Prevalence and Causes of Prescribing ErrorsL The PRescribing Outcomes for Trainee Doctors Engaged in Clinical Training (PROTECT) Study

Objectives: Study objectives were to investigate the prevalence and causes of prescribing errors amongst foundation doctors (i.e. junior doctors in their first (F1) or second (F2) year of post-graduate training), describe their knowledge and experience of prescribing errors, and explore their self-efficacy (i.e. confidence) in prescribing.

Method: A three-part mixed-methods design was used, comprising: prospective observational study; semi-structured interviews and cross-sectional survey. All doctors prescribing in eight purposively selected hospitals in Scotland participated. All foundation doctors throughout Scotland participated in the survey. The number of prescribing errors per patient, doctor, ward and hospital, perceived causes of errors and a measure of doctors’ self-efficacy were established.

Results: 4710 patient charts and 44,726 prescribed medicines were reviewed. There were 3364 errors, affecting 1700 (36.1%) charts (overall error rate: 7.5%; F1:7.4%; F2:8.6%; consultants:6.3%). Higher error rates were associated with : teaching hospitals (p,0.001), surgical (p = ,0.001) or mixed wards (0.008) rather thanmedical ward, higher patient turnover wards (p,0.001), a greater number of prescribed medicines (p,0.001) and the months December and June (p,0.001). One hundred errors were discussed in 40 interviews. Error causation was multi-factorial; work environment and team factors were particularly noted. Of 548 completed questionnaires (national response rate of 35.4%), 508 (92.7% of respondents) reported errors, most of which (328 (64.6%) did not reach the patient. Pressure from other staff, workload and interruptions were cited as the main causes of errors. Foundation year 2 doctors reported greater confidence than year 1 doctors in deciding the most appropriate medication regimen.

Conclusions: Prescribing errors are frequent and of complex causation. Foundation doctors made more errors than other doctors, but undertook the majority of prescribing, making them a key target for intervention. Contributing causes included work environment, team, task, individual and patient factors. Further work is needed to develop and assess interventions that address these.

Investigation of Machining Parameters for Multiple Response Optimization in Microelectrodischarge Milling

This paper investigated the influence of three micro electrodischarge milling process parameters, which were feed rate, capacitance, and voltage. The response variables were average surface roughness (R a ), maximum peak-to-valley roughness height (R y ), tool wear ratio (TWR), and material removal rate (MRR). Statistical models of these output responses were developed using three-level full factorial design of experiment. The developed models were used for multiple-response optimization by desirability function approach to obtain minimum R a , R y , TWR, and maximum MRR. Maximum desirability was found to be 88%. The optimized values of R a , R y , TWR, and MRR were 0.04, 0.34 μm, 0.044, and 0.08 mg min−1, respectively for 4.79 μm s−1 feed rate, 0.1 nF capacitance, and 80 V voltage. Optimized machining parameters were used in verification experiments, where the responses were found very close to the predicted values.

The influence of providing perches and string on activity levels, fearfulness and leg health in commercial broiler chickens

The aim of this study was to assess the effect of providing environmental enrichment in the form of perches and string on the behaviour and welfare of commercial broiler chickens. Houses containing ~23 000 broiler chickens were assigned to one of four treatments in a 2×2 factorial design. Treatments involved two levels of access to perches (P) (present (24/house) ‘+P’ or absent ‘−P’) and two levels of access to string (S) (present (24/house) ‘+S’ or absent ‘−S’). All houses contained windows, and 30 straw bales were provided from day 10 of the rearing cycle. Treatments were applied in one of four houses on a single farm, and were replicated over four production cycles. Behaviour and leg health were observed in weeks 3 to 5 of the rearing cycle. Production performance and environmental parameters were also measured. There was an interaction between perches and age in the percentage of birds observed lying, with higher percentages of birds observed lying in the +P treatment than in the −P treatment during weeks 4 and 5. There was also a significant interaction between string and age in the percentage of birds observed in locomotion, with higher percentages observed in locomotion in the −S treatment than in the +S treatment during weeks 4 and 5. There was also an interaction between string and age in average gait scores, with lower gait scores in the +S treatment than in the −S treatment during weeks 3 and 5 but not within week 4. Daytime observations showed that perches and strings were used frequently, with one bout of perching occurring approximately every 80 s/perch, and one bout of pecking at string occurring every 78 s/string on average. There was a significant effect of age on use of perches (P<0.001) and string (P<0.001), with perching peaking during week 5 and string pecking peaking during week 3. We conclude that commercial broilers in windowed houses with access to straw bales display an interest in additional enrichment stimuli in the form of perches and string, and therefore that these stimuli have the potential to improve welfare. In addition, provision of string as a pecking device appeared to positively influence walking ability. However, this effect was numerically small, was only shown in certain weeks and was not reflected in the other leg health measure (latency to lie). The results also showed an apparent negative effect of string and perches on the activity levels of birds (recorded away from the immediate vicinity of these enrichments) towards the end of the production cycle. These results emphasise the need for further research into optimum design and layout of enrichment stimuli for modern broilers in windowed houses to ensure that their provision leads to clear welfare benefits.

