Trends in long-term prescribing of dependence forming medicines

Using patient-level primary care data to estimate the extent to which antidepressant medicines are prescribed to people continuously for long periods of time. Aim This descriptive research used patient-level primary care data to estimate the extent to which antidepressant medicines are prescribed to people continuously for long periods of time. The study also drew on survey data and data on the number of prescriptions dispensed. Findings - The number of antidepressant prescriptions dispensed each year in England doubled between 2008 and 2018 - Survey data show that the proportion of adults reporting use of antidepressants in the past year increased in the 1990s, and again between 2007 and 2014 - The average length of time that antidepressants are continuously prescribed to people for has increased over time. - Some types of antidepressants (for example, tricyclics and other antidepressants) tend to be prescribed for longer periods than other types (such as SSRIs). - In 2014, one in twelve prescribing periods for tricyclics and other antidepressants lasted for three years or more Methods The analyses in this report are descriptive and show the overall prevalence of long-term prescribing in each year. We used a sample of around 50,000 patients prescribed at least one antidepressant medicine between 2000 and 2017. This was drawn from the Clinical Practice Research Datalink (CPRD). The CPRD contains data about prescriptions issued by GPs (including the length and size of prescription) and characteristics of the patients prescribed to (such as their age, sex, and area where they live). Medicines were grouped for analysis into: tricyclics, selective serotonin reuptake inhibitors (SSRIs), and other ADMs. The length of individual prescriptions and continuous prescribing periods were derived using information on consultation dates, the quantity of tablets prescribed, and the numeric daily dose

Construct-level predictive validity of educational attainment and intellectual aptitude tests in medical student selection: meta-regression of six UK longitudinal studies

Background: Measures used for medical student selection should predict future performance during training. A problem for any selection study is that predictor-outcome correlations are known only in those who have been selected, whereas selectors need to know how measures would predict in the entire pool of applicants. That problem of interpretation can be solved by calculating construct-level predictive validity, an estimate of true predictor-outcome correlation across the range of applicant abilities. Methods: Construct-level predictive validities were calculated in six cohort studies of medical student selection and training (student entry, 1972 to 2009) for a range of predictors, including A-levels, General Certificates of Secondary Education (GCSEs)/O-levels, and aptitude tests (AH5 and UK Clinical Aptitude Test (UKCAT)). Outcomes included undergraduate basic medical science and finals assessments, as well as postgraduate measures of Membership of the Royal Colleges of Physicians of the United Kingdom (MRCP(UK)) performance and entry in the Specialist Register. Construct-level predictive validity was calculated with the method of Hunter, Schmidt and Le (2006), adapted to correct for right-censorship of examination results due to grade inflation. Results: Meta-regression analyzed 57 separate predictor-outcome correlations (POCs) and construct-level predictive validities (CLPVs). Mean CLPVs are substantially higher (.450) than mean POCs (.171). Mean CLPVs for first-year examinations, were high for A-levels (.809; CI: .501 to .935), and lower for GCSEs/O-levels (.332; CI: .024 to .583) and UKCAT (mean = .245; CI: .207 to .276). A-levels had higher CLPVs for all undergraduate and postgraduate assessments than did GCSEs/O-levels and intellectual aptitude tests. CLPVs of educational attainment measures decline somewhat during training, but continue to predict postgraduate performance. Intellectual aptitude tests have lower CLPVs than A-levels or GCSEs/O-levels. Conclusions: Educational attainment has strong CLPVs for undergraduate and postgraduate performance, accounting for perhaps 65% of true variance in first year performance. Such CLPVs justify the use of educational attainment measure in selection, but also raise a key theoretical question concerning the remaining 35% of variance (and measurement error, range restriction and right-censorship have been taken into account). Just as in astrophysics, ‘dark matter’ and ‘dark energy’ are posited to balance various theoretical equations, so medical student selection must also have its ‘dark variance’, whose nature is not yet properly characterized, but explains a third of the variation in performance during training. Some variance probably relates to factors which are unpredictable at selection, such as illness or other life events, but some is probably also associated with factors such as personality, motivation or study skills

Alien Registration- Mcmanus, Fred N. (Rumford, Oxford County)

