Effect of pay for performance on the management and outcomes of hypertension in the United Kingdom: interrupted time series study

Objective To assess the impact of a pay for performance incentive on quality of care and outcomes among UK patients with hypertension in primary care

Burden of respiratory viral infection in persons with human immunodeficiency virus

This study was conducted to determine the prevalence of respiratory viral infections (RVI) in persons living with HIV (PLH) admitted with a respiratory complaint using real-time reverse transcription polymerase chain reaction and primer-independent next-generation sequencing (NGS). Of 82 subjects, respiratory viruses were the most common pathogen identified in 27 (33%), followed by fungus and bacteria in 8 (10%) and 4 (5%) subjects, respectively. Among subjects with RVI, 11 (41%) required ICU admission and 16 (59%) required mechanical ventilation. The proportion of respiratory viruses identified, and the associated complicated hospital course highlights the significant role that RVIs play in the lung health of PLH

Incorporation of globally available datasets into the roving cosmic-ray neutron probe method for estimating field-scale soil water content

The need for accurate, real-time, reliable, and multi-scale soil water content (SWC) monitoring is critical for a multitude of scientific disciplines trying to understand and predict the Earth’s terrestrial energy, water, and nutrient cycles. One promising technique to help meet this demand is fixed and roving cosmic-ray neutron probes (CRNPs). However, the relationship between observed low-energy neutrons and SWC is affected by local soil and vegetation calibration parameters. This effect may be accounted for by a calibration equation based on local soil type and the amount of vegetation. However, determining the calibration parameters for this equation is labor- and time-intensive, thus limiting the full potential of the roving CRNP in large surveys and long transects, or its use in novel environments. In this work, our objective is to develop and test the accuracy of globally available datasets (clay weight percent, soil bulk density, and soil organic carbon) to support the operability of the roving CRNP. Here, we develop a 1 km product of soil lattice water over the continental United States (CONUS) using a database of in situ calibration samples and globally available soil taxonomy and soil texture data. We then test the accuracy of the global dataset in the CONUS using comparisons from 61 in situ samples of clay percent (RMSE=5.45 wt %, R2=0.68), soil bulk density (RMSE=0.173 g cm-3, R2=0.203), and soil organic carbon (RMSE=1.47 wt %, R2=0.175). Next, we conduct an uncertainty analysis of the global soil calibration parameters using a Monte Carlo error propagation analysis (maximum RMSE~0.035cm3 cm-3 at a SWC=0.40 cm3 cm-3). In terms of vegetation, fast-growing crops (i.e., maize and soybeans), grasslands, and forests contribute to the CRNP signal primarily through the water within their biomass and this signal must be accounted for accurate estimation of SWC. We estimated the biomass water signal by using a vegetation index derived from MODIS imagery as a proxy for standing wet biomass (RMSEm-2). Lastly, we make recommendations on the design and validation of future roving CRNP experiments

Evaluation of Bird Shield as a blackbird repellent in ripening rice and sunflower fields

Chemical repellents sometimes can provide a nonlethal alternative for reducing wildlife impacts to agricultural production. In late summer and autumn 2002, we evaluated Bird Shield™ (active ingredient: methyl anthranilate, Bird Shield Repellent Corporation, Spokane, Wash.) as a blackbird (Icteridae) repellent in Missouri rice fields and North Dakota sunflower fields. We selected 5 pairs of ripening rice fields in southeastern Missouri and randomly allocated treatments (treated and control) within pairs. The repellent was aerially applied by fixed-winged aircraft at the recommended label rate and volume (1.17 L Bird Shield/ha and 46.7 L/ha, respectively); 1 field received 2X the label rate. We observed no difference in average bird activity (birds/minute) between treated and control fields over the 3-day posttreatment period (P = 0.503). We used reversed-phase liquid chromatography to quantify methyl anthranilate residues in treated fields. The maximum concentration of methyl anthranilate in rice samples was 4.71 μg/g. This concentration was below reported threshold values that irritate birds. In North Dakota we selected 6 pairs of sunflower fields used by foraging blackbirds. We randomly selected 1 field from each pair for 2 aerial applications of Bird Shield at the label-recommended rate ~1 week apart. The remaining 6 fields served as controls. Daily bird counts, starting the first day of application and continuing for 5–7 days after the second application, showed similar numbers of blackbirds within treated and control fields (P = 0.964). We observed no difference in sunflower damage within treated and control fields (P = 0.172) prior and subsequent to the treatment. Bird Shield was not effective for repelling blackbirds from ripening rice and sunflower fields

