Statin prescribing in Northern Ireland and England pre and post introduction of the quality and outcomes framework

Objective The objective of this research was to examine differences in patterns of statin prescribing between Northern Ireland and England both before and after the introduction of the Quality and Outcomes Framework (QOF). Setting: Primary care practices in Northern Ireland and England. Method Northern Ireland practices were matched with practices in England, statin prescribing data and QOF achievement scores (for the first year post-QOF) were obtained. Crude prescribing data from matched practices were manipulated to provide a data set of Defined Daily Doses (DDDs)/1,000 patients and cost/DDD/1,000 patients for each statin drug entity covering 1 year before and after the introduction of QOF. QOF achievements were converted into percentage scores for matched practices. Main outcome measure Cost per defined daily dose (DDD) per 1,000 patients. Results Significantly less statins (DDD/1,000 patients) were dispensed in Northern Ireland compared with the matched region in England both before and after the introduction of QOF (P

Quasiexperimental Study of the Effects of Antibiotic Use, Gastric Acid-Suppressive Agents, and Infection Control Practices on the Incidence of Clostridium difficile-Associated Diarrhea in Hospitalized Patients

The objective of this study was to evaluate the effects of antimicrobial drug use, gastric acid-suppressive agent use, and infection control practices on the incidence of Clostridium difficile-associated diarrhea (CDAD) in a 426-bed general teaching hospital in Northern Ireland. The study was retrospective and ecological in design. A multivariate autoregressive integrated moving average (time-series analysis) model was built to relate CDAD incidence with antibiotic use, gastric acid-suppressive agent use, and infection control practices within the hospital over a 5-year period (February 2002 to March 2007). The findings of this study showed that temporal variation in CDAD incidence followed temporal variations in expanded-spectrum cephalosporin use (average delay = 2 months; variation of CDAD incidence = 0.01/100 bed-days), broad-spectrum cephalosporin use (average delay = 2 months; variation of CDAD incidence = 0.02/100 bed-days), fluoroquinolone use (average delay = 3 months; variation of CDAD incidence = 0.004/100 bed-days), amoxicillin-clavulanic acid use (average delay = 1 month; variation of CDAD incidence = 0.002/100 bed-days), and macrolide use (average delay = 5 months; variation of CDAD incidence = 0.002/100 bed-days). Temporal relationships were also observed between CDAD incidence and use of histamine-2 receptor antagonists (H2RAs; average delay = 1 month; variation of CDAD incidence = 0.001/100 bed-days). The model explained 78% of the variance in the monthly incidence of CDAD. The findings of this study highlight a temporal relationship between certain classes of antibiotics, H2RAs, and CDAD incidence. The results of this research can help hospitals to set priorities for restricting the use of specific antibiotic classes, based on the size-effect of each class and the delay necessary to observe an effect.

THE IMPACT OF BURNING AND GRAZING OF HEATHLAND PLANTS AND INVERTEBRATES IN COUNTRY ANTRIM

The impact of burning and grazing on plant, ground beetle and spider species was investigated experimentally in stands of varying ages (burnt in 1982 and 1988 and unburnt plots) on an area of heather moorland in County Antrim, north-east Ireland. Burning initiated complex succession pathways which appear to have characteristic plant and invertebrate species associations. Removal of Calluna dominance initiated a period of high plant species diversity. Investigation of initial post-fire regeneration suggested that the frequency of occurrence of plant species changed over time and was affected by grazing. Grouping of species by the position of their renewal bud, i.e. their life-form, did not account for all observed interspecific variation. The dominant species after burning were Eriophorum vaginatum, E. angustifolium and Vaccinium myrtillus. Studies of vegetation canopy structure showed that, even with the exclusion of the main grazing herbivores, Calluna will not re-establish itself as the dominant species until several years after burning. The ground beetle Nebria salina was trapped more often on plots burnt in 1988 than on unburnt plots or those burnt in 1982. In comparison, Pterostichus niger and Carabus granulatus were trapped in greater numbers on plots burnt in 1982 than on unburnt plots and plots burnt in 1988. The large species Carabus problematicus and Carabus glabratus were trapped in greater numbers on unburnt plots. Similarly, more of the spiders Ceratinella brevipes and Centromerita concinna were trapped on the plots burnt in 1982. In comparison, Lepthyphantes zimmermanni and Robertus lividus were trapped more often on unburnt plots than on plots burnt in 1982 and 1988. Results are discussed with respect to the importance of the continuation of traditional heathland management practices.

The importance that community pharmacists in Malta place on the introduction of pharmaceutical care

The results from a study to assess the importance Maltese pharmacists placed on various aspects of pharmaceutical care and their willingness to provide such care are reported. A modified version of the Behavioural Pharmaceutical Care Scale (BPCS) questionnaire (consisting of three dimensions and 14 domains) was mailed to the 198 privately owned community pharmacies in Malta. A total of 99 questionnaires were returned following two reminder telephone calls.

