Antipsychotic prescribing in care homes before and after launch of a national dementia strategy:an observational study in English institutions over a 4-year period

Objectives To assess associations between the launch of the National Dementia Strategy (NDS) and antipsychotic prescribing in long-term residential care (LTC) in England. Setting and participants Retrospective analysis of prescribing patterns in 616 LTC institutions (31 619 residents) following launch of the NDS, using information from electronic medicines management system. Primary and secondary outcome measures Antipsychotic prescribing point prevalence (PP) for all residents in a cross section of LTC settings over a 4-year period following NDS launch. Secondary outcomes included dosages, length of treatment and use of recommended second-generation antipsychotics (SGAs) versus first-generation antipsychotics (FGAs). Associations between facility-level PP values and institutional characteristics, resident demographics were explored. Variations across geographical areas examined. Prescription net ingredient costs calculated. Results No statistically significant difference was observed in overall prescribing rates over the 4-year period (Kolmogorov-Smirnov (KS) test p=0.60), and there was no significant shift towards newer SGAs (KS test p=0.32). Dosages were above the maximum indicated in only 1.3% of cases, but duration of prescribing was excessive in 69.7% of cases. Care homes in the highest prescribing quintile were more likely to be located in a deprived area (rate ratio (Q5/Q1) RR=5.89, 95% CI 4.35 to 7.99), registered for dementia (RR=3.38, 95% CI 3.06 to 3.73) and those in the lowest quintile were more likely to be served by a single general practitioner (GP) practice (RR=0.48; 95% CI 0.37 to 0.63); p<0.001 all. A sixfold variation in PP levels was observed between geographical areas. The average annual expenditure on antipsychotics was £65.6 per person resident (2012 prices). Conclusions The NDS in England was not associated with reduced PP levels or the types of antipsychotic prescribing in care homes. Further research is needed to explore why. Clear standards specifying recommended agents, dosages and length of treatment, together with routine monitoring and greater accountability for antipsychotic prescribing, may be required

Software Application Profile:mrrobust - A Tool For Performing Two-Sample Summary Mendelian Randomization Analyses

AbstractMotivationIn recent years Mendelian randomization analysis using summary data from genome-wide association studies has become a popular approach for investigating causal relationships in epidemiology. The mrrobust Stata package implements several of the recently developed methods.Implementationmrrobust is freely available as a Stata package.General FeaturesThe package includes inverse variance weighted estimation, as well as a range of median and MR-Egger estimation methods. Using mrrobust, plots can be constructed visualising each estimate either individually or simultaneously. The package also provides statistics such as which are useful in assessing attenuation bias in causal estimates.AvailabilityThe software is freely available from GitHub [https://raw.github.com/remlapmot/mrrobust/master/].</jats:sec

MICROGRID RESILIENCE ANALYSIS SOFTWARE DEVELOPMENT

Military installation microgrids need to be resilient to a variety of potential disruptions (storms, attacks, et cetera). Various metrics for assessing microgrid resilience have been described in literature, and multiple tools for simulating microgrid performance have been constructed; however, it is often left to system owners and maintainers to bring these efforts together to identify and realize effective, efficient improvement strategies. Military microgrid stakeholders have expressed a desire for an integrated, unified platform that provides these multiple capabilities in a coordinated fashion. In support of these endeavors, analysis methods developed by NPS and NAVFAC Expeditionary Warfare Center researchers for measuring microgrid resilience have been integrated into an existing web-based microgrid power flow simulation and distributed energy resource rightsizing software tool. This was achieved by the development of additional functions and methods within the existing software platform code base, and expansion of the application programming interface (API). These API additions enabled access to the new calculation and analysis capabilities, as well as increased control over power flow simulation parameters. These analytical and functional contributions were validated through a design of experiments, including comparison to independently generated data, and factorial analysis.Outstanding ThesisCivilian, Department of the NavyCivilian, Department of the NavyCivilian, Department of the NavyCivilian, Department of the NavyCivilian, Department of the NavyApproved for public release. Distribution is unlimited

X-ray phase contrast imaging of biological specimens with tabletop synchrotron radiation

Since their discovery in 1896, x-rays have had a profound impact on science, medicine and technology. Here we show that the x-rays from a novel tabletop source of bright coherent synchrotron radiation can be applied to phase contrast imaging of biological specimens, yielding superior image quality and avoiding the need for scarce or expensive conventional sources

