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.

Political Violence and Child Adjustment in Northern Ireland: Testing Pathways in a Social-Ecological Model Including Single- and Two-Parent Families

Moving beyond simply documenting that political violence negatively impacts children, we tested a social ecological hypothesis for relations between political violence and child outcomes. Participants were 700 mother child (M = 12.1 years, SD = 1.8) dyads from 18 working-class, socially deprived areas in Belfast, Northern Ireland, including single- and two-parent families. Sectarian community violence was associated with elevated family conflict and children's reduced security about multiple aspects of their social environment (i.e., family, parent child relations, and community), with links to child adjustment problems and reductions in prosocial behavior. By comparison, and consistent with expectations, links with negative family processes, child regulatory problems, and child outcomes were less consistent for nonsectarian community violence. Support was found for a social ecological model for relations between political violence and child outcomes among both single- and two-parent families, with evidence that emotional security and adjustment problems were more negatively affected in single-parent families. The implications for understanding social ecologies of political violence and children's functioning are discussed.

Perturbations to trophic interactions and the stability of complex food webs

The pattern of predator-prey interactions is thought to be a key determinant of ecosystem processes and stability. Complex ecological networks are characterized by distributions of interaction strengths that are highly skewed, with many weak and few strong interactors present. Theory suggests that this pattern promotes stability as weak interactors dampen the destabilizing potential of strong interactors. Here, we present an experimental test of this hypothesis and provide empirical evidence that the loss of weak interactors can destabilize communities in nature. We ranked 10 marine consumer species by the strength of their trophic interactions. We removed the strongest and weakest of these interactors from experimental food webs containing >100 species. Extinction of strong interactors produced a dramatic trophic cascade and reduced the temporal stability of key ecosystem process rates, community diversity and resistance to changes in community composition. Loss of weak interactors also proved damaging for our experimental ecosystems, leading to reductions in the temporal and spatial stability of ecosystem process rates, community diversity, and resistance. These results highlight the importance of conserving species to maintain the stabilizing pattern of trophic interactions in nature, even if they are perceived to have weak effects in the system.

Structural changes in the hippocampus and amygdala at first episode of psychosis

Hippocampus and amygdala changes have been implicated in the pathophysiology and symptomatology of both schizophrenia (SCZ) and bipolar disorder (BD). However relationships between illness course, neuropathological changes and variations in symptomatology remain unclear. This investigation examined the associations between hippocampus and amygdala volumes and symptom dimensions in schizophrenia and bipolar disorder patients after their first episode of psychosis. Symptom severity was associated with decreases in hippocampus/amygdala complex volume across groups. In keeping with previous work bilateral hippocampus and amygdala volume reductions were also identified in the SCZ patients while in BD patients only evidence of amygdala inflation reached significance. The study concludes that there appear to be important relationships between volume changes in the hippocampus and amygdala and dimensions and severity of symptomatology in psychosis. Structural alterations are apparent in both SCZ and BD after first episode of psychosis but present differently in each illness and are more severe in SCZ.

Intelligent demand response electric water heating to integrate wind power in Ireland

Dwindling fossil fuel resources and pressures to reduce greenhouse gas (GHG) emissions will result in a more diverse range of generation portfolios for future electricity systems. Irrespective of the portfolio mix the overarching requirement for all electricity suppliers and system operators is that supply instantaneously meets demand and that robust operating standards are maintained to ensure a consistent supply of high quality electricity to end-users. Therefore all electricity market participants will ultimately need to use a variety of tools to balance the power system. Thus the role of demand side management (DSM) with energy storage will be paramount to integrate future diverse generation portfolios. Electric water heating (EWH) has been studied previously, particularly at the domestic level to provide load control, peak shave and to benefit end-users financially with lower bills, particularly in vertically integrated monopolies. In this paper, a continuous Direct Load Control (DLC) EWH algorithm is applied in a liberalized market environment using actual historical electricity system and market data to examine the potential energy savings, cost reductions and electricity system operational improvements.

