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.

Causes and prevalence of visual impairment among adults in the United States.

OBJECTIVES: To estimate the cause-specific prevalence and distribution of blindness and low vision in the United States by age, race/ethnicity, and gender, and to estimate the change in these prevalence figures over the next 20 years. METHODS: Summary prevalence estimates of blindness (both according to the US definition of < or =6/60 [< or =20/200] best-corrected visual acuity in the better-seeing eye and the World Health Organization standard of < 6/120 [< 20/400]) and low vision (< 6/12 [< 20/40] best-corrected vision in the better-seeing eye) were prepared separately for black, Hispanic, and white persons in 5-year age intervals starting at 40 years. The estimated prevalences were based on recent population-based studies in the United States, Australia, and Europe. These estimates were applied to 2000 US Census data, and to projected US population figures for 2020, to estimate the number of Americans with visual impairment. Cause-specific prevalences of blindness and low vision were also estimated for the different racial/ethnic groups. RESULTS: Based on demographics from the 2000 US Census, an estimated 937 000 (0.78%) Americans older than 40 years were blind (US definition). An additional 2.4 million Americans (1.98%) had low vision. The leading cause of blindness among white persons was age-related macular degeneration (54.4% of the cases), while among black persons, cataract and glaucoma accounted for more than 60% of blindness. Cataract was the leading cause of low vision, responsible for approximately 50% of bilateral vision worse than 6/12 (20/40) among white, black, and Hispanic persons. The number of blind persons in the US is projected to increase by 70% to 1.6 million by 2020, with a similar rise projected for low vision. CONCLUSIONS: Blindness or low vision affects approximately 1 in 28 Americans older than 40 years. The specific causes of visual impairment, and especially blindness, vary greatly by race/ethnicity. The prevalence of visual disabilities will increase markedly during the next 20 years, owing largely to the aging of the US population.

Message from the President of the United States, transmitting of a report of the Secretary of State, in relation to individuals selected from American prisoners of war, and sent to Great Britain for trial, and also in relation to any orders for retaliation, &c., &c.--

April 16, 1814. Printed by order of the Senate of the United States.

Voucher #15 from the Engineer Department of Port Dalhousie and Thorold Railway Extension to A. H. Armour for office supplies, Apr. 1, 1857

Voucher #15 from the Engineer Department of Port Dalhousie and Thorold Railway Extension to A. H. Armour for office supplies, Apr. 1, 1857.

Pay roll voucher #12 from the Engineer Department of Port Dalhousie and Thorold Railway Extension for the office approved by F. Shanly, chief engineer, April, 1857

Pay roll voucher #12 from the Engineer Department of Port Dalhousie and Thorold Railway Extension for the office approved by F. Shanly, chief engineer, April, 1857.

Pay roll voucher #16 from the Engineer Department of Port Dalhousie and Thorold Railway Extension, for the office approved by F. Shanly, chief engineer, May 30, 1857

Pay roll voucher #16 from the Engineer Department of Port Dalhousie and Thorold Railway Extension, for the office approved by F. Shanly, chief engineer, May 30, 1857.

Voucher from the Engineer Department of Port Dalhousie and Thorold Railway Extension for W.G. Thompson for the Northern Division. There are attached notes from the Welland Railway Company to John Mitchell for putting up shelves; to William Waud, staff; and to William Martin to repair the office (copy), June 10, 1857

Voucher from the Engineer Department of Port Dalhousie and Thorold Railway Extension for W.G. Thompson for the Northern Division. There are attached notes from the Welland Railway Company to John Mitchell for putting up shelves; to William Waud, staff; and to William Martin to repair the office (copy), June 10, 1857.

Voucher from the Engineer Department of Port Dalhousie and Thorold Railway Extension to Francis A. Doyle for fees at the Fonthill Registry Office (copy), July 28, 1857

Voucher from the Engineer Department of Port Dalhousie and Thorold Railway Extension to Francis A. Doyle for fees at the Fonthill Registry Office (copy), July 28, 1857.

Pay roll voucher #24 from the Engineer Department of Port Dalhousie and Thorold Railway Extension, for the office, for the month of July, 1857 approved by F. Shanly, chief engineer (copy), July 31, 1857

Pay roll voucher #24 from the Engineer Department of Port Dalhousie and Thorold Railway Extension, for the office, for the month of July, 1857 approved by F. Shanly, chief engineer (copy), July 31, 1857.

Vignettes and self-reported work disability in the United States: Correction of report heterogeneity

Subjective measures of health tend to suffer from bias given by reporting heterogeneity. however, some methodologies are used to correct the bias in order to compare self-assessed health for respondents with different sociodemographic characteristics. One of the methods to correct this is the hierarchical ordered probit (hopit), which includes rates of vignettes -hypothetical individuals with a fixed health state- and where two assumptions have to be fulfilled, vignette equivalence and response consistency. this methodology is used for the self-reported work disability for a sample of the united states for 2011. The results show that even though sociodemographic variables influence rating scales, adjusting for this does not change their effect on work disability, which is only influenced by income. the inclusion of variables related with ethnicity or place of birth does not influence the true work disability. however, when only one of them is excluded, it becomes significant and affects the true level of work disability as well as income.

Tendencias recientes en las importaciones de productos latinoamericanos en los Estados Unidos = Recent trends in United States imports of Latin American products

Incluye Bibliografía

An assessment of fiscal and regulatory barriers to deployment of energy efficiency and renewable energy technologies in Guyana

Includes bibliography.

An assessment of fiscal and regulatory barriers to deployment of energy efficiency and renewable energy technologies in Curaçao

The current energy systems within Curaçao depend primarily on high cost, imported fossil fuels, and typically constitute power sectors that are characterized by small, inefficient generation plants which result in high energy prices. As a consequence of its dependence on external fuel supplies, Curaçao is extremely vulnerable to international oil price shocks, which can impact on economic planning and foreign direct investment within their industrial sectors. The ability of the successive governments to source capital for economic stimulation and social investment is therefore significantly challenging. Additionally, there is over-dependence on two of the most climate-sensitive economic sectors, namely the tourism and fisheries sectors, but the vulnerabilities of the country to the effects of climate change make adaptation difficult and costly. It is within this context that this report focuses on identification of the fiscal and regulatory barriers to implementation of energy efficiency and renewable energy technologies in Curaçao with a view of making recommendations for removal of these barriers. Consultations with key Government officials, the private sector as well as civil society were conducted to obtain information and data on the energy sector in the country. Desktop research was also conducted to supplement the information gathered from the consultations. The major result of the assessment is that Curaçao is at an early stage in the definition of its energy sector. Despite some infrastructural legacies of the pre-independence era, as well as a number of recent developments including the modernization and expansion of its windfarms and completion of a modern Electricity Policy, there are still a number of important institutional and policy gaps within the energy sector in Curaçao. The most significant deficiency is the absence of a ministry or Government agency with portfolio responsibility for the energy sector as a whole; this has: limited the degree to which the activities of energy sector stakeholders are coordinated and retarded the development and implementation of a comprehensive national energy policy. The absence of an energy policy, which provides the framework for energy planning, increases investor risk. Also, the lack of political continuity that has emanated from the frequent changes in Government administrations is a concern among stakeholders and has served to reduce investor confidence in particular, and market confidence in general.