The structure of interrupted human AC microsatellites

Microsatellite lengths change over evolutionary time through a process of replication slippage. A recently proposed model of this process holds that the expansionary tendencies of slippage mutation are balanced by point mutations breaking longer microsatellites into smaller units and that this process gives rise to the observed frequency distributions of uninterrupted microsatellite lengths. We refer to this as the slippage/point-mutation theory. Here we derive the theory's predictions for interrupted microsatellites comprising regions of perfect repeats, labeled segments, separated by dinucleotide interruptions containing point mutations. These predictions are tested by reference to the frequency distributions of segments of AC microsatellite in the human genome, and several predictions are shown not to be supported by the data, as follows. The estimated slippage rates are relatively low for the first four repeats, and then rise initially linearly with length, in accordance with previous work. However, contrary to expectation and the experimental evidence, the inferred slippage rates decline in segments above 10 repeats. Point mutation rates are also found to be higher within microsatellites than elsewhere. The theory provides an excellent fit to the frequency distribution of peripheral segment lengths but fails to explain why internal segments are shorter. Furthermore, there are fewer microsatellites with many segments than predicted. The frequencies of interrupted microsatellites decline geometrically with microsatellite size measured in number of segments, so that for each additional segment, the number of microsatellites is 33.6% less. Overall we conclude that the detailed structure of interrupted microsatellites cannot be reconciled with the existing slippage/point-mutation theory of microsatellite evolution, and we suggest that microsatellites are stabilized by processes acting on interior rather than on peripheral segments.

The causes of prescribing errors in English general practices: a qualitative study

Aim: To examine the causes of prescribing and monitoring errors in English general practices and provide recommendations for how they may be overcome. Design: Qualitative interview and focus group study with purposive sampling and thematic analysis informed by Reason’s accident causation model. Participants: General practice staff participated in a combination of semi-structured interviews (n=34) and six focus groups (n=46). Setting: Fifteen general practices across three primary care trusts in England. Results: We identified seven categories of high-level error-producing conditions: the prescriber, the patient, the team, the task, the working environment, the computer system, and the primary-secondary care interface. Each of these was further broken down to reveal various error-producing conditions. The prescriber’s therapeutic training, drug knowledge and experience, knowledge of the patient, perception of risk, and their physical and emotional health, were all identified as possible causes. The patient’s characteristics and the complexity of the individual clinical case were also found to have contributed to prescribing errors. The importance of feeling comfortable within the practice team was highlighted, as well as the safety of general practitioners (GPs) in signing prescriptions generated by nurses when they had not seen the patient for themselves. The working environment with its high workload, time pressures, and interruptions, and computer related issues associated with mis-selecting drugs from electronic pick-lists and overriding alerts, were all highlighted as possible causes of prescribing errors and often interconnected. Conclusion: This study has highlighted the complex underlying causes of prescribing and monitoring errors in general practices, several of which are amenable to intervention.

Care homes’ use of medicines study: prevalence, causes and potential harm of medication errors in care homes for older people

Introduction: Care home residents are at particular risk from medication errors, and our objective was to determine the prevalence and potential harm of prescribing, monitoring, dispensing and administration errors in UK care homes, and to identify their causes. Methods: A prospective study of a random sample of residents within a purposive sample of homes in three areas. Errors were identified by patient interview, note review, observation of practice and examination of dispensed items. Causes were understood by observation and from theoretically framed interviews with home staff, doctors and pharmacists. Potential harm from errors was assessed by expert judgement. Results: The 256 residents recruited in 55 homes were taking a mean of 8.0 medicines. One hundred and seventy-eight (69.5%) of residents had one or more errors. The mean number per resident was 1.9 errors. The mean potential harm from prescribing, monitoring, administration and dispensing errors was 2.6, 3.7, 2.1 and 2.0 (0 = no harm, 10 = death), respectively. Contributing factors from the 89 interviews included doctors who were not accessible, did not know the residents and lacked information in homes when prescribing; home staff’s high workload, lack of medicines training and drug round interruptions; lack of team work among home, practice and pharmacy; inefficient ordering systems; inaccurate medicine records and prevalence of verbal communication; and difficult to fill (and check) medication administration systems. Conclusions: That two thirds of residents were exposed to one or more medication errors is of concern. The will to improve exists, but there is a lack of overall responsibility. Action is required from all concerned.

