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Context: People experiencing homelessness (PEH) who also experience problem drug use, have complex medical and social needs, with barriers to accessing services and treatments. Their treatment burden (the workload of self-management and impact on well-being) has not been described. Objective: The aim of this sub study is to use a validated questionnaire, the Patient Experience with Treatment and Self- management (PETS), to investigate perceived treatment burden in PEH. Study Design: Baseline data from the Pharmacist Homeless Outreach Engagement Non medical Independent prescribing Rx (PHOENIx) Trial. Setting/Population: Study undertaken in Scotland. Participants were homeless adults age 18 years or older, who had at least one non-fatal drug related overdose in the preceding 6 months. Results: 123/128 (96%) of participants completed PETS at baseline interview; mean age 42.1 (SD 8.6); 71.5 % male, and 99.2% white ethnicity. 91.2% had more than 5 chronic health conditions with mean of 8.5/participant. Scores range from 0-100, with higher score indicating higher burden of treatment. Mean PETS scores were highest in the domains indicating the impact of self- management on well-being: physical/mental exhaustion (Mean=79.54, SD=3.26); and role-social activity limitations (Mean=64, SD=3.48). Impact summary score; aggregated mean scores of domains indicating the impact of the self management of well being, was higher (71.8 SD 10.99) than the work load summary score; aggregated mean score of domains indicating the work a patient has to do to maintain health (45.77 SD 12.46). Conclusions : In a socially vulnerable chronologically young group of patients with high risk of overdose, PETS can be used to measure treatment burden. This study identified a profound impact of self-management on well-being and daily activities in a population at high risk with few resources. Scores were markedly higher than those observed in studies of non-homeless patient samples, despite this population being a younger cohort. Measuring PETs for this patient group should help with future resource allocation, service planning and patient care, Presenters Caitlin Jones, BSc, MBChB, Frances Mair, MD, FRCGP, Andrea Williamson, David Eton, PhD, Richard Lowrie, PhD, Andrew McPherson, PhD, [...]

Context: Almost 400 million people globally have chronic obstructive pulmonary disease (COPD). People with COPD often have multimorbidity and experience frequent exacerbations leading to hospitalisation. A feasibility study has shown pharmacist home-visits can provide holistic care, improve medication adherence and reduce exacerbations and hospital admission. A pilot randomised controlled trial (RCT) is now investigating the implementation and potential effects of such pharmacist home-visits. Objective: To examine patient and health care professional (HCP) perceptions of the intervention, acceptability of trial procedures and identify likely barriers and facilitators to future implementation. Study Design & Analysis: Qualitative interviews as part of a process evaluation embedded in pilot RCT. Thematic Analysis is being undertaken; we are conceptualising the work of self-management, including the issue of treatment burden and implementation issues through a Normalisation Process Theory (NPT) lens while also utilising the Cumulative Complexity Model to consider factors influencing patient capacity to self-manage. Setting & Population: 15 patients and 8 HCPs over two sites in Scotland. Intervention/Instrument: Tailored intervention in the home for patients with moderate-to-severe COPD and comorbidity by pharmacists and physicians. Results: The pharmacist intervention was well received by patients and HCPs, it identified and addressed much unmet need. While the intervention was beneficial to most patients it may particularly benefit those of lower socioeconomic status who have experienced more challenges in prior health care and self-management and seemed to more greatly value additional input provided by the pharmacist. Trial procedures were broadly acceptable to participants and HCPs. Facilitators included: relationships between HCPs involved in implementation; positive views of the pharmacist; and patients experiencing improvements as a result of the intervention. Barriers and challenges included: stretched resources; Information Technology problems; and issues implementing the intervention across different sites. Conclusions: The tailored at home pharmacist intervention was perceived positively by patients and HCPs and trial procedures were acceptable, suggesting that a full-scale trial is feasible. Future research may consider targeting of such interventions towards more socioeconomically deprived individuals., Presenters Karen Wood, MA, Richard Lowrie, PhD, Georgia Smith, Frances Mair, MD, FRCGP, Elaine Rankine, Donald Noble, MD, MBChB, Lynda Attwood, BSc, MSc, Gillian Cameron, BSc, MSc, GPhC [...]

