Nature or nurture BMI and blood pressure at 90. Findings from the Belfast Elderly longitudinal free-living aging study Belfast

Hypertension is a key risk factor for stroke, cardiovascular disease and dementia. Although the link between weight, sodium and hypertension is established in younger people, little is known about their inter-relationship in people beyond 80 years of age. Associations between blood pressure, anthropometric indices and sodium were investigated in 495 apparently healthy, community-living participants (age 90, SD 4.8; range 80–106), from the cross-sectional Belfast Elderly Longitudinal Free-living Aging STudy (BELFAST) study. In age-sex-adjusted logistic regression models, blood pressure =140/90 mmHg significantly associated with body mass index (BMI) [odds ratio (OR)?=?1.28/ kg/m2], with weight (OR?=?1.22/kg) approaching significance (P?=?0.07). In further age-sex-adjusted models, blood pressure above the 120/80 mmHg normotensive reference value significantly associated with BMI (OR?=?1.44/kg/m2), weight (OR?=?1.36/kg), skin-fold-thickness (OR?=?1.33/mm) and serum sodium (OR?=?1.37 mmol/l). In BELFAST participants over 80 years old, blood pressure =140/90 mmHg is associated with BMI, in apparently similar ways to younger groups.

The extent and nature of family alcohol and drug use: Findings from the Belfast Youth Development Study

Using data from an ongoing longitudinal study of adolescent drug use, this study examines the proportion of teenagers living with parents who are problem alcohol or drug users. Around two percent of parents report high levels of problem drinking and one per cent report problem drug use. If a broader definition of hazardous drinking is used, the proportion of teenagers exposed increases to over 15 per cent. When substance use is examined at a family level (taking account of alcohol and drug use amongst dependent children in addition to that of parents), the proportion of families experiencing some form of substance use is considerable. These findings add further support to the call for increased recognition of the needs of dependent children within adult treatment services when working with parents. Likewise, the reduction of harm to children as a result of parent substance use should be an increasingly important priority for family support services. This is likely to be achieved through the closer integration of addiction and family services.

In situ study of ozone and hybrid plasma Ag-Al catalysts for the oxidation of toluene: Evidence of the nature of the active sites

Silver colloids have been prepared by reducing AgNO3 in aqueous solution and embeded in alumina following a sol-gel procedure in the presence of Pluronic 84 ((EO)(19)(PO)(39)(EO)(19)), as surfactant. Plasma-catalytic experiments aimed at the mineralization of toluene showed that the selectivity to CO2 was significantly increased in the presence of Ag catalysts compared with results obtained using the plasma alone. In-situ studies of the ozone interaction with catalysts provide an insight into the nature of the active sites of supported silver colloids for mineralization reactions. It is noticeable that when ozone is chemisorbed on embedded Ag colloidal catalysts no change in the silver oxidation state or size is found. The population of the chemisorbed species is higher at lower temperatures, where the non-selective decomposition of ozone is smaller. The catalysts exhibit high stability, preserving the structural and textural properties after the catalytic tests, that is indeed very important in the presence of ozone. (C) 2011 Elsevier B.V. All rights reserved.

Prevalence, Nature, Severity and Risk Factors for Prescribing Errors in Hospital Inpatients: Prospective Study in 20 UK Hospitals

Introduction: It has been suggested that doctors in their first year of post-graduate training make a disproportionate number of prescribing errors.

Obkective: This study aimed to compare the prevalence of prescribing errors made by first-year post-graduate doctors with that of errors by senior doctors and non-medical prescribers and to investigate the predictors of potentially serious prescribing errors.

Methods: Pharmacists in 20 hospitals over 7 prospectively selected days collected data on the number of medication orders checked, the grade of prescriber and details of any prescribing errors. Logistic regression models (adjusted for clustering by hospital) identified factors predicting the likelihood of prescribing erroneously and the severity of prescribing errors.

Results: Pharmacists reviewed 26,019 patients and 124,260 medication orders; 11,235 prescribing errors were detected in 10,986 orders. The mean error rate was 8.8 % (95 % confidence interval [CI] 8.6-9.1) errors per 100 medication orders. Rates of errors for all doctors in training were significantly higher than rates for medical consultants. Doctors who were 1 year (odds ratio [OR] 2.13; 95 % CI 1.80-2.52) or 2 years in training (OR 2.23; 95 % CI 1.89-2.65) were more than twice as likely to prescribe erroneously. Prescribing errors were 70 % (OR 1.70; 95 % CI 1.61-1.80) more likely to occur at the time of hospital admission than when medication orders were issued during the hospital stay. No significant differences in severity of error were observed between grades of prescriber. Potentially serious errors were more likely to be associated with prescriptions for parenteral administration, especially for cardiovascular or endocrine disorders.

