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Mental illness poses a large and growing disease burden worldwide. Its management is increasingly provided by primary care. The prescribing of psychotropic drugs in general practice has risen in recent decades, and variation in prescribing rates has been identified by a number of studies. It is unclear which factors lead to this variation.
To describe the variables that cause variation in prescribing rates for psychotropic drugs between general practices.
A narrative review was conducted in January 2018 by searching electronic databases using the PRISMA statement. Studies investigating causal factors for variation in psychotropic prescribing between at least two general practice sites were eligible for inclusion.
Ten studies met the inclusion criteria. Prescribing rates varied considerably between practices. Positive associations were found for many variables, including social deprivation, ethnicity, patient age and gender, urban location, co-morbidities, chronic diseases and GP demographics. However studies show conflicting findings, and no single regression model explained more than 57% of the variation in prescribing rates.
There is no consensus on the factors that most predict prescribing rates. Most research was conducted in countries with central electronic databases, such as the United Kingdom; it is unclear whether these findings apply in other healthcare systems. More research is needed to determine the variables that explain prescribing rates for psychotropic medications.
OBJECTIVES/SPECIFIC AIMS: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) recurrence ranges from 16% to 43% and presents significant challenges to clinicians, patients, and families. This comparative effectiveness research study aims to disseminate, implement and evaluate whether an existing intervention, consisting of decolonization and decontamination procedures, which has been determined to be effective in hospital intensive care unit settings, can be implemented by Community Health Workers (CHWs) or “promotoras” conducting home visits prevent recurrence of CA-MRSA and transmission within their households for patients presenting to primary care with SSTIs. METHODS/STUDY POPULATION: In partnership with 3 Community Health Centers and 4 community hospitals in NYC, this study will recruit patients (n=278) with confirmed MRSA SSTIs and their household members. Participants are randomized to receive either a CHW/Promotora-delivered decolonization-decontamination intervention or usual care, which includes hygiene education. The highly engaged stakeholder team meets monthly to review interim results, identify areas for refinement and new research questions, and develop and implement strategies to improve participant engagement and retention. RESULTS/ANTICIPATED RESULTS: MRSA and MSSA were found in 19% and 21.1% of wound cultures, respectively. 59.5% with MRSA+ wound culture had one or more MRSA+ surveillance culture; 67.8% with MSSA+ wound culture had one or more MSSA+ surveillance culture. The “warm handoff” approach, developed and implemented by the stakeholder team to engage patients from their initial consent to return of lab results and scheduling of the home visits, helped improve completion of baseline home visits by 14%, from 45% to 59% of eligible participants. Home visits have demonstrated that 60% of households had at least one surface contaminated with S. aureus. Of the surfaces that tested positive in the households, nearly 20% were MRSA and 81% were MSSA; 32.5% of household members had at least one surveillance culture positive for S. aureus (MRSA: 7.7%, MSSA: 92.3%). DISCUSSION/SIGNIFICANCE OF IMPACT: This study aims to understand the systems-level, patient-level, and environmental-level factors associated with SSTI recurrence and household transmission, and to examine the interactions between bacterial genotypic and clinical/phenotypic factors on decontamination, decolonization, SSTI recurrence and household transmission. This study will evaluate the barriers and facilitators of implementation of home visits by CHWs in underserved populations, and aims to strengthen the weak evidence base for implementation of strategies to reduce SSTI recurrence and household transmission.
Early life exposures affect health and disease across the life course and potentially across multiple generations. The Clinical and Translational Research Institutes (CTSIs) offer an opportunity to utilize and link existing databases to conduct lifespan research.
A survey with Lifespan Domain Taskforce expert input was created and distributed to lead lifespan researchers at each of the 64 CTSIs. The survey requested information regarding institutional databases related to early life exposure, child-maternal health, or lifespan research.
Of 64 CTSI, 88% provided information on a total of 130 databases. Approximately 59% (n=76/130) had an associated biorepository. Longitudinal data were available for 72% (n=93/130) of reported databases. Many of the biorepositories (n=44/76; 68%) have standard operating procedures that can be shared with other researchers.
The majority of CTSI databases and biorepositories focusing on child-maternal health and lifespan research could be leveraged for lifespan research, increased generalizability and enhanced multi-institutional research in the United States.
Our collaboration involves groups in Denmark, the U.S.A. Spain and of course New Zealand. Combining ground-based and satellite (IUE and HST) observations we aim to determine accurate and precise stellar fundamental parameters for the components of Magellanic Cloud Eclipsing Binaries as well as the distances to these systems and hence the parent galaxies themselves. This poster presents our latest progress.