PURPOSE Anticholinergic burden (ACB), the cumulative effect of anticholinergic medications, is associated with adverse outcomes in older people but is less studied in middle-aged populations. Numerous scales exist to quantify ACB. The aims of this study were to quantify ACB in a large cohort using the 10 most common anticholinergic scales, to assess the association of each scale with adverse outcomes, and to assess overlap in populations identified by each scale. METHODS We performed a longitudinal analysis of the UK Biobank community cohort (502,538 participants, baseline age: 37-73 years, median years of follow-up: 6.2). The ACB was calculated at baseline using 10 scales. Baseline data were linked to national mortality register records and hospital episode statistics. The primary outcome was a composite of all-cause mortality and major adverse cardiovascular event (MACE). Secondary outcomes were all-cause mortality, MACE, hospital admission for fall/fracture, and hospital admission with dementia/ delirium. Cox proportional hazards models (hazard ratio [HR], 95% CI) quantified associations between ACB scales and outcomes adjusted for age, sex, socioeconomic status, body mass index, smoking status, alcohol use, physical activity, and morbidity count. RESULTS Anticholinergic medication use varied from 8% to 17.6% depending on the scale used. For the primary outcome, ACB was significantly associated with all-cause mortality/MACE for each scale. The Anticholinergic Drug Scale was most strongly associated with mortality/MACE (HR = 1.12; 95% CI, 1.11-1.14 per 1-point increase in score). The ACB was significantly associated with all secondary outcomes. The Anticholinergic Effect on Cognition scale was most strongly associated with dementia/delirium (HR = 1.45; 95% CI, 1.3-1.61 per 1 -point increase). CONCLUSIONS The ACB was associated with adverse outcomes in a middle- to older-aged population. Populations identified and effect size differed between scales. Scale choice influenced the population identified as potentially requiring reduction in ACB in clinical practice or intervention trials. Key words: anticholinergic burden; polypharmacy; multimorbidity; mortality; cardiovascular events, INTRODUCTION Many frequently prescribed medications for a range of medical conditions have anticholinergic properties. (1) The use of multiple anticholinergic medications leads to a cumulative effect, referred to as the [...]

The past ten years has seen a marked increase in the numbers of people experiencing homelessness globally and an associated public health epidemic of drug-related deaths. Drawing from qualitative interviews as part of a wider pilot randomised controlled trial (RCT) conducted in Glasgow, Scotland with National Health Service pharmacists and third sector homeless outreach caseworkers, insights from those with living experience of both homelessness and a recent non-fatal drug overdose will be presented. Twenty people experiencing homelessness with at least one drug overdose in the past six months were interviewed in person, in a homelessness drop in centre or in emergency accommodation between November 2021 and January 2022. Findings from our study indicate that participants' drug use and overdose risk were exacerbated during the Covid-19 pandemic due to the pervasive availability of illicit drugs for those placed in emergency accommodation, alongside reduced support and access to health and social care services. Additionally, multi-agency stressors such as a lack of autonomy and dehumanising experiences were reported, leading to a significant sense of powerlessness. Furthermore, the necessity of advocacy-based services as critical aspects of support was identified, with importance placed upon dedicated, homelessness staff and access to safe environments. [ABSTRACT FROM AUTHOR]

Context: Limitations to crop yield due to subsurface (5–15 cm depth) compaction layers (>2 MPa) and subsurface acidity (pHCa <4.8) have frequently been reported on the non-sodic soils of south-eastern Australia, but amendment studies have been limited in number and inconsistent in the extent and longevity of any response. Aim: We tested the hypothesis that amendment of subsurface acidity and compaction would lead to increased grain yield. Method: We investigated crop response to the alleviation of these combined subsurface soil constraints by using deep ripping and dry limestone injection to 30 cm depth over 3 years in a canola–cereal sequence. Key results: Deep tillage and injection of limestone into the soil both failed to produce significant grain yield responses in any year, despite the reduction of soil strength and increase in pH in subsurface layers. Early vegetative growth sometimes responded to the treatments, but the loss of stored soil water during drier than average seasons appeared to limit grain response. However, we also observed that a proportion of plant roots penetrated these relatively thin constraint layers in unamended soils. Conclusions: Amelioration of subsurface acidity and compaction does not necessarily increase grain yield. Implications: The effects of subsurface acidity and compaction should be tested on other species and during varying rainfall deciles. Given the potentially large resource requirements for deep amendment of soils, we propose that the selection of tolerant species and cultivars might be more effective in the short term. Recorded apparent declines in canola grain yield have been associated with abnormal canola roots. We investigated the amelioration of low subsurface soil pH and hardpans by deep lime placement and deep ripping. Despite increased soil pH and lower soil strength in the subsurface soil, there were no significant grain yield responses in either canola or cereals during drier than normal years. [ABSTRACT FROM AUTHOR]