https://digitalmaine.com/alien_docs/13521/thumbnail.jp

Dynamic and Integrative Properties of the Primary Visual Cortex

The ability to derive meaning from complex, ambiguous sensory input requires the integration of information over both space and time, as well as cognitive mechanisms to dynamically shape that integration. We have studied these processes in the primary visual cortex (V1), where neurons have been proposed to integrate visual inputs along a geometric pattern known as the association field (AF). We first used cortical reorganization as a model to investigate the role that a specific network of V1 connections, the long-range horizontal connections, might play in temporal and spatial integration across the AF. When retinal lesions ablate sensory information from portions of the visual field, V1 undergoes a process of reorganization mediated by compensatory changes in the network of horizontal collaterals. The reorganization accompanies the brain’s amazing ability to perceptually “fill-inâ€, or “seeâ€, the lost visual input. We developed a computational model to simulate cortical reorganization and perceptual fill-in mediated by a plexus of horizontal connections that encode the AF. The model reproduces the major features of the perceptual fill-in reported by human subjects with retinal lesions, and it suggests that V1 neurons, empowered by their horizontal connections, underlie both perceptual fill-in and normal integrative mechanisms that are crucial to our visual perception. These results motivated the second prong of our work, which was to experimentally study the normal integration of information in V1. Since psychophysical and physiological studies suggest that spatial interactions in V1 may be under cognitive control, we investigated the integrative properties of V1 neurons under different cognitive states. We performed extracellular recordings from single V1 neurons in macaques that were trained to perform a delayed-match-to-sample contour detection task. We found that the ability of V1 neurons to summate visual inputs from beyond the classical receptive field (cRF) imbues them with selectivity for complex contour shapes, and that neuronal shape selectivity in V1 changed dynamically according to the shapes monkeys were cued to detect. Over the population, V1 encoded subsets of the AF, predicted by the computational model, that shifted as a function of the monkeys’ expectations. These results support the major conclusions of the theoretical work; even more, they reveal a sophisticated mode of form processing, whereby the selectivity of the whole network in V1 is reshaped by cognitive state

The ranking of factors influencing the behaviour of light structures on expansive soils in Victoria, Australia

In this paper a Neural Network Model was used to develop a ranking of the potential damage influences for light structures on expansive soils in Victoria. These influences include geology, Thornthwaite moisture index, vegetation covers, construction foundation type, construction wall type, geographical region and age of building when first inspected. Approximately 400 cases of damage to light structures in Victoria, Australia were considered in this study. Feedforward Backpropagation was adopted to train the data. The ranking of importance was estimated using connection weight approach and then compared to results calculated from sensitivity analysis. From the analysis, the ranking of importance for potential damage factor was noted.<br /

Meta-analytic findings reveal lower means but higher variances in visuospatial ability in dyslexia

Conflicting empirical and theoretical accounts suggest that dyslexia is associated with either average, enhanced, or impoverished high-level visuospatial processing relative to controls. Such heterogeneous results could be due to the presence of wider variability in dyslexic samples, which is unlikely to be identified at the single study level, due to lack of power. To address this, the current study reports a meta-analysis of means and variances in high-level visuospatial ability in 909 non-dyslexic and 956 dyslexic individuals. The findings suggest that dyslexia is associated not only with a lower mean performance on visuospatial tasks, but also with greater variability in performance. Through novel meta-analytic techniques, we demonstrate a negative effect size for mean differences (-.457), but a positive effect size for SD differences (+.118; SD ratio = 1.107). In doing so, this is the first study to demonstrate impoverished visuospatial processing of the majority of individuals with dyslexia in addition to greater variance in performance in this group. The findings advocate for further consideration of both the presence of, and reasons for, increased variance in perception, attention and memory across neurodevelopmental disorders

Self-monitoring for improving control of blood pressue in patients with hypertension

The objective of this review is to determine the effect of SBPM in adults with hypertension on blood pressure control as compared to OBPM or usual care

Human SULT1A genes: Cloning and activity assays of the SULT1A promoters

The three human SULT1A sulfotransferase enzymes are closely related in amino acid sequence (>90%), yet differ in their substrate preference and tissue distribution. SULT1A1 has a broad tissue distribution and metabolizes a range of xenobiotics as well as endogenous substrates such as estrogens and iodothyronines. While the localization of SULT1A2 is poorly understood, it has been shown to metabolize a number of aromatic amines. SULT1A3 is the major catecholamine sulfonating form, which is consistent with it being expressed principally in the gastrointestinal tract. SULT1A proteins are encoded by three separate genes, located in close proximity to each other on chromosome 16. The presence of differential 5′-untranslated regions identified upon cloning of the SULT1A cDNAs suggested the utilization of differential transcriptional start sites and/or differential splicing. This chapter describes the methods utilized by our laboratory to clone and assay the activity of the promoters flanking these different untranslated regions found on SULT1A genes. These techniques will assist investigators in further elucidating the differential mechanisms that control regulation of the human SULT1A genes. They will also help reveal how different cellular environments and polymorphisms affect the activity of SULT1A gene promoters

Resource ecology of the Bolinao coral reef system

Resource /Energy Economics and Policy,

Are vitiligo treatments cost-effective? A systematic review

Vitiligo is characterised by well demarcated, cutaneous, macular depigmentation, with worldwide prevalence estimated to be between 0.2-1.8% [1]. Vitiligo treatments aim to encourage re-pigmentation and include topical corticosteroids, calcineurin inhibitors and NB-UVB phototherapy. Camouflage can also be prescribed to help mask the appearance of vitiligo, although this is frequently only prescribed for the face