Potentially inappropriate prescribing in an Irish elderly population in primary care.

AIMS Screening tools have been formulated to identify potentially inappropriate prescribing (IP) in older people. Beers’ criteria are the most widely used but have disadvantages when used in Europe. New
IP screening tools called Screening Tool of Older Person’s Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) have been developed to identify potential IP and potential prescribing omissions (PPOs). The aim was to measure the prevalence rates of potential IP and PPOs in primary care using Beers’ criteria, STOPP and START.

METHODS
Case records of 1329 patients 65 years old from three general practices in one region of southern Ireland were studied. The mean age SD of the patients was 74.9 6.4 years, 60.9% were female. Patients’current diagnoses and prescription medicines were reviewed and the Beers’ criteria, STOPP and START tools applied.

RESULTS
The total number of medicines prescribed was 6684; median number of medicines per patient was ?ve (range 1–19). Overall, Beers’ criteria identi?ed 286 potentially inappropriate prescriptions in 18.3% (243) of patients, whilst the corresponding IP rate identi?ed by STOPP was 21.4% (284), in respect of 346 potentially inappropriate prescriptions. A total of 333 PPOs were identi?ed in 22.7% (302) of patients using the START tool.

CONCLUSION
Potentially inappropriate drug prescribing and errors of drug omission are highly prevalent among older people living in the community. Prevention strategies should involve primary care doctors and community pharmacists.

A chemoenzymatic synthesis of 5a-carba-alpha-D-mannose-6-phosphate

An efficient chemical synthesis of 5a-carba-alpha-D-mannose and its enzymatic elaboration to 5a-carba-alpha-D-mannose-6-phosphate, using yeast hexokinase, is described.

Limits on HDS/H2S abundance ratios in hot molecular cores

We have searched for HDS emission in a small number of hot cores. Using observations of (H2S)-S-34, we have derived upper limits to the [HDS]/[H2S] abundance ratio. The upper limits, which are close to 10(-3) can be interpreted in two ways, depending on whether grain surface reactions contribute to the formation of H2S. If grains do not dominate, then the H2S observed is formed in hot, post-shocked gas and a ratio close to the cosmic [D]/[H] ratio is expected for [HDS]/[H2S]. This scenario is consistent with our upper limits and with the relatively low abundance ratio found for [HDO]/[H2O] in hot cores but does not seem to account for all of the molecular [D]/[H] ratios observed in hot cores. If grains do dominate the formation of HBS, then the observed upper limit to the ratio is consistent with the formation of 'hot core ices' at a temperature of 60-80 K, close to the temperature at which cometary ices are thought to form.

The VLT-FLAMES survey of massive stars: Nitrogen abundances for Be-type stars in the Magellanic Clouds

Aims. We compare the predictions of evolutionary models for early-type stars with atmospheric parameters, projected rotational velocities and nitrogen abundances estimated for a sample of Be-type stars. Our targets are located in 4 fields centred on the Large Magellanic Cloud cluster: NGC 2004 and the N 11 region as well as the Small Magellanic Cloud clusters: NGC 330 and NGC 346.

Spray Congealed Lipid Microparticles with High Protein Loading: Preparation and Solid State Characterization

The spray-congealing technique, a solvent-free drug encapsulation process, was successfully employed to obtain lipid-based particulate systems with high (10–20% w/w) protein loading. Bovine serum albumin (BSA) was utilised as model protein and three low melting lipids (glyceryl palmitostearate, trimirystin and tristearin) were employed as carriers. BSA-loaded lipid microparticles were characterised in terms of particle size, morphology and drug loading. The results showed that the microparticles exhibited a spherical shape, mean diameter in the range 150–300 µm and an encapsulation efficiency higher than 90%. Possible changes in the protein structure as a result of the manufacturing process was then investigated for the first time using UV spectrophotometry in fourth derivative mode and FT-Raman spectroscopy. The results suggested that the structural integrity of the protein was maintained within the particles. Thermal analysis indicated that the effect of protein on the thermal properties of the carriers could be detected. Spray-congealing could thus be considered a suitable technique to produce highly BSA-loaded microparticles preserving the structure of the protein.

