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

A search for massive neutral bosons in orthopositronium decay

We have searched for an exotic decay of orthopositronium into a single photon and a short-lived neutral boson in the hitherto unexplored mass region above 900 ${\rm keV}/{\it c}^{2}$, by noting that this decay is one of few remaining candidates which could explain the discrepancy of the orthopositronium decay-rate. A high-resolution measurement of the associated photon energy spectrum was carried out with a germanium detector to search for a sharp peak from this two-body decay. Our negative result provides the upper-limits of\mbox{ }$2.0 \times 10^{-4}$ on the branching ratio of such a decay in the mass region from 847 to 1013 ${\rm keV}/{\it c}^{2}$, and excludes the possibility of this decay mode explaining the discrepancy in the orthopositronium decay-rate.Comment: a LaTeX file (text 7 pages) and a uuencoded gz-compressed PostScript file (text 7 pages + figures 4 pages

Violation of the Cauchy-Schwarz inequality with matter waves

The Cauchy-Schwarz (CS) inequality -- one of the most widely used and important inequalities in mathematics -- can be formulated as an upper bound to the strength of correlations between classically fluctuating quantities. Quantum mechanical correlations can, however, exceed classical bounds.Here we realize four-wave mixing of atomic matter waves using colliding Bose-Einstein condensates, and demonstrate the violation of a multimode CS inequality for atom number correlations in opposite zones of the collision halo. The correlated atoms have large spatial separations and therefore open new opportunities for extending fundamental quantum-nonlocality tests to ensembles of massive particles.Comment: Final published version (with minor changes). 5 pages, 3 figures, plus Supplementary Materia

PREDICTING THE DATE OF FIRST CATCH OF THE CORN EARWORM, HELICOVERPA ZEA, IN CENTRAL U.S.

This paper develops predictive (or correlative) models for the date of first catch of the com earworm, Helicoverpa zea, as a basis for identifying biotic and abiotic factors that influence dispersal and migration. Data described in Goodenough et al. (1988, J. Econ. Entomol.) on the catch of H. zea gathered at over 150 sites predominantly in the central U.S. from 1983 to 1986 are analyzed. The dependent variables, Y1 and Y2, are date of first meaningful catch and date when cumulative catch exceeds 5, respectively; the independent variables are latitude, longitude and elevation of the site. Outstanding among the findings are the following : 1) There is no statistical evidence based on all the data that the slopes of the simple linear regression models of Y2 on latitude differ among the four years. The common slope estimate is 8.11 days/degree, the intercepts differ by as many as 16 days, and the combined model has r2 = 0.69. 2) There is no statistical evidence based on the data in the central U.S. that the partial slopes of the multiple regression models of Y2 on latitude and longitude differ among the four years. The common partial slope estimates are 7.36 and -1.27 days/degree, the intercepts differ by as many as 17 days, and the combined model has R 2= 0.69. Second order terms are not significant . 3) An exploratory analysis using GIS mapping software suggests that elevation is also a significant predictor variable. The suggestion is confirmed in multiple regression models for both Y1 and Y22= 0.71 and 0.72 respectively. The intercepts differ by as many as 20 and 17 days, respectively, over the four years . These results imply that the time of fi!\u27st appearance at any location in the central U.S. could be predicted once the date of first appearance in South Texas is ascertained. They also demonstrate the utility of analyzing residuals using GIS mapping software. Research is in progress to investigate other possible predictor variables including soil moisture, soil temperature and precipitation

Development and application of an indicator assessment tool for measuring health services accreditation programs