CCD uVJIC photometry was obtained for three eclipsing binaries in the Magellanic Clouds and the preliminary analyses of their light curves has been made using a modified Wilson code. The LMC system, MACHO*05:36:48.7-69:17:00, is detached and eccentric, most likely comprising of two similar stars. The system has apsidal motion with a period of 100 ± 5 years. Initial results for two other systems in the SMC, MOA J005018.4–723855 and MOA J005623.5–722123, indicate circular orbits with the former semi-detached and the latter detached with two stars of very similar temperature.
Recent years have seen great interest in the importance of species richness for the functioning and stability of ecological communities (Ives and Carpenter 2007). Empirical examinations of richness effects typically vary the number of species in experimental treatments and measure resulting ecosystem functions such as biomass accumulation or resource uptake (Naeem et al. 2009). Across trophic levels and communities of many types, a clear pattern has emerged from these experiments: community processes (biomass accumulation, resource uptake, etc.) generally become more efficient when more species are present (Hooper et al. 2005; Cardinale et al. 2006). This pattern is generally attributed to resource partitioning among species, where species differ in ecologically significant ways such that they complement one another (Hooper et al. 2005). For example, in English meadow communities multiple plant species coexist, because different plant species exploit different hydrological conditions (Silvertown et al. 1999). The plants that dominate drought-prone areas are different from those that thrive in flood-prone areas and, presumably, total plant biomass is greatest when both plant groups (drought tolerant and flood tolerant) are present.
A remaining challenge is to effectively predict, a priori, the particular species (or groups of species) that will complement one another. One simplifying scheme that has received considerable attention is the lumping of species into ‘functional groups’. In this functional-group approach, species within a group are relatively similar to one another, and considered ecologically redundant, whereas species in different groups are distinct and complementary (Hillebrand and Matthiessen 2009). This approach gained support from studies suggesting that plant species can be classified into such functional groups (grasses, forbs, legumes and woody plants), and that the number of functional groups is a more effective predictor of ecosystem function than species richness (Diaz and Cabido 2001). For example, in savannah grasslands, plant communities that included C3 grasses, C4 grasses, forbs, legumes and woody plants had greater biomass and plant nitrogen accumulation, and reduced light penetration, than those communities lacking one or more of these groups (Tilman et al. 1997). These authors suggested that competition was greater within than between functional groups, consistent with niche similarity within, but niche differentiation among, groups.
Commercially deposited titanium nitride (TIN) thin films have been available daring recent years. These TiN films possess high hardness and have good wear resistance; however, the deposition process typically requires a temperature of 500°C or higher. In many cases, due to substrate characteristics, a deposition temperature below 150°C is required in order to exploit TiN coating properties.
The objective of this work is to demonstrate that ion beam assisted deposition (IBAD) makes it possible to deposit gold-color TiN films with good adhesion onto a variety of substrates including plastics at temperatures below 150°C. These films have physical and mechanical properties as good as those produced at high temperatures. Samples have also been examined by nanohardness techniques to accurately determine the hardness of the films and relate them to process parameters and crystal sizes. Our results indicate that, by controlling the grain size of TiN, it is possible to fabricate TiN coatings at room temperature with hardness as high as 25.5 ± 1 GPa.
Typical high-temperature thin-film deposition techniques are not suitable for certain substrates such as polymers and thermally-sensitive steels. In this work, ion beam assisted deposition (IBAD) was used to deposit ceramic and metallic films at temperatures below 150°C with nanocrystalline (< 100Å diameter) grain size. Nanoindentation studies of these films have shown hardnesses 50 to 100% greater than larger-grained films and, in some cases, fracture toughness approaching that of Si3N4.
By combining chromium evaporation with nitrogen beam bombardment, hard, adherent CrN films without any porosity have been produced at low temperatures with a N/Cr arrival ratio of about 1. The grain size is typically smaller than 100Å and hardness is typically higher than 25 GPa. For a N/Cr arrival ratio slightly less than 1, we observed possible grain boundary porosity. However, even with porosity, hardness is typically 20 to 24 GPa for grain sizes smaller than 100Å. For a N/Cr arrival ratio of 1/4 we deposited elemental Cr with a grain size of 300 to 500Å and a hardness greater than that of silicon (12 GPa). Using Ar ions and a N backfill, we produced elemental Cr containing a mixture of coarse (120 to 150Å) and fine (25 to 30Å) grains. For high-temperature deposition of CrN, the grain size increases (200 to 600Å) with a noticeable decrease in hardness. Mechanical properties of CrN are greatly influenced by impurities, as well as by surface conditioning of the substrate.
TiN films having gold color and grain sizes from 50 to 1000Å have been produced at low temperatures. Nanoindentation measurements of hardness and fracture toughness indicate that impurity-free TiN (with grains smaller than 100Å) has a hardness higher than 25 GPa and a fracture toughness close to that of Si3N4, but with higher wear resistance. Mechanical properties of our TiN films are greatly influenced by impurities, particularly oxygen, although it does not influence the gold color of TiN.
