Investigating and learning lessons from early experiences of implementing ePrescribing systems into NHS hospitals:a questionnaire study

Background: ePrescribing systems have significant potential to improve the safety and efficiency of healthcare, but they need to be carefully selected and implemented to maximise benefits. Implementations in English hospitals are in the early stages and there is a lack of standards guiding the procurement, functional specifications, and expected benefits. We sought to provide an updated overview of the current picture in relation to implementation of ePrescribing systems, explore existing strategies, and identify early lessons learned.Methods: a descriptive questionnaire-based study, which included closed and free text questions and involved both quantitative and qualitative analysis of the data generated.Results: we obtained responses from 85 of 108 NHS staff (78.7% response rate). At least 6% (n = 10) of the 168 English NHS Trusts have already implemented ePrescribing systems, 2% (n = 4) have no plans of implementing, and 34% (n = 55) are planning to implement with intended rapid implementation timelines driven by high expectations surrounding improved safety and efficiency of care. The majority are unclear as to which system to choose, but integration with existing systems and sophisticated decision support functionality are important decisive factors. Participants highlighted the need for increased guidance in relation to implementation strategy, system choice and standards, as well as the need for top-level management support to adequately resource the project. Although some early benefits were reported by hospitals that had already implemented, the hoped for benefits relating to improved efficiency and cost-savings remain elusive due to a lack of system maturity.Conclusions: whilst few have begun implementation, there is considerable interest in ePrescribing systems with ambitious timelines amongst those hospitals that are planning implementations. In order to ensure maximum chances of realising benefits, there is a need for increased guidance in relation to implementation strategy, system choice and standards, as well as increased financial resources to fund local activitie

The Operation and Evolution of the Swift X-ray Telescope

The Swift X-ray Telescope (XRT) is a CCD based X-ray telescope designed for localization, spectroscopy and long term light curve monitoring of Gamma-Ray Bursts and their X-ray afterglows. Since the launch of Swift in November 2004, the XRT has undergone significant evolution in the way it is operated. Shortly after launch there was a failure of the thermo-electric cooler on the XRT CCD, which led to the XRT team being required to devise a method of keeping the XRT CCD temperature below 50C utilizing only passive cooling by minimizing the exposure of the XRT radiator to the Earth. We present in this paper an update on how the modeling of this passive cooling method has improved in first -1000 days since the method was devised, and the success rate of this method in day-to-day planning. We also discuss the changes to the operational modes and onboard software of the XRT. These changes include improved rapid data product generation in order to improve speed of rapid Gamma-Ray Burst response and localization to the community; changes to the way XRT observation modes are chosen in order to better fine tune data aquisition to a particular science goal; reduction of "mode switching" caused by the contamination of the CCD by Earth light or high temperature effects

Towards environmentally sound intensification pathways for dairy development in the Tanga region of Tanzania

The gap between milk demand and domestic supply in Tanzania is large and projected to widen. Meeting such demand through local production of affordable milk presents an opportunity to improve the welfare of producers and market agents through the income and employment generated along the value chain (VC). Efforts to maximize milk yields, production and profitability need to be balanced with long-term sustainability. We combined environmental and economic ex-ante impact assessments of four intervention scenarios for two production systems in the Tanzanian dairy VC using the CLEANED model and an economic feasibility analysis. Intervention scenarios propose increases in milk production through (i) animal genetic improvement, (ii) improved feed, (iii) improved animal health and (iv) a package combining all interventions. Results show that economically feasible farm-level productivity increases of up to 140% go hand-in-hand with increased resource-use efficiency and up to 50% reduction in greenhouse gas (GHG) emission intensities. Absolute increases in water, land and nitrogen requirements in mixed crop-livestock systems call for careful management of stocks and quality of these resources. An overall rise in GHG emissions is expected, with a maximum of 53% increase associated with an 89% increase in milk supply at VC level. The CLEANED tool proved effective to evaluate livestock interventions that improve incomes and food security with minimal environmental footprint. Here, our simulations suggest that due to current low productivity, the greatest efficiency gains in combination with relatively low increases in total GHG emissions can be made in the extensive agro-pastoral dairy systems, which represent the majority of herds

