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Bringing meaning to user involvement in mental health care planning: a qualitative exploration of service user perspectives
No full textThe 2011 English 'Riots': Prosecutorial Zeal and Judicial Abandon
No full textMuch attention has focussed on the severity of the sentences imposed following the 2011 ‘summer rioting’ in England. The Court of Appeal confirmed that participation in a collective outbreak of disorder takes offending outside the sentencing guidelines. The position for sentencing riot-related offending in future is unclear, however, as the Court gave no indication of how to calibrate this departure, and the Sentencing Council has made offending during public disorder an aggravating factor only in its burglary guideline. This article explores new empirical evidence regarding the sentences imposed in Manchester, together with national Ministry of Justice data, to demonstrate for the first time how this ‘uplift’ effect was a feature throughout the criminal process, from arrest to sentence
Low use and adherence to maintenance medication in chronic obstructive pulmonary disease in the general population.
No full textOBJECTIVE: We tested the hypothesis that use of and adherence to maintenance medication is low among individuals in the general population who have chronic obstructive pulmonary disease (COPD) , even in cases of severe and very severe COPD. DESIGN AND PARTICIPANTS: We identified 5,812 individuals with COPD from the Copenhagen General Population Study, and classified them according to the Global Initiative for Obstructive Lung Disease (GOLD) airflow limitation grades 1-4. Dispensing of fixed-dose combinations of inhaled corticosteroids with long-acting beta2-agonists, long-acting anti-cholinergics, or long-acting beta2-agonists was identified in a nationwide registry. Use of medication was defined as medication dispensed during a one-year period , and adherence was calculated from dosages available in one year. KEY RESULTS: Use of fixed-dose combinations of inhaled corticosteroids with long-acting beta2-agonists varied from 2 % to 61 % (p <0.001, test for trend), long-acting anti-cholinergics varied from 0.4 % to 36 % (p <0.001), and long-acting beta2-agonists varied from 0.3 % to 11 % (p <0.001. Among utilizers of these medications, adherence varied from 29 % to 56 % (p <0.001, test for trend) across GOLD 1-4 for fixed-dose combinations of inhaled corticosteroids with long-acting beta2-agonists, from 51 % to 68 % (p = 0.11) for long-acting anti-cholinergics, and from 25 to 62 % (p = 0.01) for long-acting beta2-agonists. CONCLUSIONS: Use of and adherence to maintenance medication for COPD in the general population was associated with the severity of COPD as defined by GOLD, but even in severe and very severe COPD, use and adherence was low
Efficacy of human papillomavirus 16 and 18 (HPV-16/18) AS04-adjuvanted vaccine against cervical infection and precancer in young women: final event-driven analysis of the randomized, double-blind PATRICIA trial.
No full textWe report final event-driven analysis data on the immunogenicity and efficacy of the human papillomavirus 16 and 18 ((HPV-16/18) AS04-adjuvanted vaccine in young women aged 15 to 25 years from the PApilloma TRIal against Cancer In young Adults (PATRICIA). The total vaccinated cohort (TVC) included all randomized participants who received at least one vaccine dose (vaccine, n = 9,319; control, n = 9,325) at months 0, 1, and/or 6. The TVC-naive (vaccine, n = 5,822; control, n = 5,819) had no evidence of high-risk HPV infection at baseline, approximating adolescent girls targeted by most HPV vaccination programs. Mean follow-up was approximately 39 months after the first vaccine dose in each cohort. At baseline, 26% of women in the TVC had evidence of past and/or current HPV-16/18 infection. HPV-16 and HPV-18 antibody titers postvaccination tended to be higher among 15- to 17-year-olds than among 18- to 25-year-olds. In the TVC, vaccine efficacy (VE) against cervical intraepithelial neoplasia grade 1 or greater (CIN1+), CIN2+, and CIN3+ associated with HPV-16/18 was 55.5% (96.1% confidence interval [CI], 43.2, 65.3), 52.8% (37.5, 64.7), and 33.6% (-1.1, 56.9). VE against CIN1+, CIN2+, and CIN3+ irrespective of HPV DNA was 21.7% (10.7, 31.4), 30.4% (16.4, 42.1), and 33.4% (9.1, 51.5) and was consistently significant only in 15- to 17-year-old women (27.4% [10.8, 40.9], 41.8% [22.3, 56.7], and 55.8% [19.2, 76.9]). In the TVC-naive, VE against CIN1+, CIN2+, and CIN3+ associated with HPV-16/18 was 96.5% (89.0, 99.4), 98.4% (90.4, 100), and 100% (64.7, 100), and irrespective of HPV DNA it was 50.1% (35.9, 61.4), 70.2% (54.7, 80.9), and 87.0% (54.9, 97.7). VE against 12-month persistent infection with HPV-16/18 was 89.9% (84.0, 94.0), and that against HPV-31/33/45/51 was 49.0% (34.7, 60.3). In conclusion, vaccinating adolescents before sexual debut has a substantial impact on the overall incidence of high-grade cervical abnormalities, and catch-up vaccination up to 18 years of age is most likely effective. (This study has been registered at ClinicalTrials.gov under registration no. NCT001226810.)