Experimental design and batch experiments for optimization of Cr(VI) removal from aqueous solutions by hydrous cerium oxide nanoparticles

Hydrous cerium oxide (HCO) was synthesized by intercalation of solutions of cerium(III) nitrate and sodium hydroxide and evaluated as an adsorbent for the removal of hexavalent chromium from aqueous solutions. Simple batch experiments and a 2⁵ factorial experimental design were employed to screen the variables affecting Cr(VI) removal efficiency. The effects of the process variables; solution pH, initial Cr(VI) concentration, temperature, adsorbent dose and ionic strength were examined. Using the experimental results, a linear mathematical model representing the influence of the different variables and their interactions was obtained. Analysis of variance (ANOVA) demonstrated that Cr(VI) adsorption significantly increases with decreased solution pH, initial concentration and amount of adsorbent used (dose), but slightly decreased with an increase in temperature and ionic strength. The optimization study indicates 99% as the maximum removal at pH 2, 20 °C, 1.923 mM of metal concentration and a sorbent dose of 4 g/dm³. At these optimal conditions, Langmuir, Freundlich and Redlich–Peterson isotherm models were obtained. The maximum adsorption capacity of Cr(VI) adsorbed by HCO was 0.828 mmol/g, calculated by the Langmuir isotherm model. Desorption of chromium indicated that the HCO adsorbent can be regenerated using NaOH solution 0.1 M (up to 85%). The adsorption interactions between the surface sites of HCO and the Cr(VI) ions were found to be a combined effect of both anion exchange and surface complexation with the formation of an inner-sphere complex.

Parametric design optimization of hard turning of AISI 4340 steel (69 HRC)

Continuous research endeavors on hard turning (HT), both on machine tools and cutting tools, have made the previously reported daunting limits easily attainable in the modern scenario. This presents an opportunity for a systematic investigation on finding the current attainable limits of hard turning using a CNC turret lathe. Accordingly, this study aims to contribute to the existing literature by providing the latest experimental results of hard turning of AISI 4340 steel (69 HRC) using a CBN cutting tool. An orthogonal array was developed using a set of judiciously chosen cutting parameters. Subsequently, the longitudinal turning trials were carried out in accordance with a well-designed full factorial-based Taguchi matrix. The speculation indeed proved correct as a mirror finished optical quality machined surface (an average surface roughness value of 45 nm) was achieved by the conventional cutting method. Furthermore, Signal-to-noise (S/N) ratio analysis, Analysis of variance (ANOVA), and Multiple regression analysis were carried out on the experimental datasets to assert the dominance of each machining variable in dictating the machined surface roughness and to optimize the machining parameters. One of the key findings was that when feed rate during hard turning approaches very low (about 0.02mm/rev), it could alone be most significant (99.16%) parameter in influencing the machined surface roughness (Ra). This has, however also been shown that low feed rate results in high tool wear, so the selection of machining parameters for carrying out hard turning must be governed by a trade-off between the cost and quality considerations.

