An evaluation of an adapted United States model of pharmaceutical care to improve psychoactive prescribing for nursing home residents in Northern Ireland (Fleetwood NI Study).

OBJECTIVES: To test the effect of an adapted U.S. model of pharmaceutical care on prescribing of inappropriate psychoactive (anxiolytic, hypnotic, and antipsychotic) medications and falls in nursing homes for older people in Northern Ireland (NI).

DESIGN: Cluster randomized controlled trial.

SETTING: Nursing homes randomized to intervention (receipt of the adapted model of care; n=11) or control (usual care continued; n=11).

PARTICIPANTS: Residents aged 65 and older who provided informed consent (N=334; 173 intervention, 161 control).

INTERVENTION: Specially trained pharmacists visited intervention homes monthly for 12 months and reviewed residents' clinical and prescribing information, applied an algorithm that guided them in assessing the appropriateness of psychoactive medication, and worked with prescribers (general practitioners) to improve the prescribing of these drugs. The control homes received usual care.

MEASUREMENTS: The primary end point was the proportion of residents prescribed one or more inappropriate psychoactive medicine according to standardized protocols; falls were evaluated using routinely collected falls data mandated by the regulatory body for nursing homes in NI.

RESULTS: The proportion of residents taking inappropriate psychoactive medications at 12 months in the intervention homes (25/128, 19.5%) was much lower than in the control homes (62/124, 50.0%) (odds ratio=0.26, 95% confidence interval=0.14–0.49) after adjustment for clustering within homes. No differences were observed at 12 months in the falls rate between the intervention and control groups.

CONCLUSION: Marked reductions in inappropriate psychoactive medication prescribing in residents resulted from pharmacist review of targeted medications, but there was no effect on falls.

Universality and self-similarity of an energy-constrained sandpile model with random neighbors

We study an energy-constrained sandpile model with random neighbors. The critical behavior of the model is in the same universality class as the mean-field self-organized criticality sandpile. The critical energy E-c depends on the number of neighbors n for each site, but the various exponents are independent of n. A self-similar structure with n-1 major peaks is developed for the energy distribution p(E) when the system approaches its stationary state. The avalanche dynamics contributes to the major peaks appearing at E-Pk = 2k/(2n - 1) with k = 1,2,...,n-1, while the fine self-similar structure is a natural result of the way the system is disturbed. [S1063-651X(99)10307-6].

Implementation of Menter's Transition Model on an Isolated Natural Laminar Flow Nacelle

This study evaluates the implementation of Menter's gamma-Re-theta Transition Model within the CFX12 solver for turbulent transition prediction on a natural laminar flow nacelle. Some challenges associated with this type of modeling have been identified. The computational fluid dynamics transitional flow simulation results are presented for a series of cruise cases with freestream Mach numbers ranging from 0.8 to 0.88, angles of attack from 2 to 0 degrees, and mass flow ratios from 0.60 to 0.75. These were validated with a series of wind-tunnel tests on the nacelle by comparing the predicted and experimental surface pressure distributions and transition locations. A selection of the validation cases are presented in this paper. In all cases, computational fluid dynamics simulations agreed reasonably well with the experiments. The results indicate that Menter's gamma-Re-theta Transition Model is capable of predicting laminar boundary-layer transition to turbulence on a nacelle. Nonetheless, some limitations exist in both the Menter's gamma-Re-theta Transition Model and in the implementation of the computational fluid dynamics model. The implementation of a more comprehensive experimental correlation in Menter's gamma-Re-theta Transition Model, preferably the ones from nacelle experiments, including the effects of compressibility and streamline curvature, is necessary for an accurate transitional flow simulation on a nacelle. In addition, improvements to the computational fluid dynamics model are also suggested, including the consideration of varying distributed surface roughness and an appropriate empirical correction derived from nacelle experimental transition location data.

