Influences on Decision-Making Regarding Antipsychotic Prescribing in Nursing Home Residents With Dementia: A Systematic Review and Synthesis of Qualitative Evidence.

BACKGROUND: Antipsychotic prescribing is prevalent in nursing homes for the management of behavioral and psychological symptoms of dementia (BPSD), despite the known risks and limited effectiveness. Many studies have attempted to understand this continuing phenomenon, using qualitative research methods, and have generated varied and sometimes conflicting findings. To date, the totality of this qualitative evidence has not been systematically collated and synthesized. AIMS: To synthesize the findings from individual qualitative studies on decision-making and prescribing behaviors for antipsychotics in nursing home residents with dementia, with a view to informing intervention development and quality improvement in this field. METHODS: A systematic review and synthesis of qualitative evidence was conducted (PROSPERO protocol registration CRD42015029141). Six electronic databases were searched systematically from inception through July 2016 and supplemented by citation, reference, and gray literature searching. Studies were included if they used qualitative methods for both data collection and analysis, and explored antipsychotic prescribing in nursing homes for the purpose of managing BPSD. The Critical Appraisal Skills Program assessment tool was used for quality appraisal. A meta-ethnography was conducted to synthesize included studies. The Confidence in the Evidence from Reviews of Qualitative research approach was used to assess the confidence in individual review findings. All stages were conducted by at least 2 independent reviewers. RESULTS: Of 1534 unique records identified, 18 met the inclusion criteria. Five key concepts emerged as influencing decision-making: organizational capacity; individual professional capability; communication and collaboration; attitudes; regulations and guidelines. A "line of argument" was synthesized and a conceptual model constructed, comparing this decision-making process to a dysfunctional negative feedback loop. Our synthesis indicates that when all stakeholders come together to communicate and collaborate as equal and empowered partners, this can result in a successful reduction in inappropriate antipsychotic prescribing. CONCLUSIONS: Antipsychotic prescribing in nursing home residents with dementia occurs in a complex environment involving the interplay of various stakeholders, the nursing home organization, and external influences. To improve the quality of antipsychotic prescribing in this cohort, a more holistic approach to BPSD management is required. Although we have found the issue of antipsychotic prescribing has been extensively explored using qualitative methods, there remains a need for research focusing on how best to change the prescribing behaviors identified

Selection and phylogenetics of salmonid MHC class I: wild brown trout (Salmo trutta) differ from a non-native introduced strain

We tested how variation at a gene of adaptive importance, MHC class I (UBA), in a wild, endemic Salmo trutta population compared to that in both a previously studied non-native S. trutta population and a co-habiting Salmo salar population ( a sister species). High allelic diversity is observed and allelic divergence is much higher than that noted previously for cohabiting S. salar. Recombination was found to be important to population-level divergence. The alpha 1 and alpha 2 domains of UBA demonstrate ancient lineages but novel lineages are also identified at both domains in this work. We also find examples of recombination between UBA and the non-classical locus, ULA. Evidence for strong diversifying selection was found at a discrete suite of S. trutta UBA amino acid sites. The pattern was found to contrast with that found in re-analysed UBA data from an artificially stocked S. trutta population

Supersymmetric D-term Inflation, Reheating and Affleck-Dine Baryogenesis

The phenomenology of supersymmetric models of inflation, where the inflationary vacuum energy is dominated by D-terms of a U(1), is investigated. Particular attention is paid to the questions of how to arrange for sufficient e-folds of inflation to occur, what kind of thermal history is expected after the end of inflation, and how to implement successful baryogenesis. Such models are argued to require a more restrictive symmetry structure than previously thought. In particular, it is non-trivial that the decays of the fields driving D-inflation can reheat the universe in such a way as to avoid the strong gravitino production constraints. We also show how the initial conditions for Affleck-Dine baryogenesis can arise in these models and that the simplest flat directions along which baryon number is generated can often be ruled out by the constraints coming from decoherence of the condensate in a hot environment. At the end, we find that successful reheating and baryogenesis can take place in a large subset of D-inflationary models.Comment: 23 pages LaTe

Naturally Large Cosmological Neutrino Asymmetries in the MSSM

A large neutrino asymmetry is an interesting possibility for cosmology, which can have significant observable consequences for nucleosynthesis and the cosmic microwave background. However, although it is a possibility, there is no obvious reason to expect the neutrino asymmetry to be observably large. Here we note that if the baryon asymmetry originates via the Affleck-Dine mechanism along a d=4 flat direction of the MSSM scalar potential and if the lepton asymmetry originates via Affleck-Dine leptogenesis along a d=6 direction, corresponding to the lowest dimension directions conserving R-parity, then the ratio n_{L}/n_{B} is naturally in the range 10^{8}-10^{9}. As a result, a potentially observable neutrino asymmetry is correlated with a baryon asymmetry of the order of 10^{-10}.Comment: 10 pages LaTeX. Final version to be published in Physical Review Letter

