Addressing potentially inappropriate prescribing in older patients: development and pilot study of an intervention in primary care (the OPTI-SCRIPT study)

Background: Potentially inappropriate prescribing (PIP) in older people is common in primary care and can result in increased morbidity, adverse drug events, hospitalizations and mortality. The prevalence of PIP in Ireland is estimated at 36% with an associated expenditure of over [euro sign]45 million in 2007. The aim of this paper is to describe the application of the Medical Research Council (MRC) framework to the development of an intervention to decrease PIP in Irish primary care.

Methods: The MRC framework for the design and evaluation of complex interventions guided the development of the study intervention. In the development stage, literature was reviewed and combined with information obtained from experts in the field using a consensus based methodology and patient cases to define the main components of the intervention. In the pilot stage, five GPs tested the proposed intervention. Qualitative interviews were conducted with the GPs to inform the development and implementation of the intervention for the main randomised controlled trial.

Results: The literature review identified PIP criteria for inclusion in the study and two initial intervention components - academic detailing and medicines review supported by therapeutic treatment algorithms. Through patient case studies and a focus group with a group of 8 GPs, these components were refined and a third component of the intervention identified - patient information leaflets. The intervention was tested in a pilot study. In total, eight medicine reviews were conducted across five GP practices. These reviews addressed ten instances of PIP, nine of which were addressed in the form of either a dose reduction or a discontinuation of a targeted medication. Qualitative interviews highlighted that GPs were receptive to the intervention but patient preference and time needed both to prepare for and conduct the medicines review, emerged as potential barriers. Findings from the pilot study allowed further refinement to produce the finalised intervention of academic detailing with a pharmacist, medicines review with web-based therapeutic treatment algorithms and tailored patient information leaflets.

Conclusions: The MRC framework was used in the development of the OPTI-SCRIPT intervention to decrease the level of PIP in primary care in Ireland. Its application ensured that the intervention was developed using the best available evidence, was acceptable to GPs and feasible to deliver in the clinical setting. The effectiveness of this intervention is currently being tested in a pragmatic cluster randomised controlled trial.

Trial registration: Current controlled trials ISRCTN41694007.© 2013 Clyne et al.; licensee BioMed Central Ltd.

‘Who Ate All the Pride?’:Patriotic Sentiment and English National Football Support.

The growing popularity of English national insignia in international football tournaments has been widely interpreted as evidence of the emergence of a renewed English national consciousness. However, little empirical research has considered how people in England actually understand football support in relation to national identity. Interview data collected around the time of the Euro 2000 and the 2002 World Cup tournaments fail to substantiate the presumption that support for the England football team maps onto claims to patriotic sentiment in any straightforward way. People with far-right political affiliations did generally use national football support to symbolise a general pride in English national identity. However, other people either claimed not to support the England national team precisely because of its associations with nationalism, or else bracketed the domain of football support from more general connotations of English patriotism.

Management in distributed systems: A semi-formal approach

The reverse engineering of a skeleton based programming environment and redesign to distribute management activities of the system and thereby remove a potential single point of failure is considered. The Ore notation is used to facilitate abstraction of the design and analysis of its properties. It is argued that Ore is particularly suited to this role as this type of management is essentially an orchestration activity. The Ore specification of the original version of the system is modified via a series of semi-formally justified derivation steps to obtain a specification of the decentralized management version which is then used as a basis for its implementation. Analysis of the two specifications allows qualitative prediction of the expected performance of the derived version with respect to the original, and this prediction is borne out in practice.

Measuring Interactions in Networks: Evidence from Soccer Teams

This paper contributes to the literature on centrality measures in economics by defining a team game and identifying the key players in the game. As an illustration of the theory, we create a unique data set from the UEFA Euro 2008 tournament. To capture the interaction between players, we create the passing network of each team. This all allows us to identify the key player and key groups of players for both teams in each game. We then use our measure to explain player ratings by experts and their market values. Our measure is significant in explaining expert ratings. We also find that players having higher intercentrality measures, regardless of their field position have significantly higher market values.

Model checking support for conflict resolution in multiple non-functional concern management

When implementing autonomic management of multiple non-functional concerns a trade-off must be found between the ability to develop independently management of the individual concerns (following the separation of concerns principle) and the detection and resolution of conflicts that may arise when combining the independently developed management code. Here we discuss strategies to establish this trade-off and introduce a model checking based methodology aimed at simplifying the discovery and handling of conflicts arising from deployment-within the same parallel application-of independently developed management policies. Preliminary results are shown demonstrating the feasibility of the approach.