© 2015 Mumford et al. Background: Hospital accreditation programs are internationally widespread and consume increasingly scarce health resources. However, we lack tools to consistently identify suitable indicators to assess and monitor accreditation outcomes. We describe the development and validation of such a tool. Results: Using Australian accreditation standards as our reference point we: reviewed the research evidence for potential indicators; looked for links with existing external indicators; and assessed relevant state and federal policies. We allocated provisional scores, on a five point Likert scale, to the five accountability criteria in the tool: research; accuracy; proximity; no adverse effects; and specificity. An expert panel validated the use of the purpose designed indicator assessment tool. The panel identified hand hygiene compliance rates as a suitable process indicator, and hospital acquired Staphylococcus aureus infection (SAB) rates as an outcome indicator, with the hypothesis that improved hand hygiene compliance rates and lower SAB rates would correlate with accreditation performance. Conclusions: This new tool can be used to identify, analyse, and compare accreditation indicators. Using infection control indicators such as hand hygiene compliance and SAB rates to measure accreditation effectiveness has merit, and their efficacy can be determined by comparing accreditation scores with indicator outcomes. To verify the tool as a robust instrument, testing is needed in other health service domains, both in Australia and internationally. This tool provides health policy makers with an important means for assessing the accreditation programs which form a critical part of the national patient safety and quality framework

Efficient LZ78 factorization of grammar compressed text

We present an efficient algorithm for computing the LZ78 factorization of a text, where the text is represented as a straight line program (SLP), which is a context free grammar in the Chomsky normal form that generates a single string. Given an SLP of size $n$ representing a text $S$ of length $N$, our algorithm computes the LZ78 factorization of $T$ in $O(n\sqrt{N}+m\log N)$ time and $O(n\sqrt{N}+m)$ space, where $m$ is the number of resulting LZ78 factors. We also show how to improve the algorithm so that the $n\sqrt{N}$ term in the time and space complexities becomes either $nL$, where $L$ is the length of the longest LZ78 factor, or $(N - \alpha)$ where $\alpha \geq 0$ is a quantity which depends on the amount of redundancy that the SLP captures with respect to substrings of $S$ of a certain length. Since $m = O(N/\log_\sigma N)$ where $\sigma$ is the alphabet size, the latter is asymptotically at least as fast as a linear time algorithm which runs on the uncompressed string when $\sigma$ is constant, and can be more efficient when the text is compressible, i.e. when $m$ and $n$ are small.Comment: SPIRE 201

Chemical Kinetic Modeling of Hydrogen Combustion Limits

A detailed chemical kinetic model is used to explore the flammability and detonability of hydrogen mixtures. In the case of flammability, a detailed chemical kinetic mechanism for hydrogen is coupled to the CHEMKIN Premix code to compute premixed, laminar flame speeds. The detailed chemical kinetic model reproduces flame speeds in the literature over a range of equivalence ratios, pressures and reactant temperatures. A series of calculation were performed to assess the key parameters determining the flammability of hydrogen mixtures. Increased reactant temperature was found to greatly increase the flame speed and the flammability of the mixture. The effect of added diluents was assessed. Addition of water and carbon dioxide were found to reduce the flame speed and thus the flammability of a hydrogen mixture approximately equally well and much more than the addition of nitrogen. The detailed chemical kinetic model was used to explore the detonability of hydrogen mixtures. A Zeldovich-von Neumann-Doring (ZND) detonation model coupled with detailed chemical kinetics was used to model the detonation. The effectiveness on different diluents was assessed in reducing the detonability of a hydrogen mixture. Carbon dioxide was found to be most effective in reducing the detonability followed by water and nitrogen. The chemical action of chemical inhibitors on reducing the flammability of hydrogen mixtures is discussed. Bromine and organophosphorus inhibitors act through catalytic cycles that recombine H and OH radicals in the flame. The reduction in H and OH radicals reduces chain branching in the flame through the H + O{sub 2} = OH + O chain branching reaction. The reduction in chain branching and radical production reduces the flame speed and thus the flammability of the hydrogen mixture

Disentangling quality and safety indicator data: a longitudinal, comparative study of hand hygiene compliance and accreditation outcomes in 96 Australian hospitals.

The study aims are twofold. First, to investigate the suitability of hand hygiene as an indicator of accreditation outcomes and, second, to test the hypothesis that hospitals with better accreditation outcomes achieve higher hand hygiene compliance rates