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.

Politicians, elections and catastrophe: the general election of 1847

Over the last decade, much new research has appeared on the subject of the Great Irish Famine but, remarkably, a major political event during the famine - the 1847 general election - has received virtually no mention. Recent work on politics in this period has tended to concentrate on political reaction in Britain rather than Ireland. The aim of this article is to examine the response of Irish politicians to the famine during the general election of 1847. The main source has been the political addresses and nomination speeches of most of the 140 candidates. The evidence from this material shows that, although the famine was an important matter in many constituencies, it was not the dominant issue countrywide. Various proposals to deal with the famine emerged, but there was an absence of agreed, practical measures to deal with immediate problems. The parties in Ireland failed to create a common platform to challenge the government over its efforts. Ideological constraints played an important part in these failures. The general election of 1847 represents a lost opportunity to tackle some of the effects of the famine.

Radiotherapy in the presence of contrast agents: a general figure of merit and its application to gold nanoparticles

Delivering sufficient dose to tumours while sparing surrounding tissue is one of the primary challenges of radiotherapy, and in common practice this is typically achieved by using highly penetrating MV photon beams and spatially shaping dose. However, there has been a recent increase in interest in the possibility of using contrast agents with high atomic number to enhance the dose deposited in tumours when used in conjunction with kV x-rays, which see a significant increase in absorption due to the heavy element's high-photoelectric cross-section at such energies. Unfortunately, the introduction of such contrast agents significantly complicates the comparison of different source types for treatment efficacy, as the dose deposited now depends very strongly on the exact composition of the spectrum, making traditional metrics such as beam quality less valuable. To address this, a 'figure of merit' is proposed, which yields a value which enables the direct comparison of different source types for tumours at different depths inside a patient. This figure of merit is evaluated for a 15 MV LINAC source and two 150 kVp sources (both of which make use of a tungsten target, one with conventional aluminium filtration, while the other uses a more aggressive thorium filter) through analytical methods as well as numerical models, considering tissue treated with a realistic concentration and uptake ratio of gold nanoparticle contrast agents (10 mg ml(-1) concentration in 'tumour' volume, 10: 1 uptake ratio). Finally, a test case of human neck phantom is considered with a similar contrast agent to compare the abstract figure to a more realistic treatment situation. Good agreement was found both between the different approaches to calculate the figure of merit, and between the figure of merit and the effectiveness in a more realistic patient scenario. Together, these observations suggest that there is the potential for contrast-enhanced kilovoltage radiation to be a useful therapeutic tool for a number of classes of tumour on dosimetric considerations alone, and they point to the need for further research in this area.

The Future of Preventive Wars: The Case of Iraq

Eight years have past since the devastating September 11 attacks, and the USA has engaged in two wars in the name of uprooting global ‘terrorism’ and providing security to American citizens. The Bush administration bequeathed a legacy of two ongoing wars and growing threats emerging from ‘terrorist’ acts. This article analyses the future of the preventive war doctrine, formulated by the Bush administration, under international law. The article thus explores whether the preventive war doctrine has the potential to set a customary precedence, or whether it merely constitutes a breach of international law.

An Analysis of Advertising Wars

Comparative advertising by one brand against another showcases its merits versus the demerits of the other. In a two-stage game with finitely many firms, firms decide first how much to advertise against whom. In the second stage, given the advertising configuration, firms compete as Cournot oligopolists. In the symmetric case, equilibrium advertising constitutes a clear welfare loss. In the asymmetric case, depending on parameter values, a variety of outcomes are possible in equilibrium. An a priori disadvantaged firm (in terms of advertising costs or advertising effectiveness) may advertise more. Advertising can affect firms that are not advertisers or targets themselves.

British Society of Haematology, Slide Session presented at the Annual Scientific Meeting, Brighton 2009

P>Seven cases were discussed by an expert panel at the 2009 Annual Scientific Meeting of the British Society of Haematology. These cases are presented in a similar format to that adopted for the meeting. There was an initial discussion of the presenting morphology, generation of differential diagnoses and then, following display of further presenting and diagnostic information, each case was concluded with provision of a final diagnosis.

How different are the correlates of onset and continuation of civil wars?

It is very common to analyse the factors associated with the onset and continuation of civil wars entirely separately, as if there were likely to be no similarity between them. This is an overstatement of the theoretical position, which has established only that they may be different (i.e. less than perfectly correlated). The hypothesis that the explanatory variables are the same is not theoretically excludable and is empirically testable, both for individual variables and for combinations of them. Starting from this approach yields a rather different picture of the factors associated with the continuation of civil wars, because the relatively small sample size means that confidence intervals on individual coefficients are wide in this case. It is shown here that country size, mountainous terrain and (in most datasets) ethnic diversity seem significant for the continuation of civil wars, starting from the null hypothesis that variables affect onset and continuation probabilities identically, rather than entirely independently. One variable that affects onset and continuation significantly differently is anocracy, which we find to matter only for onset. Civil war is more likely if it occurred two years previously, as well as one year previously, which indicates that wars are more likely to restart after only one year of peace, and also more likely to stop in their first year. The combined model strengthens the result that ethnic diversity matters (it is consistently significant across datasets, whereas it is not when onset is analysed separately), although in the UCD/PRIO dataset it is significant only for onset. By contrast, if continuation is analysed independently, virtually nothing is significant except a pre-1991 dummy and a dummy for civil war two years previously.