Differential impact of two risk communications on antipsychotic prescribing to people with dementia in Scotland: segmented regression time series analysis 2001-2011

The two risk communications were associated with reductions in antipsychotic use, in ways which were compatible with marked differences in their content and dissemination. Further research is needed to ensure that the content and dissemination of regulatory risk communications is optimal, and to track their impact on intended and unintended outcomes. Although rates are falling, antipsychotic prescribing in dementia in Scotland remains unacceptably hig

Inhaled nitric oxide in premature infants: effect on tracheal aspirate and plasma nitric oxide metabolites

ObjectiveInhaled nitric oxide (iNO) is a potential new therapy for prevention of bronchopulmonary dysplasia and brain injury in premature infants. This study examined dose-related effects of iNO on NO metabolites as evidence of NO delivery.Study designA subset of 102 premature infants in the NO CLD trial, receiving 24 days of iNO (20 p.p.m. decreasing to 2 p.p.m.) or placebo, were analyzed. Tracheal aspirate (TA) and plasma samples collected at enrollment and at intervals during study gas were analyzed for NO metabolites.ResultiNO treatment increased NO metabolites in TA at 20 and 10 p.p.m. (1.7- to 2.3-fold vs control) and in plasma at 20, 10, and 5 p.p.m. (1.6- to 2.3-fold). In post hoc analysis, treated infants with lower metabolite levels at entry had an improved clinical outcome.ConclusioniNO causes dose-related increases in NO metabolites in the circulation as well as lung fluid, as evidenced by TA analysis, showing NO delivery to these compartments

Willow Cultivars

The State University of New York College of Environmental Science and Forestry (SUNY-ESF) presents fact sheets on Salix purpurea ‘Allegany’, Salix sachalinensis × S. miyabeana ‘Canastota’, Salix purpurea ‘Fish Creek’, Salix purpurea × S. miyabeana ‘Millbrook’, Salix purpurea × S. miyabeana ‘Oneida’, Salix purpurea ‘Onondaga’, Salix viminalis × S. miyabeana ‘Otisco’, Salix viminalis × S. miyabeana ‘Owasco’, Salix eriocephala ‘S25’, Salix caprea hybrid ‘S365’, Salix sachalinensis × S. miyabeana ‘Sherburne’, Salix × dasyclados ‘SV1’, Salix sachalinensis ‘SX61’, Salix miyabeana ‘SX64’, Salix miyabeana ‘SX67’, Salix viminalis × S. miyabeana ‘Tully Champion’

Diagnosing observation error correlations for Doppler radar radial winds in the Met Office UKV model using observation-minus-background and observation-minus-analysis statistics

With the development of convection-permitting numerical weather prediction the efficient use of high-resolution observations in data assimilation is becoming increasingly important. The operational assimilation of these observations, such as Doppler radar radial winds (DRWs), is now common, though to avoid violating the assumption of uncorrelated observation errors the observation density is severely reduced. To improve the quantity of observations used and the impact that they have on the forecast requires the introduction of the full, potentially correlated, error statistics. In this work, observation error statistics are calculated for the DRWs that are assimilated into the Met Office high-resolution UK model using a diagnostic that makes use of statistical averages of observation-minus-background and observation-minus-analysis residuals. This is the first in-depth study using the diagnostic to estimate both horizontal and along-beam observation error statistics. The new results obtained show that the DRW error standard deviations are similar to those used operationally and increase as the observation height increases. Surprisingly the estimated observation error correlation length-scales are longer than the operational thinning distance. They are dependent both on the height of the observation and on the distance of the observation away from the radar. Further tests show that the long correlations cannot be attributed to the background error covariance matrix used in the assimilation, although they are, in part, a result of using superobservations and a simplified observation operator. The inclusion of correlated error statistics in the assimilation allows less thinning of the data and hence better use of the high-resolution observations

Program on Earth Observation Data Management Systems (EODMS)

An assessment was made of the needs of a group of potential users of satellite remotely sensed data (state, regional, and local agencies) involved in natural resources management in five states, and alternative data management systems to satisfy these needs are outlined. Tasks described include: (1) a comprehensive data needs analysis of state and local users; (2) the design of remote sensing-derivable information products that serve priority state and local data needs; (3) a cost and performance analysis of alternative processing centers for producing these products; (4) an assessment of the impacts of policy, regulation and government structure on implementing large-scale use of remote sensing technology in this community of users; and (5) the elaboration of alternative institutional arrangements for operational Earth Observation Data Management Systems (EODMS). It is concluded that an operational EODMS will be of most use to state, regional, and local agencies if it provides a full range of information services -- from raw data acquisition to interpretation and dissemination of final information products

