ADRIC: Adverse Drug Reactions In Children - a programme of research using mixed methods

Aims To comprehensively investigate the incidence, nature and risk factors of adverse drug reactions (ADRs) in a hospital-based population of children, with rigorous assessment of causality, severity and avoidability, and to assess the consequent impact on children and families. We aimed to improve the assessment of ADRs by development of new tools to assess causality and avoidability, and to minimise the impact on families by developing better strategies for communication. Review methods Two prospective observational studies, each over 1 year, were conducted to assess ADRs in children associated with admission to hospital, and those occurring in children who were in hospital for longer than 48 hours. We conducted a comprehensive systematic review of ADRs in children. We used the findings from these studies to develop and validate tools to assess causality and avoidability of ADRs, and conducted interviews with parents and children who had experienced ADRs, using these findings to develop a leaflet for parents to inform a communication strategy about ADRs. Results The estimated incidence of ADRs detected in children on admission to hospital was 2.9% [95% confidence interval (CI) 2.5% to 3.3%]. Of the reactions, 22.1% (95% CI 17% to 28%) were either definitely or possibly avoidable. Prescriptions originating in the community accounted for 44 out of 249 (17.7%) of ADRs, the remainder originating from hospital. A total of 120 out of 249 (48.2%) reactions resulted from treatment for malignancies. Off-label and/or unlicensed (OLUL) medicines were more likely to be implicated in an ADR than authorised medicines [relative risk (RR) 1.67, 95% CI 1.38 to 2.02; p  48 hours, the overall incidence of definite and probable ADRs based on all admissions was 15.9% (95% CI 15.0 to 16.8). Opiate analgesic drugs and drugs used in general anaesthesia (GA) accounted for > 50% of all drugs implicated in ADRs. The odds ratio of an OLUL drug being implicated in an ADR compared with an authorised drug was 2.25 (95% CI 1.95 to 2.59; p < 0.001). Risk factors identified were exposure to a GA, age, oncology treatment and number of medicines. The systematic review estimated that the incidence rates for ADRs causing hospital admission ranged from 0.4% to 10.3% of all children [pooled estimate of 2.9% (95% CI 2.6% to 3.1%)] and from 0.6% to 16.8% of all children exposed to a drug during hospital stay. New tools to assess causality and avoidability of ADRs have been developed and validated. Many parents described being dissatisfied with clinician communication about ADRs, whereas parents of children with cancer emphasised confidence in clinician management of ADRs and the way clinicians communicated about medicines. The accounts of children and young people largely reflected parents’ accounts. Clinicians described using all of the features of communication that parents wanted to see, but made active decisions about when and what to communicate to families about suspected ADRs, which meant that communication may not always match families’ needs and expectations. We developed a leaflet to assist clinicians in communicating ADRs to parents. Conclusion The Adverse Drug Reactions In Children (ADRIC) programme has provided the most comprehensive assessment, to date, of the size and nature of ADRs in children presenting to, and cared for in, hospital, and the outputs that have resulted will improve the management and understanding of ADRs in children and adults within the NHS. Recommendations for future research: assess the values that parents and children place on the use of different medicines and the risks that they will find acceptable within these contexts; focusing on high-risk drugs identified in ADRIC, determine the optimum drug dose for children through the development of a gold standard practice for the extrapolation of adult drug doses, alongside targeted pharmacokinetic/pharmacodynamic studies; assess the research and clinical applications of the Liverpool Causality Assessment Tool and the Liverpool Avoidability Assessment Tool; evaluate, in more detail, morbidities associated with anaesthesia and surgery in children, including follow-up in the community and in the home setting and an assessment of the most appropriate treatment regimens to prevent pain, vomiting and other postoperative complications; further evaluate strategies for communication with families, children and young people about ADRs; and quantify ADRs in other settings, for example critical care and neonatology

Valuable Behavioural Phenotypes in Australian Farm Dogs

This report presents findings regarding the ways to optimise the performance of livestock working dogs in Australia. The methods available to optimise dog performance include both environmental and genetic factors. The objectives of this study were to identify objective measures of desirable behavioural phenotypes in Australian livestock working dogs and explore genetic parameters of these \u27quality of working life\u27 traits within the Kelpie breed. The document reports on genotyping that reveals gene-behaviour associations and describes heritability estimates that underpin a database for potential estimated breeding value (EBV) calculations

Estimating the Economic Value of Australian Stock Herding Dogs

This study aimed to estimate the value of the typical Australian herding dog in terms of predicted return on investment. This required an assessment of the costs associated with owning herding dogs and estimation of the work they typically perform. Data on a total of 4,027 dogs were acquired through The Farm Dog Survey which gathered information from 812 herding dog owners around Australia. The median cost involved in owning a herding dog was estimated to be a total of AU$7,763 over the period of its working life. The work performed by the dog throughout this time was estimated to have a median value of AU$40,000. So, herding dogs typically provided their owners with a 5.2-fold return on investment. When respondents were asked to nominate the maximal, one-off, veterinary expenditure they would consider to remedy an illness or injury for an especially valued dog, the median response was AU$1,001–2,000 which is not concordant with the dogs’ calculated median lifetime value. The current findings equip working dog owners with useful information to make financially appropriate expenditure decisions related to their working dogs. This is expected to increase farm profitability and improve welfare for farm dogs

