Secondary students' values and perceptions of science-related careers: responses to vignette-based scenarios

There has been concern about the attractiveness of science-based careers to many adolescent learners, and it has been suggested that school science may not always recognise or engage personal values that are important to young people in making life choices. The present study discusses interview comments made by upper secondary level students in England when 15 young people were asked to give their personal responses to brief vignettes describing scientific careers. Using an interview-about-scenarios approach, the students were asked about whether they would feel comfortable working in the scientific careers represented. The career areas were purposefully selected because they might be considered to potentially raise issues in relation to personal values or commitments that some students might hold. A range of student perceptions relating to the mooted careers were elicited (positive, negative and indifferent), but all of the participants raised issues that impacted on the acceptability or attractiveness of at least one of the mooted scientific careers, in terms of aspects of their own personal beliefs and values systems. It is recommended that teachers and career advisors should be aware of the range of value-related considerations that influence student views of science-related careers and should consider exploring aspects of science-based careers that link to values commonly shared by young people. This exploratory study also offers indications for directions for further research exploring how learners' value systems impact upon their perceptions of science and scientific work

Comprehensive study of micro-seismicity by using an automatic monitoring platform

A modern digital seismic network, with many stations optimally distributed on the earthquake causative seismic zone, enables detection of very low magnitude earthquakes and determination of their source parameters. It is essential to associate to such kind of networks procedures to analyze the huge amount of continuously recorded data for monitoring the space-time-magnitude evolution of natural and/or induced seismicity. Hence, the demand for near-real-time, automated data collection and analysis procedures for assisting seismic network operators in carrying out microearthquake monitoring is growing. In response to this need, we designed a computational software platform, TREMOR, for fast and reliable detection and characterization of seismicity recorded by a dense local seismic network. TREMOR integrates different open-source seismological algorithms for earthquake signal detection, location, and source characterizations in a fully automatic workflow. We applied the platform in play-back mode to the continuous waveform data recorded during 1 month at the Japanese Hi-net seismic network in the Nagano region (Japan) and compared the resulting catalog with the Japan Meteorological Agency bulletin in terms of number of detections, location pattern and magnitudes. The results show that the completeness magnitude of the new seismic catalog decreased by 0.35 units of the local magnitude scale and consequently the number of events increased by about 60% with respect to the available catalog. Moreover, the fault plane solutions resulted coherent with the stress regime of the region, and the Vp/Vs ratio well delineated the main structural features of the area. According to our results, TREMOR has shown to be a valid tool for investigating and studying earthquakes, especially to identify and monitor natural or induced micro-seismicity

Combinations of QT-prolonging drugs: towards disentangling pharmacokinetic and pharmaco-dynamic effects in their potentially additive nature.

Background: Whether arrhythmia risks will increase if drugs with electrocardiographic (ECG) QT-prolonging properties are combined is generally supposed but not well studied. Based on available evidence, the Arizona Center for Education and Research on Therapeutics (AZCERT) classification defines the risk of QT prolongation for exposure to single drugs. We aimed to investigate how combining AZCERT drug categories impacts QT duration and how relative drug exposure affects the extent of pharmacodynamic drug–drug interactions. Methods: In a cohort of 2558 psychiatric inpatients and outpatients, we modeled whether AZCERT class and number of coprescribed QT-prolonging drugs correlates with observed rate-corrected QT duration (QTc) while also considering age, sex, inpatient status, and other QTc-prolonging risk factors. We concurrently considered administered drug doses and pharmacokinetic interactions modulating drug clearance to calculate individual weights of relative exposure with AZCERT drugs. Because QTc duration is concentration-dependent, we estimated individual drug exposure with these drugs and included this information as weights in weighted regression analyses. Results: Drugs attributing a ‘known’ risk for clinical consequences were associated with the largest QTc prolongations. However, the presence of at least two versus one QTc-prolonging drug yielded nonsignificant prolongations [exposure-weighted parameter estimates with 95% confidence intervals for ‘known’ risk drugs + 0.93 ms (–8.88;10.75)]. Estimates for the ‘conditional’ risk class increased upon refinement with relative drug exposure and coadministration of a ‘known’ risk drug as a further risk factor. Conclusions: These observations indicate that indiscriminate combinations of QTc-prolonging drugs do not necessarily result in additive QTc prolongation and suggest that QT prolongation caused by drug combinations strongly depends on the nature of the combination partners and individual drug exposure. Concurrently, it stresses the value of the AZCERT classification also for the risk prediction of combination therapies with QT-prolonging drugs