Transforming Researchers into Educators: Some Reflections on the University College Dublin School of Law Syllabus Design Workshop 2010

The priority given to the development of research skills during doctrinal legal education often neglects the importance of equipping PhD students with the pedagogical skills necessary to fulfill their important educational role as academics. Thus, in many instances there is a significant gap in the requisite skill base that PhD students acquire when they complete their doctrinal education. This paper outlines a first step that has been taken to address this deficiency in postgraduate legal education in Ireland. The PhD community of the University College Dublin (UCD) School of Law convened an internal Syllabus Design Workshop in April 2010 in order to provide doctrinal students with an opportunity to design a university module and to explore the issues which arise in undertaking such an exercise. The first part of this paper outlines how the workshop was conceived and convened, and provides an account of the considerations that each student had to take into account in the design of a syllabus. From here, we address the content of the workshop and reflect upon some of the important issues which were
raised. Finally, we offer a number of recommendations in relation to the development of doctrinal students as future educators. By highlighting the importance of uniting research and teaching, it is hoped that this paper will contribute to postgraduate legal education in Ireland,and also internationally.

Guest sorption and desorption in the metal-organic framework [Co(INA)(2)] (INA = isonicotinate) - evidence of intermediate phases during desorption

The metal-organic framework [Co(INA)(2)].0.5EtOH (INA = isonicotinate, NC5H4-4-CO2-), 1 was synthesised under solvothermal conditions. Its X-ray crystal structure shows channels containing ethanol guests which are hydrogen-bonded to carboxylate oxygens of the framework. The pyridyl rings of the framework alternate between `open' and `closed' positions along the channels resulting in large variation in the channel cross-sectional area from ca. 1.4 by 2.3 at the narrowest point to 4.9 by 5.3 at the widest. Despite the very small windows, the ethanol guests (of van der Waals diameter ca. 4.2-6.1 Angstrom) may be reversibly desorbed and sorbed into the structure quantitatively, as shown by in situ variable-temperture IR spectroscopy and XRPD. The single-crystal structure of the desolvated form [Co(INA)(2)]2 shows that there is no change in the overall connectivity on desolvation, but the rotational positions of the pyridine rings are altered. This suggests that pyridyl rotation may occur to allow guests to pass in and out. When the synthesis was conducted in 1-propanol solvent [Co(INA)(2)].0.5Pr(n)OH.H2O 3, was obtained, and a single-crystal X-ray structure revealed the same overall connectivity as in 1 but with pyridine rings disordered over closed and open positions. There was no evidence of included guests from X-ray crystallography, suggesting that they are also highly disordered. Variable-temperature XRPD performed on bulk samples showed peaks which were unsymmetrical and exhibited shoulders, suggesting that for each pattern obtained the material actually consisted of several closely-related phases. The movements of the peaks during desolvation showed the presence of intermediate phases before the final desolvated product was formed. The peak positions of the intermediate phases matched more closely with the calculated pattern for 3 than with 1 or 2, suggesting that they may have disordered structures similar to 3. The results also suggest that the intermediate phase represents an initial increase in volume before a larger decrease in volume occurs to give the final desolvated material.

The hydrodynamics of small seabed mounted bottom hinged wave energy converters in shallow water:PhD thesis

This thesis investigates the hydrodynamics of a small, seabed mounted, bottom hinged, wave energy converter in shallow water. The Oscillating Wave Surge Converter is a pitching flap-type device which is located in 10-15m of water to take advantage of the amplification of horizontal water particle motion in shallow water. A conceptual model of the hydrodynamics of the device has been formulated and shows that, as the motion of the flap is highly constrained, the magnitude of the force applied to the flap by the wave is strongly linked to the power absorption.

An extensive set of experiments has been carried out in the wave tank at Queen’s University at both 40th and 20th scales. The experiments have included testing in realistic sea states to estimate device performance as well as fundamental tests using small amplitude monochromatic waves to determine the force applied to the flap by the waves. The results from the physical modelling programme have been used in conjunction with numerical data from WAMIT to validate the conceptual model.

The work finds that tuning the OWSC to the incident wave periods is problematic and only results in a marginal increase in power capture. It is also found that the addition of larger diameter rounds to the edges of the flap reduces viscous losses and has a greater effect on the performance of the device than tuning. As wave force is the primary driver of device performance it is shown that the flap should fill the water column and should pierce the water surface to reduce losses due to wave overtopping.

With the water depth fixed at approximately 10m it is shown that the width of the flap has the greatest impact on the magnitude of wave force, and thus device performance. An 18m wide flap is shown to have twice the absorption efficiency of a 6m wide flap and captures 6 times the power. However, the increase in power capture with device width is not limitless and a 24m wide flap is found to be affected by two-dimensional hydrodynamics which reduces its performance per unit width, especially in sea states with short periods. It is also shown that as the width increases the performance gains associated with the addition of the end effectors reduces. Furthermore, it is shown that as the flap width increases the natural pitching period of the flap increases, thus detuning the flap further from the wave periods of interest for wave energy conversion.

