An interprofessional approach to improving paediatric medication safety.

BACKGROUND: Safe drug prescribing and administration are essential elements within undergraduate healthcare curricula, but medication errors, especially in paediatric practice, continue to compromise patient safety. In this area of clinical care, collective responsibility, team working and communication between health professionals have been identified as key elements in safe clinical practice. To date, there is limited research evidence as to how best to deliver teaching and learning of these competencies to practitioners of the future.

METHODS: An interprofessional workshop to facilitate learning of knowledge, core competencies, communication and team working skills in paediatric drug prescribing and administration at undergraduate level was developed and evaluated. The practical, ward-based workshop was delivered to 4th year medical and 3rd year nursing students and evaluated using a pre and post workshop questionnaire with open-ended response questions.

RESULTS: Following the workshop, students reported an increase in their knowledge and awareness of paediatric medication safety and the causes of medication errors (p < 0.001), with the greatest increase noted among medical students. Highly significant changes in students' attitudes to shared learning were observed, indicating that safe medication practice is learnt more effectively with students from other healthcare disciplines. Qualitative data revealed that students' participation in the workshop improved communication and teamworking skills, and led to greater awareness of the role of other healthcare professionals.

CONCLUSION: This study has helped bridge the knowledge-skills gap, demonstrating how an interprofessional approach to drug prescribing and administration has the potential to improve quality and safety within healthcare.

Fully hardware based WFQ architecture for high-speed QoS packet scheduling

A full hardware implementation of a Weighted Fair Queuing (WFQ) packet scheduler is proposed. The circuit architecture presented has been implemented using Altera Stratix II FPGA technology, utilizing RLDII and QDRII memory components. The circuit can provide fine granularity Quality of Service (QoS) support at a line throughput rate of 12.8Gb/s in its current implementation. The authors suggest that, due to the flexible and scalable modular circuit design approach used, the current circuit architecture can be targeted for a full ASIC implementation to deliver 50 Gb/s throughput. The circuit itself comprises three main components; a WFQ algorithm computation circuit, a tag/time-stamp sort and retrieval circuit, and a high throughput shared buffer. The circuit targets the support of emerging wireline and wireless network nodes that focus on Service Level Agreements (SLA's) and Quality of Experience.

Holothurians – potential biomonitors for metal levels in deep-sea sediments

Levels of cadmium, copper, aluminium, iron, manganese and zinc (Cd, Cu, Al, Fe, Mn and Zn) in deep-sea sediments and sediment-feeding holothurians are reported. Profiles of metals were found to vary with depth in the sediment. Holothurian foregut metal values are generally closer to surficial sediment levels, whereas body wall levels, with the exception of Cd and Cu, were generally lower. Holothurians are presented as potential biomonitors of metal concentrations in the deep-sea floor environment.

Composition profiling of seized ecstasy tablets by Raman spectroscopy

Raman spectroscopy with far-red excitation has been investigated as a simple and rapid technique for composition profiling of seized ecstasy (MDMA, N-methyl-3,4-methylenedioxyamphetamine) tablets. The spectra obtained are rich in vibrational bands and allow the active drug and excipient used to bulk the tablets to be identified. Relative band heights can be used to determine drug/excipient ratios and the degree of hydration of the drug while the fact that 50 tablets per hour can be analysed allows large numbers of spectra to be recorded. The ability of Raman spectroscopy to distinguish between ecstasy tablets on the basis of their chemical composition is illustrated here by a sample set of 400 tablets taken from a large seizure of > 50000 tablets that were found in eight large bags. The tablets are all similar in appearance and carry the same logo. Conventional analysis by GC-MS showed they contained MDMA. Initial Raman studies of samples from each of the eight bags showed that despite some tablet-to-tablet variation within each bag the contents could be classified on the basis of the excipients used. The tablets in five of the bags were sorbitol-based, two were cellulose-based and one bag contained tablets with a glucose excipient. More extensive analysis of 50 tablets from each of a representative series of sample bags gave distribution profiles that showed the contents of each bag were approximately normally distributed about a mean value, rather than being mixtures of several discrete types. Two of the sorbitol-containing sample sets were indistinguishable while a third was similar but not identical to these, in that it contained the same excipient and MDMA with the same degree of hydration but had a slightly different MDMA/sorbitol ratio. The cellulose-based samples were badly manufactured and showed considerable tablet-to-tablet variation in their drug/excipient ratio while the glucose-based tablets had a tight distribution in their drug/excipient ratios. The degree of hydration in the MDMA feedstocks used to manufacture the cellulose-, glucose- and sorbitol-based tablets were all different from each other. This study, because it centres on a single seizure of physically similar tablets with the same active drug, highlights the fact that simple physical descriptions coupled with active drug content do not in themselves fully characterize the nature of the seized materials. There is considerable variation in the composition of the tablets within this single seizure and the fact that this variation can be detected from Raman spectra demonstrates that the potential benefits of obtaining highly detailed spectra can indeed translate into information that is not readily available from other methods but would be useful for tracing of drug distribution networks.

