± 5.2 kg; height 1.71 ± 0.07 m) underwent a) three to four familiarization sessions on each dynamometer and b) four sessions at different times of day (03:00, 09:00, 15:00 and 21:00 h). Each session was administered in a counterbalanced order and included a period when Perceived onset of mood states (POMS), then rectal and muscle temperature (Trec, Tm) was measured at rest, after which a 5-min standardized 150 W warm-up was performed on a cycle ergometer. Once completed, Isokinetic (60 and 240°·s-1 for extension and flexion) and Isometric dynamometry with peak torque (PT), time-to-peak-torque (tPT) and peak force (PF) and % activation was measured. Lastly, Trec and Tm were measured before the bench press (at 30, 50 and 70 kg) and back squat (at 40, 60 and 80 kg) exercises. A linear encoder was attached to an Olympic bar used for the exercises and average force (AF), peak velocity (PV) and time-to-peak-velocity (tPV) were measured (MuscleLab software; MuscleLab Technology, Langesund, Norway) during the concentric phase of the movements. Five-min recovery was allowed between each set with three repetitions being completed. General linear models with repeated measures and cosinor analysis were used to analyse the data. Values for Trec and Tm at rest were higher in the evening compared to morning values (Acrophase Φ: 16:35 and 17:03 h, Amplitude A: 0.30 and 0.23°C, Mesor M: 36.64 and 37.43°C, p < 0.05). Vigor, happy and fatigue mood states responses showed Φ 16:11 and 16:03 h and 02:05 h respectively. Circadian rhythms were apparent for all variables irrespective of equipment used where AF, PF and PT values peaked between 16:18 and 18:34 h; PV, tPV and tPT peaked between 05:54 and 08:03 h (p < 0.05). In summary, circadian rhythms in force output (force, torque, power, and velocity) were shown for isokinetic, isometric dynamometers and complex multi-joint movements (using a linear encoder); where tPV and tPT occur in the morning compared to the evening. Circadian rhythms in strength can be detected using a portable, low-cost instrument that shows similar cosinor characteristics as established dynamometers. Hence, muscle-strength can be measured in a manner that is more directly transferable to the world of athletic and sports performance.

Food Systems Interventions for Nutrition: Lessons from 6 Program Evaluations in Africa and South Asia.

Although there is growing global momentum behind food systems strategies to improve planetary and human health-including nutrition-there is limited evidence of what types of food systems interventions work. Evaluating these types of interventions is challenging due to their complex and dynamic nature and lack of fit with standard evaluation methods. In this article, we draw on a portfolio of 6 evaluations of food systems interventions in Africa and South Asia that were intended to improve nutrition. We identify key methodological challenges and formulate recommendations to improve the quality of such studies. We highlight 5 challenges: a lack of evidence base to justify the intervention, the dynamic and multifaceted nature of the interventions, addressing attribution, collecting or accessing accurate and timely data, and defining and measuring appropriate outcomes. In addition to more specific guidance, we identify 6 cross-cutting recommendations, including a need to use multiple and diverse methods and flexible designs. We also note that these evaluation challenges present opportunities to develop new methods and highlight several specific needs in this space.

The genetics of falling susceptibility and identification of causal risk factors.

Falls represent a huge health and economic burden. Whilst many factors are associated with fall risk (e.g. obesity and physical inactivity) there is limited evidence for the causal role of these risk factors. Here, we used hospital and general practitioner records in UK Biobank, deriving a balance specific fall phenotype in 20,789 cases and 180,658 controls, performed a Genome Wide Association Study (GWAS) and used Mendelian Randomisation (MR) to test causal pathways. GWAS indicated a small but significant SNP-based heritability (4.4%), identifying one variant (rs429358) in APOE at genome-wide significance (P < 5e-8). MR provided evidence for a causal role of higher BMI on higher fall risk even in the absence of adverse metabolic consequences. Depression and neuroticism predicted higher risk of falling, whilst higher hand grip strength and physical activity were protective. Our findings suggest promoting lower BMI, higher physical activity as well as psychological health is likely to reduce falls.

Investigating Palestinian in-service teachers' beliefs about the integration of information and communication technology (ICT) into teaching English.