Dietary patterns and bone mineral status in young adults: the Northern Ireland Young Hearts Project

Studies of individual nutrients or foods have revealed much about dietary influences on bone. Multiple food or nutrient approaches, such as dietary pattern analysis, could offer further insight but research is limited and largely confined to older adults. We examined the relationship between dietary patterns, obtained by a posteriori and a priori methods, and bone mineral status (BMS; collective term for bone mineral content (BMC) and bone mineral density (BMD)) in young adults (20-25 years; n 489). Diet was assessed by 7 d diet history and BMD and BMC were determined at the lumbar spine and femoral neck (FN). A posteriori dietary patterns were derived using principal component analysis (PCA) and three a priori dietary quality scores were applied (dietary diversity score (DDS), nutritional risk score and Mediterranean diet score). For the PCA-derived dietary patterns, women in the top compared to the bottom fifth of the 'Nuts and Meat' pattern had greater FN BMD by 0.074 g/cm(2) (P=0.049) and FN BMC by 0.40 g (P=0.034) after adjustment for confounders. Similarly, men in the top compared to the bottom fifth of the 'Refined' pattern had lower FN BMC by 0.41 g (P-0.049). For the a priori DDS, women in the top compared to the bottom third had lower FN BMD by 0.05 g/cm(2) after adjustments (P=0.052), but no other relationships with BMS were identified. In conclusion, adherence to a 'Nuts and Meat' dietary pattern may be associated with greater BMS in young women and a 'Refined' dietary pattern may be detrimental for bone health in young men.

The nervous system of Amphilina foliacea (Platyhelminthes, Amphilinidea). An immunocytochemical, ultrastructural and spectrofluorometrical study

The nervous system of young and adult Amphilina foliacea was studied with immunocytochemical, electron microscopical and spectrofluorometrical methods. The general neuroanatomy is described in detail. New data on the structure and development of the brain were obtained. The 5-HT and GYIRFamide-immunoreactivities occur in separate sets of neurones. The innervation of the reproductive organs is described. The fine structure of 2 types of neurones in the CNS, a sensory neurone, a 'glial' cell type, the neuropile and the synapses are described. The level of 5-HT varies between 0.074 and 0.461 mug/g wet weight. This is the first detailed study of the nervous system of A. foliacea. Earlier data on the structure of the nervous system in A. foliacea published in Russian are introduced into the discussion. The study provides data that can be used when considering the phylogenetic position of Amphilinidea.

GABA IN THE NERVOUS-SYSTEM OF PARASITIC FLATWORMS

In an immunocytochemical study, using an antiserum and a monoclonal antibody specific for the amino acid, gamma-aminobutyric acid (GABA), GABA-like immunoreactivity (GLIR) has been demonstrated for the first time in parasitic flatworms. In Moniezia expansa (Cestoda), GLIR was seen in nerve nets which were closely associated with the body wall musculature and in the longitudinal nerve cords. In the liver fluke Fasciola hepatica (Trematoda), the GLIR occurred in the longitudinal nerve cords and lateral nerves in the posterior half of the worm. GLIR was also detected in subtegumental fibres in F. hepatica. The presence of GABA was verified, using high-pressure liquid chromatography coupled with fluorescence detection. The concentration of GABA (mean+/-S.D.) in M. expansa anterior region was 124.8+/-15.3 picomole/mg wet weight, while in F. hepatica it was 16.8+/-4.9 picomole/mg. Since several insecticides and anti-nematodal drugs are thought to interfere with GABA-receptors, the findings indicate that GABAergic neurotransmission may be a potential target for chemotherapy in flatworms too.

