A pilot study of the S-MAP (Solutions for Medications Adherence Problems) intervention for older adults prescribed polypharmacy in primary care: Study protocol

Background: Adhering to multiple medications as prescribed is challenging for older patients (aged ≥ 65 years) and a difficult behaviour to improve. Previous interventions designed to address this have been largely complex in nature but have shown limited effectiveness and have rarely used theory in their design. It has been recognised that theory ('a systematic way of understanding events or situations') can guide intervention development and help researchers better understand how complex adherence interventions work. This pilot study aims to test a novel community pharmacy-based intervention that has been systematically developed using the Theoretical Domains Framework (12-domain version) of behaviour change. Methods: As part of a non-randomised pilot study, pharmacists in 12 community pharmacies across Northern Ireland (n = 6) and London, England (n = 6), will be trained to deliver the intervention to older patients who are prescribed ≥ 4 regular medicines and are non-adherent (self-reported). Ten patients will be recruited per pharmacy (n = 120) and offered up to four tailored one-to-one sessions, in the pharmacy or via telephone depending on their adherence, over a 3-4-month period. Guided by an electronic application (app) on iPads, the intervention content will be tailored to each patient's underlying reasons for non-adherence and mapped to the most appropriate solutions using established behaviour change techniques. This study will assess the feasibility of collecting data on the primary outcome of medication adherence (self-report and dispensing data) and secondary outcomes (health-related quality of life and unplanned hospitalisations). An embedded process evaluation will assess training fidelity for pharmacy staff, intervention fidelity, acceptability to patients and pharmacists and the intervention's mechanism of action. Process evaluation data will include audio-recordings of training workshops, intervention sessions, feedback interviews and patient surveys. Analysis will be largely descriptive. Discussion: Using pre-defined progression criteria, the findings from this pilot study will guide the decision whether to proceed to a cluster randomised controlled trial to test the effectiveness of the S-MAP intervention in comparison to usual care in community pharmacies. The study will also explore how the intervention components may work to bring about change in older patients' adherence behaviour and guide further refinement of the intervention and study procedures. Trial registration: This study is registered at ISRCTN: https://doi.org/10.1186/ISRCTN7383153

Community experiences of organised crime in Scotland

The research explored community experiences of serious organised crime in Scotland (SOC). The report provides information on the nature and extent of the impact of SOC on everyday life in the community, as well as offering suggestions for policy development. The study sought to answer the following questions: 1)What are the relationships that exist between SOC and communities in Scotland? 2)What are the experiences and perceptions of residents, stakeholders and organisations of the scope and nature of SOC within their local area? and 3)How does SOC impact on community wellbeing, and to what extent can the harms associated with SOC be mitigated

The role of cosmic ray pressure in accelerating galactic outflows

We study the formation of galactic outflows from supernova explosions (SNe) with the moving-mesh code AREPO in a stratified column of gas with a surface density similar to the Milky Way disk at the solar circle. We compare different simulation models for SNe placement and energy feedback, including cosmic rays (CR), and find that models that place SNe in dense gas and account for CR diffusion are able to drive outflows with similar mass loading as obtained from a random placement of SNe with no CRs. Despite this similarity, CR-driven outflows differ in several other key properties including their overall clumpiness and velocity. Moreover, the forces driving these outflows originate in different sources of pressure, with the CR diffusion model relying on non-thermal pressure gradients to create an outflow driven by internal pressure and the random-placement model depending on kinetic pressure gradients to propel a ballistic outflow. CRs therefore appear to be non-negligible physics in the formation of outflows from the interstellar medium.Comment: 8 pages, 4 figures, accepted for publication in ApJL; movie of simulated gas densities can be found here: http://www.h-its.org/tap-images/galactic-outflows

Group treatments for sensitive health care problems : a randomised controlled trial of group versus individual physiotherapy sessions for female urinary incontinence

