A medication error reporting scheme:Analysis of the first 12 months

Aims and method: A new medication error reporting scheme ('Safemed') was introduced within the East Kent NHS and Social Care Partnership Trust. All medication incidents reported using this system in the first year were analysed by the Chief Pharmacist. Results: Over a 12-month period a total of 66 incidents were reported through Safemed, compared with 55 incidents under the previous system. The low level of reporting made detailed statistical analysis and drawing meaningful conclusions problematic. There was a large variability in reporting between similar sites. Clinical implications: The low level of reporting was associated with cultural factors, in particular the failure to fully implement a 'no blame' culture. Until such a culture is established, reporting will remain variable and a systems approach to preventing medication errors will not be adopted, leading to significant clinical risk

Grid Size Effects With Smeared Cracking in Finite Element Analysis of Reinforced Concrete

The effects of modeling parameters on the response of finite element representations of reinforced concrete members are examined. Convergence of load-deflection curves and cracking patterns is studied. Nonlinear behavior is limited to cracking of the concrete and yielding of the reinforcement. The ''smeared" crack representation is governed by a limiting tensile stress criterion. Concrete is treated as linear elastic in compression. Reinforcement has a bilinear stress-strain curve. Constant strain bar elements and rectangular isoparametric elements model the steel and the concrete, respectively. Analyses are performed for flexural members with span-to-depth ratios of 12-1, 5-l and 2-1, under both a uniformly distributed load and a concentrated load at midspan, using a minimum of three variations in grid refinement. Load-deflection curves exhibit convergence with grid refinement. Concrete tensile s tr eng th has a negligible influence on response for the members studied. Load increment size affects the response only in unstable regions of the load deflection curve and does not affect the stiff ness or the post-yield response

Nitrogen, Phosphorus, and Eutrophication in Streams

Flowing waters receive substantial nutrient inputs, including both nitrogen (N) and phosphorus (P), in many parts of the world. Eutrophication science for rivers and streams has unfortunately lagged behind that for lakes, and results from lakes might inform those interested in stream eutrophication. A key controversy in lake eutrophication science is the relative importance of controlling P and N in water quality management, and we are interested how the science of this controversy transfers to flowing waters. A literature review indicates (1) stream benthic chlorophyll is significantly correlated to both total N and total P in the water column, with both nutrients explaining more variance than either considered alone; (2) nutrients have increased substantially in many rivers and streams of the United States over reference conditions, and strong shifts in N and P stoichiometry have occurred as well; (3) bioassays often indicate N responses alone or in concert with P responses for autotrophic (primary production and chlorophyll) and heterotrophic (respiration) responses; (4) both heterotrophic and autotrophic processes are influenced by the availability of N and P; and (5) N-fixing cyanobacteria usually do not seem to be able to fully satisfy N limitations in rivers and streams when P is present in excess of N. These data suggest both N and P control should be considered in the eutrophication management of streams

Acceptability of HIV self-sampling kits (TINY vial) among people of black African ethnicity in the UK: a qualitative study

Background: Increasing routine HIV testing among key populations is a public health imperative, so improving access to acceptable testing options for those in need is a priority. Despite increasing targeted distribution and uptake of HIV self-sampling kits (SSKs) among men who have sex with men in the UK, little is known about why targeted SSK interventions for black African users are not as wide-spread or well-used. This paper addresses this key gap, offering insight into why some groups may be less likely than others to adopt certain types of SSK interventions in particular contexts. These data were collected during the development phase of a larger study to explore the feasibility and acceptability of targeted distribution of SSKs to black African people. Methods: We undertook 6 focus groups with members of the public who self-identified as black African (n = 48), 6 groups with specialists providing HIV and social services to black African people (n = 53), and interviews with HIV specialist consultants and policy-makers (n = 9). Framework analysis was undertaken, using inductive and deductive analysis to develop and check themes. Results: We found three valuable components of targeted SSK interventions for this population: the use of settings and technologies that increase choice and autonomy; targeted offers of HIV testing that preserve privacy and do not exacerbate HIV stigma; and ensuring that the specific kit being used (in this case, the TINY vial) is perceived as simple and reliable. Conclusions: This unique and rigorous research offers insights into participants’ views on SSK interventions, offering key considerations when targeting this population.. Given the plethora of HIV testing options, our work demonstrates that those commissioning and delivering SSK interventions will need to clarify (for users and providers) how each kit type and intervention design adds value. Most significantly, these findings demonstrate that without a strong locus of control over their own circumstances and personal information, black African people are less likely to feel that they can pursue an HIV test that is safe and secure. Thus, where profound social inequalities persist, so will inequalities in HIV testing uptake – by any means

Phase I study of TP300 in patients with advanced solid tumors with pharmacokinetic, pharmacogenetic and pharmacodynamic analyses

