Any versus long-term prescribing of high risk medications in older people using 2012 Beers Criteria: results from three cross-sectional samples of primary care records for 2003/4, 2007/8 and 2011/12

Background: High risk medications are commonly prescribed to older US patients. Currently, less is known about high risk medication prescribing in other Western Countries, including the UK. We measured trends and correlates of high risk medication prescribing in a subset of the older UK population (community/institutionalized) to inform harm minimization efforts. Methods: Three cross-sectional samples from primary care electronic clinical records (UK Clinical Practice Research Datalink, CPRD) in fiscal years 2003/04, 2007/08 and 2011/12 were taken. This yielded a sample of 13,900 people aged 65 years or over from 504 UK general practices. High risk medications were defined by 2012 Beers Criteria adapted for the UK. Using descriptive statistical methods and regression modelling, prevalence of ‘any’ (drugs prescribed at least once per year) and ‘long-term’ (drugs prescribed all quarters of year) high risk medication prescribing and correlates were determined. Results: While polypharmacy rates have risen sharply, high risk medication prevalence has remained stable across a decade. A third of older (65+) people are exposed to high risk medications, but only half of the total prevalence was long-term (any = 38.4 % [95 % CI: 36.3, 40.5]; long-term = 17.4 % [15.9, 19.9] in 2011/12). Long-term but not any high risk medication exposure was associated with older ages (85 years or over). Women and people with higher polypharmacy burden were at greater risk of exposure; lower socio-economic status was not associated. Ten drugs/drug classes accounted for most of high risk medication prescribing in 2011/12. Conclusions: High risk medication prescribing has not increased over time against a background of increasing polypharmacy in the UK. Half of patients receiving high risk medications do so for less than a year. Reducing or optimising the use of a limited number of drugs could dramatically reduce high risk medications in older people. Further research is needed to investigate why the oldest old and women are at greater risk. Interventions to reduce high risk medications may need to target shorter and long-term use separately.

Using particle dispersal models to assist in the conservation and recovery of the overexploited native oyster (Ostrea edulis) in an enclosed sea lough

Oyster populations around the world have seen catastrophic decline which has been largely attributed to overexploitation, disease and pollution. While considerable effort and resources have been implemented into restoring these important environmental engineers, the success of oyster populations is often limited by poor understanding of site-specific dispersal patterns of propagules. Water-borne transport is a key factor controlling or regulating the dispersal of the larval stage of benthic marine invertebrates which have limited mobility. The distribution of the native oyster Ostrea edulis in Strangford Lough, Northern Ireland, together with their densities and population structure at subtidal and intertidal sites has been documented at irregular intervals between 1997 and 2013. This paper revisits this historical data and considers whether different prevailing environmental conditions can be used to explain the distribution, densities and population structure of O. edulis in Strangford Lough. The approach adopted involved comparing predictive 2D hydrodynamic models coupled with particle tracking to simulate the dispersal of oyster larvae with historical and recent field records of the distribution of both subtidal and intertidal, populations since 1995. Results from the models support the hypothesis that commercial stocks of O. edulis introduced into Strangford Lough in the 1990s resulted in the re-establishment of wild populations of oysters in the Northern Basin which in turn provided a potential source of propagules for subtidal populations. These results highlight that strategic site selection (while inadvertent in the case of the introduced population in 1995) for the re-introduction of important shellfish species can significantly accelerate their recovery and restoration.

Historical Dialogue and Memory in Policing Change: the Case of the Police in Northern Ireland

This paper explores the complex relationship between organisational change and historical dialogue in transitional societies. Using the policing reform process in Northern Ireland as an example, the paper does three things: the first is to explore the ways in which policing changes were understood within the policing organisation and ‘community’ itself. The second is to make use of a processual approach, privileging the interactions of context, process and time within the analysis. Thirdly, it considers this perspective through the relatively new lens of ‘historical dialogue’: understood here as a conversation and an oscillation between the past, present and future through reflections on individual and collective memory. Through this analysis, we consider how members’ understandings of a difficult past (and their roles in it) facilitated and/or impeded the organisations change process. Drawing on a range of interviews with previous and current members of the organisation, this paper sheds new light on how institutions deal with and understand the past as they experience organisational change within the a wider societal transition from conflict to non-violence.