Induced seismicity in the Castarthao reservoir, NE Brazil - Preliminary results

The Castanhao reservoir was built in the state of Ceara, a dry region in Northeastern Brazil, to regulate the flow of the Jaguaribe River, for irrigation, and for power generation. It is an earth-filled dam, 60 m high, with a water capacity of 4.5 x 10(9) m(3). The seismicity in the area has been monitored since 1998, with a few interruptions, using one analog or one digital station and, during a few periods, a three-station network. The first earthquakes likely to be induced events were detected in 2003, when the water level was about 20 in high. In early 2004 a very heavy rainfall season quickly filled the reservoir. Shortly after, an increase in the seismic activity occurred and many micro-earthquakes were recorded. We suggest that this activity resulted from an increase in pore pressure due to undrained response. Therefore, we may classify this cluster of microearthquakes as ""initial seismicity."" We deployed a network with four analog stations in the area, following this activity, to determine the epicentral zone. At least three epicentral areas under the reservoir were detected. The spatio-temporal analysis of the available data revealed that the seismicity occurs in clusters and that these were activated at different periods. We identified four sets of faults (N-S-, E-W-, NW-SE-, and NE-SW-oriented), some of which moved in shallow crustal levels and as recently as the Quaternary (1.8 Ma). Under the present-day stress regime, the last two sets moved as strike-slip structures. We suggest a possible correlation between dormant faults and the observed induced seismicity. (c) 2008 Elsevier B.V. All rights reserved.

Informationssäkerhet inom grafiska företag

The study shows the current need for security solutions concerning work with information in different areas.Investigations will show important solutions for printers’ needs to meet the increasingly harder demands forfast and safe digital communications. Important factors to be analyzed in the investigations are: access todifferent types of information, workers authority of information, access to the data base register internallyand externally, production solutions for an effective fault detection and data base solutions fororders and distribution.Planned and unplanned stops result in a standard of value in interruptions. Internal data bases areprotected by so-called “Fire Walls”, “Watch Dogs” and Virtual Private Networks. Offset plates are locked infor a definitive range of time. Subsequent destruction and remaining sheets are shredded and recycled. Alldocumentation is digital, in business control systems, which guarantees that no important documents arelying around in working places. Fault detection work is facilitated by the ability to fully track the order numberson incoming orders.

A restricted curriculum for second language learners : a self-fulfilling teacher strategy?

The focus of this article is on relations between classroom interaction, curricular knowledge and student engagement in diverse classrooms. It is based on a study with ethnographic perspective in which two primary school classes in Sweden were followed for three years. The analysis draws on Halliday's Systemic Functional Linguistics. The results indicate that language use in the classrooms is on a basic everyday level and that high teacher control results in low-demanding tasks and low engagement among students. Interaction in the classrooms mainly consists of short talk-turns with fragmented language, frequent repairs and interruptions, while writing and reading consists of single words and short sentences. Although the classroom atmosphere is friendly and inclusive, second language students are denied necessary opportunities to develop curricular knowledge and Swedish at the advanced level, which they will need higher up in the school system. The restricted curriculum that these students are offered in school thus restricts their opportunities to school success. Thus, I argue for a more reflective and critical approach regarding language use in classrooms.

Beyond the workshop : doing multiliteracies with adolescents

Engaging students’ lifeworlds and the concerns of their communities in globalised, semiotic and information societies is imperative with the complexity of multimodal communication (Lemke 2006) in the ‘new media age’ (Kress 2003). As youth continue to demonstrate their multiliteracies proficiency with new literacies emerging from Internet Communication Technologies (ICTs), education - particularly curriculum and instruction - remains largely focused around monomodal, print-only literacy practices, often ignoring their multiple voices. In New Times (Hall 1996), there has been much rhetoric about the role of education in equipping students for the future. Multiliteracies pedagogy allows individual teachers to reconceptualise pedagogy and curriculum thereby addressing adolescents’ complex and demanding literacy needs (New London Group 1996). This paper presents new and emerging virtual contexts and environments for adolescent literacy instruction highlighting one teacher’s curricular interruptions where Multiliteracies pedagogies replaced the progressive monomodal reading and writing workshop. In conclusion, new perspectives on research related to the education of teachers in the education in post-typographic societies of the 21st century.