Run-in periods and clinical outcomes of antipsychotics in dementia:A meta-epidemiological study of placebo-controlled trials

PURPOSE: Run-in periods are used to identify placebo-responders and washout. Our aim was to assess the association of run-in periods with clinical outcomes of antipsychotics in dementia. METHODS: We searched randomized placebo-controlled trials of conventional and atypical antipsychotics for neuropsychiatric symptoms (NPS) in dementia in electronic sources and references of selected articles. We extracted (a) the presence of a run-in period, use of placebo/investigated drug during run-in (versus washout only), and run-in duration (1 week or more) and (b) the reduction in NPS, number of participants with somnolence, extrapyramidal symptoms (EPS), and deaths per treatment group. We pooled clinical outcomes comparing antipsychotic and placebo groups in trials with and without run-in. RESULTS: We identified 35 trials. Twenty-nine trials used run-in. The pooled standardized mean difference in the reduction of NPS was -0.170 (95% CI, -0.227 to -0.112) in trials with run-in and -0.142 (95% CI, -0.331 to 0.047) in trials without run-in. The pooled odds ratio for somnolence was 2.8 (95% CI, 2.3-3.5) in trials with run-in and 3.5 (95% CI, 1.2-10.7) in trials without run-in; for EPS, these ORs were 1.8 (95% CI, 1.4-2.2) and 2.0 (95% CI, 1.3-3.1) respectively, and for mortality 1.4 (95% CI, 1.0-2.0) and 1.6 (95% CI, 0.7-3.4). The use of placebo/investigated drug during run-in and run-in duration did not affect the estimates in a consistent way. CONCLUSIONS: The use of run-in in trials might have led to overestimated efficacy and especially underestimated risks of side effects of antipsychotics compared with placebo for NPS in dementia

Cosmic Ray Acceleration at Relativistic Shock Waves with a "Realistic" Magnetic Field Structure

The process of cosmic ray first-order Fermi acceleration at relativistic shock waves is studied with the method of Monte Carlo simulations. The simulations are based on numerical integration of particle equations of motion in a turbulent magnetic field near the shock. In comparison to earlier studies, a few "realistic" features of the magnetic field structure are included. The upstream field consists of a mean field component inclined at some angle to the shock normal with finite-amplitude sinusoidal perturbations imposed upon it. The perturbations are assumed to be static in the local plasma rest frame. Their flat or Kolmogorov spectra are constructed with randomly drawn wave vectors from a wide range $(k_{min}, k_{max})$. The downstream field structure is derived from the upstream one as compressed at the shock. We present particle spectra and angular distributions obtained at mildly relativistic sub- and superluminal shocks and also parallel shocks. We show that particle spectra diverge from a simple power-law, the exact shape of the spectrum depends on both the amplitude of the magnetic field perturbations and the wave power spectrum. Features such as spectrum hardening before the cut-off at oblique subluminal shocks and formation of power-law tails at superluminal ones are presented and discussed. At parallel shocks, the presence of finite-amplitude magnetic field perturbations leads to the formation of locally oblique field configurations at the shock and the respective magnetic field compressions. This results in the modification of the particle acceleration process, introducing some features present in oblique shocks, e.g., particle reflections from the shock. We demonstrate for parallel shocks a (nonmonotonic) variation of the particle spectral index with the turbulence amplitude.Comment: revised version (37 pages, 13 figures

Managed moves: schools collaborating for collective gain

Government guidance in the United Kingdom encourages groups of schools to take collective responsibility for supporting and making provision for excluded pupils and those at risk of exclusion. Managed-moves are one way that some schools and authorities are enacting such guidance. This paper presents the results of an evaluation of one such scheme. The scheme, involving seven neighbouring secondary schools, was nearing its first year of completion. The paper draws primarily on interview data with pupils, parents and school staff to describe a number of positive outcomes associated with the scheme and to explore how these were achieved. We found that while some of these could be attributed directly to the managed-move, others arose from the more inclusive ethos and practices of particular schools. The concepts of tailored support, care and commitment emerged as strong themes that underpinned the various practical ways in which some schools in the cluster were able to re-engage 'at-risk' pupils. As managed moves become more widely practiced it will be important to remember that it is how the move proceeds and develops rather than the move itself that will ultimately make the difference for troubled and troublesome pupils