Evaluation of Bird Shield as a blackbird repellent in ripening rice and sunflower fields

Chemical repellents sometimes can provide a nonlethal alternative for reducing wildlife impacts to agricultural production. In late summer and autumn 2002, we evaluated Bird Shield™ (active ingredient: methyl anthranilate, Bird Shield Repellent Corporation, Spokane, Wash.) as a blackbird (Icteridae) repellent in Missouri rice fields and North Dakota sunflower fields. We selected 5 pairs of ripening rice fields in southeastern Missouri and randomly allocated treatments (treated and control) within pairs. The repellent was aerially applied by fixed-winged aircraft at the recommended label rate and volume (1.17 L Bird Shield/ha and 46.7 L/ha, respectively); 1 field received 2X the label rate. We observed no difference in average bird activity (birds/minute) between treated and control fields over the 3-day posttreatment period (P = 0.503). We used reversed-phase liquid chromatography to quantify methyl anthranilate residues in treated fields. The maximum concentration of methyl anthranilate in rice samples was 4.71 μg/g. This concentration was below reported threshold values that irritate birds. In North Dakota we selected 6 pairs of sunflower fields used by foraging blackbirds. We randomly selected 1 field from each pair for 2 aerial applications of Bird Shield at the label-recommended rate ~1 week apart. The remaining 6 fields served as controls. Daily bird counts, starting the first day of application and continuing for 5–7 days after the second application, showed similar numbers of blackbirds within treated and control fields (P = 0.964). We observed no difference in sunflower damage within treated and control fields (P = 0.172) prior and subsequent to the treatment. Bird Shield was not effective for repelling blackbirds from ripening rice and sunflower fields

Building a patient safety toolkit for use in general practice

Despite 340 000 000 primary care consultations annually in the UK, most of the literature on patient safety has focused on hospital-based services. To improve safety in primary care settings, we must know what methods, tools and indicators are available to measure and monitor patient safety. In collaboration with patient safety experts at the University of Dundee, we were able to identify a number of existing tools, and many of these were adopted for use in the Patient Safety Toolkit

Scaling-up a pharmacist-led information technology intervention (PINCER) to reduce hazardous prescribing in general practices:Multiple interrupted time series study

Background We previously reported on a sandomsied trial demonstrating the effectiveness and cost-effectiveness of a pharmacist-led information technology intervention (PINCER). We sought to investigate whether PINCER was effective in reducing hazardous prescribing when rolled out at scale in UK general practices. Methods and findings We used a multiple interrupted time series design whereby successive groups of general practices received the PINCER intervention between September 2015 and April 2017. We used 11 prescribing safety indicators to identify potentially hazardous prescribing and collected data over a maximum of 16 quarterly time periods. The primary outcome was a composite of all the indicators; a composite for indicators associated with gastrointestinal (GI) bleeding was also reported, along with 11 individual indicators of hazardous prescribing. Data were analysed using logistic mixed models for the quarterly event numbers with the appropriate denominator, and calendar time included as a covariate. PINCER was implemented in 370 (94.1%) of 393 general practices covering a population of almost 3 million patients in the East Midlands region of England; data were successfully extracted from 343 (92.7%) of these practices. For the primary composite outcome, the PINCER intervention was associated with a decrease in the rate of hazardous prescribing of 16.7% (adjusted odds ratio (aOR) 0.83, 95% confidence interval (CI) 0.80 to 0.86) at 6 months and 15.3% (aOR 0.85, 95% CI 0.80 to 0.90) at 12 months postintervention. The unadjusted rate of hazardous prescribing reduced from 26.4% (22,503 patients in the numerator/853,631 patients in the denominator) to 20.1% (11,901 patients in the numerator/591,364 patients in the denominator) at 6 months and 19.1% (3,868 patients in the numerator/ 201,992 patients in the denominator). The greatest reduction in hazardous prescribing associated with the intervention was observed for the indicators associated with GI bleeding; for the GI composite indicator, there was a decrease of 23.9% at both 6 months (aOR 0.76, 95% CI 0.73 to 0.80) and 12 months (aOR 0.76, 95% CI 0.70 to 0.82) postintervention. The unadjusted rate of hazardous prescribing reduced from 31.4 (16,185 patients in the numerator/515,879 patients in the denominator) to 21.2% (7,607 patients in the numerator/358,349 patients in the denominator) at 6 months and 19.5% (2,369 patients in the numerator/121,534 patients in the denominator). We adjusted for calendar time and practice, but since this was an observational study, the findings may have been influenced by unknown confounding factors or behavioural changes unrelated to the PINCER intervention. Data were also not collected for all practices at 6 months and 12 months postintervention. Conclusions The PINCER intervention, when rolled out at scale in routine clinical practice, was associated with a reduction in hazardous prescribing by 17% and 15% at 6 and 12 months postintervention. The greatest reductions in hazardous prescribing were for indicators associated with risk of GI bleeding. These findings support the wider national rollout of PINCER in England