Let there be More Light!
No full textIn 1832, the last words of the German genius, Johann Wolfgang von Goethe, were Mehr Licht (more light). This was either a plea for increased enlightenment or – more prosaically – “Do open the shutter of the bedroom so that more light may enter�! Either way, the thought resonates with preoccupations in the Dental Materials community about achieving more consistent clinical success with resin-composites by efficient and effective photo-polymerization or light curing. Such has been the concern of Professor Richard Price that he has organized two seminal international conferences on this theme at Dalhousie University, Halifax, Nova Scotia. The first, held in October 2012, was supported by the Canadian government. The second in May 2014 was supported by dental industry and attended by scientists and other experts from Universities and industrial companies. Another is forthcoming in June 2015. Also during 2014, the Nobel Prize in Physics was awarded jointly to Isamu Akasaki, Hiroshi Amano and Shuji Nakamura for their development in the early 1990s of efficient blue light-emitting diodes. Through the foresight and inventiveness of Jandt and Mills, these were then introduced quite rapidly into dentistry for LED light-curing units (LCUs) [1]. As we have noted previously [2], the energy-efficient but relatively narrow band width of LED light sources creates some problems for effective photo-initiation of cure through the challenge of matching output spectra of LCUs to some photo-initiator (PI) absorption spectra. Moreover, the shorter-wavelength violet light from polywave LCUs is somewhat less efficient at penetrating deeply into composite materials than blue wavelengths. Added to this, there is the complexity of uneven light-beam-profiles emerging from a number of LCU optic tips, particularly those mass-produced with poor design, safety features and quality control. During the 2014 Dalhousie conference the goal was to achieve consensus on a number of issues. Firstly, it was helpful to adopt standard scientific nomenclature for physical quantities and units as expressed in Table 1. The scientific discussions in Halifax addressed the factors that are most relevant to the photo-polymerization of dental resins and resin-based composite materials. One of the perennial scientific issues relating to light curing is the question of reciprocity. This concept comes from the world of photography (conventional, and probably also digital) and more broadly from other fields of irradiation, such as X-ray irradiation. In those realms it has been exhaustively examined; but this is less so for photo curing of dental resins. Sometimes this principle is referred to as a Law of Reciprocity, such that energy delivered has the same effect for a given product of irradiance and exposure time. But the equivalence of the effect depends upon what is the outcome (property) under consideration. Clinically, the only aspects of major significance would be properties after 1 month or longer. So the concept of reciprocity gives us a very simple formula to test (it assumes there is no non-linear behavior) – but the understanding of such a concept depends upon a deeper analysis involving light scattering, absorption, photochemistry, polymerization kinetics, and much more. As not all composites and resin-matrices are created equal (because they can each differ in formulation), the conclusions that can be drawn from analysis of a single resin-composite are limited to that single composite (and perhaps to other composites that closely resemble it in all key respects). The assumption of reciprocity may well prove valid with some materials and not others. Wydra et al. [3] investigated experimentally and theoretically the question of a reciprocity law applied to BisGMA/TEGDMA photopolymers. The outcomes measured were conversion and shrinkage stress. As far as these properties are concerned, they concluded that this system does not and should not be expected to follow reciprocity behavior. Rather the properties studied depend upon irradiance and the corresponding rate of cure. Strategic matters debated in Halifax were concerned with how to improve oral health by disseminating the research and consensus statements to other interested parties including: manufacturers, regulatory authorities, researchers, and clinicians in an understandable format for each group, and by means most appropriate for each group. Agreement is sought on the measurement parameters and evaluations that should be included when describing a dental curing light. This could lead to establishing the minimum amount of information that should be provided to clinicians to help them purchase and use a curing light
Primary Care Medication Safety Surveillance with Integrated Primary and Secondary Care Electronic Health Records: A Cross-Sectional Study.
