Suchergebnisse

Bristol is a major city and port in the south-west of England. In medieval times, it became the third largest city in the kingdom, behind London and York. Bristol was founded in the late Saxon period and grew rapidly in the 12th and 13th centuries. Initially, seaborne trading links with Ireland and France were particularly significant; later, from the 16th century onwards, the city became a focus for trade with Iberia, Africa, and the New World. This led to the growth of new industries such as brass manufacture, glass production and sugar refining, producing items for export, and processing imported raw materials. Bristol also derived wealth from the slave trade between Africa and the New World. The city has a long history of antiquarian and archaeological investigation. This volume provides, for the first time, a comprehensive overview of the historical development of Bristol, based on archaeological and architectural evidence.Part 1 describes the geological and topographical context of Bristol and discusses evidence for the environment prior to the foundation of the city. The history of archaeological work in Bristol is discussed in detail, as is the pictorial record and the cartographic evidence for the city. In Part 2, a series of period-based chapters considers the historical background and archaeological evidence for Bristol's development from the prehistoric, Roman, and post-Roman eras through the establishment and growth of Bristol between about 950 and 1200 AD; the medieval city; early modern period; and the period from 1700 to 1900 AD, when Bristol was particularly important for its role in transatlantic trade. Each chapter discusses the major civic, military, and religious monuments of the time and the complex topographical evolution of the city. Part 3 assesses the significance of Bristol's archaeology and presents a range of themes for future research.

Bristol is a major city and port in the south-west of England. In medieval times, it became the third largest city in the kingdom, behind London and York. Bristol was founded in the late Saxon period and grew rapidly in the 12th and 13th centuries. Initially, seaborne trading links with Ireland and France were particularly significant; later, from the 16th century onwards, the city became a focus for trade with Iberia, Africa, and the New World. This led to the growth of new industries such as brass manufacture, glass production and sugar refining, producing items for export, and processing imported raw materials. Bristol also derived wealth from the slave trade between Africa and the New World. The city has a long history of antiquarian and archaeological investigation. This volume provides, for the first time, a comprehensive overview of the historical development of Bristol, based on archaeological and architectural evidence.Part 1 describes the geological and topographical context of Bristol and discusses evidence for the environment prior to the foundation of the city. The history of archaeological work in Bristol is discussed in detail, as is the pictorial record and the cartographic evidence for the city. In Part 2, a series of period-based chapters considers the historical background and archaeological evidence for Bristol's development from the prehistoric, Roman, and post-Roman eras through the establishment and growth of Bristol between about 950 and 1200 AD; the medieval city; early modern period; and the period from 1700 to 1900 AD, when Bristol was particularly important for its role in transatlantic trade. Each chapter discusses the major civic, military, and religious monuments of the time and the complex topographical evolution of the city. Part 3 assesses the significance of Bristol's archaeology and presents a range of themes for future research.

ObjectivesTapentadol is a µ-opioid agonist, moderate noradrenaline reuptake inhibitor (NRI) and very weak serotonin reuptake inhibitor. The sustained release (SR) formulation is indicated for relief of chronic moderate to severe pain. We examined utilisation trends and concordance with prescribing guidelines of prescription SR tapentadol in Australia between 2014-2021.
ApproachWe used a 10% sample of Australian Pharmaceutical Benefits Scheme dispensing data linked to death records. We assessed incidence, prevalence, and trends in monthly dispensed prescriptions between June 2014 (date of public subsidy) and September 2021. We defined incident users in adults aged ≥18 years as no tapentadol dispensings in the previous year. We assessed characteristics of initiators and patterns of utilization in the year following initiation, including prescription strengths, concurrent dispensing of tapentadol and medicines with known interactions or contraindications, and switching to other opioids.
Results4,883,840 prescriptions of tapentadol were dispensed during the study period. Total monthly dispensed prescriptions increased from 2,040 (June 2014) to 91,300 (September 2021). The lowest strength formulations (50mg, 100mg) comprised nearly three quarters of all dispensed prescriptions (3,628,400; 74.3%). We identified 66,334 new episodes of tapentadol use. Incidence rose from 0.8/1000 population in 2014 to a high of 8.4/1000 in 2019, dropping to 5.5/1000 in 2020. Most people initiating tapentadol were aged 45-84 years (48,464; 73.1%) and female (37,709; 56.9%). More than half (38,157; 57.5%) did not receive a second tapentadol dispensing within 90 days of initiation. 10,868 (16.4%) were dispensed a non-opioid medicine with known interaction on the same day as initiation, and 23,205 (35.0%) were concurrently dispensed tapentadol and other opioids.
ConclusionThe only approved subsidized indication is tapentadol SR for chronic pain. However, the very high prevalence of single dispensings of tapentadol SR suggests it may be being used off-label for acute pain instead of tapentadol immediate-release; this would be less safe, less effective and also against Australian therapeutic guidelines.

Publisher's version (útgefin grein) ; 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. ; This research was supported by the National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Medicines and Ageing (CREMA), a Project Grant for measuring low-value care for targeted policy action and JB received funding support from an NHMRC Postgraduate award. These funding bodies played no role in the design of the study and collection, analysis, and interpretation of data or in writing the manuscript. ; Peer Reviewed

<b><i>Introduction:</i></b> Sleep disturbance is common during methamphetamine (MA) use and withdrawal; however, the feasibility of combined subjective-objective measurement of sleep-wake has not been shown in this population. Actigraphy is a well-established, non-invasive measure of sleep-wake cycles with good concordance with polysomnography. This study aimed to investigate the feasibility and utility of using actigraphy and sleep diaries to investigate sleep during MA withdrawal. <b><i>Methods:</i></b> We conducted a feasibility and utility study of actigraphy and sleep diaries during a clinical trial of lisdexamfetamine for MA withdrawal. Participants were inpatients for 7 days, wore an actigraph (Philips Actiwatch 2) and completed a modified Consensus Sleep Diary each morning. Participants were interviewed between days 3–5. <b><i>Results:</i></b> Ten participants (mean age 37 years, 90% male) were enrolled. No participant removed the device prematurely. Participants interviewed (<i>n</i> = 8) reported that the actigraph was not difficult or distracting to wear or completion of daily sleep diary onerous. Actigraphic average daily sleep duration over 7 days was 568 min, sleep onset latency 22.4 min, wake after sleep onset (WASO) 75.2 min, and sleep efficiency 83.6%. Sleep diaries underreported daily sleep compared with actigraphy (sleep duration was 56 min (<i>p</i> = 0.008) and WASO 47 min (<i>p</i> &lt; 0.001) less). Overall sleep quality was 4.4 on a nine-point Likert scale within the diary. <b><i>Conclusions:</i></b> Continuous actigraphy is feasible to measure sleep-wake in people withdrawing from MA, with low participant burden. We found important differences in self-reported and actigraphic sleep, which need to be explored in more detail.