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.

‘Towards a Concrete Utopian Model of Green Political Economy’

Much of the thinking about the appropriate ‘political economy’ to underpin sustainable development has been either utopian (as in some ‘green’ political views) or ‘business as usual’ approaches. This article suggests that ‘ecological modernisation’ is the dominant conceptualisation of ‘sustainable development’ within the UK and other ‘developed’ Northern polities and most corporate/business interests, and illustrates this by looking at some key ‘sustainable development’ policy documents from the UK Government. While critical of the reformist ‘policy telos’ of ecological modernisation, supporters of a more radical version of sustainable development need to also be aware of the strategic opportunities of this policy discourse. In particular, the article suggests that the discourse of ‘economic security’, which can be attached to a radicalised notion of ecological modernisation, ought to be used as a way of articulating a radical, robust and principled understanding of sustainable development, which offers a normatively compelling and policy-relevant path to outlining aspects of a ‘green political economy’ to underpin sustainable development.

Mass media and polarisation processes in the bounded confidence model of opinion dynamics

This paper presents a social simulation in which we add an additional layer of mass media communication to the social network 'bounded confidence' model of Deffuant et al (2000). A population of agents on a lattice with continuous opinions and bounded confidence adjust their opinions on the basis of binary social network interactions between neighbours or communication with a fixed opinion. There are two mechanisms for interaction. 'Social interaction' occurs between neighbours on a lattice and 'mass communication' adjusts opinions based on an agent interacting with a fixed opinion. Two new variables are added, polarisation: the degree to which two mass media opinions differ, and broadcast ratio: the number of social interactions for each mass media communication. Four dynamical regimes are observed, fragmented, double extreme convergence, a state of persistent opinion exchange leading to single extreme convergence and a disordered state. Double extreme convergence is found where agents are less willing to change opinion and mass media communications are common or where there is moderate willingness to change opinion and a high frequency of mass media communications. Single extreme convergence is found where there is moderate willingness to change opinion and a lower frequency of mass media communication. A period of persistent opinion exchange precedes single extreme convergence, it is characterized by the formation of two opposing groups of opinion separated by a gradient of opinion exchange. With even very low frequencies of mass media communications this results in a move to central opinions followed by a global drift to one extreme as one of the opposing groups of opinion dominates. A similar pattern of findings is observed for Neumann and Moore neighbourhoods.

Disorder-induced phase transition in a one-dimensional model of rice pile

We propose a one-dimensional rice-pile model which connects the 1D BTW sandpile model (Phys. Rev. A 38 (1988) 364) and the Oslo rice-pile model (Phys. Rev. Lett. 77 (1997) 107) in a continuous manner. We found that for a sufficiently large system, there is a sharp transition between the trivial critical behaviour of the 1D BTW model and the self-organized critical (SOC) behaviour. When there is SOC, the model belongs to a known universality class with the avalanche exponent tau = 1.53. (C) 1999 Elsevier Science B.V. All rights reserved.

On the universality of a one-dimensional model of a rice pile

A one-dimensional model of a rice pile is numerically studied for different driving mechanisms and different levels of medium disorder. The universality of the scaling exponents for the transit time distribution and avalanche size distribution is discussed. (C) 1997 Published by Elsevier Science B.V.

A NEW CHEMICAL-MODEL OF THE CIRCUMSTELLAR ENVELOPE SURROUNDING IRC+10216

A new chemical model of the circumstellar envelope surrounding the carbon-rich star IRC+10216 has been developed. This model incorporates a variety of newly measured rapid neutral-neutral reactions between carbon atoms and hydrocarbons and between the radical CN and a variety of stable neutral molecules. In addition, other neutral-neutral reactions in the above two classes or involving atoms such as N or radicals such as C(2n)H have been included with large rate coefficients although they have not yet been studied in the laboratory. Unlike the interstellar case, where the inclusion of these neutral-neutral reactions destroys molecular complexity, our model results for IRC+10216 show that sufficient abundances of large hydrocarbon radicals and cyanpolyynes can be produced to explain observations. We also discuss the formation of H2CN and NH2CN, two potentially observable molecules in IRC+10216.

Order Flow and the Monetary Model of Exchange Rates: Evidence from a Novel Data Set

We propose an exchange rate model that is a hybrid of the conventional specification with monetary fundamentals and the Evans–Lyons microstructure approach. We estimate a model augmented with order flow variables, using a unique data set: almost 100 monthly observations on interdealer order flow on dollar/euro and dollar/yen. The augmented macroeconomic, or “hybrid,” model exhibits greater in-sample stability and out of sample forecasting improvement vis-à-vis the basic macroeconomic and random walk specifications.