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.

Human Parechovirus Infection in Neonatal Intensive Care

Background: Approximately 5-6% of all infective episodes in NICU are of viral origin. Previous studies suggest that human parechovirus (HPeV) infection presents most commonly in term infants, as a sepsis-like syndrome in which meningoencephalitis is prominent. Our aim was to study the infection rate and associated features of HPeV.

Methods: Blood samples were taken from NICU babies greater than 48 hours old, who were being investigated for late onset sepsis. Clinical and laboratory data were collected at the time of the suspected sepsis episode. Samples were tested using universal primers and probe directed at the 5'-untranslated region of the HPeV genome by reverse transcriptase PCR. Results were confirmed by electrophoresis and DNA sequencing.

Results: HPeV was detected in 11 of 84 samples (13%). These infants had a mean (interquartile range, IQR) gestational age of 28.9 (26.9 - 30.6) weeks and mean birth weight of 1.26 (SD = 0.72) kg. The median day of presentation was 16 (IQR: 11-27). These characteristics were similar to the infants without positive viral detection. Six infants presented with respiratory signs. One infant presented with signs of meningitis. Six of the 11 episodes of HPeV infection occurred during the winter months (December - February). No HPeV positive infants had abnormal findings on their 28-day cranial ultrasound examination.

Conclusions: We found a HPeV infection rate of 13% in infants being tested for late onset sepsis. HPeV should be considered as a possible cause of sepsis-like symptoms in preterm infants.

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.

Selective deuterium ion acceleration using the Vulcan petawatt laser

We report on the successful demonstration of selective acceleration of deuterium ions by target-normal sheath acceleration (TNSA) with a high-energy petawatt laser. TNSA typically produces a multi-species ion beam that originates from the intrinsic hydrocarbon and water vapor contaminants on the target surface. Using the method first developed by Morrison et al. [Phys. Plasmas 19, 030707 (2012)], an ion beam with >99% deuterium ions and peak energy 14 MeV/nucleon is produced with a 200 J, 700 fs, > 10 20 W/cm 2 laser pulse by cryogenically freezing heavy water (D<inf>2</inf>O) vapor onto the rear surface of the target prior to the shot. Within the range of our detectors (0°-8.5°), we find laser-to-deuterium-ion energy conversion efficiency of 4.3% above 0.7 MeV/nucleon while a conservative estimate of the total beam gives a conversion efficiency of 9.4%.

High temperature thermal stability studies of ultrathin Al2O3 layers deposited on native oxide and sulphur passivated InGaAs surfaces

High resolution synchrotron radiation core level photoemission measurements have been used to undertake a comparative study of the high temperature stability of ultrathin Al2O3 layers deposited by atomic layer deposition (ALD) on both sulphur passivated and native oxide covered InGaAs. The residual interfacial oxides between sulphur passivated InGaAs and the ultrathin Al2O3 layer can be substantially removed at high temperature (up to 700 °C) without impacting on the InGaAs stoichiometry while significant loss of indium was recorded at this temperature on the native oxide InGaAs surface.

A novel recovery process for lipids from microalgæ for biodiesel production using a hydrated phosphonium ionic liquid

The use of a hydrated phosphonium ionic liquid, [P(CH<inf>2</inf>OH)<inf>4</inf>]Cl, for the extraction of microalgæ lipids for biodiesel production, was evaluated using two microalgæ species, Chlorella vulgaris and Nannochloropsis oculata. The ionic liquid extraction was compared to the conventional Soxhlet, and Bligh & Dyer, methods, giving the highest extraction efficiency in the case of C. vulgaris, at 8.1%. The extraction from N. oculata achieved the highest lipid yield for Bligh & Dyer (17.3%), while the ionic liquid extracted 12.8%. Nevertheless, the ionic liquid extraction showed high affinity to neutral/saponifiable lipids, resulting in the highest fatty acid methyl esters (FAMEs)-biodiesel yield (4.5%) for C. vulgaris. For N. oculata, the FAMEs yield of the ionic liquid and Bligh & Dyer extraction methods were similar (>8%), and much higher than for Soxhlet (<5%). The ionic liquid extraction proved especially suitable for lipid extraction from wet biomass, giving even higher extraction yields than from dry biomass, 14.9% and 12.8%, respectively (N. oculata). Remarkably, the overall yield of FAMEs was almost unchanged, 8.1% and 8.0%, for dry and wet biomass. The ionic liquid extraction process was also studied at ambient temperature, varying the extraction time, giving 75% of lipid and 93% of FAMEs recovery after thirty minutes, as compared to the extraction at 100 °C for one day. The recyclability study demonstrated that the ionic liquid was unchanged after treatment, and was successfully reused. The ionic liquid used is best described as [P(CH<inf>2</inf>OH)<inf>4</inf>]Cl·2H<inf>2</inf>O, where the water is not free, but strongly bound to the ions.

Properties of extragalactic dust inferred from linear polarimetry of Type Ia Supernovae

Aims
The aim of this paper is twofold: 1) to investigate the properties of extragalactic dust and compare them to what is seen in the Galaxy; 2) to address in an independent way the problem of the anomalous extinction curves reported for reddened Type Ia Supernovae (SN) in connection to the environments in which they explode. 

Methods
The properties of the dust are derived from the wavelength dependence of the continuum polarization observed in four reddened Type Ia SN: 1986G, 2006X, 2008fp, and 2014J. The method is based on the observed fact that Type Ia SN have a negligible intrinsic continuum polarization. This and their large luminosity makes them ideal tools to probe the dust properties in extragalactic environments.

Results
All four objects are characterized by exceptionally low total-to-selective absorption ratios (R<inf>V</inf>) and display an anomalous interstellar polarization law, characterized by very blue polarization peaks. In all cases the polarization position angle is well aligned with the local spiral structure. While SN 1986G is compatible with the most extreme cases of interstellar polarization known in the Galaxy, SN 2006X, 2008fp, and 2014J show unprecedented behaviours. The observed deviations do not appear to be connected to selection effects related to the relatively large amounts of reddening characterizing the objects in the sample.

Conclusions
The dust responsible for the polarization of these four SN is most likely of interstellar nature. The polarization properties can be interpreted in terms of a significantly enhanced abundance of small grains. The anomalous behaviour is apparently associated with the properties of the galactic environment in which the SN explode, rather than with the progenitor system from which they originate. For the extreme case of SN 2014J, we cannot exclude the contribution of light scattered by local material; however, the observed polarization properties require an ad hoc geometrical dust distribution.