Effect of atorvastatin on circulating hsCRP concentrations: A sub-study of the Achieve Cholesterol Targets Fast with Atorvastatin Stratified Titration (ACTFAST) study

Background: Elevated C-reactive protein (CRP) concentration is a risk factor for cardiovascular events that may add prognostic information. Statin treatment is associated with significant reductions in CRP concentrations, which appear to be unrelated to the magnitude of LDL-cholesterol reduction. We investigated the effect of atorvastatin, across its dose range, on high sensitivity (hs)CRP in subjects at high cardiovascular risk. Methods: ACTFAST was a 12 week, prospective, multicenter, open-label trial in which high-risk subjects were assigned a starting dose of atorvastatin (10, 20, 40 or 80 mg/d) based on LDL-C and status of statin use at screening (1345 statin-free [ SF] and 772 previously statin-treated [ST]). Results: At baseline, ST subjects had significantly lower hsCRP levels than SF subjects (ST group 2.31, 95% CI 2.15, 2.48 mg/L vs. SF group 3.16, 95% CI 2.98, 3.34 mg/L, p

Electrochemistry of Sulfur and Polysulfides in Ionic Liquids

The electrochemistry of elemental sulfur (S-8) and the polysulfides Na2S4 and Na2S6 has been studied for the first time in nonchloroaluminate ionic liquids. The cyclic voltammetry of S-8 in the ionic liquids is different to the behavior reported in some organic solvents, with two reductions and one oxidation peak observed. Supported by in situ UV-vis spectro-electrochemical experiments, the main reduction products of S-8 in [C(4)mim][DCA] ([C(4)mim] = 1-butyl-3-methylimidazolium; DCA = dicyanamide) have been identified as s(6)(2-) and S-4(2-), and plausible pathways for the formation of these species are proposed. Dissociation and/or disproportionation of the polyanions S-6(2-) and S-4(2-) appears to be slow in the ionic liquid, with only small amounts of the blue radical species S3(center dot-) formed in the solutions at r.t., in contrast with that observed in most molecular solvents.

Rotational Molding Cycle Time Reduction Using a Combination of Physical Techniques

Rotational molding is a process used to manufacture hollow plastic products, and has been heralded as a molding method with great potential. Reduction of cycle times is an important issue for the rotational molding industry, addressing a significant disadvantage of the process. Previous attempts to reduce cycle times have addressed surface enhanced molds, internal pressure, internal cooling, water spray cooling, and higher oven air flow rates within the existing process. This article explores the potential benefits of these cycle time reduction techniques, and combinations of them. Recommendations on a best practice combination are made, based on experimental observations and resulting product quality. Applying the proposed molding conditions (i.e., a combination of surface-enhanced molds, higher oven flow rates, internal mold pressure, and water spray cooling), cycle time reductions of up to 70% were achieved. Such savings are very significant, inviting the rotomolding community to incorporate these techniques efficiently in an industrial setting. POLYM. ENG. SCI., 49:1846-1854, 2009. (C) 2009 Society of Plastics Engineers

A search for line intensity enhancements in the far-UV spectra of active late-type stars arising from opacity

Context. Radiative transfer calculations have predicted intensity enhancements for optically thick emission lines, as opposed to the normal intensity reductions, for astrophysical plasmas under certain conditions. In particular, the results are predicted to be dependent both on the geometry of the emitting plasma and the orientation of the observer. Hence in principle the detection of intensity enhancement may provide a way of determining the geometry of an unresolved astronomical source.
Aims. To investigate such enhancements we have analysed a sample of active late-type stars observed in the far ultraviolet spectral region.
Methods. Emission lines of O vi in the FUSE satellite spectra of ϵ Eri, II Peg and Prox Cen were searched for intensity enhancements due to opacity.
Results. We have found strong evidence for line intensity enhancements due to opacity during active or flare-like activity for all three stars. The O vi 1032/1038 line intensity ratios, predicted to have a value of 2.0 in the optically thin case, are found to be up to ~30% larger during several orbital phases.
Conclusions. Our measurements, combined with radiative transfer models, allow us to constrain both the geometry of the O vi emitting regions in our stellar sources and the orientation of the observer. A spherical emitting plasma can be ruled out, as this would lead to no intensity enhancement. In addition, the theory tells us that the line-of-sight to the plasma must be close to perpendicular to its surface, as observations at small angles to the surface lead to either no intensity enhancement or the usual line intensity decrease over the optically thin value. For the future, we outline a laboratory experiment, that could be undertaken with current facilities, which would provide an unequivocal test of predictions of line intensity enhancement due to opacity, in particular the dependence on plasma geometry.

