PINCER trial: a cluster randomised trial comparing the effectiveness and cost-effectiveness of a pharmacist-led IT-based intervention with simple feedback in reducing rates of clinically important errors in medicines management in general practices

Background: Medication errors in general practice are an important source of potentially preventable morbidity and mortality. Building on previous descriptive, qualitative and pilot work, we sought to investigate the effectiveness, cost-effectiveness and likely generalisability of a complex pharm acist-led IT-based intervention aiming to improve prescribing safety in general practice. Objectives: We sought to: • Test the hypothesis that a pharmacist-led IT-based complex intervention using educational outreach and practical support is more effective than simple feedback in reducing the proportion of patients at risk from errors in prescribing and medicines management in general practice. • Conduct an economic evaluation of the cost per error avoided, from the perspective of the National Health Service (NHS). • Analyse data recorded by pharmacists, summarising the proportions of patients judged to be at clinical risk, the actions recommended by pharmacists, and actions completed in the practices. • Explore the views and experiences of healthcare professionals and NHS managers concerning the intervention; investigate potential explanations for the observed effects, and inform decisions on the future roll-out of the pharmacist-led intervention • Examine secular trends in the outcome measures of interest allowing for informal comparison between trial practices and practices that did not participate in the trial contributing to the QRESEARCH database. Methods Two-arm cluster randomised controlled trial of 72 English general practices with embedded economic analysis and longitudinal descriptive and qualitative analysis. Informal comparison of the trial findings with a national descriptive study investigating secular trends undertaken using data from practices contributing to the QRESEARCH database. The main outcomes of interest were prescribing errors and medication monitoring errors at six- and 12-months following the intervention. Results: Participants in the pharmacist intervention arm practices were significantly less likely to have been prescribed a non-selective NSAID without a proton pump inhibitor (PPI) if they had a history of peptic ulcer (OR 0.58, 95%CI 0.38, 0.89), to have been prescribed a beta-blocker if they had asthma (OR 0.73, 95% CI 0.58, 0.91) or (in those aged 75 years and older) to have been prescribed an ACE inhibitor or diuretic without a measurement of urea and electrolytes in the last 15 months (OR 0.51, 95% CI 0.34, 0.78). The economic analysis suggests that the PINCER pharmacist intervention has 95% probability of being cost effective if the decision-maker’s ceiling willingness to pay reaches £75 (6 months) or £85 (12 months) per error avoided. The intervention addressed an issue that was important to professionals and their teams and was delivered in a way that was acceptable to practices with minimum disruption of normal work processes. Comparison of the trial findings with changes seen in QRESEARCH practices indicated that any reductions achieved in the simple feedback arm were likely, in the main, to have been related to secular trends rather than the intervention. Conclusions Compared with simple feedback, the pharmacist-led intervention resulted in reductions in proportions of patients at risk of prescribing and monitoring errors for the primary outcome measures and the composite secondary outcome measures at six-months and (with the exception of the NSAID/peptic ulcer outcome measure) 12-months post-intervention. The intervention is acceptable to pharmacists and practices, and is likely to be seen as costeffective by decision makers.

Practicing sustainability in PFI project management

This paper investigates the relationship of the project management in Private Finance Initiative (PFI) and sustainability. A live PFI project is selected as a case study, where contract review and monitoring on project management are carried out to evaluate the sustainability of project management. The PFI procurement shows great advantages in increased contractual responsibilities of the contractor in sustainable construction, and also in practicing sustainability in project management. Six main sustainable attributes of the project management are selected to evaluate the sustainability of project management in the PFI project. The project management process in the case study is closely monitored in order to verify how the PFI project promotes sustainability in practice. The project management in the different stages of the PFI project, including tendering, design, construction and operation, contributes to the six sustainable attributes in different ways. The project management in PFI project paid more attention in sustainable development during its whole process. As the private sector is responsible to the whole life of the building project, the project manager has to consider the long-term benefits during the management process. The government should take advantages of PFI project management in practicing sustainability therefore to promote sustainable development of the national infrastructure services.