Background: The aim was to compare effectiveness of group versus individual sessions of physiotherapy in terms of symptoms, quality of life, and costs, and to investigate the effect of patient preference on uptake and outcome of treatment. Methods: A pragmatic, multi-centre randomised controlled trial in five British National Health Service physiotherapy departments. 174 women with stress and/or urge incontinence were randomised to receive treatment from a physiotherapist delivered in a group or individual setting over three weekly sessions. Outcome were measured as Symptom Severity Index; Incontinence-related Quality of Life questionnaire; National Health Service costs, and out of pocket expenses. Results: The majority of women expressed no preference (55%) or preference for individual treatment (36%). Treatment attendance was good, with similar attendance with both service delivery models. Overall, there were no statistically significant differences in symptom severity or quality of life outcomes between the models. Over 85% of women reported a subjective benefit of treatment, with a slightly higher rating in the individual compared with the group setting. When all health care costs were considered, average cost per patient was lower for group sessions (Mean cost difference £52.91 95%, confidence interval (£25.82 - £80.00)). Conclusion: Indications are that whilst some women may have an initial preference for individual treatment, there are no substantial differences in the symptom, quality of life outcomes or non-attendance. Because of the significant difference in mean cost, group treatment is recommended

Discrete-time rewards model-checked

This paper presents a model-checking approach for analyzing discrete-time Markov reward models. For this purpose, the temporal logic probabilistic CTL is extended with reward constraints. This allows to formulate complex measures – involving expected as well as accumulated rewards – in a precise and succinct way. Algorithms to efficiently analyze such formulae are introduced. The approach is illustrated by model-checking a probabilistic cost model of the IPv4 zeroconf protocol for distributed address assignment in ad-hoc networks

Recent results and new hardware developments for protein crystal growth in microactivity

Protein crystal growth experiments have been performed on 16 space shuttle missions since April, 1985. The initial experiments utilized vapor diffusion crystallization techniques similar to those used in laboratories for earth-based experiments. More recent experiments have utilized temperature induced crystallization as an alternative method for growing high quality protein crystals in microgravity. Results from both vapor diffusion and temperature induced crystallization experiments indicate that proteins grown in microgravity may be larger, display more uniform morphologies, and yield diffraction data to significantly higher resolutions than the best crystals of these proteins grown on earth

Sensitivity of 3D Convective Urca Simulations to Changes in Urca Reactions

A proposed setting for thermonuclear (Type Ia) supernovae is a white dwarf that has gained mass from a companion to the point of carbon ignition in the core. There is a simmering phase in the early stages of burning that involves the formation and growth of a core convection zone. One aspect of this phase is the convective Urca process, a linking of weak nuclear reactions to convection that may alter the composition and structure of the white dwarf. Convective Urca is not well understood and requires 3D fluid simulations to realistically model. Additionally, the convection is relatively slow (Mach number less than 0.005) so a low-Mach method is needed to make simulating computationally feasible. Using the MAESTROeX low-Mach hydrodynamics code, we investigate recent changes to how the weak reactions are modeled in the convective Urca simulations. We present results that quantify the changes to the reaction rates and their impact on the evolution of the simulation.Comment: 9 pages, 7 figures, submitted to the Proceedings of 15th International Conference on Numerical Modeling of Space Plasma Flows (AstroNum

Linear criteria for gravity-wave breaking in resonant stratified flow over a ridge

Using linear theory, it is shown that, in resonant flow over a 2D mountain ridge, such as exists when a layer of uniform wind is topped by an environmental critical level, the conditions for internal gravity-wave breaking are different from those determined in previous studies for non-resonant flows. For Richardson numbers in the shear layer not exceeding 2.25, two zones of flow overturning exist, respectively below and downstream and above and upstream of the expected locations. Flow overturning occurs for values of the dimensionless height of the ridge smaller than those required for a uniform wind profile. These results may have implications for the physical understanding of high-drag states

Nonperturbative Vertices in Supersymmetric Quantum Electrodynamics

We derive the complete set of supersymmetric Ward identities involving only two- and three- point proper vertices in supersymmetric QED. We also present the most general form of the proper vertices consistent with both the supersymmetric and U(1) gauge Ward identities. These vertices are the supersymmetric equivalent of the non supersymmetric Ball-Chiu vertices.Comment: seventeen pages late