Choosing wisely? Quantifying the extent of three low value psychotropic prescribing practices in Australia

BACKGROUND:The global Choosing Wisely campaign has identified the following psychotropic prescribing as low-value (harmful or wasteful): (1) benzodiazepine use in the elderly, (2) antipsychotic use in dementia and (3) prescribing two or more antipsychotics concurrently. We aimed to quantify the extent of these prescribing practices in the Australian population. METHODS:We applied indicators to dispensing claims of a 10% random sample of Australian Pharmaceutical Benefits Scheme beneficiaries to quantify annual rates of each low-value practice from 2013 to 2016. We also assessed patient factors and direct medicine costs (extrapolated to the entire Australian population) associated with each practice in 2016. RESULTS:We observed little change in the rates of the three practices between 2013 and 2016. In 2016, 15.3% of people aged ≥65 years were prescribed a benzodiazepine, 0.5% were prescribed antipsychotics in the context of dementia and 0.2% of people aged ≥18 years received two or more antipsychotics concurrently. The likelihood of elderly people receiving benzodiazepines or antipsychotics in the context of dementia increased with age and the likelihood of receiving all three practices increased with comorbidity burden. In 2016, direct medicine costs to the government of all three practices combined, extrapolated to national figures, were > $21 million AUD. CONCLUSIONS:Our indicators suggest that the frequency of these three practices has not changed appreciably in recent years and that they incur significant costs. Worryingly, people with the greatest risk of harm from these prescribing practices are often the most likely to receive them.Jonathan Brett, Helga Zoega, Nicholas A. Buckley, Benjamin J. Daniels, Adam G. Elshaug and Sallie-Anne Pearso

Alpha-1 antitrypsin mitigates the inhibition of airway epithelial cell repair by neutrophil elastase

Copyright © 2016 by the American Thoracic Society. Neutrophil elastase (NE) activity is associated with many destructive lung diseases and is a predictor for structural lung damage in early cystic fibrosis (CF), which suggests normal maintenance of airway epitheliumis prevented byuninhibitedNE.However, limited data exist on how the NE activity in airways of very young children with CF affects function of the epithelia. The aimof this studywas to determine if NE activity could inhibit epithelial homeostasis and repair and whether any functional effect was reversible by antiprotease alpha-1 antitrypsin (a1AT) treatment. Viability, inflammation, apoptosis, and proliferation were assessed in healthy non-CF and CF pediatric primary airway epithelial cells (pAEC non-CF and pAEC CF , respectively) during exposure to physiologically relevant NE. The effect of NE activity on pAEC CF wound repair was also assessed.We report that viability after 48 hours was significantly decreased by 100 nM NE in pAEC non-CF and pAEC CF owing to rapid cellular detachment that was accompanied by inflammatory cytokine release. Furthermore, both phenotypes initiated an apoptotic response to 100 nM NE, whereas ≥50 nM NE activity significantly inhibited the proliferative capacity of cultures. Similar concentrations of NE also significantly inhibited wound repair of pAEC CF , but this effect was reversed by the addition of a1AT. Collectively, our results demonstrate free NE activity is deleterious for epithelial homeostasis and support the hypothesis that proteases inthe airway contribute directly toCF structural lung disease. Our results also highlight the need to investigate antiprotease therapies in early CF disease in more detail

Heat treatment of cold extruded polycarbonate: Some implications for design engineers

Polycarbonate was subjected to various combinations of mechanical - thermal histories to investigate such effects on subsequent tensile mechanical properties. This was accomplished by "cold extruding" the material initially; nominal "reductions in area" of 18, 40 and 64% were used. Cold extruded bars were then heat treated at three temperature levels, all being less than Tg (150[deg]C) of polycarbonate. As compared with the material that was only cold extruded, it was found that in general, heat treating tends to raise the yield stress while lowering the tensile strength, elastic modulus and stress at fracture. The results suggest that a desired combination of properties may be obtainable by the use of a cold work - heat treating sequence.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/22085/1/0000509.pd

The effect of two-temperature post-shock accretion flow on the linear polarization pulse in magnetic cataclysmic variables

The temperatures of electrons and ions in the post-shock accretion region of a magnetic cataclysmic variable (mCV) will be equal at sufficiently high mass flow rates or for sufficiently weak magnetic fields. At lower mass flow rates or in stronger magnetic fields, efficient cyclotron cooling will cool the electrons faster than the electrons can cool the ions and a two-temperature flow will result. Here we investigate the differences in polarized radiation expected from mCV post-shock accretion columns modeled with one- and two-temperature hydrodynamics. In an mCV model with one accretion region, a magnetic field >~30 MG and a specific mass flow rate of ~0.5 g/cm/cm/s, along with a relatively generic geometric orientation of the system, we find that in the ultraviolet either a single linear polarization pulse per binary orbit or two pulses per binary orbit can be expected, depending on the accretion column hydrodynamic structure (one- or two-temperature) modeled. Under conditions where the physical flow is two-temperature, one pulse per orbit is predicted from a single accretion region where a one-temperature model predicts two pulses. The intensity light curves show similar pulse behavior but there is very little difference between the circular polarization predictions of one- and two-temperature models. Such discrepancies indicate that it is important to model some aspect of two-temperature flow in indirect imaging procedures, like Stokes imaging, especially at the edges of extended accretion regions, were the specific mass flow is low, and especially for ultraviolet data.Comment: Accepted for publication in Astrophysics & Space Scienc