The purpose of this study was to look into how Information and Communication Technology (ICT) is used in teaching English language from the point-of-view of English language teachers in Palestine. A quantitative approach was employed to collect data from 780 language school teachers from 260 schools who participated in a course project utilizing ICT in English as a Foreign Language teaching (TEFL). These participants responded to a questionnaire survey about the effects of the Covid-19 epidemic on language education and how they dealt with these. We statistically analysed the responses through four domains: the use of ICT in students' lives; the use of ICT in education generally; the use of ICT to support learning and teaching in EFL; and teachers' perceived skills for using ICT in education. Results indicated that English language teachers in Palestinian public schools believed that ICT has clear potential to support the learning of English, but that there remain barriers to its implementation. Teachers feel equipped to use ICT but would like to see a greater emphasis on training in order to maximise their teaching.

In Vivo Efficacy of a Novel, Sutureless Coaptation Device for Repairing Peripheral Nerve Defects.

Although microsuture neurorrhaphy is the accepted clinical standard treatment for severed peripheral nerves, this technique requires microsurgical proficiency and still often fails to provide adequate nerve approximation for effective regeneration. Entubulation utilizing commercially available conduits may enhance the technical quality of the nerve coaptation and potentially provide a proregenerative microenvironment, but still requires precise suture placement. We developed a sutureless nerve coaptation device, Nerve Tape®, that utilizes Nitinol microhooks embedded within a porcine small intestinal submucosa backing. These tiny microhooks engage the outer epineurium of the nerve, while the backing wraps the coaptation to provide a stable, entubulated repair. In this study, we examine the impact of Nerve Tape on nerve tissue and axonal regeneration, compared with repairs performed with commercially available conduit-assisted or microsuture-only repairs. Eighteen male New Zealand white rabbits underwent a tibial nerve transection, immediately repaired with (1) Nerve Tape, (2) conduit plus anchoring sutures, or (3) four 9-0 nylon epineurial microsutures. At 16 weeks postinjury, the nerves were re-exposed to test sensory and motor nerve conduction, measure target muscle weight and girth, and perform nerve tissue histology. Nerve conduction velocities in the Nerve Tape group were significantly better than both the microsuture and conduit groups, while nerve compound action potential amplitudes in the Nerve Tape group were significantly better than the conduit group only. Gross morphology, muscle characteristics, and axon histomorphometry were not statistically different between the three repair groups. In the rabbit tibial nerve repair model, Nerve Tape offers similar regeneration efficacy compared with conduit-assisted and microsuture-only repairs, suggesting minimal impact of microhooks on nerve tissue.

Isolating the species element in grass pollen allergy: A review.

Grass pollen is a leading cause of allergy in many countries, particularly Europe. Although many elements of grass pollen production and dispersal are quite well researched, gaps still remain around the grass species that are predominant in the air and which of those are most likely to trigger allergy. In this comprehensive review we isolate the species aspect in grass pollen allergy by exploring the interdisciplinary interdependencies between plant ecology, public health, aerobiology, reproductive phenology and molecular ecology. We further identify current research gaps and provide open ended questions and recommendations for future research in an effort to focus the research community to develop novel strategies to combat grass pollen allergy. We emphasise the role of separating temperate and subtropical grasses, identified through divergence in evolutionary history, climate adaptations and flowering times. However, allergen cross-reactivity and the degree of IgE connectivity in sufferers between the two groups remains an area of active research. The importance of future research to identify allergen homology through biomolecular similarity and the connection to species taxonomy and practical implications of this to allergenicity is further emphasised. We also discuss the relevance of eDNA and molecular ecological techniques (DNA metabarcoding, qPCR and ELISA) as important tools in quantifying the connection between the biosphere with the atmosphere. By gaining more understanding of the connection between species-specific atmospheric eDNA and flowering phenology we will further elucidate the importance of species in releasing grass pollen and allergens to the atmosphere and their individual role in grass pollen allergy.

The Role of Content Knowledge in Influencing Student Physical Activity, On-Task Behavior, and Skill Performance.

