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.

The anonymity of the hunt: A critique of hunting as sharing

Hunter-gatherers are often ascribed a “monistic” worldview at odds with the nature-society dichotomy. The centerpiece of this claim is that they view hunting as similar to sharing within the band and prey animals as part of a common sphere of sociality. This article challenges this thesis. An examination of the work of its main proponents shows that it conflates two different senses of “animal”—the flesh-and-blood animals of the hunt and the animal Spirit that is said to control the animals. The sharing motif in hunting makes sense with respect to the anthropomorphic Spirit but not to the animals hunted. The conditions of the hunt as a spatiotemporal event provide further grounds for skepticism toward the idea of hunting-as-sharing. Drawing on biologist Robert Hinde’s model of relationships, I argue that hunting represents an anonymous one-off interaction that cannot develop into a personal relationship, in stark contrast to the durable forms of personalized sociality associated with the hunter-gatherer band. This is not to deny the possibility of human-animal cosociality in the form of personal relationships but rather to redirect the search away from the hunt to the interface with domesticated animals.

The effect of lutein- and zeaxanthin-rich foods v. supplements on macular pigment level and serological markers of endothelial activation inflammation and oxidation pilot studies in healthy volunteers:pilot studies in healthy volunteers

The aim of the present study was to compare the effect of lutein- and zeaxanthin-rich foods and supplements on macular pigment level (MPL) and serological markers of endothelial activation, inflammation and oxidation in healthy volunteers. We conducted two 8-week intervention studies. Study 1 (n 52) subjects were randomised to receive either carrot juice (a carotene-rich food) or spinach powder (a lutein- and zeaxanthin-rich food) for 8 weeks. Study 2 subjects (n 75) received supplements containing lutein and zeaxanthin, ß-carotene, or placebo for 8 weeks in a randomised, double-blind, placebo-controlled trial. MPL, serum concentrations of lipid-soluble antioxidants, inter-cellular adhesion molecule 1, vascular cell adhesion molecule 1, C-reactive protein and F2-isoprostane levels were assessed at baseline and post-intervention in both studies. In these intervention studies, no effects on MPL or markers of endothelial activation, inflammation or oxidation were observed. However, the change in serum lutein and zeaxanthin was associated or tended to be associated with the change in MPL in those receiving lutein- and zeaxanthin-rich foods (lutein r 0.40, P = 0.05; zeaxanthin r 0.30, P = 0.14) or the lutein and zeaxanthin supplement (lutein r 0.43, P = 0.03; zeaxanthin r 0.22, P = 0.28). In both studies, the change in MPL was associated with baseline MPL (food study r - 0.54, P <0.001; supplement study r - 0.40, P <0.001). We conclude that this 8-week supplementation with lutein and zeaxanthin, whether as foods or as supplements, had no significant effect on MPL or serological markers of endothelial activation, inflammation and oxidation in healthy volunteers, but may improve MPL in the highest serum responders and in those with initially low MPL.

New identifications for blue objects towards the Galactic center: post-AGE stars, Be/disk stars and others

As part of a programme to investigate spatial variations in the Galactic chemical composition, we have been searching for normal B-type stars and A-type supergiants near the Galactic center. During this search we have found eleven peculiar stars, and in some cases performed detailed abundance analyses of them which suggest that they may be at a post-AGB evolutionary stage.

Patient satisfaction with realtime teledermatology in Northern Ireland

Teledermatology consultations were organized between two health centers and two hospitals in Northern Ireland using low-cost videoconferencing equipment. A prospective study of patient satisfaction was carried out. Following each teleconsultation, patients were asked to complete a questionnaire assessing their satisfaction with the service. Over 22 months, 334 patients were seen by a dermatologist over the video-link, and 292 patients (87%) completed the 16-item questionnaire. Patients reported universal satisfaction with the technical aspects of teledermatology. The quality of both the audio and the display was highly acceptable to patients. Personal experiences of the teledermatology consultation were also favourable: 85% felt comfortable using the video-link. The benefits of teledermatology were generally recognized: 88% of patients thought that a teleconsultation could save time. Patients found the teledermatology consultation to be as acceptable as the conventional dermatology consultation. These findings suggest overall patient satisfaction with realtime teledermatology.

Measuring icon complexity: An automated analysis

Measures of icon designs rely heavily on surveys of the perceptions of population samples. Thus, measuring the extent to which changes in the structure of an icon will alter its perceived complexity can be costly and slow. An automated system capable of producing reliable estimates of perceived complexity could reduce development costs and time. Measures of icon complexity developed by Garcia, Badre, and Stasko (1994) and McDougall, Curry, and de Bruijn (1999) were correlated with six icon properties measured using Matlab (MathWorks, 2001) software, which uses image-processing techniques to measure icon properties. The six icon properties measured were icon foreground, the number of objects in an icon, the number of holes in those objects, and two calculations of icon edges and homogeneity in icon structure. The strongest correlates with human judgments of perceived icon complexity (McDougall et al., 1999) were structural variability (r(s) = .65) and edge information (r(s) =.64).

Interlocking directorates and conflicts of interest: The Rotterdamsche Bankvereeniging, Müller & Co. and the Dutch financial crisis of the 1920s

How can interlocking directorates cause financial instability for universal banks? A detailed history of the Rotterdamsche Bankvereeninging in the 1920s answers this question in a case study. This large commercial bank adopted a new German-style universal banking business model from the early 1910s, sharing directors with the firms it financed as a means of controlling its interests. Then, in 1924, it required assistance from the Dutch state in order to survive a bank run brought on by public concerns over its close ties with Müller & Co., a trading conglomerate that suffered badly in the economic downturn of the early 1920s. Using a new narrative history combined with an interpretive model, this article shows how the interlocking directorates between the bank and this major client, and in particular the direction of influence of these interlocks, resulted in a conflict of interest that could not be easily overcome.