A Cluster Randomized Controlled Trial of an Adapted U.S. Model of Pharmaceutical Care for Nursing Home Residents in Northern Ireland (Fleetwood Northern Ireland Study): A Cost-Effectiveness Analysis

OBJECTIVES: To evaluate the cost-effectiveness of an adapted U.S. model of pharmaceutical care to improve psychoactive prescribing for nursing home residents in Northern Ireland (Fleetwood NI Study).
DESIGN: Economic evaluation alongside a cluster randomized controlled trial.
SETTING: Nursing homes in NI randomized to intervention (receipt of the adapted model of care; n511) or control (usual care continued; n511).
PARTICIPANTS: Residents aged 65 and older who provided informed consent (N5253; 128 intervention, 125 control) and who had full resource use data at 12 months.
INTERVENTION: Trained pharmacists reviewed intervention home residents’ clinical and prescribing information for 12 months, applied an algorithm that guided them in assessing the appropriateness of psychoactive medication, and worked with prescribers (general practitioners) to make changes. The control homes received usual care in which there was no pharmacist intervention.
MEASUREMENTS: The proportion of residents prescribed one or more inappropriate psychoactive medications (according to standardized protocols), costs, and a cost-effectiveness acceptability curve. The latter two outcomes are the focus for this article.
RESULTS: The proportions of residents receiving inappropriate psychoactive medication at 12 months in the intervention and control group were 19.5% and 50.4%, respectively. The mean cost of healthcare resources used per resident per year was $4,923 (95% con?dence interval.

Irresponsible Lending?: A Case Study of a U.K. Credit Industry Reform Initiative

There are major concerns about the level of personal borrowing, particularly sourced from credit cards. This paper charts the progress of an initiative to create a Responsible Lending Index (RLI) for the credit industry. The RLI proposed to voluntarily benchmark lending standards and promote best practice within the credit industry by involving suppliers of credit, customer representatives and regulators. However, despite initial support from some banks, consumer bodies and the Chair of the Treasury Select Committee, it failed to gain sufficient support from financial institutions in its original format. The primary reasons for this were related to the complexity of building such a robust index and the banks trade body’s fear of exposing its members to public scrutiny. A revised alternative, the Responsible Lending Initiative, was proposed which took into account these concerns. However, the Association of Payment Clearing Service (APACS), the trade body of the credit industry, then effectively destroyed the proposal. This article describes an attempt to address the challenges in the credit card industry with the initiation of the RLI, reflected in stakeholder discourse and in the context of a wider concern expressed by the involved stakeholders in terms of the need for greater responsibility in the banking industry’s lending practices.

A New Principal Curve Algorithm for Nonlinear Principal Component Analysis

This paper emerged from work supported by EPSRC grant GR/S84354/01 and proposes a method of determining principal curves, using spline functions, in principal component analysis (PCA) for the representation of non-linear behaviour in process monitoring. Although principal curves are well established, they are difficult to implement in practice if a large number of variables are analysed. The significant contribution of this paper is that the proposed method has minimal complexity, assuming simple spline geometry, thus enabling efficient computation. The paper provides a foundation for further work where multiple curves may be required to represent underlying non-linear information in complex data.

Genetic studies of body mass index yield new insights for obesity biology

Obesity is heritable and predisposes to many diseases. To understand the genetic basis of obesity better, here we conduct a genome-wide association study and Metabochip meta-analysis of body mass index (BMI), a measure commonly used to define obesity and assess adiposity, in up to 339,224 individuals. This analysis identifies 97 BMI-associated loci (P < 5 × 10(-8)), 56 of which are novel. Five loci demonstrate clear evidence of several independent association signals, and many loci have significant effects on other metabolic phenotypes. The 97 loci account for ∼2.7% of BMI variation, and genome-wide estimates suggest that common variation accounts for >20% of BMI variation. Pathway analyses provide strong support for a role of the central nervous system in obesity susceptibility and implicate new genes and pathways, including those related to synaptic function, glutamate signalling, insulin secretion/action, energy metabolism, lipid biology and adipogenesis.

LSQ14bdq: a type Ic Super-luminous Supernova with a double-peaked light curve

We present data for LSQ14bdq, a hydrogen-poor super-luminous supernova (SLSN) discovered by the La Silla QUEST survey and classified by the Public ESO Spectroscopic Survey of Transient Objects. The spectrum and light curve are very similar to slow-declining SLSNe such as PTF12dam. However, detections within ∼1 day after explosion show a bright and relatively fast initial peak, lasting for ∼15 days, prior to the usual slow rise to maximum light. The broader, main peak can be fit with either central engine or circumstellar interaction models. We discuss the implications of the precursor peak in the context of these models. It is too bright and narrow to be explained as a normal ⁵⁶Ni-powered SN, and we suggest that interaction models may struggle to fit the two peaks simultaneously. We propose that the initial peak may arise from the post-shock cooling of extended stellar material, and reheating by a central engine drives the second peak. In this picture, we show that an explosion energy of ∼2 × 10⁵² erg and a progenitor radius of a few hundred solar radii would be required to power the early emission. The competing engine models involve rapidly spinning magnetars (neutron stars) or fallback onto a central black hole. The prompt energy required may favor the black hole scenario. The bright initial peak may be difficult to reconcile with a compact Wolf-Rayet star as a progenitor since the inferred energies and ejected masses become unphysical.