Protocol for the PINCER trial: a cluster randomised trial comparing the 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 are an important cause of morbidity and mortality in primary care. The aims of this study are to determine the effectiveness, cost effectiveness and acceptability of a pharmacist-led information-technology-based complex intervention compared with simple feedback in reducing proportions of patients at risk from potentially hazardous prescribing and medicines management in general (family) practice. Methods: Research subject group: "At-risk" patients registered with computerised general practices in two geographical regions in England. Design: Parallel group pragmatic cluster randomised trial. Interventions: Practices will be randomised to either: (i) Computer-generated feedback; or (ii) Pharmacist-led intervention comprising of computer-generated feedback, educational outreach and dedicated support. Primary outcome measures: The proportion of patients in each practice at six and 12 months post intervention: - with a computer-recorded history of peptic ulcer being prescribed non-selective non-steroidal anti-inflammatory drugs - with a computer-recorded diagnosis of asthma being prescribed beta-blockers - aged 75 years and older receiving long-term prescriptions for angiotensin converting enzyme inhibitors or loop diuretics without a recorded assessment of renal function and electrolytes in the preceding 15 months. Secondary outcome measures; These relate to a number of other examples of potentially hazardous prescribing and medicines management. Economic analysis: An economic evaluation will be done of the cost per error avoided, from the perspective of the UK National Health Service (NHS), comparing the pharmacist-led intervention with simple feedback. Qualitative analysis: A qualitative study will be conducted to explore the views and experiences of health care professionals and NHS managers concerning the interventions, and investigate possible reasons why the interventions prove effective, or conversely prove ineffective. Sample size: 34 practices in each of the two treatment arms would provide at least 80% power (two-tailed alpha of 0.05) to demonstrate a 50% reduction in error rates for each of the three primary outcome measures in the pharmacist-led intervention arm compared with a 11% reduction in the simple feedback arm. Discussion: At the time of submission of this article, 72 general practices have been recruited (36 in each arm of the trial) and the interventions have been delivered. Analysis has not yet been undertaken.

Verifying and fixing password authentication protocol

Password Authentication Protocol (PAP) is widely used in the Wireless Fidelity Point-to-Point Protocol to authenticate an identity and password for a peer. This paper uses a new knowledge-based framework to verify the PAP protocol and a fixed version. Flaws are found in both the original and the fixed versions. A new enhanced protocol is provided and the security of it is proved The whole process is implemented in a mechanical reasoning platform, Isabelle. It only takes a few seconds to find flaws in the original and the fixed protocol and to verify that the enhanced version of the PAP protocol is secure.

An enhanced relay-enabled medium access control protocol for wireless ad hoc networks

In this paper we propose an enhanced relay-enabled distributed coordination function (rDCF) for wireless ad hoc networks. The idea of rDCF is to use high data rate nodes to work as relays for the low data rate nodes. The relay helps to increase the throughput and lower overall blocking time of nodes due to faster dual-hop transmission. rDCF achieves higher throughput over IEEE 802.11 distributed coordination function (DCF). The protocol is further enhanced for higher throughput and reduced energy. These enhancements result from the use of a dynamic preamble (i.e. using short preamble for the relay transmission) and also by reducing unnecessary overhearing (by other nodes not involved in transmission). We have modeled the energy consumption of rDCF, showing that rDCF provides an energy efficiency of 21.7% at 50 nodes over 802.11 DCF. Compared with the existing rDCF, the enhanced rDCF (ErDCF) scheme proposed in this paper yields a throughput improvement of 16.54% (at the packet length of 1000 bytes) and an energy saving of 53% at 50 nodes.

Rethinking construction: the Generic Design and Construction Process Protocol

The complexity of construction projects and the fragmentation of the construction industry undertaking those projects has effectively resulted in linear, uncoordinated and highly variable project processes in the UK construction sector. Research undertaken at the University of Salford resulted in the development of an improved project process, the Process Protocol, which considers the whole lifecycle of a construction project whilst integrating its participants under a common framework. The Process Protocol identifies the various phases of a construction project with particular emphasis on what is described in the manufacturing industry as the ‘fuzzy front end’. The participants in the process are described in terms of the activities that need to be undertaken in order to achieve a successful project and process execution. In addition, the decision-making mechanisms, from a client perspective, are illustrated and the foundations for a learning organization/industry are facilitated within a consistent Process Protocol.

Modulation of pro-survival Akt/protein kinase B and ERK1/2 signaling cascades by quercetin and its in vivo metabolites underlie their action on neuronal viability

Much recent interest has focused on the potential of flavonoids to interact with intracellular signaling pathways such as with the mitogen-activated protein kinase cascade. We have investigated whether the observed strong neurotoxic potential of quercetin in primary cortical neurons may occur via specific and sensitive interactions within neuronal mitogen-activated protein kinase and Akt/protein kinase B (PKB) signaling cascades, both implicated in neuronal apoptosis. Quercetin induced potent inhibition of both Akt/PKB and ERK phosphorylation, resulting in reduced phosphorylation of BAD and a strong activation of caspase-3. High quercetin concentrations (30 microM) led to sustained loss of Akt phosphorylation and subsequent Akt cleavage by caspase-3, whereas at lower concentrations (<10 microM) the inhibition of Akt phosphorylation was transient and eventually returned to basal levels. Lower levels of quercetin also induced strong activation of the pro-survival transcription factor cAMP-responsive element-binding protein, although this did not prevent neuronal damage. O-Methylated quercetin metabolites inhibited Akt/PKB to lesser extent and did not induce such strong activation of caspase-3, which was reflected in the lower amount of damage they inflicted on neurons. In contrast, neither quercetin nor its O-methylated metabolites had any measurable effect on c-Jun N-terminal kinase phosphorylation. The glucuronide of quercetin was not toxic and did not evoke any alterations in neuronal signaling, probably reflecting its inability to enter neurons. Together these data suggest that quercetin and to a lesser extent its O-methylated metabolites may induce neuronal death via a mechanism involving an inhibition of neuronal survival signaling through the inhibition of both Akt/PKB and ERK rather than by an activation of the c-Jun N-terminal kinase-mediated death pathway.

Orthogonal on-off BPSK: a convenient signaling scheme for near-far resistant detection in DS/CDMA

This paper proposes a convenient signaling scheme-orthogonal on-off BPSK (O3BPSK)-for near-far (NF) resistant detection in asynchronous direct-sequence code-division multiple-access (DS/CDMA) systems (uplink). The temporally adjacent bits from different users in the received signals are decoupled by using the on-off signaling, and the original data rate is maintained with no increase in transmission rate by adopting an orthogonal structure. The detector at the receiver is a one-shot linear decorrelating detector, which depends upon neither hard decision nor specific channel coding. The application of O3 strategy to the differentially encoded BPSK (D-BPSK) sequences is also presented. Finally, some computer simulations are shown to confirm the theoretical analysis.

A new signaling scheme for one-shot near-far resistant detection in DS/CDMA

This paper proposes a new signaling scheme: orthogonal on-off BPSK (O3BPSK), for near-far resistant detection in the asynchronous DS/CDMA systems (up-link). The temporally adjacent bits from different users in the received signals are decoupled by using the on-off signaling, and the original data rate is maintained with no increase in transmission rate by adopting an orthogonal structure. The detector at the receiver is a one-shot linear decorrelating detector, which depends upon neither hard-decision nor specific channel coding. Some computer simulations are shown to confirm the theoretical analysis.