Effect of feed space allowance and period of access to food on dairy cow performance

Two experiments were conducted to examine the ‘long-term’ effect of feed space allowance and period of access to feed on dairy cow performance. In Experiment 1, three horizontal feed space allowances (20, 40 and 60 cm cow−1) were examined over a 127-d period (14 cows per treatment). In Experiment 2, 48 dairy cows were used in a continuous design (10-week duration) 2 × 2 factorial design experiment comprising two horizontal feed space allowances (15 and 40 cm cow−1), and two periods of access to feed (unrestricted and restricted). With the former, uneaten feed was removed at 08·00 h, while feeding took place at 09·00 h. With the latter, uneaten feed was removed at 06·00 h, while feeding was delayed until 12·00 h. Mean total dry-matter (DM) intakes were 19·0, 18·7 and 19·3 kg cow−1 d−1 with the 20, 40 and 60 cm cow−1 treatments in Experiment 1, and 18·1 and 18·2 kg cow−1 d−1 with the ‘restricted feeding time’ treatments, and 17·8 and 18·1 kg d−1 with the ‘unrestricted feeding time’ treatments (15 and 40 cm respectively) in Experiment 2. None of milk yield, milk composition, or end-of-study live weight or condition score were significantly affected by treatment in either experiment (P > 0·05), while fat + protein yield was reduced with the 15-cm treatment in Experiment 2 (P < 0·05). When access to feed was restricted by space or time constraints, cows modified their time budgets and increased their rates of intake.

Cross-age tutoring in kindergarten and elementary school settings: a systmeatic review and meta-analysis

Background: Qualified teaching staffs are neither available nor affordable to provide large numbers of children with individual attention. One solution to providing individual tuition has been the development of tutoring programs that are delivered by nonprofessional tutors, such as classmates, older children and community volunteers. Objectives: We have conducted a systematic review of cross-age tutoring interventions delivered by non-professional tutors to children between 5 and 11 years old. Only randomized controlled trials with reliable measures of academic outcomes, and continuing for at least 12 weeks, compared to instruction as usual, were included. Results: Searches of electronic databases and previous reviews, and contacts with researchers yielded 11,564 titles; after screening, 15 studies were included in the analysis. Cross-age tutoring showed small significant effects for tutees on the composite measure of reading (g=0.18, 95% CI: 0.08, 0.27, N=8251), decoding skills (g=0.29, 95% CI: 0.13, 0.44, N=7081), and reading comprehension (g=0.11, 95% CI: 0.01, 0.21, N=6945). No significant effects were detected for other reading sub-skills or for mathematics. The quality of evidence is decreased by study limitations and high heterogeneity of effects. Conclusions: The benefits for tutees of non-professional peer and cross-age tutoring can be given a positive but weak recommendation, considering the low quality of evidence and lack of cost information. Subgroup analyses suggested that highly-structured reading programs may be more useful than loosely-structured programs. Large-scale replication trials using factorial design, process evaluations, reliable outcome measures and logic models are needed to better understand under what conditions, and for whom, cross-age non-professional tutoring may be effective.

Cross-age tutoring in kindergarten and elementary school settings: A systematic review and meta-analysis

This systematic review summarizes effects of peer tutoring delivered to children between 5 and 11 years old by non-professional tutors, such as classmates, older children and adult community peer volunteers. Inclusion criteria for the review included tutoring studies with a randomized controlled trial design, reliable measures of academic outcomes, and duration of at least 12 weeks. Searches of electronic databases, previous reviews, and contacts with researchers yielded 11,564 titles. After screening, 15 studies were included in the analysis. Cross-age tutoring showed small significant effects for tutees on the composite measure of reading (g = 0.18, 95% CI: 0.08, 0.27, N = 8251), decoding skills (g = 0.29, 95% CI: 0.13, 0.44, N = 7081), and reading comprehension (g = 0.11, 95% CI: 0.01, 0.21, N = 6945). No significant effects were detected for other reading sub-skills or for mathematics. The benefits to tutees of non-professional cross-age peer tutoring can be given a positive, but weak recommendation. Effect Sizes were modest and in the range −0.02 to 0.29. Questions regarding study limitations, lack of cost information, heterogeneity of effects, and the relatively small number of studies that have used a randomized controlled trial design means that the evidence base is not as strong as it could be. Subgroup analyses of included studies indicated that highly-structured reading programmes were of more benefit than those that were loosely-structured. Large-scale replication trials using factorial designs, reliable outcome measures, process evaluations and logic models are needed to better understand under what conditions, and for whom, cross-age non-professional peer tutoring may be most effective.