Conclusions: The problem of prescribing errors in hospitals is substantial and not solely a problem of the most junior medical prescribers, particularly for those errors most likely to cause significant patient harm. Interventions are needed to target these high-risk errors by all grades of staff and hence improve patient safety.

Evaluation of extended training for general practice in Northern Ireland: qualitative study.

Objective To evaluate participants' perceptions of the impact on them of an additional six months' training beyond the standard 12 month general practice vocational training scheme. Design Qualitative study using focus groups. Setting General practice vocational training in Northern Ireland. Participants 13 general practitioner registrars, six of whom participated in the additional six months' training, and four trainers involved in the additional six months' training. Main outcome measures: Participants' views about their experiences in 18 month and 12 month courses. Results Participants reported that the 12 month course was generally positive but was too pressurised and focused on examinations, and also that it had a negative impact on self care. The nature of the learning and assessment was reported to have left participants feeling averse to further continuing education and lacking in confidence. In contrast, the extended six month component was reported to have restimulated learning by focusing more on patient care and promoting self directed learning. It developed confidence, promoted teamwork, and gave experience of two practice contexts, and was reported as valuable by both ex-registrars and trainers. However, both the 12 and 18 month courses left participants feeling underprepared for practice management and self care. Conclusions 12 months' training in general practice does not provide doctors with the necessary competencies and confidence to enter independent practice. The extended period was reported to promote greater professional development, critical evaluation skills, and orientation to lifelong learning but does not fill all the gaps.

A study of the Type II-P supernova 2003gd in M74

We present photometric and spectroscopic data of the Type II-P supernova (SN II-P) 2003gd, which was discovered in M74 close to the end of its plateau phase. SN 2003gd is the first Type II supernova ( SN) to have a directly confirmed red supergiant ( RSG) progenitor. We compare SN 2003gd to SN 1999 em, a similar SN II-P, and estimate an explosion date of 2003 March 18. We determine a reddening towards the SN of E(B-V) = 0.14 +/- 0.06, using three different methods. We also calculate three new distances to M74 of 9.6 +/- 2.8, 7.7 +/- 1.7 and 9.6 +/- 2.2 Mpc. The former was estimated using the standard candle method (SCM), for Type II supernovae (SNe II), and the latter two using the brightest supergiants method (BSM). When combined with existing kinematic and BSM distance estimates, we derive a mean value of 9.3 +/- 1.8 Mpc. SN 2003gd was found to have a lower tail luminosity compared with other normal Type II-P supernovae ( SNe II-P) bringing into question the nature of this SN. We present a discussion concluding that this is a normal SN II-P, which is consistent with the observed progenitor mass of 8(-2)(+4) M-circle dot.

Aggression after traumatic brain injury: Analysing socially desirable responses and the nature of aggressive traits.

Primary objective: To compare patients with traumatic brain injury (TBI) with controls on sub-types of aggression and explore the role of social desirability.
Design: Quasi-experimental, matched-participants design.
Methods and procedures: Sixty-nine participants were included in the study. The sample comprised a TBI group (n = 24), a spinal cord injury (SCI) group (n = 21) and an uninjured (UI) group of matched healthy volunteers (n = 24). Participants were given self-report measures of aggression, social desirability and impulsivity. Sixty-one independent ‘other-raters’ were nominated, who rated participant pre-morbid and post-morbid aggression.
Main outcomes and results: Using standardized norms, 25–39% of participants with TBI were classified as high average–very high on anger and 35–38% as high average–very high on verbal aggression. Other-raters rated participants with TBI as significantly higher on verbal aggression than SCI and UI participants. There were no differences between the groups on physical aggression. The TBI group also had higher levels of impulsivity than SCI and UI groups. Social desirability was a highly significant predictor of self-reported aggression for the entire sample.
Conclusions: Impulsive verbal aggression and anger are the principal aggressive traits after brain injury. Physical aggression may present in extreme cases after TBI, but appears less prominent overall in this population. Social desirability, previously overlooked in research examining TBI aggression, emerged as an influential variable that should be considered in future TBI research.