The EU economic and social model in the global crisis: Interdisciplinary perspectives:Interdisciplinary perspectives

This book addresses the viability of the EU economic and social model within and after the global economic crisis. It identifies four key issues which warrant further discussion: (1) the asymmetry of the legal and policy framework of the euro and potential recalibration; (2) substantive tensions between the EU 'economic constitution' and its normative aim of social justice and impacts on national policy; (3) the role of civil society, including the two sides of industry in overcoming these tensions and (4) the EU's global aspirations towards the creation of a viable socio-economic model. Its chapters offer two perspectives on each of the four main issues. In drawing these debates together, the book provides a broad understanding as well as starting points for future research. Bringing together different disciplinary approaches, ranging from legal studies to political economy, sociology and macroeconomics, it is a valuable contribution to the debate on the European social model and introduces new insights by focusing on legal and political tensions, the impact of the financial crisis and other economic contexts as well as global dimensions. 

The German Federal Constitutional Court's Ruling on Outright Monetary Transactions (OMT) - Another Step Towards National Closure?

The German Federal Constitutional Court (FCC) ruling of 14 January 2014 deserves a thorough evaluation on several accounts: It is the first ever reference by the FCC to the Court of Justice of the European Union (CJEU), it represents a continuation of FCC case law aimed at restricting the impact of European Union law as interpreted by the Court of Justices of the European Union (CJEU) on German law as well as questioning Germany’s participation in an ever closer European Union, and it has the potential to dictate the future course of the EU’s Economic and Monetary Union (EMU).

This case note discusses three aspects of this decision. First, it considers the aims of challenging the youngest measures to contain the euro currency crisis before the FCC, focusing on the question in how far the claims are based on national closure as opposed to an ever closer union of the peoples of Europe. Secondly it analyzes in how far the aims the claims pursue are reflected in the FCC’s response. Thirdly, it considers the substantive relevance of this reference, highlighting the surprisingly vague consequences the FCC envisages should the CJEU not re-interpret the OMT decision as the FCC suggests, and illuminating the strategic aims of the reference without deference. In conclusion, it sketches the remaining scope for the EU to engage in or at least facilitate transnational solidarity.

Network Based Malware Detection in Virtualised Environment

While virtualisation can provide many benefits to a networks infrastructure, securing the virtualised environment is a big challenge. The security of a fully virtualised solution is dependent on the security of each of its underlying components, such as the hypervisor, guest operating systems and storage.

This paper presents a single security service running on the hypervisor that could potentially work to provide security service to all virtual machines running on the system. This paper presents a hypervisor hosted framework which performs specialised security tasks for all underlying virtual machines to protect against any malicious attacks by passively analysing the network traffic of VMs. This framework has been implemented using Xen Server and has been evaluated by detecting a Zeus Server setup and infected clients, distributed over a number of virtual machines. This framework is capable of detecting and identifying all infected VMs with no false positive or false negative detection.

A study exploring disordered eating patterns in first-year university students: student and service needs

This qualitative study explored disordered eating in a small group of first-year undergraduate students and addresses a gap in the literature by exploring their lived experience.

Aims: To better understand student’s needs in those experiencing or at risk of developing disordered eating during their first year at university and to illustrate what support mechanisms and services are required to better support students experiencing or at risk during their first year at university.

Conclusion: The University could further develop its outreach to new students with a more consistently supportive programme providing better facilities and training for stress appraisal and coping and more support via student buddying. The University could also extend its programme on positive mental health in an attempt to better inform on disordered eating and to reduce a sense of stigma within the student population. Personal tutors and student health care facilities need to be consistently trained in the understanding and person centred approach to students experiencing disordered eating, particularly the sub-clinical group. In addition the University could consider some small changes and adaptations to the refectory eating areas to better facilitate students who may be at risk from disordered eating. Finally the University could perhaps better use the potentially liminal period within the first few months of student's arrival at university (a new beginning) to help embed a program to develop a stronger sense of coherence and well-being.

Economic Ideas and the Political Construction of the Financial Crash of 2008

This article is a short introduction to a special section on economic ideas and the political construction of the financial crash. It begins by explaining why economic ideas and the politics of appeals to certain ideas are so integral to the historical significance of the crash of 2008 and the question of whether it can be considered a crash at all. The first section covers the literature on ideas and economic crisis. The second section highlights that the contribution of the special section is to engage in a stock taking exercise of the empirical and conceptual patterns concerning the politics of ideational change underway in the areas of: comparative fiscal policy; monetary policy and Euro zone debt management; capital controls; and financial and securities market regulation and standard setting. The final section outlines the structure of this special section and content of the individual articles.