Truth at 24 frames a second? A working dialogue between a film-maker and a historical consultant about the making of The Enigma of Frank Ryan

We employ a practice-based methodology based on a ‘live’ film project to explore the different ways that film-makers and historians narrate the past. Through a case-study of the production and exhibition of a drama-documentary feature-film, The Enigma of Frank Ryan, on which both authors (film-maker Bell and historian McGarry) worked respectively as director and historical consultant, we explore a range of critical issues arising from our collaboration. Through a dialogue between a director and a historian, a model of good practice between historians and film-makers emerges.

The TRAVATAN Dosing Aid accurately records when drops are taken.

PURPOSE:

To assess the accuracy of Travatan Dosing Aid recordings.

DESIGN:

Prospective evaluation of drop-recording accuracy.

METHODS:

Physicians and patients used the Dosing Aid, and logs of usage were compared to the data obtained from the Dosing Aid.

RESULTS:

Five physicians and 20 patients participated. Devices used by physicians recorded all drops dispensed. Extra readings were recorded when physicians carried the devices during the day. For patients, 93% of all drops were recorded, with 18 of 20 subjects having over 85% of the drops recorded. Seventy percent of patients would continue using the device.

CONCLUSIONS:

The Dosing Aid accurately recorded most eyedrops administered by patients and physicians. Given recent documentation of widespread under-compliance with medical therapy, the Dosing Aid could be a useful addition to clinical practice and research.

Exploiting local controversy: regional British censorship of Last Tango in Paris (1972)

This article explores local authority responses to the cinematic release of Last Tango in Paris in Britain. Using a range of archival material from the BBFC, the National Archives and the Public Records Office of Northern Ireland, it offers a detailed, comparative case study of three different locations; Belfast, Newport and Oxford. It argues that comparing local censorship decisions with the national decisions of the BBFC offer little in the way of regional nuance. In order to effectively understand the workings of local censorship, a deeper understanding of local discourses is needed as well as acknowledgement of broader pressure group activity and its impact on the local picture, such as that of the National Festival of Light.

Geochronological database and classification system for age uncertainties in Neotropical pollen records.

The newly updated inventory of palaeoecological research in Latin America offers an important overview of sites available for multi-proxy and multi-site purposes. From the collected literature supporting this inventory, we collected all available age model metadata to create a chronological database of 5116 control points (e.g. 14C, tephra, fission track, OSL, 210Pb) from 1097 pollen records. Based on this literature review, we present a summary of chronological dating and reporting in the Neotropics. Difficulties and recommendations for chronology reporting are discussed. Furthermore, for 234 pollen records in northwest South America, a classification system for age uncertainties is implemented based on chronologies generated with updated calibration curves. With these outcomes age models are produced for those sites without an existing chronology, alternative age models are provided for researchers interested in comparing the effects of different calibration curves and age–depth modelling software, and the importance of uncertainty assessments of chronologies is highlighted. Sample resolution and temporal uncertainty of ages are discussed for different time windows, focusing on events relevant for research on centennial- to millennial-scale climate variability. All age models and developed R scripts are publicly available through figshare, including a manual to use the scripts.

State History, Historical Legitimacy and Modern Ethnic Diversity

How much does the antiquity of states, and the sometimes arbitrary nature of colonial boundaries, explain the modern degree of ethnic diversity? It is shown that states with greater historical legitimacy (more continuity between the pre-colonial and post-colonial state) have less ethnic diversity. Historical legitimacy is more strongly correlated with ethnic diversity than are the antiquity of states, genetic diversity or the duration of human settlement. Although historical legitimacy is particularly pertinent to Africa, the correlation also holds outside Africa.

The Evolution of Extreme Cooperation via Shared Dysphoric Experiences

Willingness to lay down one’s life for a group of non-kin, well documented in the
historical and ethnographic records, represents an evolutionary puzzle. Here we
present a novel explanation for the willingness to fight and die for a group, combining evolutionary theorizing with empirical evidence from real-world human groups. Building on research in social psychology, we develop a mathematical model showing how conditioning cooperation on previous shared experience can allow extreme (i.e., life-threatening) pro-social behavior to evolve. The model generates a series of predictions that we then test empirically in a range of special sample populations (including military veterans, college fraternity/sorority members, football fans, martial arts practitioners, and twins). Our results show that sharing painful experiences produces “identity fusion” – a visceral sense of oneness – more so even than bonds of kinship, in turn motivating extreme pro-group behavior, including willingness to fight and die for the group. These findings have theoretical and practical relevance. Theoretically, our results speak to the origins of human cooperation, as we offer an explanation of extremely costly actions left unexplained by existing models.
Practically, our account of how shared dysphoric experiences produce identity fusion, which produces a willingness to fight and die for a non-kin group, helps us better understand such pressing social issues as suicide terrorism, holy wars, sectarian violence, gang-related violence, and other forms of intergroup conflict.

