Data resource profile : the Scottish national prescribing information system (PIS)

Data Resource Basics: The Prescribing Information System (PIS) covers the prescribed,dispensed and reimbursed prescriptions in community pharmacies from the 5.3 million residents in Scotland. Summary information is available from 1993 and at an individual level from 2009 to the present. Data Collected: The raw data are generated by three data sources: ePrescribed -generated by GPs messages, eDispensed –generated by messages from community pharmacies and Reimbursed messages from scanned paper prescriptions dispensed in the community pharmacies. The four main categories of data collected are: (1) Patient-specific, (2) Prescriber, (3) Dispenser and (4) Drug-specific. PIS data can be linked via a unique identifier to other national databases, including hospital records, maternal and neonatal, the Scottish Cancer Registry and mortality records. The catalogue of databases is available in www.ndc.scot.nhs.uk . Subject to approval of the data controllers other external datasets can also be linked. Data Resource Use: PIS has been used to describe the utilisation of several groups of drugs;factors influencing prescribing and evaluation of interventions to improve it; generation of polypharmacy guidelines; risk of side effects; monitoring of antibiotic use and generation of policy recommendations; associations between community prescription of antimicrobials and deprivation or infection; evaluation of prescription fee abolition; clinical effectiveness, safety and health technology assessment of drugs approved in the last decade. Reasons to be cautious: PIS does not capture information about diagnosis or indication for treatment, over the counter medicines, medicines administered during inpatient hospital stays, upon discharge for short term use, outpatient supplies or some specialist drugs for chronic use. Drug data is currently coded according to the British National Formulary. For longitudinal studies, patient level data is available from 2009 and the frequency of data collection from the three sources is different. Collaboration and data access: PIS data are available upon request to the electronic Data Research and Innovation Service ([email protected]) and project approval by the Public Benefit and Privacy Panel. Funding and competing interests: This dataset is funded from the public monies available to the NHS. Current work to develop an improved PIS research ready analysis platform and this study is supported by the Farr Institute @ Scotland and its 10-funder consortium. The authors declare no conflict of interest

Osteo-chondritis of the lumbar spine

A journal article on Osteo-chondritis of the lumbar spine.Osteo-chondritis of the thoracic spine is a fairly well recognized condition; often referred to as Scheuermann’s disease (adolescent kyphosis, vertebral epiphysitis). There is, however, a variety of this condition affecting the lumbar spine, described by Wiles 11949) and Haffner (1952). The importance of the condition is that it usually occurs in children between the ages of 12 and 17 years and may be mistaken for a more serious condition such as tuberculosis of the spine. The patient is usually a healthy boy who suddenly starts to complain of a lumbar backache. Quite often this may start after an athletic injury, or misguided attempts at toe touching with the knees extended in a child with tight hamstring muscles

Welcome to Portland; Now Let’s Eat

This case study describes how nationally-acclaimed chefs and restaurants and the farm-to-table movement have led to Portland, Maine becoming a major culinary tourism destination

Fractures of the Head of the Radius with Medial Displacement

A CAJM article on bone fractures.It is now well recognised that fractures of the head of the radius are not trivial injuries, but are due to the elbow joint being subjected to a considerable degree of violence. The injury usually occurs when the patient falls on to the outstretched hand and the head of the radius is driven violently against the capitellum, which acts rather like a blunt chisel and either impacts the radial head or else splinters off a portion of it. The capitellum itself often suffers a considerable degree of damage to its articular cartilage, although this does not usually show on routine X-rays. Unless the crack in the head of the radius is of a very trivial nature, operation should be advised in order to excise the radial head. This should not be delayed for more than a few days, and I have found that the best results are obtained if the operation can be performed within a few hours of the injury. Attempts have been made to replace the radial head with plastic or metal inserts, but I do not consider that this procedure is' advisable and that experimental surgery of this nature should be left to large clinics, where the problem can be properly evaluated

A two-dimensional hexagonal network model of alveolar mechanics

Pulmonary micromechanics (at the scale of alveoli) involves a delicate balance among tissue material properties, geometry, surface tension, pressure and stress distribution. To date, there is not a consensus among alveolar mechanics researchers about how these factors interact, in part because alveoli are so difficult to image and study in vivo. Here, we propose a basic mathematical model of a two-dimensional hexagonal network of mechanically coupled alveoli. We investigate equilibrium configurations of both dry and wet, internally pressurized elastic networks. Specifically, we compute pressure-area curves to quantify the differences among networks with different spring constants, internal pressures, network size and surface tensions. We conclude that a two-dimensional hexagonal network in force equilibrium is an appropriate first step in modeling the mechanics of the dynamic lung

Paradise Lost? Impact of Tourism and Public Use on the Mnemba House Reef

With the increasing popularity and promotion of marine park tourism, coral reef ecosystems may be subject to stresses beyond their sustainable thresholds. Mnemba Island’s house reef was surveyed to assess impacts of public use and efficacy of current protection measures. The study was conducted with objectives of characterizing physical damage and providing a holistic overview of reef conditions. To obtain relative impact profiles in the area, line transects were carried out in two different zones - one more frequented by private island guests and one more frequented by boat tour operators. Benthic coral cover and damage, biological indicators (fish populations and sea urchin abundance), and proximal human activity were documented over a two-week period. While instances of tissue damage were comparable at both sites, it was found that the boat-side had a significant amount of unhealthier, bleached, and dead coral as well as rubble and algal growth. More anchor breakage and sediment damage were also observed on the boat-side. All these factors indicate that overall health on the boat-side is compromised, and suggests that coral in that section are more vulnerable and less resilient as a result of higher human activity. The findings demonstrate negative impacts of human activity on coral status, and demand immediate further action in protecting the reef as a whole. Recommendations were made for future monitoring and management in an effort to balance human usage without causing permanent environmental degradation

