Evaluation of the implementation of the alert issued by the UK National Patient Safety Agency on the storage and handling of potassium chloride concentrate solution

Objectives: To assess the effectiveness of the response of NHS hospital trusts to an alert issued by the National Patient Safety Agency designed to limit the availability of concentrated potassium chloride in hospitals in England and Wales, and to determine the nature of any unintended consequences. Design: Multi-method study involving interviews and a physical inspection of clinical areas. Setting: 207 clinical areas in 20 randomly selected acute NHS trusts in England and Wales between 31 October 2002 and 31 January 2003. Participants: Senior managers and ward based medical and nursing staff. Main outcome measures: Degree of staff awareness of and compliance with the requirements of the national alert, withdrawal of concentrated potassium chloride solutions from non-critical areas, provision of pre-diluted alternatives, storage and recording in accordance with controlled drug legislation. Results: All trusts required that potassium chloride concentrate be stored in a separate locked cupboard from common injectable diluents (100% compliance). Unauthorised stocks of potassium chloride were found in five clinical areas not authorised by the trust (98% compliance). All trusts required documentation control of potassium chloride concentrate in clinical areas, but errors were recorded in 20 of the 207 clinical areas visited (90% compliance). Of those interviewed, 78% of nurses and 30% of junior doctors were aware of the alert. Conclusions: The NPSA alert was effective and resulted in rapid development and implementation of local policies to reduce the availability of concentrated potassium chloride solutions. The success is likely to be partly due to the nature of the proposed changes and it cannot be assumed that future alerts will be equally effective. Continued vigilance will be necessary to help sustain the changes

Analysis of model rotor blade pressures during parallel interaction with twin vortices

This paper presents and provides analysis of unsteady surface pressures measured on a model rotor blade as the blade experienced near parallel blade vortex interaction with a twin vortex system. To provide a basis for analysis, the vortex system was characterized by hot-wire measurements made in the interaction plane but in the absence of the rotor. The unsteady pressure response resulting from a single vortex interaction is then presented to provide a frame of reference for the twin vortex results. A series of twin vortex interaction cases are then presented and analyzed. It is shown that the unsteady blade pressures and forces are very sensitive to the inclination angle and separation distance of the vortex pair. When the vortex cores lie almost parallel to the blade chord, the interaction is characterized by a two-stage response associated with the sequential passage of the two cores. Conversely, when the cores lie on a plane that is almost perpendicular to the blade chord, the response is similar to that of a single vortex interaction. In all cases, the normal force response is consistent with the distribution of vertical velocity in the flow field of the vortex system. The pitching moment response, on the other hand, depends on the localized suction associated with the vortex cores as they traverse the blade chord

Curve crossing in linear potential grids: the quasidegeneracy approximation

The quasidegeneracy approximation [V. A. Yurovsky, A. Ben-Reuven, P. S. Julienne, and Y. B. Band, J. Phys. B {\bf 32}, 1845 (1999)] is used here to evaluate transition amplitudes for the problem of curve crossing in linear potential grids involving two sets of parallel potentials. The approximation describes phenomena, such as counterintuitive transitions and saturation (incomplete population transfer), not predictable by the assumption of independent crossings. Also, a new kind of oscillations due to quantum interference (different from the well-known St\"uckelberg oscillations) is disclosed, and its nature discussed. The approximation can find applications in many fields of physics, where multistate curve crossing problems occur.Comment: LaTeX, 8 pages, 8 PostScript figures, uses REVTeX and psfig, submitted to Physical Review

Double Beta Decay: Historical Review of 75 Years of Research

Main achievements during 75 years of research on double beta decay have been reviewed. The existing experimental data have been presented and the capabilities of the next-generation detectors have been demonstrated.Comment: 25 pages, typos adde

Supporting carers to manage pain medication in cancer patients at the end of life: A feasibility trial

Background: Carers of people with advanced cancer play a significant role in managing pain medication, yet they report insufficient information and support to do so confidently and competently. There is limited research evidence on the best ways for clinicians to help carers with medication management. Aims: To develop a pain medicines management intervention (Cancer Carers Medicines Management) for cancer patients’ carers near the end of life and evaluate feasibility and acceptability to nurses and carers. To test the feasibility of trial research procedures and to inform decisions concerning a full-scale randomised controlled trial. Design: Phase I-II clinical trial. A systematic, evidence-informed participatory method was used to develop CCMM: a nurse-delivered structured conversational process. A two-arm, cluster randomised controlled feasibility trial of Cancer Carers Medicines Management was conducted, with an embedded qualitative study to evaluate participants’ experiences of Cancer Carers Medicines Management and trial procedures. Setting: Community settings in two study sites. Participants: Phase I comprises 57 carers, patients and healthcare professionals and Phase II comprises 12 nurses and 15 carers. Results: A novel intervention was developed. Nurses were recruited and randomised. Carer recruitment to the trial was problematic with fewer than predicted eligible participants, and nurses judged a high proportion unsuitable to recruit into the study. Attrition rates following recruitment were typical for the study population. Cancer Carers Medicines Management was acceptable to carers and nurses who took part, and some benefits were identified. Conclusion: Cancer Carers Medicines Management is a robustly developed medicines management intervention which merits further research to test its effectiveness to improve carers’ management of pain medicines with patients at the end of life. The study highlighted aspects of trial design that need to be considered in future research