Aspirin and folic acid for the prevention of recurrent colorectal adenomas

BACKGROUND & AIMS: Although observational studies have found regular aspirin use to be associated with a reduced risk of colorectal neoplasia, results from randomized trials using aspirin have been inconsistent. Dietary folate intake also has been found to be associated with a reduced risk of colorectal neoplasms in observational studies.

METHODS: A multicenter, randomized, double-blind trial of aspirin (300 mg/day) and folate supplements (0.5 mg/day) to prevent colorectal adenoma recurrence was performed using a 2 x 2 factorial design. All patients had an adenoma (>/=0.5 cm) removed in the 6 months before recruitment and were followed-up at 4-month intervals with a second colonoscopy after approximately 3 years. The primary outcome measure was a colorectal adenoma diagnosed after baseline.

RESULTS: A total of 945 patients were recruited into the study, of whom 853 (90.3%) underwent a second colonoscopy. In total, 99 (22.8%) of 434 patients receiving aspirin had a recurrent adenoma compared with 121 (28.9%) of 419 patients receiving placebo (relative risk, 0.79; 95% confidence interval [CI], 0.63-0.99). A total of 104 patients developed an advanced colorectal adenoma; 41 (9.4%) of these were in the aspirin group and 63 (15.0%) were in the placebo group (relative risk, 0.63; 95% CI, 0.43-0.91). Folate supplementation was found to have no effect on adenoma recurrence (relative risk, 1.07; 95% CI, 0.85-1.34).

CONCLUSIONS: Aspirin (300 mg/day) but not folate (0.5 mg/day) use was found to reduce the risk of colorectal adenoma recurrence, with evidence that aspirin could have a significant role in preventing the development of advanced lesions.

Evaluating environmental enrichment options for commercial broiler chickens

Implications Provision of environmental enrichment in line with that required by welfare-based quality assurance schemesdoes not always appear to lead to clear improvements in broiler chicken welfare. This research perhaps serves to highlightthe deficit in information regarding the ‘real world’ implications of enrichment with perches, string and straw bales.

Introduction Earlier work showed that provision of natural light and straw bales improved leg health in commercial broilerchickens (Bailie et al., 2013). This research aimed to determine if additional welfare benefits were shown in windowedhouses by increasing straw bale provision (Study 1), or by providing perches and string in addition to straw bales (Study 2).

Material and methods Commercial windowed houses in Northern Ireland containing ~23,000 broiler chickens (placed inhouses as hatched) were used in this research which took place in 2011. In Study 1 two houses on a single farm wereassigned to one of two treatments: (1) 30 straw bales per house (1 bale/44m2), or (2) 45 straw bales per house (1bale/29m2). Bales of wheat straw, each measuring 80cm x 40cm x 40cm were provided from day 10 of the rearing cycle,as in Bailie et al. (2013). Treatments were replicated over 6 production cycles (using 276,000 Ross 308 and Cobb birds),and were swapped between houses in each replicate. In Study 2, four houses on a single farm were assigned to 1 of 4treatments in a 2 x 2 factorial design. Treatments involved 2 levels of access to perches (present (24/house), or absent), and2 levels of access to string (present (24/house), or absent), and both types of enrichment were provided from the start of thecycle. Each perch consisted of a horizontal, wooden beam (300 cm x 5 cm x 5cm) with a rounded upper edge resting on 2supports (15 cm high). In the string treatment, 6 pieces of white nylon string (60 cm x 10 mm) were tied at their mid-pointto the wire above each of 4 feeder lines. Thirty straw bales were also provided per house from day 10. This study wasreplicated over 4 production cycles using 368,000 Ross 308 birds. In both studies behaviour was observed between 0900and 1800 hours in weeks 3-5 of the cycle. In Study 1, 8 focal birds were selected in each house each week, and generalactivity, exploratory and social behaviours recorded directly for 10 minutes. In Study 2, 10 minute video recordings weremade of 6 different areas (that did not contain enrichment) of each house each week. The percentage of birds engaged inlocomotion or standing was determined through scan sampling these recordings at 120 second intervals. Four perches andfour pieces of string were filmed for 25 mins in each house that contained these enrichments on one day per week. The totalnumber of times the perch or string was used was recorded, along with the duration of each bout. In both studies, gaitscores (0 (perfect) to 5 (unable to walk)) and latency to lie (measured in seconds from when a bird had been encouraged tostand) were recorded in 25 birds in each house each week. Farm and abattoir records were also used in both studies todetermine the number of birds culled for leg and other problems, mortality levels, slaughter weights, and levels of pododermatitis and hock burn. Data were analysed using SPSS (version 20.0) and treatment and age effects on behaviouralparameters were determined in normally distributed data using ANOVA (‘Straw bale density*week’, or‘string*perches*week’ as appropriate), and in non-normally distributed data using Kuskall-Wallace tests (P<0.05 forsignificance) . Treatment (but not age) effects on performance and health data were determined using the same testsdepending on normality of data.