Rapid analysis of ecstasy and related phenethylamines in seized tablets by Raman spectroscopy

Raman spectroscopy with far-red excitation has been used to study seized, tableted samples of MDMA (N-methyl-3,4-methylenedioxyamphetamine) and related compounds (MDA, MDEA, MBDB, 2C-B and amphetamine sulfate), as well as pure standards of these drugs. We have found that by using far-red (785 nm) excitation the level of fluorescence background even in untreated seized samples is sufficiently low that there is little difficulty in obtaining good quality data with moderate 2 min data accumulation times. The spectra can be used to distinguish between even chemically-similar substances, such as the geometrical isomers MDEA and MBDB, and between different polymorphic/hydrated forms of the same drug. Moreover, these differences can be found even in directly recorded spectra of seized samples which have been bulked with other materials, giving a rapid and non-destructive method for drug identification. The spectra can be processed to give unambiguous identification of both drug and excipients (even when more than one compound has been used as the bulking agent) and the relative intensities of drug and excipient bands can be used for quantitative or at least semi-quantitative analysis. Finally, the simple nature of the measurements lends itself to automatic sample handling so that sample throughputs of 20 samples per hour can be achieved with no real difficulty.

Are causal and intervention judgments inextricably linked? A developmental study.

The application of the formal framework of causal Bayesian Networks to children's causal learning provides the motivation to examine the link between judgments about the causal structure of a system, and the ability to make inferences about interventions on components of the system. Three experiments examined whether children are able to make correct inferences about interventions on different causal structures. The first two experiments examined whether children's causal structure and intervention judgments were consistent with one another. In Experiment 1, children aged between 4 and 8years made causal structure judgments on a three-component causal system followed by counterfactual intervention judgments. In Experiment 2, children's causal structure judgments were followed by intervention judgments phrased as future hypotheticals. In Experiment 3, we explicitly told children what the correct causal structure was and asked them to make intervention judgments. The results of the three experiments suggest that the representations that support causal structure judgments do not easily support simple judgments about interventions in children. We discuss our findings in light of strong interventionist claims that the two types of judgments should be closely linked. © 2011 Cognitive Science Society, Inc.


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FDTD analysis of close-coupled 418 MHz radiating devices for human biotelemetry

This paper describes the finite-difference time-domain (FDTD) analysis of antenna-body interaction effects occurring when chest-mounted 418 MHz radio transmitters are used for medical telemetry applications. Whole-body software models (homogeneous, layered and tissue-segmented) were developed for an adult male subject. Using an electrically small (300 mm(2)) planar loop antenna, calculated radiation efficiencies ranged between 33.5% and 39.2% for a whole-body model, and between 60.7% and 66.1% for a torso; radiation patterns were found to be largely independent of model composition. The computed radiation efficiency for a 21.5 kg phantom representing a six-year-old female was within 1.1 dB of measured results (actual body mass 28 kg) and well-correlated azimuthal radiation patterns were noted.

Electric Vehicles - a well to wheel analysis

The European Union has set a target for 10% renewable energy in transport by 2020, which will be met using both biofuels and electric vehicles. In the case of biofuels, for the purposes of meeting the target, the biofuel must achieve greenhouse gas savings of 35% relative to the fossil fuel replaced. For biofuels, greenhouse gas savings can be calculated using life cycle analysis, or the European Union default values. In contrast, all electricity used in transport is considered to be the same, regardless of the source or the type of electric vehicle. However, the choice of the electric vehicle and electricity source will have a major impact on the greenhouse gas savings. This paper examines different electric-vehicle scenarios in terms of greenhouse gas savings, using a well-to-wheel life cycle analysis.

Efficient advanced encryption standard implementation using lookup and normal basis

A new type of advanced encryption standard (AES) implementation using a normal basis is presented. The method is based on a lookup technique that makes use of inversion and shift registers, which leads to a smaller size of lookup for the S-box than its corresponding implementations. The reduction in the lookup size is based on grouping sets of inverses into conjugate sets which in turn leads to a reduction in the number of lookup values. The above technique is implemented in a regular AES architecture using register files, which requires less interconnect and area and is suitable for security applications. The results of the implementation are competitive in throughput and area compared with the corresponding solutions in a polynomial basis.

Mixed radix Reed-Muller expansions

The choice of radix is crucial for multi-valued logic synthesis. Practical examples, however, reveal that it is not always possible to find the optimal radix when taking into consideration actual physical parameters of multi-valued operations. In other words, each radix has its advantages and disadvantages. Our proposal is to synthesise logic in different radices, so it may benefit from their combination. The theory presented in this paper is based on Reed-Muller expansions over Galois field arithmetic. The work aims to firstly estimate the potential of the new approach and to secondly analyse its impact on circuit parameters down to the level of physical gates. The presented theory has been applied to real-life examples focusing on cryptographic circuits where Galois Fields find frequent application. The benchmark results show the approach creates a new dimension for the trade-off between circuit parameters and provides information on how the implemented functions are related to different radices.