Origin of basalts by hybridisation in andesite-dominated arcs

This is the accepted manuscript. The final version is available from OUP at http://dx.doi.org/10.1093/petrology/egv002Mafic magmas are common in subduction zone settings, yet their high density restricts their ascent to the surface. Once stalled in the crust, these magmas may differentiate, assimilate crust and other melts and mushes to produce hybridised intermediate magmas. The Soufriere Hills Volcano on Montserrat is a ?type locality? for these hybridisation processes and yet, just 3 km south of the crater, voluminous basalts have erupted from the South Soufriere Hills volcano within the same time period as the Soufriere Hills Volcano was erupting hybrid andesites (131 - 128 ka). Basaltic South Soufriere Hills magmas have 48 - 53 32 wt% SiO2 and 4 - 6 wt% MgO. They were hot (970 - 1160 ?C), volatile-rich (melt inclusions contain up to 6.2 wt% H2O) and were stored at 8 ? 13 km prior to eruption (based on olivine and pyroxene-hosted melt inclusion volatile geochemistry). Melt inclusions do not preserve basaltic liquids: they are andesitic to rhyolitic in composition, related to one another by a line of descent controlled by simple closed-system fractionation. Whole rock compositions, however, are best described by a hybridisation model involving ?back?-mixing of andesitic to rhyolitic melts with mafic crystal phases such as magnetite, olivine, orthopyroxene and clinopyroxene. Phenocryst zoning illustrates repeated mixing events between evolved melts and mafic phenocrysts, which, when coupled with the heterogeneity of crystal compositions, strongly suggests that although the bulk composition is basalt (containing Fo80 olivine), they were assembled from disparate ingredients, likely derived from mafic crystal mushes and more evolved melt lenses of variable composition. The mixing events occur days to weeks prior to eruption. We propose that the South Soufriere Hills basaltic magmas, with their higher bulk density over andesites from neighbouring volcanoes, ultimately may have been eruptible owing to both the transtensional tectonics imposed by offshore grabens (related to the oblique subduction of the Lesser Antilles) and to surface unloading caused by large scale edifice collapse. Our observations support the idea that compositional changes in arcs might \ud reflect not only changes in source compositions, but also effects caused by patterns in crustal strain and tectonics.MC and SFLW thank NERC for financial support via grant NE/K000403/1

Draft genome sequences of <i>Pantoea agglomerans</i> and <i>Pantoea vagans</i> isolates associated with termites

The genus Pantoea incorporates many economically and clinically important species. The plant-associated species, Pantoea agglomerans and Pantoea vagans, are closely related and are often isolated from similar environments. Plasmids conferring certain metabolic capabilities are also shared amongst these two species. The genomes of two isolates obtained from fungus-growing termites in South Africa were sequenced, assembled and annotated. A high number of orthologous genes are conserved within and between these species. The difference in genome size between P. agglomerans MP2 (4,733,829 bp) and P. vagans MP7 (4,598,703 bp) can largely be attributed to the differences in plasmid content. The genome sequences of these isolates may shed light on the common traits that enable P. agglomerans and P. vagans to co-occur in plant- and insect-associated niches.The Danish Council for Independent Research, Natural Sciences (STENO grant: Michael Poulsen), the National Research Foundation (NRF) (RCA Fellowship: Pieter De Maayer) and the NRF/Dept. of Science and Technology Centre of Excellence in Tree Health Biotechnology (CTHB), South Africa.http://www.standardsingenomics.org/index.php/sigenam2016Forestry and Agricultural Biotechnology Institute (FABI)Microbiology and Plant Patholog

Attachment and therapeutic alliance in psychological therapy for people with recent onset psychosis who use cannabis

We examine associations between client attachment style and therapeutic alliance in a 3-arm randomized controlled trial of brief motivational interviewing and cognitive–behavioural therapy compared with longer term motivational interviewing and cognitive–behavioural therapy or standard care alone. Client self-report measures of attachment style were completed at baseline, and both clients and therapists in the treatment arms of the trial completed alliance measures 1 month into therapy. We found that insecure–anxious attachment was positively associated with therapist-rated alliance, whereas clients with insecure–avoidant attachment were more likely to report poorer bond with therapist. There was no evidence that client attachment significantly predicted clinical or substance misuse outcomes either directly or indirectly via alliance. Nor evidence that the length of therapy offered interacted with attachment to predict alliance