Cloud banding and winds in intense European cyclones: results from the DIAMET project

The DIAMET (DIAbatic influences on Mesoscale structures in ExTratropical storms) project aims to improve forecasts of high-impact weather in extratropical cyclones through field measurements, high-resolution numerical modeling, and improved design of ensemble forecasting and data assimilation systems. This article introduces DIAMET and presents some of the first results. Four field campaigns were conducted by the project, one of which, in late 2011, coincided with an exceptionally stormy period marked by an unusually strong, zonal North Atlantic jet stream and a succession of severe windstorms in northwest Europe. As a result, December 2011 had the highest monthly North Atlantic Oscillation index (2.52) of any December in the last 60 years. Detailed observations of several of these storms were gathered using the UK’s BAe146 research aircraft and extensive ground-based measurements. As an example of the results obtained during the campaign, observations are presented of cyclone Friedhelm on 8 December 2011, when surface winds with gusts exceeding 30 m s-1 crossed central Scotland, leading to widespread disruption to transportation and electricity supply. Friedhelm deepened 44 hPa in 24 hours and developed a pronounced bent-back front wrapping around the storm center. The strongest winds at 850 hPa and the surface occurred in the southern quadrant of the storm, and detailed measurements showed these to be most intense in clear air between bands of showers. High-resolution ensemble forecasts from the Met Office showed similar features, with the strongest winds aligned in linear swaths between the bands, suggesting that there is potential for improved skill in forecasts of damaging winds.

The DACCIWA project: dynamics-aerosol-chemistry-cloud interactions in West Africa

Massive economic and population growth, and urbanization are expected to lead to a tripling of anthropogenic emissions in southern West Africa (SWA) between 2000 and 2030. However, the impacts of this on human health, ecosystems, food security, and the regional climate are largely unknown. An integrated assessment is challenging due to (a) a superposition of regional effects with global climate change, (b) a strong dependence on the variable West African monsoon, (c) incomplete scientific understanding of interactions between emissions, clouds, radiation, precipitation, and regional circulations, and (d) a lack of observations. This article provides an overview of the DACCIWA (Dynamics-Aerosol-Chemistry-Cloud Interactions in West Africa) project. DACCIWA will conduct extensive fieldwork in SWA to collect high-quality observations, spanning the entire process chain from surface-based natural and anthropogenic emissions to impacts on health, ecosystems, and climate. Combining the resulting benchmark dataset with a wide range of modeling activities will allow (a) assessment of relevant physical, chemical, and biological processes, (b) improvement of the monitoring of climate and atmospheric composition from space, and (c) development of the next generation of weather and climate models capable of representing coupled cloud-aerosol interactions. The latter will ultimately contribute to reduce uncertainties in climate predictions. DACCIWA collaborates closely with operational centers, international programs, policy-makers, and users to actively guide sustainable future planning for West Africa. It is hoped that some of DACCIWA’s scientific findings and technical developments will be applicable to other monsoon regions.

Adaptive project planning and management based on best practices - COBRA system

Planning a project with proper considerations of all necessary factors and managing a project to ensure its successful implementation will face a lot of challenges. Initial stage in planning a project for bidding a project is costly, time consuming and usually with poor accuracy on cost and effort predictions. On the other hand, detailed information for previous projects may be buried in piles of archived documents which can be increasingly difficult to learn from the previous experiences. Project portfolio has been brought into this field aiming to improve the information sharing and management among different projects. However, the amount of information that could be shared is still limited to generic information. This paper, we report a recently developed software system COBRA to automatically generate a project plan with effort estimation of time and cost based on data collected from previous completed projects. To maximise the data sharing and management among different projects, we proposed a method of using product based planning from PRINCE2 methodology. (Automated Project Information Sharing and Management System -�COBRA) Keywords: project management, product based planning, best practice, PRINCE2