Accommodative dysfunction in children with cerebral palsy: a population based study

Purpose. To determine the prevalence, nature, and degree of accommodative dysfunction among children with different types and severities of cerebral palsy (CP) in Northern Ireland. Methods. Ninety subjects with CP (aged 4–15 years) were recruited through the Northern Ireland CP Register (NICPR). Modified Nott dynamic retinoscopy was used to measure lag and lead of accommodation at three test distances: 25 cm (4 D), 16.7 cm (6 D), and 10 cm (10 D) with the distance correction in place. Accommodative function was also assessed in an age-matched control group (n = 125) for comparison. Each subject’s neurologic status was derived from the NICPR. Results. Children with CP demonstrate significantly reduced accommodative responses compared with their neurologically normal peers. Of the subjects with CP, 57.6% demonstrated an accommodative lag outside normal limits at one or more distances. Reduced accommodative responses were significantly associated with more severe motor and intellectual impairments (ANOVA P = 0.001, P < 0.01, respectively). Conclusions. Brain injury such as that present in CP has a significant impact on accommodative function. These findings have implications for the optometric care of children with CP and inform our understanding of the impact of early brain injury on visual development.

Innovation persistence: Survey and case-study evidence

Evidence on the persistence of innovation sheds light on the nature of the innovation process and can guide appropriate policy development. This paper examines innovation persistence in Ireland and Northern Ireland using complementary quantitative and case-study approaches. Panel data derived from innovation surveys is used, and suggests very different results to previous analyses of innovation persistence primarily based on patents data. Product and process innovation are found to exhibit strong general persistence but we find no evidence that persistence is stronger among highly active innovators. Our quantitative evidence is most strongly consistent with a process of cumulative accumulation at plant level. Our case-studies highlight a number of factors which can either interrupt or stimulate this process including market volatility, plants’ organisational context and regulatory changes. Notably, however, the balance of influences on product and process innovation persistence differs, with product innovation persistence linked more strongly to strategic factors and process changes more often driven by market pressures.
© 2007 Elsevier B.V. All rights reserved.

The journey to concordance for patients with hypertension: a qualitative study in primary care

Objective: We aimed to explore, using qualitative methods, the perspectives of patients with hypertension on issues relating to concordance in prescribing.

Method: This study took place in NHS general practices in Northern Ireland. A purposeful sample of patients who had been prescribed anti-hypertensive medication for at least one year were invited to participate in focus groups or semi-structured interviews; data were analysed using constant comparison.

Main outcome measures: The perspectives of patients with hypertension on issues relating to concordance in prescribing.

Results: Twenty-five individuals participated in five focus groups; two participated in semi-structured interviews. Participants felt they could make valuable contributions to consultations regarding their management. They were prepared to negotiate with GPs regarding their medication, but most deferred to their doctor’s advice, perceiving doctors’ attitudes and time constraints as barriers to their greater involvement in concordant decision-making. They had concerns about taking anti-hypertensive drugs, were aware of lifestyle influences on hypertension and reported using personal strategies to facilitate adherence and reduce the need to take medication.

Conclusions: Participants indicated a willingness to be?involved in concordance in prescribing anti- hypertensive medication but needed health professionals to address their concerns and confusion about the nature of hypertension. These findings suggest that there is a need for doctors and other healthcare professionals with responsibility for prescribing to develop skills specifically to explore the beliefs and views underlying an individual’s medication use. Such skills may need to be developed through specific training programmes at both undergraduate and postgraduate level.

Lean principles and techniques for improving the quality and productivity of software development projects: a case study

Software product development is recognised as difficult due to the intangible nature of the product, requirements elicitation, effective progress measurement, and so forth. In this paper, we describe some of the challenges of software product development and how the challenges are being met by lean management principles and techniques. Specifically, we examine lean principles and techniques that were devised by Toyota and other manufacturers over the last 50 years. Applying lean principles to software development projects has been advocated for over ten years and it will be shown that the extensive lean literature is a valuable source of ideas for software development. A case study with a software development organisation, Timberline Inc., will demonstrate that lean principles and techniques can be successfully applied to software product development.