Purpose: The purpose of this study was to compare the impact of interventions aimed at improving teacher's content knowledge on students' MVPA, on-task behavior, and skill performance. Differences between treatment and comparison groups were further examined by skill level and gender. Method: We conducted a retroactive analysis of teacher and student data from two randomly controlled trials and one well-controlled quasi-experimental trial measuring MVPA, student performance in badminton, and on-task behavior in lessons. We used descriptive and ANOVA analyses to determine our results. Results: The data show statistically significant effects for student performance and MVPA, and statistically significant effects for on-task performance between groups. Effect sizes for student performance exceed 1SD. MVPA for two of the three studies exceeded the 50% of the lesson criterion. Data are reported for high, average and low skilled students for each variable. Conclusions: This is the first study to examine three important outcomes of physical education, namely skill performance, MVPA, and on-task behavior in one investigation. Our results show that multiple objectives in physical education can be achieved. A strength of the study is that we did not sample any of our variables. The data represent a complete picture of every trial, and continuous interval recording for MVPA and on-task variables occurring in each lesson.

Climate change related phenological decoupling in species belonging to the Betulaceae family.

Betulaceae species are anemophilous, and allergens from their pollen are a major cause of respiratory allergies in temperate areas where they are widely distributed. It is expected that, due to the strong influence of temperature on Betulaceae phenology, global warming will impact both the distribution and phenology of these species during the coming decades. This study examines potential decoupling of flowering and leafing phenophases in Betulaceae species (i.e. Alnus glutinosa, Betula pendula and Corylus avellana) over long-term (1951-2015) and as shorter (15-year) periods. Phenological phases for flowering and leaf unfolding of Betulaceae species from the Pan-European Phenology (PEP725) database were examined along with maximum and minimum daily temperature data for the periods September-October-November (SON), December-January-February (DJF) and March-April-May (MAM). Significant increases in temperature since 1951 have been recorded in the relevant chilling and forcing periods. Both flowering and leaf unfolding phenophases are advancing, but flowering is advancing faster than leaf unfolding. This is increasing the time between phenophases, although analysis of 15-year periods shows that the pattern of change was not constant. The results presented here represent the most comprehensive analysis of flowering and leaf unfolding phenophases of Betulaceae species using the PEP725 database to date. It is expected that these changes to Betulaceae phenology will continue and that global warming-related phenological decoupling will increase plant stress in Betulaceae populations in central Europe.

A comprehensive aerobiological study of the airborne pollen in the Irish environment.

Respiratory allergies triggered by pollen allergens represent a significant health concern to the Irish public. Up to now, Ireland has largely refrained from participating in long-term aerobiological studies. Recently, pollen monitoring has commenced in several sampling locations around Ireland. The first results of the pollen monitoring campaigns for Dublin (urban) and Carlow (rural) concerning the period 2017-2019 and 2018-2019, respectively, are presented herein. Additional unpublished pollen data from 1978-1980 and, 2010-2011 were also incorporated in creating the first pollen calendar for Dublin. During the monitoring period over 60 pollen types were identified with an average Annual Pollen Integral (APIn) of 32,217 Pollen × day/m3 for Dublin and 78,411 Pollen × day/m3 for Carlow. The most prevalent pollen types in Dublin were: Poaceae (32%), Urticaceae (29%), Cupressaceae/Taxaceae (11%), Betula (10%), Quercus (4%), Pinus (3%), Fraxinus (2%), Alnus (2%) and Platanus (1%). The predominant pollen types in Carlow were identified as Poaceae (70%), Urticaceae (12%), Betula (10%), Quercus (2%), Fraxinus (1%) and Pinus (1%). These prevalent pollen types increased in annual pollen concentration in both locations from 2018 to 2019 except for Fraxinus. Although higher pollen concentrations were observed for the Carlow (rural) site a greater variety of pollen types were identified for the Dublin (urban) site. The general annual trend in the pollen season began with the release of tree pollen in early spring, followed by the release of grass and herbaceous pollen which dominated the summer months with the annual pollen season coming to an end in October. This behaviour was illustrated for 21 different pollen types in the Dublin pollen calendar. The correlation between ambient pollen concentration and meteorological parameters was also examined and differed greatly depending on the location and study year. A striking feature was a substantial fraction of the recorded pollen sampled in Dublin did not correlate with the prevailing wind directions. However, using non-parametric wind regression, specific source regions could be determined such as Alnus originating from the Southeast, Betula originating from the East and Poaceae originating from the Southwest. Supplementary Information: The online version contains supplementary material available at 10.1007/s10453-022-09751-w.

Real-time automatic detection of starch particles in ambient air.