Background: A Phase I dose escalation first in man study assessed maximum tolerated dose (MTD), dose-limiting toxicity (DLT) and recommended Phase II dose of TP300, a water soluble prodrug of the Topo-1 inhibitor TP3076, and active metabolite, TP3011. <p/>Methods: Eligible patients with refractory advanced solid tumors, adequate performance status, haematologic, renal, and hepatic function. TP300 was given as a 1-hour i.v. infusion 3-weekly and pharmacokinetic (PK) profiles of TP300, TP3076 and TP3011 were analysed. Polymorphisms in CYP2D6, AOX1 and UGT1A1 were studied and DNA strand-breaks measured in peripheral blood mononuclear cells (PBMCs). <p/>Results: 32 patients received TP300 at 1, 2, 4, 6, 8, 10, 12 mg/m2. MTD was 10 mg/m2; DLTs at 12 (2/4 patients) and 10 mg/m2 (3/12) included thrombocytopenia and febrile neutropenia; diarrhea was uncommon. Six patients (five had received irinotecan), had stable disease for 1.5-5 months. TP3076 showed dose proportionality in AUC and Cmax from 1--10 mg/m2. Genetic polymorphisms had no apparent influence on exposure. DNA strand-breaks were detected after TP300 infusion. <p/>Conclusions: TP300 had predictable hematologic toxicity, and diarrhea was uncommon. AUC at MTD is substantially greater than for SN38. TP3076 and TP3011 are equi-potent with SN38, suggesting a PK advantage

Effects of Ash Application on Cadmium Concentration in Small Mammals

In order to assess the effects of wood ash application to forests on small mammals, we collected bank voles (Clethrionomys glareolus ) and common shrews (Sorex araneus ) from a forest area in southern Finland. Part of the sample population was from sites that had been treated with ash 1.5 years earlier, part from untreated control sites. The ash increased the soil pH and gave an average cadmium load in soil of 44 g ha1.When comparing treated and control areas, we found slightly but significantly lower Cd concentrations in vole muscle, liver, and kidney from treated plots, whereas the Cd concentrations in shrew tissues were greater in animals from treated plots. In voles we detected an increase in Cd concentrations during the 45-d sampling period in treated and untreated plots. The relative weight of kidneys was greater from the ash-treated areas than untreated areas for both voles and shrews. The difference in Cd concentrations between the voles and shrews could be explained by the different food habits

An analysis of Australia's carbon pollution reduction scheme

The authors review the decision-making since the Labour Government came into office (November 2007). The Australian Government’s ‘Carbon Pollution Reduction Scheme’ White Paper (15 December 2008) proposes that an Australian Emissions Trading Scheme (AETS) be implemented in mid-2010. Acknowledging that the scheme is comprehensive, the paper finds that in many cases, Australia will take a softer approach to climate change through the AETS than the European Union ETS(EUETS). The paper assesses key issues in the White Paper such as emissions reduction targets, GHG coverage, sectoral coverage, inclusion of unlimited quantities of offsets from Kyoto international markets and exclusion of deforestation activities

Geometry of River Networks I: Scaling, Fluctuations, and Deviations

This article is the first in a series of three papers investigating the detailed geometry of river networks. Large-scale river networks mark an important class of two-dimensional branching networks, being not only of intrinsic interest but also a pervasive natural phenomenon. In the description of river network structure, scaling laws are uniformly observed. Reported values of scaling exponents vary suggesting that no unique set of scaling exponents exists. To improve this current understanding of scaling in river networks and to provide a fuller description of branching network structure, we report here a theoretical and empirical study of fluctuations about and deviations from scaling. We examine data for continent-scale river networks such as the Mississippi and the Amazon and draw inspiration from a simple model of directed, random networks. We center our investigations on the scaling of the length of sub-basin's dominant stream with its area, a characterization of basin shape known as Hack's law. We generalize this relationship to a joint probability density and show that fluctuations about scaling are substantial. We find strong deviations from scaling at small scales which can be explained by the existence of linear network structure. At intermediate scales, we find slow drifts in exponent values indicating that scaling is only approximately obeyed and that universality remains indeterminate. At large scales, we observe a breakdown in scaling due to decreasing sample space and correlations with overall basin shape. The extent of approximate scaling is significantly restricted by these deviations and will not be improved by increases in network resolution.Comment: 16 pages, 13 figures, Revtex4, submitted to PR

Comment: Cultural eutrophication of natural lakes in the United States is real and widespread

This is the published version

A Peaking and Tailing Approach to Education and Curriculum Renewal for Sustainable Development

Contextual factors for sustainable development such as population growth, energy, and resource availability and consumption levels, food production yield, and growth in pollution, provide numerous complex and rapidly changing education and training requirements for a variety of professions including engineering. Furthermore, these requirements may not be clearly understood or expressed by designers, governments, professional bodies or the industry. Within this context, this paper focuses on one priority area for greening the economy through sustainable development—improving energy efficiency—and discusses the complexity of capacity building needs for professionals. The paper begins by acknowledging the historical evolution of sustainability considerations, and the complexity embedded in built environment solutions. The authors propose a dual-track approach to building capacity building, with a short-term focus on improvement (i.e., making peaking challenges a priority for postgraduate education), and a long-term focus on transformational innovation (i.e., making tailing challenges a priority for undergraduate education). A case study is provided, of Australian experiences over the last decade with regard to the topic area of energy efficiency. The authors conclude with reflections on implications for the approach