Valuable Behavioural Phenotypes in Australian Farm Dogs

This report presents findings regarding the ways to optimise the performance of livestock working dogs in Australia. The methods available to optimise dog performance include both environmental and genetic factors. The objectives of this study were to identify objective measures of desirable behavioural phenotypes in Australian livestock working dogs and explore genetic parameters of these \u27quality of working life\u27 traits within the Kelpie breed. The document reports on genotyping that reveals gene-behaviour associations and describes heritability estimates that underpin a database for potential estimated breeding value (EBV) calculations

Estimating the Economic Value of Australian Stock Herding Dogs

This study aimed to estimate the value of the typical Australian herding dog in terms of predicted return on investment. This required an assessment of the costs associated with owning herding dogs and estimation of the work they typically perform. Data on a total of 4,027 dogs were acquired through The Farm Dog Survey which gathered information from 812 herding dog owners around Australia. The median cost involved in owning a herding dog was estimated to be a total of AU$7,763 over the period of its working life. The work performed by the dog throughout this time was estimated to have a median value of AU$40,000. So, herding dogs typically provided their owners with a 5.2-fold return on investment. When respondents were asked to nominate the maximal, one-off, veterinary expenditure they would consider to remedy an illness or injury for an especially valued dog, the median response was AU$1,001–2,000 which is not concordant with the dogs’ calculated median lifetime value. The current findings equip working dog owners with useful information to make financially appropriate expenditure decisions related to their working dogs. This is expected to increase farm profitability and improve welfare for farm dogs

A “Learning Revolution”? Investigating Pedagogic Practices around Interactive Whiteboards in British Primary Classrooms

Interactive whiteboards have been rapidly introduced into all primary schools under UK Government initiatives. These large, touch-sensitive screens, which control a computer connected to a digital projector, seem to be the first type of educational technology particularly suited for whole-class teaching and learning. Strong claims are made for their value by manufacturers and policy makers, but there has been little research on how, if at all, they influence established pedagogic practices, communicative processes and educational goals. This study has been designed to examine this issue, using observations in primary (elementary) school classrooms. It is funded by the UK Economic and Social Research Council and builds on the authors’ previous research on ICT in educational dialogues and collaborative activities

An agent-based approach to assess drivers’ interaction with pre-trip information systems.

This article reports on the practical use of a multi-agent microsimulation framework to address the issue of assessing drivers’ responses to pretrip information systems. The population of drivers is represented as a community of autonomous agents, and travel demand results from the decision-making deliberation performed by each individual of the population as regards route and departure time. A simple simulation scenario was devised, where pretrip information was made available to users on an individual basis so that its effects at the aggregate level could be observed. The simulation results show that the overall performance of the system is very likely affected by exogenous information, and these results are ascribed to demand formation and network topology. The expressiveness offered by cognitive approaches based on predicate logics, such as the one used in this research, appears to be a promising approximation to fostering more complex behavior modelling, allowing us to represent many of the mental aspects involved in the deliberation process

Algorithms for flows over time with scheduling costs

Flows over time have received substantial attention from both an optimization and (more recently) a game-theoretic perspective. In this model, each arc has an associated delay for traversing the arc, and a bound on the rate of flow entering the arc; flows are time-varying. We consider a setting which is very standard within the transportation economic literature, but has received little attention from an algorithmic perspective. The flow consists of users who are able to choose their route but also their departure time, and who desire to arrive at their destination at a particular time, incurring a scheduling cost if they arrive earlier or later. The total cost of a user is then a combination of the time they spend commuting, and the scheduling cost they incur. We present a combinatorial algorithm for the natural optimization problem, that of minimizing the average total cost of all users (i.e., maximizing the social welfare). Based on this, we also show how to set tolls so that this optimal flow is induced as an equilibrium of the underlying game

Shaping electron wave functions in a carbon nanotube with a parallel magnetic field

A magnetic field, through its vector potential, usually causes measurable changes in the electron wave function only in the direction transverse to the field. Here we demonstrate experimentally and theoretically that in carbon nanotube quantum dots, combining cylindrical topology and bipartite hexagonal lattice, a magnetic field along the nanotube axis impacts also the longitudinal profile of the electronic states. With the high (up to 17T) magnetic fields in our experiment the wave functions can be tuned all the way from "half-wave resonator" shape, with nodes at both ends, to "quarter-wave resonator" shape, with an antinode at one end. This in turn causes a distinct dependence of the conductance on the magnetic field. Our results demonstrate a new strategy for the control of wave functions using magnetic fields in quantum systems with nontrivial lattice and topology.Comment: 5 figure