Considerable amounts of starch granules can be present in the atmosphere from both natural and anthropogenic sources. The aim of this study is to investigate the variability and potential origin of starch granules in ambient air recorded at six cities situated in a region with dominantly agricultural land use. This is achieved by using a combination of laser spectroscopy bioaerosol measurements with 1 min temporal resolution, traditional volumetric Hirst type bioaerosol sampling and atmospheric modelling. The analysis of wind roses identified potential sources of airborne starch (i.e., cereal grain storage facilities) in the vicinity of all aerobiological stations analysed in this study. The analysis of the CALPUFF dispersion model confirmed that emission of dust from the location of storage towers situated about 2.5 km north of the aerobiological station in Novi Sad is a plausible source of high airborne concentrations of starch granules. This study is important for environmental health since it contributes body of knowledge about sources, emission, and dispersion of airborne starch, known to be involved in phenomena such as thunderstorm-triggered asthma. The presented approach integrates monitoring and modelling, and provides a roadmap for examining a variety of bioaerosols previously considered to be outside the scope of traditional aerobiological measurements.

Why should we care about high temporal resolution monitoring of bioaerosols in ambient air?

This is the first time that atmospheric concentrations of individual pollen types have been recorded by an automatic sampler with 1-hour and sub-hourly resolution (i.e. 1-minute and 1-second data). The data were collected by traditional Hirst type methods and state-of the art Rapid-E real-time bioaerosol detector. Airborne pollen data from 7 taxa, i.e. Acer negundo, Ambrosia, Broussonetia papyrifera, Cupressales (Taxaceae and Cupressaceae families), Platanus, Salix and Ulmus, were collected during the 2019 pollen season in Novi Sad, Serbia. Pollen data with daily, hourly and sub-hourly temporal resolution were analysed in terms of their temporal variability. The impact of turbulence kinetic energy (TKE) on pollen cloud homogeneity was investigated. Variations in Seasonal Pollen Integrals produced by Hirst and Rapid-E show that scaling factors are required to make data comparable. Daily average and hourly measurements recorded by the Rapid-E and Hirst were highly correlated and so examining Rapid-E measurements with sub-hourly resolution is assumed meaningful from the perspective of identification accuracy. Sub-hourly data provided an insight into the heterogenous nature of pollen in the air, with distinct peaks lasting ~5-10 min, and mostly single pollen grains recorded per second. Short term variations in 1-minute pollen concentrations could not be wholly explained by TKE. The new generation of automatic devices has the potential to increase our understanding of the distribution of bioaerosols in the air, provide insights into biological processes such as pollen release and dispersal mechanisms, and have the potential for us to conduct investigations into dose-response relationships and personal exposure to aeroallergens.

Mechanical constraints to cell-cycle progression in a pseudostratified epithelium.

As organs and tissues approach their normal size during development or regeneration, growth slows down, and cell proliferation progressively comes to a halt. Among the various processes suggested to contribute to growth termination,1-10 mechanical feedback, perhaps via adherens junctions, has been suggested to play a role.11-14 However, since adherens junctions are only present in a narrow plane of the subapical region, other structures are likely needed to sense mechanical stresses along the apical-basal (A-B) axis, especially in a thick pseudostratified epithelium. This could be achieved by nuclei, which have been implicated in mechanotransduction in tissue culture.15 In addition, mechanical constraints imposed by nuclear crowding and spatial confinement could affect interkinetic nuclear migration (IKNM),16 which allows G2 nuclei to reach the apical surface, where they normally undergo mitosis.17-25 To explore how mechanical constraints affect IKNM, we devised an individual-based model that treats nuclei as deformable objects constrained by the cell cortex and the presence of other nuclei. The model predicts changes in the proportion of cell-cycle phases during growth, which we validate with the cell-cycle phase reporter FUCCI (Fluorescent Ubiquitination-based Cell Cycle Indicator).26 However, this model does not preclude indefinite growth, leading us to postulate that nuclei must migrate basally to access a putative basal signal required for S phase entry. With this refinement, our updated model accounts for the observed progressive slowing down of growth and explains how pseudostratified epithelia reach a stereotypical thickness upon completion of growth.

Patterned achromatic elliptical polarizer for short-wave infrared imaging polarimetry.