Running Climate Models On The NERC Cluster Grid Using G-Rex

Compute grids are used widely in many areas of environmental science, but there has been limited uptake of grid computing by the climate modelling community, partly because the characteristics of many climate models make them difficult to use with popular grid middleware systems. In particular, climate models usually produce large volumes of output data, and running them usually involves complicated workflows implemented as shell scripts. For example, NEMO (Smith et al. 2008) is a state-of-the-art ocean model that is used currently for operational ocean forecasting in France, and will soon be used in the UK for both ocean forecasting and climate modelling. On a typical modern cluster, a particular one year global ocean simulation at 1-degree resolution takes about three hours when running on 40 processors, and produces roughly 20 GB of output as 50000 separate files. 50-year simulations are common, during which the model is resubmitted as a new job after each year. Running NEMO relies on a set of complicated shell scripts and command utilities for data pre-processing and post-processing prior to job resubmission. Grid Remote Execution (G-Rex) is a pure Java grid middleware system that allows scientific applications to be deployed as Web services on remote computer systems, and then launched and controlled as if they are running on the user's own computer. Although G-Rex is general purpose middleware it has two key features that make it particularly suitable for remote execution of climate models: (1) Output from the model is transferred back to the user while the run is in progress to prevent it from accumulating on the remote system and to allow the user to monitor the model; (2) The client component is a command-line program that can easily be incorporated into existing model work-flow scripts. G-Rex has a REST (Fielding, 2000) architectural style, which allows client programs to be very simple and lightweight and allows users to interact with model runs using only a basic HTTP client (such as a Web browser or the curl utility) if they wish. This design also allows for new client interfaces to be developed in other programming languages with relatively little effort. The G-Rex server is a standard Web application that runs inside a servlet container such as Apache Tomcat and is therefore easy to install and maintain by system administrators. G-Rex is employed as the middleware for the NERC1 Cluster Grid, a small grid of HPC2 clusters belonging to collaborating NERC research institutes. Currently the NEMO (Smith et al. 2008) and POLCOMS (Holt et al, 2008) ocean models are installed, and there are plans to install the Hadley Centre’s HadCM3 model for use in the decadal climate prediction project GCEP (Haines et al., 2008). The science projects involving NEMO on the Grid have a particular focus on data assimilation (Smith et al. 2008), a technique that involves constraining model simulations with observations. The POLCOMS model will play an important part in the GCOMS project (Holt et al, 2008), which aims to simulate the world’s coastal oceans. A typical use of G-Rex by a scientist to run a climate model on the NERC Cluster Grid proceeds as follows :(1) The scientist prepares input files on his or her local machine. (2) Using information provided by the Grid’s Ganglia3 monitoring system, the scientist selects an appropriate compute resource. (3) The scientist runs the relevant workflow script on his or her local machine. This is unmodified except that calls to run the model (e.g. with “mpirun”) are simply replaced with calls to "GRexRun" (4) The G-Rex middleware automatically handles the uploading of input files to the remote resource, and the downloading of output files back to the user, including their deletion from the remote system, during the run. (5) The scientist monitors the output files, using familiar analysis and visualization tools on his or her own local machine. G-Rex is well suited to climate modelling because it addresses many of the middleware usability issues that have led to limited uptake of grid computing by climate scientists. It is a lightweight, low-impact and easy-to-install solution that is currently designed for use in relatively small grids such as the NERC Cluster Grid. A current topic of research is the use of G-Rex as an easy-to-use front-end to larger-scale Grid resources such as the UK National Grid service.

Roles in construction projects: analysis and terminology

Standard form contracts are typically developed through a negotiated consensus, unless they are proffered by one specific interest group. Previously published plans of work and other descriptions of the processes in construction projects tend to focus on operational issues, or they tend to be prepared from the point of view of one or other of the dominant interest groups. Legal practice in the UK permits those who draft contracts to define their terms as they choose. There are no definitive rulings from the courts that give an indication as to the detailed responsibilities of project participants. The science of terminology offers useful guidance for discovering and describing terms and their meanings in their practical context, but has never been used for defining terms for responsibilities of participants in the construction project management process. Organizational analysis enables the management task to be deconstructed into its elemental parts in order that effective organizational structures can be developed. Organizational mapping offers a useful technique for reducing text-based descriptions of project management roles and responsibilities to a comparable basis. Research was carried out by means of a desk study, detailed analysis of nine plans of work and focus groups representing all aspects of the construction industry. No published plan of work offers definitive guidance. There is an enormous amount of variety in the way that terms are used for identifying responsibilities of project participants. A catalogue of concepts and terms (a “Terminology”) has been compiled and indexed to enable those who draft contracts to choose the most appropriate titles for project participants. The purpose of this terminology is to enable the selection and justification of appropriate terms in order to help define roles. The terminology brings an unprecedented clarity to the description of roles and responsibilities in construction projects and, as such, will be helpful for anyone seeking to assemble a team and specify roles for project participants.