Donepezil attenuates hippocampal neuronal damage and cognitive deficits after global cerebral ischemia in gerbils.

Decreased cerebral blood flow causes cognitive impairments and neuronal injury in vascular dementia. In the present study, we reported that donepezil, a cholinesterase inhibitor, improved transient global cerebral ischemia-induced spatial memory impairment in gerbils. Treatment with 5mg/kg of donepezil for 21 consecutive days following a 10-min period of ischemia significantly inhibited delayed neuronal death in the hippocampal CA1 region. In Morris water maze test, memory impairment was significantly improved by donepezil treatment. Western blot analysis showed that donepezil treatment prevented reductions in p-CaMKII and p-CREB protein levels in the hippocampus. These results suggest that donepezil attenuates the memory deficit induced by transient global cerebral ischemia and this neuroprotection may be associated with the phosphorylation of CaMKII and CERB in the hippocampus.

A preliminary structural design procedure for laser beam welded airframe stiffened panels

Initial sizing procedures for aircraft stiffened panels that include the influence of welding fabrication residual process effects are missing. Herein, experimental and Finite Element analyses are coupled to generate knowledge to formulate an accurate and computationally efficient sizing procedure which will enable designers to routinely consider panel fabrication, via welding, accounting for the complex distortions and stresses induced by this manufacturing process. Validating experimental results demonstrate the need to consider welding induced material property degradation, residual stresses and distortions, as these can reduce static strength performance. However, results from fuselage and wing trade-studies, using the validated sizing procedure, establish that these potential reductions in strength performance may be overcome through local geometric tailoring during initial sizing, negating any weight penalty for the majority of design scenarios.

Long Term Use of HU210 Adversely Affects Spermatogenesis in Rats by modulating the Endocannabinoid System

Recent societal acceptance of cannabinoids as recreational and therapeutic drugs has posed a potential hazard to male reproductive health. Mammals have a highly sophisticated endogenous cannabinoid (ECS) system that regulates male (and female) reproduction and exo-cannabinoids may influence it adversely. Therefore it is imperative to determine their effects on male reproduction so that men can make informed choices as to their use. Here, an animal model was used to administer HU210, a synthetic analogue of ?9-tetrahydrocannabinol (THC) and potent cannabinoid receptor (CB) agonist to determine its effects on reproductive organ weights, spermatogenesis, testicular histology and sperm motility. Its effects on the physiological endocannabinoid system were also investigated. Spermatogenesis was markedly impaired with reductions in total sperm count after 2 weeks of exposure. Spermatogenic efficiency was depleted, and Sertoli cell number decreased as exposure time increased with seminiferous tubules showing germ cell depletion developing into atrophy in some cases. Sperm motility was also adversely affected with marked reductions from 2 weeks on. HU210 also acted on the sperm’s endocannabinoid system. Long term use of exo-cannabinoids has adverse effects on both spermatogenesis and sperm function. These findings highlight the urgent need for studies evaluating the fertility potential of male recreational drug users.