Short-wave infrared (SWIR) imaging polarimetry has widespread applications in telecommunication, medical imaging, surveillance, remote-sensing, and industrial metrology. In this work, we design, fabricate, and test an achromatic SWIR elliptical polarizer, which is a key component of SWIR imaging polarimetry. The elliptical polarizer is made of a patterned linear polarizer and a patterned optical elliptical retarder. The linear polarizer is a wire grid polarizer. The elliptical retarder is constructed with three layers of nematic phase A-plate liquid crystal polymer (LCP) films with different fast axis orientations and physical film thicknesses. For each LCP layer, four arrays of hexagonal patterns with individual fast-axis orientations are realized utilizing selective linearly polarized ultraviolet (UV) irradiation on a photo-alignment polymer film. The Mueller matrices of the optical filters were measured in the wavelength range 1000 nm to 1600 nm and compared with theory. Our results demonstrate the functionality and quality of the patterned retarders with normalized analyzer vector parameter deviation below 7% over this wavelength range. To the best of our knowledge, this work represents the first polymer-based patterned elliptical polarizer for SWIR polarimetry imaging applications.

Prevention and control of mosquito-borne arboviral diseases: lessons learned from a school-based intervention in Brazil (Zikamob).

BACKGROUND: Since the 1980s, when dengue was reintroduced in Brazil, outbreaks and epidemics caused by different arbovirus strains transmitted by vector mosquitoes such as Aedes aegypti have been an annual occurrence. The aim of this study was to evaluate the behavioural change of high school students and teachers who participated in an educational intervention for the prevention and vector control of arboviral diseases. METHODS: In this school-based intervention, a self-reported questionnaire was used in a pre-post intervention methodology to assess environmental risk factors, sociodemographic variables and to measure attitudes and behaviours. In all, 883 high school students and teachers from the city of Campina Grande, in the state of Paraíba, northeastern Brazil, participated. The e-health intervention consisted of a competition between schools to comply with preventive actions via content production for social networks, and the monitoring was performed over a period of three months through the ZikaMob software developed by the researchers. RESULTS: Out of the 883 survey participants, 690 were students ranging in age from 14 to 41 years, with an average of 17 ± 2 years; and 193 were teachers from 22 to 64 years old, averaging 38 ± 9 years. The analysis of the data shows that significant differences in most of the target behaviours were apparent after the intervention, with an increase of about 10% in the performance of inspection actions; a 7% greater separation of recyclables and a 40% increase in the screening of windows among students. Students showed lower fear of, and a lower self-perception of the risk of, acquiring arboviruses than teachers on average. CONCLUSIONS: ZikaMob is an innovative strategy with the potential to be replicated in any location that has an internet network and can involve an unlimited number of participants.

Bioaerosols on the atmospheric super highway: An example of long distance transport of Alternaria spores from the Pannonian Plain to Poland.

Alternaria spores are pathogenic to agricultural crops, and the longest and the most severe sporulation seasons are predominantly recorded in rural areas, e.g. the Pannonian Plain (PP) in South-Central Europe. In Poland (Central Europe), airborne Alternaria spore concentrations peak between July and August. In this study, we test the hypothesis that the PP is the source of Alternaria spores recorded in Poland after the main sporulation season (September-October). Airborne Alternaria spores (2005-2019) were collected using volumetric Hirst spore traps located in 38 locations along the potential pathways of air masses, i.e. from Serbia, Romania and Hungary, through the Czech Republic, Slovakia and Ukraine, to Northern Poland. Three potential episodes of Long Distance Transport (LDT) were selected and characterized in detail, including the analysis of Alternaria spore data, back trajectory analysis, dispersal modelling, and description of local weather and mesoscale synoptic conditions. During selected episodes, increases in Alternaria spore concentrations in Poznan were recorded at unusual times that deviated from the typical diurnal pattern, i.e. at night or during morning hours. Alternaria spore concentrations on the PP were very high (>1000 spores/m3) at that time. The presence of non-local Ambrosia pollen, common to the PP, were also observed in the air. Air mass trajectory analysis and dispersal modelling showed that the northwest part of the PP, north of the Transdanubian Mountains, was the potential source area of Alternaria spores. Our results show that Alternaria spores are transported over long distances from the PP to Poland. These spores may markedly increase local exposure to Alternaria spores in the receptor area and pose a risk to both human and plant health. Alternaria spores followed the same atmospheric route as previously described LDT ragweed pollen, revealing the existence of an atmospheric super highway that transports bioaerosols from the south to the north of Europe.