Training drama teachers: a perspective from England

In England, drama is embedded into the National Curriculum as a part of the programmes of study for the subject of English. This means that all children aged between 5 - 16 in state funded schools have an entitlement to be taught some aspects of the subject. While the manifestation of drama in primary schools is diverse, in a great many schools for students aged between 11 – 19, drama and theatre art is taught as a discrete subject in the same way that the visual arts and music are. Students may opt for public examination courses in the subject at ages 16 and 18. In order to satisfy the specifications laid down for such examinations many schools recognise the need for specialist teachers and indeed specialist teaching rooms and equipment. This chapter outlines how drama is taught in secondary schools in England (there being subtle variations in the education systems in the other countries that make up the United Kingdom) and the theories that underpin drama’s place in the curriculum as a subject in its own right and as a vehicle for delivering other aspects of the prescribed curriculum are discussed. The paper goes on to review the way in which drama is taught articulates with the requirements and current initiatives laid down by the government. Given this context, the chapter moves on to explore what specialist subject and pedagogical knowledge secondary school drama teachers need. Furthermore, consideration is made of the tensions that may be seen to exist between the way drama teachers perceive their own identity as subject specialists and the restrictions and demands placed upon them by the education system within which they work. An insight into the backgrounds of those who become drama teachers in England is provided and the reasons for choosing such a career and the expectations and concerns that underpin their training are identified and analysed.

A tool for mapping research skills in undergraduate curricula

There has been considerable interest recently in the teaching of skills to undergraduate students. However, existing methods for collating data on how much, where and when students are taught and assessed skills have often been shown to be time-consuming and ineffective. Here, we outline an electronic research skills audit tool that has been developed to map both transferable and discipline-specific skills teaching and assessment within individual modules, the results of which can be collated and analysed across entire degree programmes. The design and use of the audit tool is described in detail and a bioscience case study is presented to illustrate the types of data that can be collected. The audit tool has been designed as a time-effective way of collecting information on skills teaching and assessment, but also actively encourages staff to reflect on their teaching and learning practices. Conclusions are drawn about the practicalities of using the audit tool and its importance in both curriculum design and as a resource to encourage dialogue with graduate employers.

Understanding the alphaviruses: Recent research on important emerging pathogens and progress towards their control

The alphaviruses were amongst the first arboviruses to be isolated, characterized and assigned a taxonomic status. They are globally very widespread, infecting a large variety of terrestrial animals, insects and even fish, and circulate both in the sylvatic and urban/peri-urban environment, causing considerable human morbidity and mortality. Nevertheless, despite their obvious importance as pathogens, there are currently no effective antiviral drugs with which to treat humans or animals infected by any of these viruses. The EU-supported project—VIZIER (Comparative Structural Genomics of Viral Enzymes Involved in Replication, FP6 Project: 2004-511960) was instigated with an ultimate view of contributing to the development of antiviral therapies for RNA viruses, including the alphaviruses [Coutard, B., Gorbalenya, A.E., Snijder, E.J., Leontovich, A.M., Poupon, A., De Lamballerie, X., Charrel, R., Gould, E.A., Gunther, S., Norder, H., Klempa, B., Bourhy, H., Rohayemj, J., L’hermite, E., Nordlund, P., Stuart, D.I., Owens, R.J., Grimes, J.M., Tuckerm, P.A., Bolognesi, M., Mattevi, A., Coll, M., Jones, T.A., Åqvist, J., Unger, T., Hilgenfeld, R., Bricogne, G., Neyts, J., La Colla, P., Puerstinger, G., Gonzalez, J.P., Leroy, E., Cambillau, C., Romette, J.L., Canard, B., 2008. The VIZIER project: preparedness against pathogenic RNA viruses. Antiviral Res. 78, 37–46]. This review highlights some of the major features of alphaviruses that have been investigated during recent years. After describing their classification, epidemiology and evolutionary history and the expanding geographic distribution of Chikungunya virus, we review progress in understanding the structure and function of alphavirus replicative enzymes achieved under the VIZIER programme and the development of new disease control strategies.