A density functional theory study of hydroxyl and the intermediate in the water formation reaction on Pt

Density functional theory has been used to study the adsorption of hydroxyl at low and high coverages and also to investigate the nature of the intermediate in the H2O formation reaction on Pt(111). At low coverages [1/9 of a monolayer (ML) to 1/3 ML] OH binds preferentially at bridge and top sites with a chemisorption energy of similar to2.25 eV. At high coverages (1/2 ML to 1 ML) H bonding between adjacent hydroxyls causes: (i) an enhancement in OH chemisorption energy by about 15%; (ii) a strong preference for OH adsorption at top sites; and (iii) the formation of OH networks. The activation energy for the diffusion of isolated OH groups along close packed rows of Pt atoms is 0.1 eV. This low barrier coupled with H bonding between neighboring OH groups indicates that hydroxyls are susceptible to island formation at low coverages. Pure OH as well as coadsorbed OH and H can be ruled out as the observed low temperature intermediate in the water formation reaction. Instead we suggest that the intermediate consists of a mixed OH+H2O overlayer with a macroscopic surface coverage of 3/4 ML in a 2:1 ratio of OH and H2O. (C) 2001 American Institute of Physics.

On the need to use steady-state or operando techniques to investigate reaction mechanisms: An in situ DRIFTS and SSITKA-based study example

The nature of the surface species formed at the surface of 2 wt.% Pt/CeO2 catalyst during the forward water-gas-shift (WGS, CO + H2O -> CO2 + H-2) and the reverse reaction (RWGS) were essentially identical. More, the surface concentration of formate, carbonate and carbonyl species was similar in each case. The presence of well-resolved IR bands allowed an unequivocal relative quantitative analysis of each species, avoiding the use of the carboxylate stretching region (1600-1200 cm(-1)). However, the quantitative analysis in the case of an isotopic study was complicated due to the overlapping of the various isotope bands, yet this problem could be overcome by integrating the high-wavenumber part of the bands. The reactivity of the surface species formed under RWGS conditions was followed under two different gaseous streams. Firstly, the reactivity of these intermediates were followed under an inert gas (i.e., At), in which case carbonates were essentially stable and less reactive than formates. Secondly, the reactivity of the same surface species was followed when switching to the corresponding C-13-labelled feed (i.e., (CO2)-C-13 + H-2), in which case carbonates were exchanged significantly faster than formates. While carbonates species have been reported as reaction intermediate under reaction conditions, the increased stability or surface poisoning by these carbonates in the absence of reaction mixture was highlighted. Ultimately, this work re-emphasises the need to use steady-state conditions if the true operando reactivity of the adsorbates and structure of the solid are to be determined. (c) 2005 Elsevier B.V. All rights reserved.

On the nature of the silver phases of Ag/Al2O3 catalysts for reactions involving nitric oxide

The nature of the silver phases of Ag/Al2O3 catalysts (prepared by silver nitrate impregnation followed by calcination) was investigated by X-ray diffractograms (XRD), transmission electron microscopy (TEM) and UV-VIS analyses and related to the activity of the corresponding materials for the oxidation of NO to NO2. The UV-VIS spectrum of the 1.2 wt.% Ag/Al2O3 exhibited essentially one band associated with Ag+ species and the NO2 yields measured over this material were negligible. A 10 wt.% Ag/Al2O3 material showed the presence of oxidic species of silver (as isolated Ag+ cations and silver aluminate), but the UV-VIS data also revealed the presence of some metallic silver. The activity for the NO oxidation to NO2 of this sample was moderate. The same 10% sample either reduced in H-2 or used for the C3H6-selective catalytic reduction (SCR) of NO showed a significantly larger proportion of silver metallic phases and these samples displayed a high activity for the formation of NO2. These data show that the structure and nature of the silver phases of Ag/Al2O3 catalysts can markedly change under reaction feed containing only a fraction of reducing agent (i.e. 500 ppm of propene) in net oxidizing conditions (2.5% O-2). The low activity for N-2 formation during the C3H6-SCR of NO (reported in an earlier study) over the high loading sample can. therefore, he related to the presence of metallic silver. which is yet a good catalyst for NO oxidation to NO2. The reverse observations apply for the oxide species observed over the low loading sample, which is a good SCR catalyst but do not oxidize NO to NO2. (C) 2002 Elsevier Science B.V. All rights reserved.