Off–label long acting injectable antipsychotics in real–world clinical practice: a cross-sectional analysis of prescriptive patterns from the STAR Network DEPOT study

Introduction: Information on the off–label use of Long–Acting Injectable (LAI) antipsychotics in the real world is lacking. In this study, we aimed to identify the sociodemographic and clinical features of patients treated with on– vs off–label LAIs and predictors of off–label First– or Second–Generation Antipsychotic (FGA vs. SGA) LAI choice in everyday clinical practice. Method: In a naturalistic national cohort of 449 patients who initiated LAI treatment in the STAR Network Depot Study, two groups were identified based on off– or on–label prescriptions. A multivariate logistic regression analysis was used to test several clinically relevant variables and identify those associated with the choice of FGA vs SGA prescription in the off–label group. Results: SGA LAIs were more commonly prescribed in everyday practice, without significant differences in their on– and off–label use. Approximately 1 in 4 patients received an off–label prescription. In the off–label group, the most frequent diagnoses were bipolar disorder (67.5%) or any personality disorder (23.7%). FGA vs SGA LAI choice was significantly associated with BPRS thought disorder (OR = 1.22, CI95% 1.04 to 1.43, p = 0.015) and hostility/suspiciousness (OR = 0.83, CI95% 0.71 to 0.97, p = 0.017) dimensions. The likelihood of receiving an SGA LAI grew steadily with the increase of the BPRS thought disturbance score. Conversely, a preference towards prescribing an FGA was observed with higher scores at the BPRS hostility/suspiciousness subscale. Conclusion: Our study is the first to identify predictors of FGA vs SGA choice in patients treated with off–label LAI antipsychotics. Demographic characteristics, i.e. age, sex, and substance/alcohol use co–morbidities did not appear to influence the choice towards FGAs or SGAs. Despite a lack of evidence, clinicians tend to favour FGA over SGA LAIs in bipolar or personality disorder patients with relevant hostility. Further research is needed to evaluate treatment adherence and clinical effectiveness of these prescriptive patterns

Comparing Long-Acting Antipsychotic Discontinuation Rates Under Ordinary Clinical Circumstances: A Survival Analysis from an Observational, Pragmatic Study

Background: Recent guidelines suggested a wider use of long-acting injectable antipsychotics (LAI) than previously, but naturalistic data on the consequences of LAI use in terms of discontinuation rates and associated factors are still sparse, making it hard for clinicians to be informed on plausible treatment courses. Objective: Our objective was to assess, under real-world clinical circumstances, LAI discontinuation rates over a period of 12 months after a first prescription, reasons for discontinuation, and associated factors. Methods: The STAR Network ‘Depot Study’ was a naturalistic, multicentre, observational prospective study that enrolled subjects initiating a LAI without restrictions on diagnosis, clinical severity or setting. Participants from 32 Italian centres were assessed at baseline and at 6 and 12 months of follow-up. Psychopathology, drug attitude and treatment adherence were measured using the Brief Psychiatric Rating Scale, the Drug Attitude Inventory and the Kemp scale, respectively. Results: The study followed 394 participants for 12 months. The overall discontinuation rate at 12 months was 39.3% (95% confidence interval [CI] 34.4–44.3), with paliperidone LAI being the least discontinued LAI (33.9%; 95% CI 25.3–43.5) and olanzapine LAI the most discontinued (62.5%; 95% CI 35.4–84.8). The most frequent reason for discontinuation was onset of adverse events (32.9%; 95% CI 25.6–40.9) followed by participant refusal of the medication (20.6%; 95% CI 14.6–27.9). Medication adherence at baseline was negatively associated with discontinuation risk (hazard ratio [HR] 0.853; 95% CI 0.742–0.981; p = 0.026), whereas being prescribed olanzapine LAI was associated with increased discontinuation risk compared with being prescribed paliperidone LAI (HR 2.156; 95% CI 1.003–4.634; p = 0.049). Conclusions: Clinicians should be aware that LAI discontinuation is a frequent occurrence. LAI choice should be carefully discussed with the patient, taking into account individual characteristics and possible obstacles related to the practicalities of each formulation

Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

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