Deciphering the extreme X-ray variability of the nuclear transient eRASSt J045650.3-203750: A likely repeating partial tidal disruption event

Context. During its all-sky survey, the extended ROentgen Survey with an Imaging Telescope Array (eROSITA) on board the Spectrum-Roentgen-Gamma (SRG) observatory has uncovered a growing number of X-ray transients associated with the nuclei of quiescent galaxies. Benefitting from its large field of view and excellent sensitivity, the eROSITA window into time-domain X-ray astrophysics yields a valuable sample of X-ray selected nuclear transients. Multi-wavelength follow-up enables us to gain new insights into understanding the nature and emission mechanism of these phenomena. Aims. We present the results of a detailed multi-wavelength analysis of an exceptional repeating X-ray nuclear transient, eRASSt J045650.3-203750 (hereafter J0456-20), uncovered by SRG/eROSITA in a quiescent galaxy at a redshift of z ∼ 0:077. We aim to understand the radiation mechanism at different luminosity states of J0456-20, and provide further evidence that similar accretion processes are at work for black hole accretion systems at different black hole mass scales. Methods. We describe our temporal analysis, which addressed both the long- and short-term variability of J0456-20. A detailed X-ray spectral analysis was performed to investigate the X-ray emission mechanism. Results. Our main findings are that (1) J0456-20 cycles through four distinctive phases defined based on its X-ray variability: an X-ray rising phase leading to an X-ray plateau phase that lasts for abouttwo months. This is terminated by a rapid X-ray flux drop phase during which the X-ray flux can drop drastically by more than a factor of 100 within one week, followed by an X-ray faint state for about two months before the X-ray rising phase starts again. (2) The X-ray spectra are generally soft in the rising phase, with a photon index & 3:0, and they become harder as the X-ray flux increases. There is evidence of a multi-colour disk with a temperature of Tin ∼ 70 eV in the inner region at the beginning of the X-ray rising phase. The high-quality XMM-Newton data suggest that a warm and hot corona might cause the X-ray emission through inverse Comptonisation of soft disk seed photons during the plateau phase and at the bright end of the rising phase. (3) J0456-20 shows only moderate UV variability and no significant optical variability above the host galaxy level. Optical spectra taken at different X-ray phases are constant in time and consistent with a typical quiescent galaxy with no indication of emission lines. (4) Radio emission is (as yet) only detected in the X-ray plateau phase and rapidly declines on a timescale of two weeks. Conclusions. J0456-20 is likely a repeating nuclear transient with a tentative recurrence time of ∼223 days. It is a new member of this rare class. We discuss several possibilities to explain the observational properties of J0456-20. We currently favour a repeating partial tidal disruption event as the most likely scenario. The long-term X-ray evolution is explained as a transition between a thermal disk-dominated soft state and a steep power-law state. This implies that the corona can be formed within a few months and is destroyed within a few weeks

Search for displaced vertices arising from decays of new heavy particles in 7 TeV pp collisions at ATLAS

We present the results of a search for new, heavy particles that decay at a significant distance from their production point into a final state containing charged hadrons in association with a high-momentum muon. The search is conducted in a pp-collision data sample with a center-of-mass energy of 7 TeV and an integrated luminosity of 33 pb^-1 collected in 2010 by the ATLAS detector operating at the Large Hadron Collider. Production of such particles is expected in various scenarios of physics beyond the standard model. We observe no signal and place limits on the production cross-section of supersymmetric particles in an R-parity-violating scenario as a function of the neutralino lifetime. Limits are presented for different squark and neutralino masses, enabling extension of the limits to a variety of other models.Comment: 8 pages plus author list (20 pages total), 8 figures, 1 table, final version to appear in Physics Letters

Search for direct production of charginos and neutralinos in events with three leptons and missing transverse momentum in √s = 7 TeV pp collisions with the ATLAS detector

A search for the direct production of charginos and neutralinos in final states with three electrons or muons and missing transverse momentum is presented. The analysis is based on 4.7 fb−1 of proton–proton collision data delivered by the Large Hadron Collider and recorded with the ATLAS detector. Observations are consistent with Standard Model expectations in three signal regions that are either depleted or enriched in Z-boson decays. Upper limits at 95% confidence level are set in R-parity conserving phenomenological minimal supersymmetric models and in simplified models, significantly extending previous results

Measurement of the polarisation of W bosons produced with large transverse momentum in pp collisions at sqrt(s) = 7 TeV with the ATLAS experiment

This paper describes an analysis of the angular distribution of W->enu and W->munu decays, using data from pp collisions at sqrt(s) = 7 TeV recorded with the ATLAS detector at the LHC in 2010, corresponding to an integrated luminosity of about 35 pb^-1. Using the decay lepton transverse momentum and the missing transverse energy, the W decay angular distribution projected onto the transverse plane is obtained and analysed in terms of helicity fractions f0, fL and fR over two ranges of W transverse momentum (ptw): 35 < ptw < 50 GeV and ptw > 50 GeV. Good agreement is found with theoretical predictions. For ptw > 50 GeV, the values of f0 and fL-fR, averaged over charge and lepton flavour, are measured to be : f0 = 0.127 +/- 0.030 +/- 0.108 and fL-fR = 0.252 +/- 0.017 +/- 0.030, where the first uncertainties are statistical, and the second include all systematic effects.Comment: 19 pages plus author list (34 pages total), 9 figures, 11 tables, revised author list, matches European Journal of Physics C versio