Follow-up after curative treatment for colorectal cancer: longitudinal evaluation of patient initiated follow-up in the first 12 months

Purpose: To compare patient-triggered follow-up (PTFU) for curatively treated colorectal cancer against traditional outpatient follow-up (OPFU). Methods: Questionnaires were mailed at four time points over one-year post-treatment to two prospectively-recruited cohorts: A, patients entering follow-up and receiving OPFU pre-implementation of PTFU; B, patients entering follow-up (FU) and receiving either OPFU (B1) or PTFU (B2) post-implementation of PTFU. Bi-variate tests were used to compare patient characteristics and outcomes eight months after entering follow-up (generic and cancer-specific quality of life (QoL), satisfaction). Regression analysis explored associations between follow-up model and outcomes. Resource implications and costs of models were compared. Results: Patients in Cohort B1 were significantly more likely to have received chemotherapy (p<0.001), radiotherapy (p<0.05), and reported poorer QoL (p=0.001). Having a longstanding co-morbid condition was the most important determinant of QoL (p<0.001); model of care was not significant. Patients were satisfied with their follow-up care regardless of model. Health service costs were higher in PTFU over the first year. Conclusions: PTFU is acceptable to patients with colorectal cancer and can be considered to be a realistic alternative to OPFU for clinically suitable patients. The initial costs are higher due to provision of a self-management (SM) programme and remote surveillance. Further research is needed to establish long-term outcomes and costs

Around the hybrid conference world in the COVID-19 era

In-person and online conferences each have their benefits, with hybrid conferences intended to blend the best of both worlds. But do hybrid conferences fulfil the promise? Fifteen attendees across three global conferences share their collective experiences.Peer reviewe

Two mini-Neptunes transiting the adolescent K-star HIP 113103 confirmed with TESS and CHEOPS

We report the discovery of two mini-Neptunes in near 2:1 resonance orbits (P = 7.610303 d for HIP 113103 b and P = 14.245651 d for HIP 113103 c ) around the adolescent K-star HIP 113103 (TIC 121490076 ). The planet system was first identified from the TESS mission, and was confirmed via additional photometric and spectroscopic observations, including a ∼17.5 hour observation for the transits of both planets using ESA CHEOPS . We place ≤4.5 min and ≤2.5 min limits on the absence of transit timing variations over the three year photometric baseline, allowing further constraints on the orbital eccentricities of the system beyond that available from the photometric transit duration alone. With a planetary radius of Rp = $1.829_{-0.067}^{+0.096}$R⊕, HIP 113103 b resides within the radius gap, and this might provide invaluable information on the formation disparities between super-Earths and mini-Neptunes. Given the larger radius Rp = $2.40_{-0.08}^{+0.10}$R⊕ for HIP 113103 c , and close proximity of both planets to HIP 113103 , it is likely that HIP 113103 b might have lost (or is still losing) its primordial atmosphere. We therefore present simulated atmospheric transmission spectra of both planets using JWST , HST , and Twinkle . It demonstrates a potential metallicity difference (due to differences in their evolution) would be a challenge to detect if the atmospheres are in chemical equilibrium. As one of the brightest multi sub-Neptune planet systems suitable for atmosphere follow up, HIP 113103 b and HIP 113103 c could provide insight on planetary evolution for the sub-Neptune K-star population

Frugal Innovation for Supply Chain Sustainability in SMEs: Multi-method Research Design

In this study we attempt to establish the missing links between supply chain sustainability and frugal innovation. Our study motivations stem from two facets of the emerging markets: firstly, the institutional barriers and secondly, the resource constraints. We argue that there is a synergy in the concepts of frugal innovation and sustainability in supply chains and there is a need to further explore this synergy. Furthermore, we claim that even in the wake of many success stories in the frugal innovative supply chain management practices from emerging markets such as India, there are very few, if any, attempts made to understand the implications of a sustainability oriented frugal innovations in the particular context. To address this gap we develop a model to establish the linkage between sustainable supply chains and frugal innovations. Our proposed conceptual framework depicts the hierarchy and interlinks of the identified enablers in developing sustainability oriented frugal innovative capabilities in supply chains. Furthermore, we have empirically validated our theoretical framework using survey data. We observed that most of the interpretive links are supported. These findings extend the understanding of frugal innovation for supply chain sustainability using multi-method research design, while also providing theoretically guidance to managers in the development of frugal innovation capability to achieve sustainability in supply chain in resource constrained environment