Determinants of Paternal Responsibility, Engagement, Accessibility

The current study was designed to examine several variables that may influence three areas of paternal involvement with young children. Specifically, 75 couples with children between the ages of 1 and 4 completed questionnaires that assessed beliefs and reported fathers\u27 involvement in three areas of childcare described by Lamb, Pleck, Charnov, and Levine ( 1985). Specifically, the three areas of paternal involvement measured were interaction/engagement, accessibility, and responsibility. Based on a review of the literature, the following variables were hypothesized to influence fathers\u27 involvement: gender-role beliefs, paternal competence in the parenting role, marital satisfaction, job stress, work-family conflict, conflict in front of children, and hours worked outside of the home. Correlational analyses were conducted to examine relationships between the predictor variables, relationships between mothers\u27 and fathers\u27 reports of paternal involvement in the three areas of fathering examined, and between the predictor variables and fathers\u27 involvement in childcare. The pattern of correlations demonstrated that mothers\u27 work hours were significantly associated with both reports of work-family conflict, as well as beliefs regarding fathers\u27 involvement in childcare. Correlations were also found between the predictor variables and the three paternal involvement variables. Most notably, mothers\u27 reports of marital satisfaction were significantly and positively associated with her reports of fathers\u27 involvement in childcare. Conversely, fathers\u27 reports of marital satisfaction were significantly and negatively related to his reports of involvement in childcare. Regressional analysis supported the correlational findings. Fathers\u27 reports of marital satisfaction significantly and negatively predicted his reports of the degree to which he took direct responsibility for the target child. In addition, reports of beliefs about fathering significantly and positively predicted his reported accessibility to the target child. Further analyses examined the degree to which the predictor variables could predict how much time the father spent as the child\u27s primary caregiver. These findings suggest interesting and important relationships between parents\u27 beliefs, hours worked, job stress, work-family conflict, marital satisfaction, and displayed conflict in front of the child and paternal involvement in childcare. Interestingly, these variables were able, in part, to predict the quantity of time men care for young children (i.e., in terms of responsibility for and accessibility to the children). However, the study variables did not predict the quality of father-child interaction as reported by either mothers or fathers ( e.g., paternal engagement)

The Ever Widening Scope of Fact Review in Federal Appellate Courts—Is the “Clearly Erroneous Rule” Being Avoided?

The expansion that has occurred in the federal courts is of principal concern to this writer

The Effect of High Voltage Electric Fields on Two Phase Flow Pattern Redistribution and Heat Exchanger Performance

A short, 30cm, test section was used to study the effect of electrohydrodynamic (EHD) forces on flow redistribution in a horizontal, shell and tube heat exchanger subject to both boiling and condensation. The use of a short test section allows for a consistent flow pattern across the test section length which provides further insight into the true effect of EHD. It was found that the voltage polarity of the applied voltages influences the flow distribution. For the current geometry studied, it was found that positive polarity voltages tend to pull liquid away from heat transfer surface and that negative voltages tended to repel more liquid toward the heat transfer surface. Using this knowledge we were able to show that positive voltages were more effective for convective condensation heat transfer enhancement, whereas negative voltages were more effective for convective boiling heat transfer enhancement. A twofold enhancement of convective boiling heat transfer was achieved for positive voltages and a 4fold enhancement was achieved for negative voltages. Similar pressure drop penalties were seen for both cases, approximately twice that of the no EHD case. Furthermore, the effect of DC level, peak to peak voltage, frequency and duty cycle waveform parameters on convective boiling enhancement were studied to explore the range of controllability for the current set of flow parameters. It was found that these various waveform parameters can induce different flow patterns and consequently different heat transfer and pressure drop configurations. In general the heat transfer is enhanced by EHD, but different pressure drop penalties can be achieved for a given enhancement ratio using different waveforms. High heat transfer for relatively low pressure drop was achieved using either negative DC signals or 50%duty cycle pulse waveforms. In some cases the enhancement is quite little compared to the pressure drop, for example the zero DC level, varying peak to peak voltage data. It is suggested that in a system where the heat exchanger pressure drop due to EHD is more dominant than the system pressure drop, it may be possible to use EHD as a method of retarding the system rather than enhancing it thereby broadening the scope of controllability. Finally we showed the proof of concept of using DC EHD as a rapid control mechanism for the load conditions. Using -8kVDC the water side heat flux could be varied by approximately ±3.2 kW/m2 within 5 seconds. As a comparison, the same experiment was repeated using the refrigerant flow rate to control the load. Response times were similar for both experiments and although the power required for the flow rate control was less, the minimal variability in flow parameters for the EHD control make it a more attractive method of load control.Master of Applied Science (MASc