Describing interruptions, multi-tasking and task-switching in the community pharmacy: A qualitative study in England

Background: There is growing evidence base around interruptions and distractions in the community pharmacy setting. There is also evidence to suggest these practices may be associated with dispensing errors. Up to date, qualitative research on this subject is limited. Objective: To explore interruptions and distractions in the community setting; utilising an ethnographic approach to be able to provide a detailed description of the circumstances surrounding such practices. Setting: Community pharmacies in England, July to October 2011. Method: An ethnographic approach was taken. Non participant, unstructured observations were utilised to make records of pharmacists’ every activities. Case studies were formed by combining field notes with detailed information on pharmacists and their respective pharmacy businesses. Content analysis was undertaken both manually and electronically, utilising NVivo 10. Results: Response rate was 12% (n=11). Over fifteen days, a total of 123 hours and 58 minutes of observations were recorded in 11 separate pharmacies of 11 individual pharmacists. The sample was evenly split by gender (female n=6; male n=5) and pharmacy ownership (independent n=5; multiple n=6). Employment statuses included employee pharmacists (n=6), owners (n=4) and a locum (n=1). Average period of registration as a pharmacist was 19 years (range 5-39 years). Average prescriptions busyness of pharmacies ranged from 2,600 – 24,000 items dispensed per month. Two key themes were: “Interruptions and task-switching” and “distractions and multi-tasking.” All observed pharmacists’ work was dominated by interruptions, task-switches, distractions and multi-tasking, often to manage a barrage of conflicting demands. These practices were observed to be part of a deep-rooted culture in the community setting. Directional work maps illustrated the extent and direction of task switching employed by pharmacists. Conclusions: In this study pharmacists’ working practices were permeated by interruptions and multi-tasking. These practices are inefficient and potentially reduce patient safety in terms of dispensing accuracy

Distributions of the Conductance and its Parametric Derivatives in Quantum Dots

Full distributions of conductance through quantum dots with single-mode leads are reported for both broken and unbroken time-reversal symmetry. Distributions are nongaussian and agree well with random matrix theory calculations that account for a finite dephasing time, $\tau_\phi$, once broadening due to finite temperature $T$ is also included. Full distributions of the derivatives of conductance with respect to gate voltage $P(dg/dV_g)$ are also investigated.Comment: 4 pages (REVTeX), 4 eps figure

The magnetic susceptibility of disordered non-diffusive mesoscopic systems

Disorder-induced spectral correlations of mesoscopic quantum systems in the non-diffusive regime and their effect on the magnetic susceptibility are studied. We perform impurity averaging for non-translational invariant systems by combining a diagrammatic perturbative approach with semiclassical techniques. This allows us to study the entire range from clean to diffusive systems. As an application we consider the magnetic response of non-interacting electrons in microstructures in the presence of weak disorder. We show that in the ballistic case (elastic mean free path $\ell$ larger than the system size) there exist two distinct regimes of behaviour depending on the relative magnitudes of $\ell$ and an inelastic scattering length $L_{\phi}$. We present numerical results for square billiards and derive approximate analytical results for generic chaotic geometries. The magnetic field dependence and $L_{\phi}$ dependence of the disorder-induced susceptibility is qualitatively similar in both types of geometry.Comment: 11 pages, 7 eps figures, to be published in Phys. Rev.

Optimal Transport, Convection, Magnetic Relaxation and Generalized Boussinesq equations

We establish a connection between Optimal Transport Theory and classical Convection Theory for geophysical flows. Our starting point is the model designed few years ago by Angenent, Haker and Tannenbaum to solve some Optimal Transport problems. This model can be seen as a generalization of the Darcy-Boussinesq equations, which is a degenerate version of the Navier-Stokes-Boussinesq (NSB) equations. In a unified framework, we relate different variants of the NSB equations (in particular what we call the generalized Hydrostatic-Boussinesq equations) to various models involving Optimal Transport (and the related Monge-Ampere equation. This includes the 2D semi-geostrophic equations and some fully non-linear versions of the so-called high-field limit of the Vlasov-Poisson system and of the Keller-Segel for Chemotaxis. Finally, we show how a ``stringy'' generalization of the AHT model can be related to the magnetic relaxation model studied by Arnold and Moffatt to obtain stationary solutions of the Euler equations with prescribed topology

Conductance scaling at the band center of wide wires with pure non--diagonal disorder

Kubo formula is used to get the scaling behavior of the static conductance distribution of wide wires showing pure non-diagonal disorder. Following recent works that point to unusual phenomena in some circumstances, scaling at the band center of wires of odd widths has been numerically investigated. While the conductance mean shows a decrease that is only proportional to the inverse square root of the wire length, the median of the distribution exponentially decreases as a function of the square root of the length. Actually, the whole distribution decays as the inverse square root of the length except close to G=0 where the distribution accumulates the weight lost at larger conductances. It accurately follows the theoretical prediction once the free parameter is correctly fitted. Moreover, when the number of channels equals the wire length but contacts are kept finite, the conductance distribution is still described by the previous model. It is shown that the common origin of this behavior is a simple Gaussian statistics followed by the logarithm of the E=0 wavefunction weight ratio of a system showing chiral symmetry. A finite value of the two-dimensional conductance mean is obtained in the infinite size limit. Both conductance and the wavefunction statistics distributions are given in this limit. This results are consistent with the 'critical' character of the E=0 wavefunction predicted in the literature.Comment: 10 pages, 9 figures, RevTeX macr