A Framework to Manage the Complex Organisation of Collaborating: Its Application to Autonomous Systems

In this paper we present an analysis of the complexities of large group collaboration and its application to develop detailed requirements for collaboration schema for Autonomous Systems (AS). These requirements flow from our development of a framework for collaboration that provides a basis for designing, supporting and managing complex collaborative systems that can be applied and tested in various real world settings. We present the concepts of "collaborative flow" and "working as one" as descriptive expressions of what good collaborative teamwork can be in such scenarios. The paper considers the application of the framework within different scenarios and discuses the utility of the framework in modelling and supporting collaboration in complex organisational structures

Ploidy variation in Kluyveromyces marxianus separates dairy and non-dairy isolates

Kluyveromyces marxianus is traditionally associated with fermented dairy products, but can also be isolated from diverse non-dairy environments. Because of thermotolerance, rapid growth and other traits, many different strains are being developed for food and industrial applications but there is, as yet, little understanding of the genetic diversity or population genetics of this species. K. marxianus shows a high level of phenotypic variation but the only phenotype that has been clearly linked to a genetic polymorphism is lactose utilisation, which is controlled by variation in the LAC12 gene. The genomes of several strains have been sequenced in recent years and, in this study, we sequenced a further nine strains fromdifferent origins. Analysis of the Single Nucleotide Polymorphisms (SNPs) in 14 strains was carried out to examine genome structure and genetic diversity. SNP diversity in K. marxianus is relatively high, with up to 3% DNA sequence divergence between alleles. It was found that the isolates include haploid, diploid, and triploid strains, as shown by both SNP analysis and flow cytometry. Diploids and triploids contain long genomic tracts showing loss of heterozygosity (LOH). All six isolates from dairy environments were diploid or triploid, whereas 6 out 7 isolates from non-dairy environment were haploid. This also correlated with the presence of functional LAC12 alleles only in dairy haplotypes. The diploids were hybrids between a non-dairy and a dairy haplotype, whereas triploids included three copies of a dairy haplotype

Growth of Inflaton Perturbations and the Post-Inflation Era in Supersymmetric Hybrid Inflation Models

It has been shown that hybrid inflation may end with the formation of non-topological solitons of inflaton field. As a first step towards a fully realistic picture of the post-inflation era and reheating in supersymmetric hybrid inflation models, we study the classical scalar field equations of a supersymmetric hybrid inflation model using a semi-analytical ansatz for the spatial dependence of the fields. Using the minimal D-term inflation model as an example, the inflaton field is evolved using the full 1-loop effective potential from the slow-rolling era to the U(1)_{FI} symmetry-breaking phase transition. Spatial perturbations of the inflaton corresponding to quantum fluctuations are introduced for the case where there is spatially coherent U(1)_{FI} symmetry breaking. The maximal growth of the dominant perturbation is found to depend only on the ratio of superpotential coupling \lambda to the gauge coupling g. The inflaton condensate fragments to non-topological solitons for \lambda/g > 0.09. Possible consequences of non-topological soliton formation in fully realistic SUSY hybrid inflation models are discussed.Comment: 27 pages LaTeX, 8 figures. Additional references and discussio

Massless D-strings and moduli stabilization in type I cosmology

We consider the cosmological evolution induced by the free energy F of a gas of maximally supersymmetric heterotic strings at finite temperature and weak coupling in dimension D>=4. We show that F, which plays the role of an effective potential, has minima associated to enhanced gauge symmetries, where all internal moduli can be attracted and dynamically stabilized. Using the fact that the heterotic/type I S-duality remains valid at finite temperature and can be applied at each instant of a quasi-static evolution, we find in the dual type I cosmology that all internal NS-NS and RR moduli in the closed string sector and the Wilson lines in the open string sector can be stabilized. For the special case of D=6, the internal volume modulus remains a flat direction, while the dilaton is stabilized. An essential role is played by light D-string modes wrapping the internal manifold and whose contribution to the free energy cannot be omitted, even when the type I string is at weak coupling. As a result, the order of magnitude of the internal radii expectation values on the type I side is (lambda_I alpha')^{1/2}, where lambda_I is the ten-dimensional string coupling. The non-perturbative corrections to the type I free energy can alternatively be described as effects of "thermal E1-instantons", whose worldsheets wrap the compact Euclidean time cycle.Comment: 39 pages, 1 figur

Search for the standard model Higgs boson in the H to ZZ to 2l 2nu channel in pp collisions at sqrt(s) = 7 TeV

A search for the standard model Higgs boson in the H to ZZ to 2l 2nu decay channel, where l = e or mu, in pp collisions at a center-of-mass energy of 7 TeV is presented. The data were collected at the LHC, with the CMS detector, and correspond to an integrated luminosity of 4.6 inverse femtobarns. No significant excess is observed above the background expectation, and upper limits are set on the Higgs boson production cross section. The presence of the standard model Higgs boson with a mass in the 270-440 GeV range is excluded at 95% confidence level.Comment: Submitted to JHE