The role of ixazomib as an augmented conditioning therapy in salvage autologous stem cell transplant (ASCT) and as a post-ASCT consolidation and maintenance strategy in patients with relapsed multiple myeloma (ACCoRd [UK-MRA Myeloma XII] trial): study protocol for a Phase III randomised controlled trial

Background: Multiple myeloma (MM) is a plasma cell tumour with an approximate annual incidence of 4500 in the UK. Therapeutic options for patients with MM have changed in the last decade with the arrival of proteasome inhibitors and immunomodulatory drugs. Despite these options, almost all patients will relapse post first-line autologous stem cell transplantation (ASCT). First relapse management (second-line treatment) has evolved in recent years with an expanding portfolio of novel agents, driving response rates influencing the durability of response. A second ASCT, as part of relapsed disease management (salvage ASCT), has been shown to prolong the progression-free survival and overall survival following a proteasome inhibitor-containing re-induction regimen, in the Cancer Research UK-funded National Cancer Research Institute Myeloma X (Intensive) study. It is now recommended that salvage ASCT be considered for suitable patients by the International Myeloma Working Group and the National Institute for Health and Care Excellence NG35 guidance. Methods/design: ACCoRd (Myeloma XII) is a UK-nationwide, individually randomised, multi-centre, multiple randomisation, open-label phase III trial with an initial single intervention registration phase aimed at relapsing MM patients who have received ASCT in first-line treatment. We will register 406 participants into the trial to allow 284 and 248 participants to be randomised at the first and second randomisations, respectively. All participants will receive re-induction therapy until maximal response (four to six cycles of ixazomib, thalidomide and dexamethasone). Participants who achieve at least stable disease will be randomised (1:1) to receive either ASCTCon, using high-dose melphalan, or ASCTAug, using high-dose melphalan with ixazomib. All participants achieving or maintaining a minimal response or better, following salvage ASCT, will undergo a second randomisation (1:1) to consolidation and maintenance or observation. Participants randomised to consolidation and maintenance will receive consolidation with two cycles of ixazomib, thalidomide and dexamethasone, and maintenance with ixazomib until disease progression. Discussion: The question of how best to maximise the durability of response to salvage ASCT warrants clinical investigation. Given the expanding scope of oral therapeutic agents, patient engagement with long-term maintenance strategies is a real opportunity. This study will provide evidence to better define post-relapse treatment in MM

Swift XRT and VLT Observations of the Afterglow of GRB 041223

The Swift Gamma-Ray Burst Explorer, launched on 2004 November 20, is a multiwavelength, autonomous, rapid-slewing observatory for gamma-ray burst (GRB) astronomy. On 2004 December 23, during the activation phase of the mission, the Swift X-Ray Telescope (XRT) was pointed at a burst discovered earlier that day by the Swift Burst Alert Telescope. A fading, uncataloged X-ray source was discovered by the XRT and was observed over a period of about 3 hours, beginning 4.6 hours after the burst. The X-ray detection triggered a VLT observation of the optical/NIR counterpart, located about 1.1 arcseconds from the XRT position. The X-ray counterpart faded rapidly, with a power law index of -1.72 +/- 0.20. The average unabsorbed X-ray flux 4.6-7.9 hours after the burst was 6.5 x 10^{-12} erg cm^{-2} s^{-1} in the 0.5-10 keV band, for a power-law spectrum of photon index 2.02 +/- 0.13 with Galactic absorption. The NIR counterpart was observed at three epochs between 16 and 87 hours after the burst, and faded with a power-law index of -1.14 +/- 0.08 with a reddening-corrected SED power-law slope of -0.40 +/- 0.03. We find that the X-ray and NIR data are consistent with a two-component jet in a wind medium, with an early jet break in the narrow component and an underlying electron index of 1.8-2.0.Comment: 16 pages, including 4 figures. Accepted by Astrophysical Journal (Letters) on 15 February 200