Mechanical and tribological properties of chromium-nitrogen films deposited by ion beam assisted deposition (IBAD) were investigated. The films were deposited reactively, i.e., via chromium evaporation with concurrent nitrogen ion beam bombardment, on stainless steel substrates at low deposition temperatures (<200°C). Two primary deposition regimes, with differing Cr/N atom-to-ion arrival ratios, were investigated: approximately 0.8–1.0 and 2.5–3.0. Rutherford Backscattering Spectroscopic analysis showed the lower arrival ratio films to be essentially stoichiometric CrN, whereas films deposited at higher arrival ratios were Cr-rich with Cr/N ratios of about 3:1. Both films were fine grained polycrystalline (typically 5–20 nanometer crystal dimension). The stoichiometric films were approximately two times harder than the Cr-rich films., based on nanohardness indentation measurements, and possessed higher residual stress levels. Both film types substantially improved the wear resistance of stainless steel disks, based on the results of ball-ondisk wear tests against ruby balls. The best performance was obtained with Cr-rich films, which exhibited a very low wear rate and lower friction than either the stoichiometric film or the uncoated steel.
A strong resonance in the inverse photoelectron spectroscopy (IPES) of cerium oxide was reported recently. Here, it is shown that dominance of the indirect channel of the resonant inverse photoelectron spectroscopy (RIPES) is so complete that the photon energy dependence can be explained in terms of emission associated with a single photon energy.
Against a backdrop of the latest ITRS predictions for CMOS junctions, we compare methods for dopant introduction and activation, methods for making contact to these regions, and methods for measurement of material and device properties. As activation without diffusion (sub-melt laser, capacitor discharge flash, or solid phase epitaxy) becomes more feasible, the burden on Xj, Rsh and abruptness falls on the implanters, and the process margin appears slim, opening the door for other methods of doping. For contact resistance, a major component of transistor parasitics, we find that either a move to a different substrate, or from a single midgap silicide to two band-edge metals/silicides can be quite beneficial. Through the use of simple test structures, we describe a means of extracting each component of the parasitic resistance, facilitating development of materials for CMOS junctions.
Films of the Tl‐Ba‐Ca‐Cu‐O high‐Tc superconductor can be prepared by several organometallic chemical vapor deposition routes. Two of these involve Ba‐Ca‐Cu‐0 films that are first prepared using the volatile metal‐organic precursors Ba(heptafluorodimethyloctanedionate)2, Ca(dipivaloylmethanate)2, and Cu(acetylacetonate)2‐ Deposition is carried out at a pressure of 5 Torr with argon as the carrier gas and water vapor as the reactant gas. Thallium is next incorporated into these films either by organometallic chemical vapor deposition using Tl(cyclopentadienide) as the source, or by vapor diffusion using bulk Tl‐Ba‐Ca‐Cu‐O as the source. Thallium deposition is carried out at atmospheric pressure with an argon carrier and water‐saturated oxygen reactant gas, followed by rapid thermal annealing. Both procedures yield films that consist primarily of the TlBa2Ca2Cu3Ox phase, have preferential orientation of the Cu‐O planes parallel to the substrate surface, and exhibit onset of superconductivity at ∼125 K with zero resistance by 100 K.
We report here a plasma‐enhanced organometallic chemical vapor deposition process for the preparation of YBa2Cu3O7‐x thin films using two rf plasma coupling configurations. For the films grown under a direct plasma glow, the YBa2Cu3O7‐x phase is not found in the as‐deposited state. However, by employing plasma‐activated nitrous oxide as the reactant gas, superconducting YBa2Cu3O7‐x films having a low carbon content and a mirror‐like surface have been prepared in‐situ at a substrate temperature of 610°C using an organometallic chemical vapor deposition process.
X-Ray Absorption Spectroscopy (XAS) and Photoelectron Spectroscopy (PES) have been performed upon highly radioactive samples, particularly Plutonium, at the Advanced Light Source in Berkeley, CA, USA. First results from alpha and delta Plutonium are reported as well as a detailed analysis of sample quality.
Fano Effect measurements are the key to direct observation of the Kondo or spin shielding intrinsic to models of electron correlation. The Fano Effect is the observation of spin polarized photoelectron emission from NONMAGNETIC materials, under chirally selective excitation, such as circularly polarized photons. Below are described three spectrometers, with which Fano Effects measurements have been made.
We have developed a particulate composite bone cement consisting of a particulate phase of tricalcium phosphate (TCP) particles bound together by a polymeric matric phase (PPF). This matrix hardens through a free radical polymerization reaction in vivo within several minutes after mixing. The initial mechanical strength of our particulate composite bone cement results from the matrix, but over time this degrades and the strength is augmented by bone ingrowth and incorporation of the tricalcium phosphate particles. Possible orthopaedic applications include fixation of fractures, augmenting fixation of implants in osteoporetic bone, and temporary stabilization of bone ingrowth prostheses.