α-Synuclein Aggregation Inhibitory Prunolides and a Dibrominated β-Carboline Sulfamate from the Ascidian Synoicum prunum

Seven new polyaromatic bis-spiroketal-containing butenolides, the prunolides D–I (4–9) and cis-prunolide C (10), a new dibrominated β-carboline sulfamate named pityriacitrin C (11), alongside the known prunolides A–C (1–3) were isolated from the Australian colonial ascidian Synoicum prunum. The prunolides D–G (4–7) represent the first asymmetrically brominated prunolides, while cis-prunolide C (10) is the first reported with a cis-configuration about the prunolide’s bis-spiroketal core. The prunolides displayed binding activities with the Parkinson’s disease-implicated amyloid protein α-synuclein in a mass spectrometry binding assay, while the prunolides (1–5 and 10) were found to significantly inhibit the aggregation (>89.0%) of α-synuclein in a ThT amyloid dye assay. The prunolides A–C (1–3) were also tested for inhibition of pSyn aggregate formation in a primary embryonic mouse midbrain dopamine neuron model with prunolide B (2) displaying statistically significant inhibitory activity at 0.5 μM. The antiplasmodial and antibacterial activities of the isolates were also examined with prunolide C (3) displaying only weak activity against the 3D7 parasite strain of Plasmodium falciparum. Our findings reported herein suggest that the prunolides could provide a novel scaffold for the exploration of future therapeutics aimed at inhibiting amyloid protein aggregation and the treatment of numerous neurodegenerative diseases.Peer reviewe

Urinary ATP as an indicator of infection and inflammation of the urinary tract in patients with lower urinary tract symptoms

BACKGROUND: Adenosine-5'-triphosphate (ATP) is a neurotransmitter and inflammatory cytokine implicated in the pathophysiology of lower urinary tract disease. ATP additionally reflects microbial biomass thus has potential as a surrogate marker of urinary tract infection (UTI). The optimum clinical sampling method for ATP urinalysis has not been established. We tested the potential of urinary ATP in the assessment of lower urinary tract symptoms, infection and inflammation, and validated sampling methods for clinical practice. METHODS: A prospective, blinded, cross-sectional observational study of adult patients presenting with lower urinary tract symptoms (LUTS) and asymptomatic controls, was conducted between October 2009 and October 2012. Urinary ATP was assayed by a luciferin-luciferase method, pyuria counted by microscopy of fresh unspun urine and symptoms assessed using validated questionnaires. The sample collection, storage and processing methods were also validated. RESULTS: 75 controls and 340 patients with LUTS were grouped as without pyuria (n = 100), pyuria 1-9 wbc ?l(-1) (n = 120) and pyuria ?10 wbc ?l(-1) (n = 120). Urinary ATP was higher in association with female gender, voiding symptoms, pyuria greater than 10 wbc ?l(-1) and negative MSU culture. ROC curve analysis showed no evidence of diagnostic test potential. The urinary ATP signal decayed with storage at 23°C but was prevented by immediate freezing at ??-20°C, without boric acid preservative and without the need to centrifuge urine prior to freezing. CONCLUSIONS: Urinary ATP may have a role as a research tool but is unconvincing as a surrogate, clinical diagnostic marker