Development of an in vitro model for study of the efficacy of ischemic preconditioning in human skeletal muscle against ischemia-reperfusion injury

Ischemia-reperfusion (I/R) injury causes skeletal muscle infarction and ischemic preconditioning (IPC) augments ischemic tolerance in animal models. To date, this has not been demonstrated in human skeletal muscle. This study aimed to develop an in vitro model to investigate the efficacy of simulated IPC in human skeletal muscle. Human skeletal muscle strips were equilibrated in oxygenated Krebs-Henseleit-HEPES buffer (37 degrees C). Aerobic and reperfusion phases were simulated by normoxic incubation and reoxygenation, respectively. Ischemia was simulated by hypoxic incubation. Energy store, cell viability, and cellular injury were assessed using ATP, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT), and lactate dehydrogenase (LDH) assays, respectively. Morphological integrity was assessed using electron microscopy. Studies were designed to test stability of the preparation (n = 5-11) under normoxic incubation over 24 h; the effect of 1, 2, 3, 4, or 6 h hypoxia followed by 2 h of reoxygenation; and the protective effect of hypoxic preconditioning (HPC; 5 min of hypoxia/5 min of reoxygenation) before 3 h of hypoxia/2 h of reoxygenation. Over 24 h of normoxic incubation, muscle strips remained physiologically intact as assessed by MTT, ATP, and LDH assays. After 3 h of hypoxia/2 h of reoxygenation, MTT reduction levels declined to 50.1 +/- 5.5% (P <0.05). MTT reduction levels in HPC (82.3 +/- 10.8%) and normoxic control (81.3 +/- 10.2%) groups were similar and higher (P <0.05) than the 3 h of hypoxia/2 h of reoxygenation group (45.2 +/- 5.8%). Ultrastructural morphology was preserved in normoxic and HPC groups but not in the hypoxia/reoxygenation group. This is the first study to characterize a stable in vitro model of human skeletal muscle and to demonstrate a protective effect of HPC in human skeletal muscle against hypoxia/reoxygenation-induced injury.

Development and Validation of a Compact Thermal Model for an Aircraft Compartment

The development of accurate structural/thermal numerical models of complex systems, such as aircraft fuselage barrels, is often limited and determined by the smallest scales that need to be modelled. The development of reduced order models of the smallest scales and consequently their integration with higher level models can be a way to minimise the bottle neck present, while still having efficient, robust and accurate numerical models. In this paper a methodology on how to develop compact thermal fluid models (CTFMs) for compartments where mixed convection regimes are present is demonstrated. Detailed numerical simulations (CFD) have been developed for an aircraft crown compartment and validated against experimental data obtained from a 1:1 scale compartment rig. The crown compartment is defined as the confined area between the upper fuselage and the passenger cabin in a single aisle commercial aircraft. CFD results were utilised to extract average quantities (temperature and heat fluxes) and characteristic parameters (heat transfer coefficients) to generate CTFMs. The CTFMs have then been compared with the results obtained from the detailed models showing average errors for temperature predictions lower than 5%. This error can be deemed acceptable when compared to the nominal experimental error associated with the thermocouple measurements.

The CTFMs methodology developed allows to generate accurate reduced order models where accuracy is restricted to the region of Boundary Conditions applied. This limitation arises from the sensitivity of the internal flow structures to the applied boundary condition set. CTFMs thus generated can be then integrated in complex numerical modelling of whole fuselage sections.

Further steps in the development of an exhaustive methodology would be the implementation of a logic ruled based approach to extract directly from the CFD simulations numbers and positions of the nodes for the CTFM.