Results Average slaughter weight, and levels of mortality, culling, hock burn and pododermatitis were not affected bytreatment in either study (P<0.05). In Study 1 straw bale (SB) density had no significant effect on the frequency orduration of behaviours including standing, walking, ground pecking, dust bathing, pecking at bales or aggression, or onaverage gait score (P>0.05). However, the average latency to lie was greater when fewer SB were provided (30SB 23.38s,45SB 18.62s, P<0.01). In Study 2 there was an interaction between perches (Pe) and age in lying behaviour, with higherpercentages of birds observed lying in the Pe treatment during weeks 4 and 5 (week 3 +Pe 77.0 -Pe 80.9, week 4 +Pe 79.5 -Pe 75.2, week 5 +Pe 78.4 -Pe 76.2, P<0.02). There was also a significant interaction between string (S) and age inlocomotory behaviour, with higher percentages of birds observed in locomotion in the string treatment during week 3 butnot weeks 4 and 5 (week 3 +S 4.9 -S 3.9, week 4 +S 3.3 -S 3.7, week 5 +S 2.6 -S 2.8, P<0.04). There was also aninteraction between S and age in average gait scores, with lower gait scores in the string treatment in weeks 3 and 5 (week3: +S 0.7, -S 0.9, week 4: +S 1.5, -S 1.4, week 5: +S 1.9, -S 2.0, P<0.05). On average per 25 min observation there were15.1 (±13.6) bouts of perching and 19.2 (±14.08) bouts of string pecking, lasting 117.4 (±92.7) and 4.2 (±2.0) s for perchesand string, respectively.

Conclusion Increasing straw bale levels from 1 bale/44m2 to 1 bale/29m2 floor space does not appear to lead to significantimprovements in the welfare of broilers in windowed houses. The frequent use of perches and string suggests that thesestimuli have the potential to improve welfare. Provision of string also appeared to positively influence walking ability.However, this effect was numerically small, was only shown in certain weeks and was not reflected in the latency to lie.Further research on optimum design and level of provision of enrichment items for broiler chickens is warranted. Thisshould include measures of overall levels of activity (both in the vicinity of, and away from, enrichment items).

The fate of 14C-naphthalene in soil microcosms containing Scots pine seedlings and enchytraeids

The fate of freshly spiked and aged ¹⁴C-naphthalene associated residues as investigated in the presence and absence of ectomycorrhizal Scots pine seedlings and enchytraeid worms, in a factorial experimental design. Microcosms were used which enabled the ¹⁴C-labelled naphthalene associated residues to be quantified, including plant lipids which acted as an additional naphthalene sink within the microcosms. The presence of plant roots altered the availability of the ¹⁴C-naphthalene and associated residues to degrading microbes. Mineralisation and volatilisation of ¹⁴C naphthalene in freshly spiked soil were lower in the presence of Scots pine. Conversely, in soil aged for 180 d, Scots pine increased mineralisation, and bioavailability of naphthalene. Root-mediated processes, microbial activity and enchytraeids interact with desorption, bioavailability and mineralisation of naphthalene. © 2006 Elsevier Ltd. All rights reserved.

Strategic behaviour in choice experiments.

Practitioners of environmental economics sometimes use repeated trinary choice experiment surveys to estimate the value of environmental policies and programs for use in policy evaluation. These surveys have several advantages over simpler forms of non-market valuation: (1) researchers can estimate the marginal value of attributes of the good or service in question, making the results useful for benefits transfer; and (2) because respondents make several choices and choose from choice sets containing three options, efficiency of the willingness to pay estimate is improved over one-shot, binary choice formats. Despite these benefits, such surveys may have incentive properties which cause the resulting value estimates to be biased. This paper presents a theoretical demonstration that subjects often have an incentive to choose the second-best option in a repeated trinary choice survey. The model shows that due to the nature of factorial choice set design, the second-best option in the choice set will often be the status quo option. The paper reports a set of experiments designed to test these theoretical predictions in an induced-value setting. The experimental results are consistent with the theoretical predictions, demonstrating that repeated trinary choice experiment surveys can generate biased value estimates under a wide range of conditions.