Abstract. Nitrification and urease inhibitors have been used to reduce nitrous oxide ([N.sub.2]O) emissions and increase nitrogen use efficiency in many agricultural systems. However, their agronomic benefits, such as the [...]

Background: People experiencing homelessness (PEH) who have problem drug use have complex medical and social needs, with barriers to accessing services and treatments. Their treatment burden (workload of self-management and impact on wellbeing) remains unexplored. Aim: To investigate treatment burden in PEH with a recent non-fatal overdose using a validated questionnaire, the Patient Experience with Treatment and Self-management (PETS). Design and setting: The PETS questionnaire was collected as part of a pilot randomised control trial (RCT) undertaken in Glasgow, Scotland; the main outcome is whether this pilot RCT should progress to a definitive RCT. Method: An adapted 52-item, 12-domain PETS questionnaire was used to measure treatment burden. Greater treatment burden was indicated by higher PETS scores. Results: Of 128 participants, 123 completed PETS; mean age was 42.1 (standard deviation [SD] 8.4) years, 71.5% were male, and 99.2% were of White ethnicity. Most (91.2%) had >5 chronic conditions, with an average of 8.5 conditions. Mean PETS scores were highest in domains focusing on the impact of self-management on wellbeing: physical and mental exhaustion (mean 79.5, SD 3.3) and role and social activity limitations (mean 64.0, SD 3.5) Scores were higher than those observed in studies of patients who are not homeless. Conclusion: In a socially marginalised patient group at high risk of drug overdose, the PETS showed a very high level of treatment burden and highlights the profound impact of self-management work on wellbeing and daily activities. Treatment burden is an important person-centred outcome to help compare the effectiveness of interventions in PEH and merits inclusion in future trials as an outcome measure. [ABSTRACT FROM AUTHOR]

Dryland cereal production systems of south-eastern Australia require viable options for reducing nitrous oxide ([N.sub.2]O) emissions without compromising productivity and profitability. A 4-year rotational experiment with wheat (Triticum aestivum L.)--canola (Brassica napus L.)--grain legumes wheat in sequence was established at Wagga Wagga, NSW, Australia, in a semiarid Mediterranean-type environment where long-term average annual rainfall is 541 mm and the incidence of summer rainfall is episodic and unreliable. The objectives of the experiment were to investigate whether (i) tillage increases [N.sub.2]O emissions and (ii) nitrogen (N) application can improve productivity without increasing [N.sub.2]O emissions. The base experimental design for each crop phase was a split-plot design with tillage treatment (tilled versus no-till) as the whole plot, and N fertiliser rate (0, 25, 50 and 100 kg N/ha) as the subplot, replicated three times. This paper reports high resolution [N.sub.2]O emission data under a canola crop. The daily [N.sub.2]O emission rate averaged 0.55 g [N.sub.2]O-N/ha. day, ranging between -0.81 and 6.71 g [N.sub.2]O-N/ha.day. The annual cumulative [N.sub.2]O-N emitted was 175.6 and 224.3 g [N.sub.2]O-N/ha under 0 and 100 kg N/ha treatments respectively. There was no evidence to support the first hypothesis that tillage increases [N.sub.2]O emissions, a result which may give farmers more confidence to use tillage strategically to manage weeds and diseases where necessary. However, increasing N fertiliser rate tended to increase [N.sub.2]O emissions, but did not increase crop production at this site. Additional keywords: conservation tillage, greenhouse gases, nitrogen fertiliser, trace gas emission., Introduction In Australia, the agriculture sector is the dominant source of anthropogenic nitrous oxide ([N.sub.2]O), accounting for 78.6% of the net national [N.sub.2]O emissions (Commonwealth of Australia 2014). Globally, 70% [...]