The effect of waves approaching the flap from an oblique angle is also investigated and the power capture is found to decrease with the cosine squared of the encounter angle. The characteristic of the damping applied by the power take off system is found to have a significant effect on the power capture of the device, with constant damping producing between 20% and 30% less power than quadratic damping. Furthermore, it is found that applying a higher level of damping, or a damping bias, to the flap as it pitches towards the beach increases the power capture by 10%.

A further set of experiments has been undertaken in a case study used to predict the power capture of a prototype of the OWSC concept. The device, called the Oyster Demonstrator, has been developed by Aquamarine Power Ltd. and is to be installed at the European Marine Energy Centre, Scotland, in 2009.

The work concludes that OWSC is a viable wave energy converter and absorption efficiencies of up 75% have been measured. It is found that to maximise power absorption the flap should be approximately 20m wide with large diameter rounded edges, having its pivot close to the seabed and its top edge piercing the water surface.

Exporting Poor Health: The Irish in England

In the twentieth century, the Irish-born population in England has typically been in worse health than both the native population and the Irish population in Ireland, a reversal of the commonly observed healthy migrant effect. Recent birth cohorts living in England and born in Ireland, however, are healthier than the English population. The substantial Irish migrant health penalty arises principally for cohorts born between 1920 and 1960. In this article, we attempt to understand the processes that generated these changing migrant health patterns for Irish migrants to England. Our results suggest a strong role for economic selection in driving the dynamics of health differences between Irish-born migrants and white English populations.

Masks as methodology and the phenomenological turn: issues of interpretation

The purposes of this chapter are to argue for (i) the heuristic value of the concept of mask and masking in research which has its basis in psychodynamic theory but relating it to socio-cultural theory as means to understanding self-experience (ii) the value of creating and performing masks as one valuable methodological ‘embodied’ form in social and educational research that represent individuals’ richly textured self-other constructions and allow for the interrogation of any simplistic dichotomies associated with notions of ‘inside’ ‘outside’ categories (iii) exploring possibilities and dilemmas of interpretation within this frame

The role of the cancer specialist nurse

Cancer specialist nurses play a key role in a patients' cancer journey, and with a growing rate of cancer diagnosis they are need now more than ever

Ritual, identity and nation: when the historian becomes the high priest of commemoration

This paper questions the use of 'memory', 'remembering' and 'collective memory' as a conceptual tool in historical study. It will ague that a synchronic model for commemorative practice needs to be highlighted, and in doing so questions the role of historians in commemorative practice.

Hepatocyte growth factor (HGF) protects c-met-expressing Burkitt''s lymphoma cell lines from apoptotic death induced by DNA damaging agents

The relative sensitivity of neoplastic cells to DNA damaging agents is a key factor in cancer therapy. In this paper, we show that pretreatment of Burkitt's lymphoma cell lines expressing the c-met protooncogene with hepatocyte growth factor (HGF) protects them from death induced by DNA damaging agents commonly used in tumour therapy. This protection was observed in assays based on morphological assessment of apoptotic cells and DNA fragmentation assays. The protection was dose- and time-dependent — maximal protection requiring pre-incubation with 100 ng/ml HGF for 48 h. Western blotting analysis and flow cytometric studies revealed that HGF inhibited doxorubicin- and etoposide-induced decreases in the levels of the anti-apoptotic proteins Bcl-XL, and to a lesser extent Bcl-2, without inducing changes in the pro-apoptotic Bax protein. Overall, these studies suggest that the accumulation of HGF within the microenvironment of neoplastic cells may contribute to the development of a chemoresistant phenotype.

Dried blood spot liquid chromatography assay for therapeutic drug monitoring of metformin

The use of blood spot collection cards is a simple way to obtain specimens for analysis of drugs for the purpose of therapeutic drug monitoring, assessing adherence to medications and preventing toxicity in routine clinical setting. We describe the development and validation of a microanalytical technique for the determination of metformin from dried blood spots. The method is based on reversed phase high-performance liquid chromatography with ultraviolet detection. Drug recovery in the developed method was found to be more than 84%. The limits of detection and quantification were calculated to be to be 90 and 150 ng/ml, respectively. The intraday and interday precision (measured by CV%) was always less than 9%. The accuracy (measured by relative error, %) was always less than 12%. Stability analysis showed that metformin is stable for at least 2 months when stored at -70 degrees C. The small volume of blood required (10 mu L), combined with the simplicity of the analytical technique makes this a useful procedure for monitoring metformin concentrations in routine clinical settings. The method is currently being applied to the analysis of blood spots taken from diabetic patients to assess adherence to medications and relationship between metformin level and metabolic control of diabetes. (c) 2006 Elsevier B.V. All rights reserved.