Protective qualities of surface treatments for concrete

Surface treatments are used as part of either a maintenance programme or repair work. In both cases, they provide additional protection to the concrete by either arresting or reducing the penetration of aggressive substances from the environment, Numerous materials are available for this purpose and their inherent generic properties differ considerably. Quite often this poses difficulties to practising engineers when selecting a surface treatment for a specific situation, In this review an attempt is made to explain the protective aspects of various surface treatments so that their selection can be made easier, The basic aspects of surface treatments are discussed: function, classification and performance requirements.

Celecoxib plus hormone therapy versus hormone therapy alone for hormone-sensitive prostate cancer: first results from the STAMPEDE multiarm, multistage, randomised controlled trial

BACKGROUND:
Long-term hormone therapy alone is standard care for metastatic or high-risk, non-metastatic prostate cancer. STAMPEDE--an international, open-label, randomised controlled trial--uses a novel multiarm, multistage design to assess whether the early additional use of one or two drugs (docetaxel, zoledronic acid, celecoxib, zoledronic acid and docetaxel, or zoledronic acid and celecoxib) improves survival in men starting first-line, long-term hormone therapy. Here, we report the preplanned, second intermediate analysis comparing hormone therapy plus celecoxib (arm D) with hormone therapy alone (control arm A).
METHODS:
Eligible patients were men with newly diagnosed or rapidly relapsing prostate cancer who were starting long-term hormone therapy for the first time. Hormone therapy was given as standard care in all trial arms, with local radiotherapy encouraged for newly diagnosed patients without distant metastasis. Randomisation was done using minimisation with a random element across seven stratification factors. Patients randomly allocated to arm D received celecoxib 400 mg twice daily, given orally, until 1 year or disease progression (including prostate-specific antigen [PSA] failure). The intermediate outcome was failure-free survival (FFS) in three activity stages; the primary outcome was overall survival in a subsequent efficacy stage. Research arms were compared pairwise against the control arm on an intention-to-treat basis. Accrual of further patients was discontinued in any research arm showing safety concerns or insufficient evidence of activity (lack of benefit) compared with the control arm. The minimum targeted activity at the second intermediate activity stage was a hazard ratio (HR) of 0·92. This trial is registered with ClinicalTrials.gov, number NCT00268476, and with Current Controlled Trials, number ISRCTN78818544.
FINDINGS:
2043 patients were enrolled in the trial from Oct 17, 2005, to Jan 31, 2011, of whom 584 were randomly allocated to receive hormone therapy alone (control group; arm A) and 291 to receive hormone therapy plus celecoxib (arm D). At the preplanned analysis of the second intermediate activity stage, with 305 FFS events (209 in arm A, 96 in arm D), there was no evidence of an advantage for hormone therapy plus celecoxib over hormone therapy alone: HR 0·94 (95% CI 0·74-1·20). [corrected]. 2-year FFS was 51% (95% CI 46-56) in arm A and 51% (95% CI 43-58) in arm D. There was no evidence of differences in the incidence of adverse events between groups (events of grade 3 or higher were noted at any time in 123 [23%, 95% CI 20-27] patients in arm A and 64 [25%, 19-30] in arm D). The most common grade 3-5 events adverse effects in both groups were endocrine disorders (55 [11%] of patients in arm A vs 19 [7%] in arm D) and musculoskeletal disorders (30 [6%] of patients in arm A vs 15 [6%] in arm D). The independent data monitoring committee recommended stopping accrual to both celecoxib-containing arms on grounds of lack of benefit and discontinuing celecoxib for patients currently on treatment, which was endorsed by the trial steering committee.
INTERPRETATION:
Celecoxib 400 mg twice daily for up to 1 year is insufficiently active in patients starting hormone therapy for high-risk prostate cancer, and we do not recommend its use in this setting. Accrual continues seamlessly to the other research arms and follow-up of all arms will continue to assess effects on overall survival.