American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults

The American Geriatrics Society (AGS) Beers Criteria® (AGS Beers Criteria®) for Potentially Inappropriate Medication (PIM) Use in Older Adults is widely used by clinicians, educators, researchers, healthcare administrators, and regulators. Since 2011, the AGS has been the steward of the criteria and has produced updates on a regular cycle. The AGS Beers Criteria® is an explicit list of PIMs that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions. For the 2023 update, an interprofessional expert panel reviewed the evidence published since the last update (2019) and based on a structured assessment process approved a number of important changes including the addition of new criteria, modification of existing criteria, and formatting changes to enhance usability. The criteria are intended to be applied to adults 65 years old and older in all ambulatory, acute, and institutionalized settings of care, except hospice and end-of-life care settings. Although the AGS Beers Criteria® may be used internationally, it is specifically designed for use in the United States and there may be additional considerations for certain drugs in specific countries. Whenever and wherever used, the AGS Beers Criteria® should be applied thoughtfully and in a manner that supports, rather than replaces, shared clinical decision-making.

Irrational career beliefs in agricultural education students, demographics, impacts, and rational career education intervention.

BACKGROUND: Studies have shown that a good number of students admitted into Agricultural Science Education program in Nigerian universities exhibit irrational career interest which affects their perceptions, feelings, and academic behaviors. This study, therefore, explored the effect of rational emotive career education on irrational career beliefs among students enrolled in agricultural education program in federal universities in Enugu state. Three null hypotheses guided the study. METHOD: Of the population (N = 79 students) targeted for the study and who underwent a screening exercise, 61 students were recruited as participants/sample size for the study. Sequence allocation software was used to assign 31 students into experimental groups and 30 into waitlisted control group. Participants in the intervention group received a rational emotive career education program that lasted for 12 sessions while those in waitlisted group did not receive the intervention. The participants in both groups were assessed at three points (Time 1, Time 2, and Time 3) using rational and irrational belief scale. A repeated measure (ANOVA) and partial eta square statistical tools were used to analyze the data collected. RESULT: This study result showed that rational emotive career education significantly reduced irrational career beliefs among students enrolled in Agricultural Science Education program exposed to intervention group compared to those in waitlisted control group. It also showed that there was time × group interaction for irrational career beliefs. The follow-up assessment indicated that the efficacy of rational emotive career education was sustained overtime. CONCLUSION: This study concluded that rational emotive career education is beneficial in reducing irrational career beliefs of university students enrolled in Agricultural Science Education program. Recommendations were also made in line with the results.

Differential expression of NF-κB heterodimer RelA/p50 in human urothelial carcinoma.

BACKGROUND: Urothelial carcinoma (UC) is the fifth most common malignancy that accounts for 5% of all cancers. Diagnostic markers that predict UC progressions are inadequate. NF-κB contributes towards disease progression upon constitutive activation in many solid tumors. The nuclear localization of NF-κB indicates increased transcriptional activity while cytoplasmic localization indicates the inactive protein repository that can be utilized readily by a malignant cell. This study delineates the nuclear and cytoplasmic differential expression of NF-κB heterodimers in UC progression. METHODS: The involvement of the NF-κB proteins in UC was analyzed in silico using cytoscape. The expression of NF-κB heterodimers was analyzed by immunohistochemistry. RESULTS: PINA4MS app in cytoscape revealed over expression of RelA and suppression of NF-κB1 (p50 precursor) in UC whereas the expression of NF-κB target proteins remained unhindered. Immunohistochemical localization showed nuclear RelA/p50 in low grade UC whereas in high grade only RelA expression was observed. Conversely, cytoplasmic expression of RelA/p50 remained extensive across high and low grade UC tissues (p < 0.005). RelA nuclear and cytoplasmic expression (p < 0.005) was directly proportional to the disease progression. In our study, some of the high-grade UC tissues with squamous differentiation and muscle invasion had extensive nuclear p50 localization. The phenomenon of RelA/p50 expression seen increased in low-grade UC than high grade UC might be due to their interaction with other members of NF-κB family of proteins. Thus, NF-κB RelA/p50 differential expression may play a unique role in UC pathogenesis and can serve as a biomarker for diagnosis.