Re-envisioning literacy instruction with adolescents: multiliteracies, multimodality and new technologies

Engaging students' lifeworlds and the concerns of their communities in globalised, semiotic and information societies is imperative in New Times. As youth continue to exhibit their proficiency with new literacies emerging from Internet communication technologies (leTs), education-particularly curriculum and instruction-remains largely focused around monomodal, print-only literacy practices, often ignoring students' hybrid multiple voices. This paper reports on two curricular interruptions to the progressive reading and writing workshop that acknowledged adolescents' engagement with digital technologies and their new multimodalliteracy practices in a year eight public classroom within a small urban academy of technology.

Doing multiliteracies: re-envisioning adolescent literacy in new times

In New Times (Hall, 1996), there has been much rhetoric about school’s role in equipping students for the future. Multiliteracies pedagogy allows individual teachers to reconceptualise pedagogy and curriculum thereby addressing adolescents’ complex and demanding literacy needs (New London Group, 1996). As a result of the advent of widespread computer use and Internet Communication Technologies (ICTs), this paper presents new and emerging virtual contexts and environments for adolescent literacy instruction. The paper highlights one teacher’s curricular initiatives/interruptions where Multiliteracies pedagogies and the incorporation of multimodal digital and multimedia design, replaced the progressive monomodal reading and writing workshop. In conclusion, new perspectives on research related to the education of teachers in the 21st century are presented to contribute to the public knowledge base of teacher education in post-typographic societies.

Observation of pain assessment and management- the complexities of clinical practice

• Pain assessment and management are complex issues that embrace physiological, emotional, cognitive, and social dimensions.

• This observational study sought to investigate nurse–patient interactions associated with pain assessment and management in hospitalized postsurgical patients in clinical practice settings.

• Twelve field observations were carried out on Registered Nurses' activities relating to pain with their assigned patients. All nurses were involved in direct patient care in one surgical unit of a metropolitan teaching hospital in Melbourne, Australia. Six observation times were identified as key periods for activities relating to pain, which included change of shift and high activity periods. Each observation period lasted 2 hours and was examined on two occasions.

• Four major themes were identified as barriers to effective pain management: nurses' responses to interruptions of activities relating to pain, nurses' attentiveness to patient cues of pain, nurses' varying interpretations of pain, and nurses' attempts to address competing demands of nurses, doctors and patients.

• These findings provide some understanding of the complexities impacting on nurses' assessment and management of postoperative pain. Further research using this observational methodology is indicated to examine these influences in more depth. This knowledge may form the basis for developing and evaluating strategic intervention programmes that analyse nurses' management of postoperative pain and, in particular, their administration of opioid analgesics.

Advanced manufacturing technology adoption - the German experience

The decision process that organisations utilise when evaluating technology investment opportunities is a complex and even political process; however, the correct decision can provide the organisation with considerable operational and competitive benefits. The research presented in this paper presents the findings of a postal survey of the benefits provided by technology investments to large German manufacturers. It was found that only where middle management generated the idea for the advanced manufacturing technology (AMT) investment was success in that investment significantly more likely. Respondents who established a project team to plan the technology proposal, regardless of the department which generated the ideas for technology investment, were not significantly associated with a greater likelihood for success.

The respondents typically took between 3 and 12 months before making the final decision to invest, irrespective of the department generating the idea for the AMT, and a further 6 months to implement the AMT. Respondents who utilised a discounted cashflow analysis took significantly longer to make the final decision to invest. The greatest number of manufacturing outcomes of significantly higher importance was identified for respondents where Engineering, IT or R&D generated the AMT ideas. It was also determined that the respondents most frequently considered AMT investments in computer hardware or software and technical training for process workers to be necessary at the time of considering the investment. Middle management were found to be significantly more concerned than managers on other levels about opposition of workers to the AMT, while the process workers were significantly more concerned about interruptions to the process during installation.

The painful nonruptured tendon : clinical aspects

Tendon injuries account for a substantial proportion of overuse injuries in competitive and recreational sports participants, as well as in individuals whose jobs require repetitive activity. Overuse type injuries account for 30% to 50% of all sports injuries, and in many endurance and power sports tendon injuries are clearly the most frequent reason for interruptions to training and competition [1] . Because tendon problems are so common, and not easily managed, this issue of Clinics is devoted to them. This article aims to provide an understanding of the pathology underlying the conditions before outlining current evidence for clinical assessment and treatment of tendinopathies.