Clinical Spectrum of Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Protection From Symptomatic Reinfection.

BACKGROUND: There are few data on the full spectrum of disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across the lifespan from community-based or nonclinical settings. METHODS: We followed 2338 people in Managua, Nicaragua, aged <94 years from March 2020 through March 2021. SARS-CoV-2 infection was identified through real-time reverse transcription polymerase chain reaction (RT-PCR) or through enzyme-linked immunosorbent assay. Disease presentation was assessed at the time of infection or retrospectively by survey at the time of blood collection. RESULTS: There was a large epidemic that peaked between March and August 2020. In total, 129 RT-PCR-positive infections were detected, for an overall incidence rate of 5.3 infections per 100 person-years (95% confidence interval [CI], 4.4-6.3). Seroprevalence was 56.7% (95% CI, 53.5%-60.1%) and was consistent from age 11 through adulthood but was lower in children aged ≤10 years. Overall, 31.0% of the infections were symptomatic, with 54.7% mild, 41.6% moderate, and 3.7% severe. There were 2 deaths that were likely due to SARS-CoV-2 infection, yielding an infection fatality rate of 0.2%. Antibody titers exhibited a J-shaped curve with respect to age, with the lowest titers observed among older children and young adults and the highest among older adults. When compared to SARS-CoV-2-seronegative individuals, SARS-CoV-2 seropositivity at the midyear sample was associated with 93.6% protection from symptomatic reinfection (95% CI, 51.1%-99.2%). CONCLUSIONS: This population exhibited a very high SARS-CoV-2 seropositivity with lower-than-expected severity, and immunity from natural infection was protective against symptomatic reinfection.

Spatiotemporal water quality variability in a highly loaded surface flow wastewater treatment wetland.

This study evaluates spatiotemporal relationships between water quality parameters (WQPs), nutrients, suspended solids, and biochemical oxygen demand (BOD) concentrations within an engineered wastewater treatment wetland system in the Georgia Piedmont, USA. We explored factors related to treatment efficiency within a heavily loaded 630-m2 surface flow wetland system over a 2-yr period. Relationships between temperature, dissolved oxygen (DO), and oxidation-reduction potential (ORP) were observed; relationships were also seen between these WQPs and nutrient concentrations. Because temperature, DO, and ORP affect nitrogen (N) cycling rates, seasonal trends in N forms were evident in the system. Organic N and inorganic/organic phosphorus concentrations correlated with solids concentrations in the vegetated system without exhibiting seasonal trends. Surface water within the vegetated section generally exhibited anoxic conditions, leading to removal of nitrate-N within the system; however, limited mineralization and nitrification occurred, which greatly limited overall N removal. Plant selection and lack of maintenance likely led to high solids and BOD contributions to treatment wetland surface water, which varied substantially between and along monitored transects. Because so few studies have investigated treatment dynamics within treatment wetland cells, focusing solely on influent/effluent characterization, radical spatiotemporal variability may be the norm as opposed to the commonly accepted assumptions of relatively uniform pollutant degradation across treatment wetland cells. This spatiotemporal variability in WQPs underscores the dynamic nature of treatment wetlands and the need for routine maintenance, including sludge removal and plant harvesting.

Quantifying Anticholinergic Burden and Sedative Load in Older Adults with Polypharmacy: A Systematic Review of Risk Scales and Models.