AUDIT OF ANTIBIOTIC USAGE IN A MEDIUM-SIZED GENERAL-HOSPITAL OVER AN 11-YEAR PERIOD - THE IMPACT OF ANTIBIOTIC POLICIES

The objective of the present study was to evaluate trends in antibiotic expenditure over an 11-year period (1982-1992) in a 370-bed district general hospital in Northern Ireland and to examine the impact of two separate antibiotic policies on antibiotic usage. A further objective was to examine the attitudes of prescribers to the second policy. Drug utilization review was used to collect information on antibiotic expenditure and usage before and after introduction of separate antibiotic policies in 1985 (not intensively monitored) and 1989 (intensively monitored). A mail questionnaire was used to determine the attitudes of prescribers. The first policy (1985) showed no benefits with regard to the number of antibiotic entities stocked (45 before, 45 after), number of dosage units issued (9.35 increase) or expenditure (33.35 increase). The 1989 policy led to significant reductions in the number of antibiotic entities stocked (28.9%), number of antibiotics issued (11.9%) and expenditure (6.1%). Expenditure began to spiral upwards when active monitoring of the second policy was suspended. The majority of prescribers (87.2%) who responded to the questionnaire (56.5% response rate) felt that the 1989 policy made a positive contribution to antibiotic usage in the hospital.

Effects of storage on thermomechanical properties of poly(epsilon-caprolactone) blends containing poly(vinyl pyrrolidone/iodine)

This study reports the effects of: the molecular weight ratio of poly(epsilon -caprolactone) (PCL) in blends containing polymer of high (50 000 g mol(-1)) and low (4000 g mol(-1)) molecular weight; the concentration (0, 1, and 5 wt-%) of poly(vinyl pyrrolidone/iodine) (PVP/I); and storage at 30 degreesC and 75% relative humidity; on the thermomechanical properties of films prepared by solvent evaporation from solutions containing both PCL and PVP/I. The tensile properties were found to be statistically dependent on the molecular weight ratio of PCL but not on the concentration of PVP/I. The reductions in tensile strength and elongation at break associated with increasing amounts of low molecular weight PCL were attributed to a reduction in the concentration of chain entanglements. No changes were observed in viscoelastic properties or the glass transition temperature. Following storage there were no changes in the tensile strength, glass transition temperature, or viscoelastic properties of the films; however, significant reductions in elongation at break were observed. It is suggested that this is due to hydrolytic chain scission of amorphous PCL. Inclusion of 5 wt-% PVP/I increased this process in films containing 100:0 and 80:20 high/low molecular weight PCL (but not 60.40), but the extent of this was small. This study highlighted significant aging properties of PCL in a moist atmosphere. Consequently, it is recommended that suitable packaging materials should be employed to control the exposure of PCL films to water during storage.

A computational model of cellular response to modulated radiation fields

Purpose:
To develop a model to describe the response of cell populations to spatially modulated radiation exposures of relevance to advanced radiotherapies.

Materials and Methods:
A Monte Carlo model of cellular radiation response was developed. This model incorporated damage from both direct radiation and intercellular communication including bystander signaling. The predictions of this model were compared to previously measured survival curves for a normal human fibroblast line (AGO1522) and prostate tumor cells (DU145) exposed to spatially modulated fields.

Results:
The model was found to be able to accurately reproduce cell survival both in populations which were directly exposed to radiation and those which were outside the primary treatment field. The model predicts that the bystander effect makes a significant contribution to cell killing even in uniformly irradiated cells. The bystander effect contribution varies strongly with dose, falling from a high of 80% at low doses to 25% and 50% at 4 Gy for AGO1522 and DU145 cells, respectively. This was verified using the inducible nitric oxide synthase inhibitor aminoguanidine to inhibit the bystander effect in cells exposed to different doses, which showed significantly larger reductions in cell killing at lower doses.

Conclusions:
The model presented in this work accurately reproduces cell survival following modulated radiation exposures, both in and out of the primary treatment field, by incorporating a bystander component. In addition, the model suggests that the bystander effect is responsible for a significant portion of cell killing in uniformly irradiated cells, 50% and 70% at doses of 2 Gy in AGO1522 and DU145 cells, respectively. This description is a significant departure from accepted radiobiological models and may have a significant impact on optimization of treatment planning approaches if proven to be applicable in vivo.