Robust filtering for uncertain discrete-time systems with uncertain noise covariance and uncertain observations

The use of Kalman filtering is very common in state estimation problems. The problem with Kalman filters is that they require full prior knowledge about the system modeling. It is also assumed that all the observations are fully received. In real applications, the previous assumptions are not true all the time. It is hard to obtain the exact system model and the observations may be lost due to communication problems. In this paper, we consider the design of a robust Kalman filter for systems subject to uncertainties in the state and white noise covariances. The systems under consideration suffer from random interruptions in the measurements process. An upper bound for the estimation error covariance is proposed. The proposed upper bound is further minimized by selection of optimal filter parameters. Simulation example shows the effectiveness of the proposed filter.

Does an evidence-based sedation protocol improve practice and patient outcomes in critical care?

Learning Objective 1: compare protocol-directed sedation management with traditional non-protocol-directed practice in mechanically ventilated patients in an Australian critical care.

Learning Objective 2: explain the contrasting international research findings on sedation protocol implementation.
Minimization of sedation in critical care patients has recently received widespread support. Professional organizations internationally have published sedation management guidelines for critically ill patients to improve the use of research in practice, decrease practice variability and shorten mechanical ventilation duration. Innovations in practice have included the introduction of decision making protocols, daily sedation interruptions and new drugs and monitoring technologies. The aim of this study was to compare protocol-directed sedation management with traditional non-protocol-directed practice in mechanically ventilated patients in an Australian critical care setting.

A randomized, controlled trial design was used to study 312 mechanically ventilated adult patients in a general critical care unit at an Australian metropolitan teaching hospital. Patients were randomly assigned to receive protocol directed sedation management developed from evidence based guidelines (n=153) or usual clinical practice (n=159).

The median (95% CI) duration of ventilation was 58 hrs (44–78 hrs) for patients in the non-protocol group and 79 hrs (56–93) for those patients in the protocol group (p=0.20). Results were not significant for length of stay in critical care or hospital, the frequency of tracheostomies, and unplanned extubations. A Cox proportional hazards model estimated that protocol directed sedation management was associated with a 22% decrease (95% CI: 40% decrease to 2% increase, p=0.07) in the occurrence of successful weaning from mechanical ventilation.

Few randomized controlled trials have evaluated the effectiveness of protocol-directed sedation outside of North America. This study highlights the lack of transferability between different settings and different models of care. Qualified, high intensity nursing in the Australian critical care setting facilitates rapid, responsive decisions for sedation management and an increased success rate for weaning from mechanical ventilation.

Implementation of a medication guideline to improve medication safety for patients

Although the incidence of medication error remains unknown, in Australian hospitals, they are thought to occur in 5-20 % of drug administrations 1. Not surprisingly, international debate has focused on the mechanisms to improve the safety of patients. Thus a new National Inpatient Medication Chart (NIMC) was endorsed to improve communication and reduce medication errors 2. This study aimed to investigate the documentation practices of clinicians following the implementation of a medication guideline and NIMC.
A pre and post-test design was used to evaluate the adoption of and adherence to the medication guideline at Western Health, an 850 bed healthcare network in Australia. Audits of inpatient medication charts (N=265) were conducted at 3 months prior to and repeated 4 months (N=290) after implementation. The pre-test data was used to formulate an interdisciplinary organizational strategy that included mandatory education for all clinical staff, practice reminders, decision prompts, a telephone hotline for support, an intranet information website and electronically distributed Frequently Asked Questions.
Pre and post implementation audits highlighted areas of potential medication error. The post-test showed an overall trend towards improvement in documentation. There were significant improvements in 4 critical practices: Drug name clear (p=0.0003); Drug dose clear (p=0.0002); Prescribed frequency equals documented frequency (p=0) and; No signature by administrator (p=0).
The majority of documentation errors showed poor attention to detail and would be considered a slip or lapse in skill based judgment 3. Although this study was designed to evaluate documentation practices, future research should include observation methods to increase our understanding of the context behind the judgments such as work place interruptions, skill mix and knowledge levels. While evidence based guidelines enable work, they are not the actual work or substance of patient care. Organisational systems can assist in preventing unconscious aberrations that lead to error.