Background-Vertebral fractures are associated with increased morbidity (e.g., pain, reduced quality of life), and mortality. Therapeutic exercise is a non-pharmacologic conservative treatment that is often recommended for patients with vertebral fractures to reduce pain and restore functional movement. Objectives-Our objectives were to evaluate the benefits and harms of exercise interventions of four weeks or greater (alone or as part of a physical therapy intervention) versus non-exercise/nonactive physical therapy intervention, no intervention or place boon the incidence of future fractures and adverse events among adults with a history of osteoporotic vertebral fracture(s). We were also examined the effects of exercise on the following secondary outcomes: falls, pain, posture, physical function, balance, mobility, muscle function, quality of life and bone mineral density of the lumbar spine or hip measured using dual-energy X-ray absorptiometry (DXA). We also reported exercise adherence.

Reinforcement is a key component of slot machine play. Multi-line video slot-machine play can lead to "losses disguised as wins" (LDWs) which are credit gains that total less than the wager on the spin. LDWs only occur on multi-line games, with their frequency increasing with the number of lines played. If perceived as wins, they will be reinforcing to the player despite actually being losses. It has been suggested that players may attempt to maximize their reinforcement rates by playing maximum lines with a minimum bet per line. We recorded the actual game play of 83 participants on two different machines having different LDW rates. On both machines, players, regardless of problem gambling status, seldom bet on a single line (<6% of spins), preferring to bet on the maximum number of lines available (>70% of spins). Post-reinforcement pauses indicated that players found LDWs significantly more rewarding than losses and as rewarding as small wins. Players significantly overestimated the number of times they won more than their spin wager (i.e., miscategorizing LDWs as wins). Players indicated a number of game traits that made them prefer one machine over the other. Players who preferred the game with many LDWs endorsed "lack of long losing streaks" and "frequency of wins" to a greater degree than those preferring the other game. In sum, gamblers prefer playing maximum lines. Maximum line-play increases the frequency of LDWs. Players may miscategorize LDWs as wins, thus increasing the perceived reinforcement rate of multi-line slot machine.

Background Polypharmacy in older adults can be associated with negative outcomes including falls, impaired cognition, reduced quality of life, and general and functional decline. It is not clear to what extent these are reversible if the number of medications is reduced. Primary care does not have a systematic approach for reducing inappropriate polypharmacy, and there are few, if any, approaches that account for the patient’s priorities and preferences. The primary objective of this study is to test the effect of TAPER (Team Approach to Polypharmacy Evaluation and Reduction), a structured operationalized clinical pathway focused on reducing inappropriate polypharmacy. TAPER integrates evidence tools for identifying potentially inappropriate medications, tapering, and monitoring guidance and explicit elicitation of patient priorities and preferences. We aim to determine the effect of TAPER on the number of medications (primary outcome) and health-related outcomes associated with polypharmacy in older adults. Methods We designed a multi-center randomized controlled trial, with the lead implementation site in Hamilton, Ontario. Older adults aged 70 years or older who are on five or more medications will be eligible to participate. A total of 360 participants will be recruited. Participants will be assigned to either the control or intervention arm. The intervention involves a comprehensive multidisciplinary medication review by pharmacists and physicians in partnership with patients. This review will be focused on reducing medication burden, with the assumption that this will reduce the risks and harms of polypharmacy. The control group is a wait list, and control patients will be given appointments for the TAPER intervention at a date after the final outcome assessment. All patients will be followed up and outcomes measured in both groups at baseline and 6 months. Discussion Our trial is unique in its design in that it aims to introduce an operationalized structured clinical pathway aimed to reduce polypharmacy in a primary care setting while at the same time recording patient’s goals and priorities for treatment. Trial registration Clinical Trials.gov NCT02942927. First registered on October 24, 2016.

An RCT of home exercise in women with vertebral fractures is feasible but recruitment was a challenge. Suggestions are made for the conduct of future trials.

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