Polyamine system in developing rat eye and an animal model of retinopathy of prematurity

BACKGROUND: In experimental models of retinopathy of prematurity (ROP), a vasoproliferative disorder of the retina, retinal lesions are usually assessed by morphological examination. However, studies suggest that the polyamine system may be useful in monitoring proliferation processes. For this reason, polyamine concentrations in rat erythrocytes (RBC) and the regulation of polyamine system in rat eyes under the conditions relevant to ROP were investigated. METHODS: Newborn Wistar rats were reared in room air (control) or exposed first to hyperoxia (60% or 80% oxygen, 2 weeks) and then to normoxia (relative hypoxia, 1 or 2 weeks). Blood was collected from orbital vessels at 2 weeks of age and before death. Polyamine system-related enzyme activities were measured in retina and lens with radioassays. Polyamines were quantified by fluorometry after extraction, dansylation and HPLC separation. RESULTS: Oxygen (80% only) significantly decreased RBC polyamine concentrations, which then markedly increased after rats were transferred for a week to normal air, suggesting retardation of growth processes and compensatory stimulation, respectively. However, polyamine system changes in the rat eye were not so pronounced. Enzyme activities and polyamine concentrations tended to be lower in retina after hyperoxia and were only slightly higher, with the exception of ornithine decarboxylase, after a subsequent 1 week of normoxia. In litters subjected to normoxia for longer periods no changes were found. CONCLUSION: The transient and short-lived alteration in polyamine metabolism, especially in the eye, suggests that exposure of newborn rats to high oxygen supplementation followed by normoxia does not necessarily result in marked retinopathy.

Generalized Langevin equation: An efficient approach to nonequilibrium molecular dynamics of open systems

The generalized Langevin equation (GLE) has been recently suggested to simulate the time evolution of classical solid and molecular systems when considering general nonequilibrium processes. In this approach, a part of the whole system (an open system), which interacts and exchanges energy with its dissipative environment, is studied. Because the GLE is derived by projecting out exactly the harmonic environment, the coupling to it is realistic, while the equations of motion are non-Markovian. Although the GLE formalism has already found promising applications, e. g., in nanotribology and as a powerful thermostat for equilibration in classical molecular dynamics simulations, efficient algorithms to solve the GLE for realistic memory kernels are highly nontrivial, especially if the memory kernels decay nonexponentially. This is due to the fact that one has to generate a colored noise and take account of the memory effects in a consistent manner. In this paper, we present a simple, yet efficient, algorithm for solving the GLE for practical memory kernels and we demonstrate its capability for the exactly solvable case of a harmonic oscillator coupled to a Debye bath.

Impacts of compressed air energy storage plant on an electricity market with a large renewable energy portfolio

Renewable energy generation is expected to continue to increase globally due to renewable energy targets and obligations to reduce greenhouse gas emissions. Some renewable energy sources are variable power sources, for example wind, wave and solar. Energy storage technologies can manage the issues associated with variable renewable generation and align non-dispatchable renewable energy generation with load demands. Energy storage technologies can play different roles in each of the step of the electric power supply chain. Moreover, large scale energy storage systems can act as renewable energy integrators by smoothing the variability. Compressed air energy storage is one such technology. This paper examines the impacts of a compressed air energy storage facility in a pool based wholesale electricity market in a power system with a large renewable energy portfolio.

Detailed validation of an automotive catalysis model using spatially resolved measurements within the catalyst substrate

Many kinetic models have appeared in literature in past decades using two main approaches: the traditional global kinetics approach, or the more complex micro-kinetics approach. Whether global or micro-kinetics, kinetic models have been based on experimental data obtained at the end of the monolith. The experimental procedure using end pipe analysis may give an accurate overview of the reaction mechanisms that occur; however, the lack of information from within the catalyst can ultimately lead to inaccuracies in the kinetic model and parameters used.

Using SpaciMS, a spatially resolved experimental technique developed at the Queen's University Belfast, information from within the catalyst can be obtained. This minimally invasive technique provides detailed information of the gas concentration and temperature profile from inside the catalytic monolith. This paper presents a kinetic model and simulations validated against experimental data obtained from three positions inside the catalyst monolith at 2, 14, and 26 mm in, using data from the SpaciMS. Also, simulations of end pipe analysis, using a commercial reactor, for the CO oxidation are presented and analyzed. The simulations presented are for varying concentrations of both CO and O2 (0.5 % and 1 % CO, 0.5 % and 2 % O2) for both the global and micro-kinetic approach.