Psychometric evaluation of the Student Authorship Questionnaire: a confirmatory factor analysis approach

This research provides new insights into the measurement of students’ authorial identity and its potential for minimising the incidence of unintentional plagiarism by providing evidence about the psychometric properties of the Student Authorship Questionnaire (SAQ). Exploratory and confirmatory factor analyses (EFA and CFA) are employed to investigate the measurement properties of the scales which comprise the SAQ using data collected from accounting students. The results provide limited psychometric support in favour of the factorial structure of the SAQ and raise a number of questions regarding the instrument’s robustness and generalisability across disciplines. An alternative model derived from the EFA outperforms the SAQ model with regard to its psychometric properties. Explanations for these findings are proffered and avenues for future research suggested.

Arbuscular mycorrhizal fungal hyphae reduce soil erosion by surface water flow in a greenhouse experiment

The role of arbuscular mycorrhizal fungi (AMF) in resisting surface flow soil erosion has never been tested experimentally. We set up a full factorial greenhouse experiment using Achillea millefolium with treatments consisting of addition of AMF inoculum and non-microbial filtrate, non-AMF inoculum and microbial filtrate, AMF inoculum and microbial filtrate, and non-AMF inoculum and non-microbial filtrate (control) which were subjected to a constant shear stress in the form of surface water flow to quantify the soil detachment rate through time. We found that soil loss can be explained by the combined effect of roots and AMF extraradical hyphae and we could disentangle the unique effect of AMF hyphal length, which significantly reduced soil loss, highlighting their potential importance in riparian systems.

Transfusion and Treatment of severe anaemia in African children (TRACT): a study protocol for a randomised controlled trial

BACKGROUND: In sub-Saharan Africa, where infectious diseases and nutritional deficiencies are common, severe anaemia is a common cause of paediatric hospital admission, yet the evidence to support current treatment recommendations is limited. To avert overuse of blood products, the World Health Organisation advocates a conservative transfusion policy and recommends iron, folate and anti-helminthics at discharge. Outcomes are unsatisfactory with high rates of in-hospital mortality (9-10 %), 6-month mortality and relapse (6 %). A definitive trial to establish best transfusion and treatment strategies to prevent both early and delayed mortality and relapse is warranted.

METHODS/DESIGN: TRACT is a multicentre randomised controlled trial of 3954 children aged 2 months to 12 years admitted to hospital with severe anaemia (haemoglobin < 6 g/dl). Children will be enrolled over 2 years in 4 centres in Uganda and Malawi and followed for 6 months. The trial will simultaneously evaluate (in a factorial trial with a 3 x 2 x 2 design) 3 ways to reduce short-term and longer-term mortality and morbidity following admission to hospital with severe anaemia in African children. The trial will compare: (i) R1: liberal transfusion (30 ml/kg whole blood) versus conservative transfusion (20 ml/kg) versus no transfusion (control). The control is only for children with uncomplicated severe anaemia (haemoglobin 4-6 g/dl); (ii) R2: post-discharge multi-vitamin multi-mineral supplementation (including folate and iron) versus routine care (folate and iron) for 3 months; (iii) R3: post-discharge cotrimoxazole prophylaxis for 3 months versus no prophylaxis. All randomisations are open. Enrolment to the trial started September 2014 and is currently ongoing. Primary outcome is cumulative mortality to 4 weeks for the transfusion strategy comparisons, and to 6 months for the nutritional support/antibiotic prophylaxis comparisons. Secondary outcomes include mortality, morbidity (haematological correction, nutritional and infectious), safety and cost-effectiveness.

DISCUSSION: If confirmed by the trial, a cheap and widely available 'bundle' of effective interventions, directed at immediate and downstream consequences of severe anaemia, could lead to substantial reductions in mortality in a substantial number of African children hospitalised with severe anaemia every year, if widely implemented.