Immigration, species radiation and extinction in a highly diverse songbird lineage: white-eyes on Indian Ocean islands

Molecular phylogenetic hypotheses of species-rich lineages in regions where geological history can be reliably inferred may provide insights into the scale of processes driving diversification. Here we sample all extant or recently extinct white-eye (Zosterops) taxa of the southwest Indian Ocean, combined with samples from all principal continental lineages. Results support a high dispersal capability, with at least two independent continental sources for white-eyes of the region. An early (within 1.8 million years ago) expansion into the Indian Ocean may have originated either from Asia or Africa; the three resulting lineages show a disparate distribution consistent with considerable extinction following their arrival. Africa is supported as the origin of a later expansion into the region (within 1.2 million years ago). On two islands, a pair of Zosterops species derived from independent immigrations into the Indian Ocean co-occur or may have formerly co-occurred, providing strong support for their origin by double-island colonization rather than within-island (sympatric or microallopatric) speciation. On Mauritius and La Reunion, phylogenetic placement of sympatric white-eyes allow us to rule out a scenario in which independent within-island speciation occurred on both islands; one of the species pairs must have arisen by double colonization, while the other pair is likely to have arisen by the same mechanism. Long-distance immigration therefore appears to be responsible for much of the region's white-eye diversity. Independent immigrations into the region have resulted in lineages with mutually exclusive distributions and it seems likely that competition with congeneric species, rather than arrival frequency, may limit present-day diversity.

Comparison of mechanical properties of tension and opposite wood in Populus

In this paper we focused on the differences of mechanical properties of tension and normal wood of 1-year-old poplar trees, artificially tilted. Elastic and fracture properties have been measured and linked to the anatomy. Tension wood is well known because it prevents good surface finishing and leads to difficulties with sawing. We studied three main mechanical properties: young modulus, energy of cutting and longitudinal residual strain of maturation (with strain gauges) because of their importance in wood technology. Moreover, this work takes place in a larger project of study, the phenomena of axes re-orientation in trees (allowing by the production of reaction wood), where these data are required for biomechanical modelling. The results show that tension wood has a higher young modulus, needs a higher energy to be cut and exhibited a higher level of longitudinal residual strain of maturation than those of normal wood. The results suggest that these differences require deeper analysis of the wood than anatomy: measurement of microfibril orientation in the S2 layer and also the lignin composition in monomeric units.

Intelligent wireless web services: context-aware computing in construction-logistics supply chain

The construction industry has incurred a considerable amount of waste as a result of poor logistics supply chain network management. Therefore, managing logistics in the construction industry is critical. An effective logistic system ensures delivery of the right products and services to the right players at the right time while minimising costs and rewarding all sectors based on value added to the supply chain. This paper reports on an on-going research study on the concept of context-aware services delivery in the construction project supply chain logistics. As part of the emerging wireless technologies, an Intelligent Wireless Web (IWW) using context-aware computing capability represents the next generation ICT application to construction-logistics management. This intelligent system has the potential of serving and improving the construction logistics through access to context-specific data, information and services. Existing mobile communication deployments in the construction industry rely on static modes of information delivery and do not take into account the worker’s changing context and dynamic project conditions. The major problems in these applications are lack of context-specificity in the distribution of information, services and other project resources, and lack of cohesion with the existing desktop based ICT infrastructure. The research works focus on identifying the context dimension such as user context, environmental context and project context, selection of technologies to capture context-parameters such wireless sensors and RFID, selection of supporting technologies such as wireless communication, Semantic Web, Web Services, agents, etc. The process of integration of Context-Aware Computing and Web-Services to facilitate the creation of intelligent collaboration environment for managing construction logistics will take into account all the necessary critical parameters such as storage, transportation, distribution, assembly, etc. within off and on-site project.