A genomic portrait of the emergence, evolution, and global spread of a methicillin-resistant staphylococcus aureus pandemic

The widespread use of antibiotics in association with high-density clinical care has driven the emergence of drug-resistant bacteria that are adapted to thrive in hospitalized patients. Of particular concern are globally disseminated methicillin-resistant Staphylococcus aureus (MRSA) clones that cause outbreaks and epidemics associated with health care. The most rapidly spreading and tenacious health-care-associated clone in Europe currently is EMRSA-15, which was first detected in the UK in the early 1990s and subsequently spread throughout Europe and beyond. Using phylogenomic methods to analyze the genome sequences for 193 S. aureus isolates, we were able to show that the current pandemic population of EMRSA-15 descends from a health-care-associated MRSA epidemic that spread throughout England in the 1980s, which had itself previously emerged from a primarily community-associated methicillin-sensitive population. The emergence of fluoroquinolone resistance in this EMRSA-15 subclone in the English Midlands during the mid-1980s appears to have played a key role in triggering pandemic spread, and occurred shortly after the first clinical trials of this drug. Genome-based coalescence analysis estimated that the population of this subclone over the last 20 yr has grown four times faster than its progenitor. Using comparative genomic analysis we identified the molecular genetic basis of 99.8% of the antimicrobial resistance phenotypes of the isolates, highlighting the potential of pathogen genome sequencing as a diagnostic tool. We document the genetic changes associated with adaptation to the hospital environment and with increasing drug resistance over time, and how MRSA evolution likely has been influenced by country-specific drug use regimens

Post-stroke inhibition of induced NADPH oxidase type 4 prevents oxidative stress and neurodegeneration

Ischemic stroke is the second leading cause of death worldwide. Only one moderately effective therapy exists, albeit with contraindications that exclude 90% of the patients. This medical need contrasts with a high failure rate of more than 1,000 pre-clinical drug candidates for stroke therapies. Thus, there is a need for translatable mechanisms of neuroprotection and more rigid thresholds of relevance in pre-clinical stroke models. One such candidate mechanism is oxidative stress. However, antioxidant approaches have failed in clinical trials, and the significant sources of oxidative stress in stroke are unknown. We here identify NADPH oxidase type 4 (NOX4) as a major source of oxidative stress and an effective therapeutic target in acute stroke. Upon ischemia, NOX4 was induced in human and mouse brain. Mice deficient in NOX4 (Nox4(-/-)) of either sex, but not those deficient for NOX1 or NOX2, were largely protected from oxidative stress, blood-brain-barrier leakage, and neuronal apoptosis, after both transient and permanent cerebral ischemia. This effect was independent of age, as elderly mice were equally protected. Restoration of oxidative stress reversed the stroke-protective phenotype in Nox4(-/-) mice. Application of the only validated low-molecular-weight pharmacological NADPH oxidase inhibitor, VAS2870, several hours after ischemia was as protective as deleting NOX4. The extent of neuroprotection was exceptional, resulting in significantly improved long-term neurological functions and reduced mortality. NOX4 therefore represents a major source of oxidative stress and novel class of drug target for stroke therapy

Elastic and vibrational properties of alpha and beta-PbO

The structure, electronic and dynamic properties of the two layered alpha (litharge) and beta (massicot) phases of PbO have been studied by density functional methods. The role of London dispersion interactions as leading component of the total interaction energy between layers has been addressed by using the Grimme's approach, in which new parameters for Pb and O atoms have been developed. Both gradient corrected and hybrid functionals have been adopted using Gaussian-type basis sets of polarized triple zeta quality for O atoms and small core pseudo-potential for the Pb atoms. Basis set superposition error (BSSE) has been accounted for by the Boys-Bernardi correction to compute the interlayer separation. Cross check with calculations adopting plane waves that are BSSE free have also been performed for both structures and vibrational frequencies. With the new set of proposed Grimme's type parameters structures and dynamical parameters for both PbO phases are in good agreement with experimental data.Comment: 8 pages, 5 figure

VERITAS and Multiwavelength Observations of the BL Lacertae Object 1ES 1741+196

We present results from multiwavelength observations of the BL Lacertae object 1ES 1741+196, including results in the very-high-energy $\gamma$-ray regime using the Very Energetic Radiation Imaging Telescope Array System (VERITAS). The VERITAS time-averaged spectrum, measured above 180 GeV, is well-modelled by a power law with a spectral index of $2.7\pm0.7_{\mathrm{stat}}\pm0.2_{\mathrm{syst}}$. The integral flux above 180 GeV is $(3.9\pm0.8_{\mathrm{stat}}\pm1.0_{\mathrm{syst}})\times 10^{-8}$ m$^{-2}$ s$^{-1}$, corresponding to 1.6% of the Crab Nebula flux on average. The multiwavelength spectral energy distribution of the source suggests that 1ES 1741+196 is an extreme-high-frequency-peaked BL Lacertae object. The observations analysed in this paper extend over a period of six years, during which time no strong flares were observed in any band. This analysis is therefore one of the few characterizations of a blazar in a non-flaring state.Comment: 8 pages, 5 figures. Accepted for publication in MNRA