Realidade histórica na narrativa de ficção angolana: Mayombe, de Pepetela o ministro, de Wanhenga Xitu o vento que desorienta o caçador, de A. Santos

Usando documentos oficiais, registos legislativos, memórias e outras fontes documentais escritas produzidos no período entre os anos 60 e início da década de 90 do século XX, o presente estudo procura estabelecer a relação entre a narrativa de ficção e a realidade histórica documentada. O procedimento metodológico consistiu no confronto de registos de factos da realidade nos referidos documentos com o mundo possível criado pelos escritores. A investigação centrou-se nos romances de três escritores angolanos (Pepetela, Wanhenga Xitu e Arnaldo Santos). Os resultados demonstram que os textos ficcionais escolhidos se estruturam a partir da matéria de extracção histórica. O produto da pesquisa contribui para legitimar o valor documental das obras escolhidas entre outras que fazem parte da narrativa de ficção angolana. O trabalho visa, também, uma finalidade didáctica: a explicação de textos de ficção narrativa que analisam momentos marcantes da história recente de Angola; HISTORICAL REALITY IN THE NARRATIVE OF ANGOLAN FICTION ABSTRACT: Using official documents, legislative records, memories, and other written documental sources produced in the period between the sixties and the early nineties of the XX century, this study seeks to establish a relationship between fiction narrative and historical reality. The methodological procedure consisted in the comparison of records of the facts in the aforesaid documents with a possible world created by the author. The research focuses on novels by three Angolan writers (Pepetela, Wanhenga Xitu, and Arnaldo Santos). The results indicate that the selected fictional texts are structured from topics relating to history. The research outcome contributes to legitimate the documental value of the Works selected amongst those forming part of the Angolan fiction. Furthermore, the research serves another didactic purpose: explaining narrative fiction texts that review defining moments of the recent history of Angola.

Electronic health records for mobile citizens: a secure and collaborative architecture

Durante as ultimas décadas, os registos de saúde eletrónicos (EHR) têm evoluído para se adaptar a novos requisitos. O cidadão tem-se envolvido cada vez mais na prestação dos cuidados médicos, sendo mais pró ativo e desejando potenciar a utilização do seu registo. A mobilidade do cidadão trouxe mais desafios, a existência de dados dispersos, heterogeneidade de sistemas e formatos e grande dificuldade de partilha e comunicação entre os prestadores de serviços. Para responder a estes requisitos, diversas soluções apareceram, maioritariamente baseadas em acordos entre instituições, regiões e países. Estas abordagens são usualmente assentes em cenários federativos muito complexos e fora do controlo do paciente. Abordagens mais recentes, como os registos pessoais de saúde (PHR), permitem o controlo do paciente, mas levantam duvidas da integridade clinica da informação aos profissionais clínicos. Neste cenário os dados saem de redes e sistemas controlados, aumentando o risco de segurança da informação. Assim sendo, são necessárias novas soluções que permitam uma colaboração confiável entre os diversos atores e sistemas. Esta tese apresenta uma solução que permite a colaboração aberta e segura entre todos os atores envolvidos nos cuidados de saúde. Baseia-se numa arquitetura orientada ao serviço, que lida com a informação clínica usando o conceito de envelope fechado. Foi modelada recorrendo aos princípios de funcionalidade e privilégios mínimos, com o propósito de fornecer proteção dos dados durante a transmissão, processamento e armazenamento. O controlo de acesso _e estabelecido por políticas definidas pelo paciente. Cartões de identificação eletrónicos, ou certificados similares são utilizados para a autenticação, permitindo uma inscrição automática. Todos os componentes requerem autenticação mútua e fazem uso de algoritmos de cifragem para garantir a privacidade dos dados. Apresenta-se também um modelo de ameaça para a arquitetura, por forma a analisar se as ameaças possíveis foram mitigadas ou se são necessários mais refinamentos. A solução proposta resolve o problema da mobilidade do paciente e a dispersão de dados, capacitando o cidadão a gerir e a colaborar na criação e manutenção da sua informação de saúde. A arquitetura permite uma colaboração aberta e segura, possibilitando que o paciente tenha registos mais ricos, atualizados e permitindo o surgimento de novas formas de criar e usar informação clínica ou complementar.