BACKGROUND: Patients taking medication with high anticholinergic and sedative properties are at increased risk of experiencing poor cognitive and physical outcomes. Therefore, precise quantification of the cumulative burden of their drug regimen is advisable. There is no agreement regarding which scale to use to simultaneously quantify the burden associated with medications. OBJECTIVES: The objective of this review was to assess the strengths and limitations of available tools to quantify medication-related anticholinergic burden and sedative load in older adults. We discuss specific limitations and agreements between currently available scales and models and propose a comprehensive table combining drugs categorized as high, moderate, low, or no anticholinergic or sedative activity as excerpted from the selected studies. METHODS: A targeted search was carried out using the National Library of Medicine through PubMed using medical subject heading terms and text words around the following search terms: (anticholinergic OR sedative) AND (load OR burden OR scale) for studies published between 1 January 1945 and 5 June 2021. In addition, the following databases were searched using the same terms: MEDLINE-EBSCO, APA PsycInfo, CINAHL Plus, Cochrane Library, Scopus, OAIster, OVID-MEDLINE, Web of Science, and Google Scholar. Screening by titles was followed by an abstract and full-text review. After blind evaluation, agreement between reviewers was reached to establish drug characteristics and categories. RESULTS: After 3163 articles were identified, 13 were included: 11 assigned risk scores to anticholinergic drugs and two to sedative drugs. Considerable variability between anticholinergic scales was observed; scales included between 27 and 548 drugs. We generated a comprehensive table combining the anticholinergic and sedative activities of drugs evaluated and proposed a categorization of these drugs based on available scientific and clinical evidence. Our table combines information about 642 drugs and categorizes 44, 25, 99, and 474 drugs as high, moderate, low, or no anticholinergic and sedative activity, respectively. CONCLUSIONS: Variability and inconsistency exists among scales used to categorize drugs with anticholinergic or sedative burden. In this review, we provide a comprehensive table that proposes a new categorization of these drugs. A longitudinal study will be required to validate the new proposed anticholinergic and sedative burden catalog in an evidence-based manner.

Use of Drug Claims Data and a Medication Risk Score to Assess the Impact of CYP2D6 Drug Interactions among Opioid Users on Healthcare Costs.

Cytochrome P450 2D6 (CYP2D6) activity is highly variable due to several factors, including genetic polymorphisms and drug-drug-gene interactions. Hydrocodone, oxycodone, codeine, and tramadol the most commonly prescribed CYP2D6-activated opioids for pain. However, the co-administration of CYP2D6 interacting drugs can modulate CYP2D6-medicated activation of these opioids, affecting drug analgesia, effectiveness, and safety, and can impact healthcare costs. A retrospective, observational cohort analysis was performed in a large (n = 50,843) adult population. This study used drug claims data to derive medication risk scores and matching propensity scores to estimate the effects of opioid use and drug-drug interactions (DDIs) on medical expenditures. 4088 individuals were identified as opioid users; 95% of those were prescribed CYP2D6-activated opioids. Among those, 15% were identified as being at risk for DDIs. Opioid users had a significant increase in yearly medical expenditure compared to non-opioid users ($2457 vs. $1210). In matched individuals, average healthcare expenditures were higher for opioid users with DDIs compared to those without DDIs ($7841 vs. $5625). The derived medication risk score was higher in CYP2D6 opioid users with interacting drug(s) compared to no DDI (15 vs. 12). Higher costs associated with CYP2D6 opioid use under DDI conditions suggest inadequate CYP2D6 opioid prescribing practices. Efforts to improve chronic opioid use in adults should reduce interacting drug combinations, especially among patients using CYP2D6 activated opioids.

Evaluation of an inner city HIV pre-exposure prophylaxis service tailored to the needs of people who inject drugs.

OBJECTIVES: HIV prevention strategies including pre-exposure prophylaxis (PrEP) must reach all in need to achieve elimination of transmission by 2030. Mainstream provision may inadvertently exclude key populations. Incidence of HIV in people who inject drugs (PWID) in Glasgow, Scotland's largest city, is increasing, partly due to sexual transmission. Scotland provides publicly funded oral PrEP for individuals at sexual risk of HIV through sexual health services; however, uptake by PWID has been negligible. We developed a tailored outreach PrEP service based in the local homeless health centre. We used active case finding, flexibility of assessment location, supervised community daily dispensing and active follow-up to optimise uptake and adherence. We describe a two-year service evaluation. METHODS: We reviewed the case records of all PWID identified by the outreach team as being at higher risk of sexual acquisition for whom PrEP was considered between November 2018 and November 2020. Evaluation focused on PrEP uptake, adherence and monitoring. We conducted a descriptive statistical analysis. RESULTS: Of 41 PWID assessed as eligible, 32 (78.0%) commenced PrEP. The proportion of PrEP-covered days was 3320/3400 days (97.6%); 31/32 (96.9%) had regular HIV serology monitoring. The service was feasible to run, but it relied on outreach provision and liaison with other services. DISCUSSION: Tailored PrEP services can reach PWID effectively. Uptake and adherence were high but the model was resource-intensive. Appropriately tailored PrEP delivery may be required to meet the needs of this and other key populations who experience barriers to accessing mainstream services.