No full textINTRODUCTION: The extent of preventable medication-related hospital admissions and medication-related issues in primary care is significant enough to justify developing decision support systems for medication safety surveillance. The prerequisite for such systems is defining a relevant set of medication safety-related indicators and understanding the influence of both patient and general practice characteristics on medication prescribing and monitoring. OBJECTIVE: The aim of the study was to investigate the feasibility of linked primary and secondary care electronic health record data for surveillance of medication safety, examining not only prescribing but also monitoring, and associations with patient- and general practice-level characteristics. METHODS: A cross-sectional study was conducted using linked records of patients served by one hospital and over 50 general practices in Salford, UK. Statistical analysis consisted of mixed-effects logistic models, relating prescribing safety indicators to potential determinants. RESULTS: The overall prevalence (proportion of patients with at least one medication safety hazard) was 5.45 % for prescribing indicators and 7.65 % for monitoring indicators. Older patients and those on multiple medications were at higher risk of prescribing hazards, but at lower risk of missed monitoring. The odds of missed monitoring among all patients were 25 % less for males, 50 % less for patients in practices that provide general practitioner training, and threefold higher in practices serving the most deprived compared with the least deprived areas. Practices with more prescribing hazards did not tend to show more monitoring issues. CONCLUSIONS: Systematic collection, collation, and analysis of linked primary and secondary care records produce plausible and useful information about medication safety for a health system. Medication safety surveillance systems should pay close attention to patient age and polypharmacy with respect to both prescribing and monitoring failures; treat prescribing and monitoring as different statistical processes, rather than a combined measure of prescribing safety; and audit the socio-economic equity of missed monitoring
Loci associated with N-glycosylation of human IgG are not associated with rheumatoid arthritis: A Mendelian randomisation study.
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Needle Penetration Through Polymeric Cellular Foam Materials
No full textThis article presents an analytical model for predicting the needle penetration force through relatively hard polymeric cellular foam. Prediction of needle penetration force is of importance to a number of applications, including textile and composites manufacture as well as robotic surgery. With the aid of this analytical model, a complete nonlinear force-displacement relation can be predicted for any needle size, material hardness, thickness, or inclination. The model assumes the needle to be a cylinder with a conical tip and ignores features, such as needle eye. The primary mechanism for needle penetration force is cell crushing while the friction between the needle and the foam plays a secondary role. There is a good agreement between the experimental and analytical force-displacement curves. In comparison to numerical methods that require nonlinear finite element analysis, this analytical model can be implemented with the knowledge on only two material properties: compression strength and frictional resistance
Retrieval and validation of carbon dioxide, methane and water vapor for the Canary Islands IR-laser occultation experiment
No full textAbstract. The first ground-based experiment to prove the concept of a novel space-based observation technique for microwave and infrared-laser occultation between low-Earth-orbit satellites was performed in the Canary Islands between La Palma and Tenerife. For two nights from 21 to 22 July 2011 the experiment delivered the infrared-laser differential transmission principle for the measurement of greenhouse gases (GHGs) in the free atmosphere. Such global and long-term stable measurements of GHGs, accompanied also by measurements of thermodynamic parameters and line-of-sight wind in a self-calibrating way, have become very important for climate change monitoring. The experiment delivered promising initial data for demonstrating the new observation concept by retrieving volume mixing ratios of GHGs along a ~144 km signal path at altitudes of ~2.4 km. Here, we present a detailed analysis of the measurements, following a recent publication that introduced the experiment's technical setup and first results for an example retrieval of CO2. We present the observational and validation data sets, the latter simultaneously measured at the transmitter and receiver sites; the measurement data handling; and the differential transmission retrieval procedure. We also determine the individual and combined uncertainties influencing the results and present the retrieval results for 12CO2, 13CO2, C18OO, H2O and CH4. The new method is found to have a reliable basis for monitoring of greenhouse gases such as CO2, CH4, and H2O in the free atmosphere