GRB 050117: Simultaneous Gamma-ray and X-ray Observations with the Swift Satellite

The Swift Gamma-Ray Burst Explorer performed its first autonomous, X-ray follow-up to a newly detected GRB on 2005 January 17, within 193 seconds of the burst trigger by the Swift Burst Alert Telescope. While the burst was still in progress, the X-ray Telescope obtained a position and an image for an un-catalogued X-ray source; simultaneous with the gamma-ray observation. The XRT observed flux during the prompt emission was 1.1 x 10^{-8} ergs cm^{-2} s^{-1} in the 0.5-10 keV energy band. The emission in the X-ray band decreased by three orders of magnitude within 700 seconds, following the prompt emission. This is found to be consistent with the gamma-ray decay when extrapolated into the XRT energy band. During the following 6.3 hours, the XRT observed the afterglow in an automated sequence for an additional 947 seconds, until the burst became fully obscured by the Earth limb. A faint, extremely slowly decaying afterglow, alpha=-0.21$, was detected. Finally, a break in the lightcurve occurred and the flux decayed with alpha<-1.2$. The X-ray position triggered many follow-up observations: no optical afterglow could be confirmed, although a candidate was identified 3 arcsecs from the XRT position.Comment: 27 pages, 6 figures. Accepted for publication in Ap

Freezing of gait and fall detection in Parkinson’s disease using wearable sensors:a systematic review

Despite the large number of studies that have investigated the use of wearable sensors to detect gait disturbances such as Freezing of gait (FOG) and falls, there is little consensus regarding appropriate methodologies for how to optimally apply such devices. Here, an overview of the use of wearable systems to assess FOG and falls in Parkinson’s disease (PD) and validation performance is presented. A systematic search in the PubMed and Web of Science databases was performed using a group of concept key words. The final search was performed in January 2017, and articles were selected based upon a set of eligibility criteria. In total, 27 articles were selected. Of those, 23 related to FOG and 4 to falls. FOG studies were performed in either laboratory or home settings, with sample sizes ranging from 1 PD up to 48 PD presenting Hoehn and Yahr stage from 2 to 4. The shin was the most common sensor location and accelerometer was the most frequently used sensor type. Validity measures ranged from 73–100% for sensitivity and 67–100% for specificity. Falls and fall risk studies were all home-based, including samples sizes of 1 PD up to 107 PD, mostly using one sensor containing accelerometers, worn at various body locations. Despite the promising validation initiatives reported in these studies, they were all performed in relatively small sample sizes, and there was a significant variability in outcomes measured and results reported. Given these limitations, the validation of sensor-derived assessments of PD features would benefit from more focused research efforts, increased collaboration among researchers, aligning data collection protocols, and sharing data sets

Cultural otherness and disaster news: the influence of western discourses on Japan in US and UK news coverage of the 2011 Great East Japan Disaster

The Great East Japan Disaster of 2011 provides an important case study to evaluate how western media cover Japan. Employing a critical discourse analysis of coverage in The New York Times, The Guardian and The Observer this article seeks to examine how Japan and the disaster-affected communities of Tohoku were represented through the context of this disaster. The analysis revealed the presence of a cultural framework, enacted during the response phase of the disaster news cycle to explain how people in Japan were coping in the aftermath of the disaster, which was premised on a discourse of cultural otherness. The textual elements that underwrote this discourse included a tendency to draw on stereotypes and in the way culture was employed to provide context to individual stories. The analysis also acknowledges how forms of bias circulated through other discourses, in particular when covering the nuclear crisis at Fukushima. The article argues that this discourse of cultural otherness is, in part, attributable to the features of disaster journalism, rather than a lack of familiarity on the part of journalists with the cultural context