Phylogenetic relationships in the genus Leontopodium (Asteraceae: Gnaphalieae) based on AFLP data.

The genus Leontopodium comprises 30-41 species. The centre of diversity is the Sino-Himalayan region in south-western China, where about 15 species occur. The two species native to Europe, L. alpinum (known as the common 'Edelweiss') and L. nivale, are part of the cultural heritage of the people living there. Despite its importance, very little is known about the systematics of the genus. Because recent molecular studies have shown that species within this genus are closely related and difficult to distinguish with rDNA and cpDNA data, we used AFLPs to obtain a more detailed understanding of the phylogeny of the genus. Our main aims were as follows: (1) to clarify species relationships within the genus; and (2) to reveal information about the biogeography of the genus. We used AFLPs with six primer combinations to investigate 216 individuals in 38 populations of 16 different species. With AFLPs, we were able to recognize 10 different groups, all of which had strong bootstrap support. These results were also congruent with the morphology-based taxonomy of the genus. Most private and rare fragments were found in the Yunnan region (south-western China) relative to Europe and Mongolia/central China, suggesting a long-lasting in situ history of populations in the centre of diversity of the genus. Our results illustrate the utility of AFLPs to resolve phylogenetic relationships between these closely related species.

Characterization, genomic organization and chromosomal distribution of Ty1-copia retrotransposons in species of Hypochaeris (Asteraceae).

This study aims to analyze the diversity of Ty1-copia retrotransposons in 18 taxa of Hypochaeris, including two Old World species H. maculata (2n=2x=10) and H. angustifolia (2n=2x=8), and representatives of the South American species (16 accessions of 15 species; all 2n=2x=8). Analysis of 380 PCR-amplified sequences, corresponding to a conserved domain of the subset of Ty1-copia reverse transcriptase (rt) gene amplifiable with degenerate standard primers, showed high levels of intra- and interspecific heterogeneity. Nucleotide diversity (Pi) of the copia fragments was high in all species and varied from 0.229 (H. angustifolia) to 0.412 (H. chillensis). Higher sequence heterogeneity correlates positively with larger genome size among analyzed species. Phylogenetic analyses of amplified fragments revealed different patterns of intraspecific heterogeneity within species, with most sequences forming one well-supported main clade while a few sequences fall into small clades or are left ungrouped. The combined analysis of all sequences revealed the presence of three main clades and showed that highly diverged species contain closely related Tyl-copia group retrotransposons. One of the main clades includes rt sequences of all South American species and three sequences of their putative ancestor, H. angustifolia, but no sequence of the Old World H. maculata. FISH with copia retrotransposons in four Hypochaeris species, including H. maculata and H. angustifolia and New World H. apargioides and H. spathulata, revealed differences in the chromosomal distribution between the two groups. In Old World species copia retroelements are distributed over the whole length of the chromosomes, excluding rDNA sites and some centromeres. In the South American species the two largest chromosome pairs are enriched in copia, while most of the long arms of the two small pairs of chromosomes are devoid of these elements. The patterns of heterogeneity and chromosomal distribution of Ty1-copia retrotransposons in Hypochaeris are discussed in the context of the origin, genome evolution and organization of the South American species.

EXPERIENCE WITH THE LARYNGEAL MASK AIRWAY IN ANAESTHESIA.

Laryngeal mask airway was used in 100 adult patients of either sex (ASA I/II) undergoing various surgical procedures. The duration of surgery varied from 17 to 145 minutes. The course of anaesthesia was smooth and uneventful in all cases. The failure rate of insertion of LMA was 7%. The overall incidence of complications was 12%. LMA insertion was associated with statistically insignificant change in haemodynamic parameters.

PERIPARTUM CARDIOMYOPATHY AND ANAESTHESIA (A Case Report).

Anaesthetic management for caesarean section in a case of peripartum cardiomyopathy is reported. Various anaesthetic problems in such a case are discussed.