The prevalence and nature of prescribing and monitoring errors in English general practice – a retrospective case note review

Objective To determine the prevalence and nature of prescribing and monitoring errors in general practices in England. Design Retrospective case note review of unique medication items prescribed over a 12 month period to a 2% random sample of patients. Mixed effects logistic regression was used to analyse the data. Setting Fifteen general practices across three primary care trusts in England. Data sources Examination of 6048 unique prescription items prescribed over the previous 12 months for 1777 patients. Main outcome measures Prevalence of prescribing and monitoring errors, and severity of errors, using validated definitions. Results Prescribing and/or monitoring errors were detected in 4.9% (296/6048) of all prescription items (95% confidence interval 4.4 - 5.5%). The vast majority of errors were of mild to moderate severity, with 0.2% (11/6048) of items having a severe error. After adjusting for covariates, patient-related factors associated with an increased risk of prescribing and/or monitoring errors were: age less than 15 (Odds Ratio (OR) 1.87, 1.19 to 2.94, p=0.006) or greater than 64 years (OR 1.68, 1.04 to 2.73, p=0.035), and higher numbers of unique medication items prescribed (OR 1.16, 1.12 to 1.19, p<0.001). Conclusion Prescribing and monitoring errors are common in English general practice, although severe errors are unusual. Many factors increase the risk of error. Having identified the most common and important errors, and the factors associated with these, strategies to prevent future errors should be developed based on the study findings.

On the nature of ULF wave power during nightside auroral activations and substorms: 2. temporal evolution

We present a statistical analysis of the time evolution of ground magnetic fluctuations in three (12–48 s, 24–96 s and 48–192 s) period bands during nightside auroral activations. We use an independently derived auroral activation list composed of both substorms and pseudo-breakups to provide an estimate of the activation times of nightside aurora during periods with comprehensive ground magnetometer coverage. One hundred eighty-one events in total are studied to demonstrate the statistical nature of the time evolution of magnetic wave power during the ∼30 min surrounding auroral activations. We find that the magnetic wave power is approximately constant before an auroral activation, starts to grow up to 90 s prior to the optical onset time, maximizes a few minutes after the auroral activation, then decays slightly to a new, and higher, constant level. Importantly, magnetic ULF wave power always remains elevated after an auroral activation, whether it is a substorm or a pseudo-breakup. We subsequently divide the auroral activation list into events that formed part of ongoing auroral activity and events that had little preceding geomagnetic activity. We find that the evolution of wave power in the ∼10–200 s period band essentially behaves in the same manner through auroral onset, regardless of event type. The absolute power across ULF wave bands, however, displays a power law-like dependency throughout a 30 min period centered on auroral onset time. We also find evidence of a secondary maximum in wave power at high latitudes ∼10 min following isolated substorm activations. Most significantly, we demonstrate that magnetic wave power levels persist after auroral activations for ∼10 min, which is consistent with recent findings of wave-driven auroral precipitation during substorms. This suggests that magnetic wave power and auroral particle precipitation are intimately linked and key components of the substorm onset process.

On the nature of large-scale mixing in the stratosphere and mesosphere

Studies of tracer transport in the stratosphere have shown that adiabatic quasi-horizontal tracer evolution is controlled primarily by the large-scale low-frequency component of the flow. This behavior is consistent with the concept of chaotic advection, wherein the Eulerian velocity field is spatially coherent and temporally quasi-regular on timescales over which the Lagrangian evolution is chaotic. In this study, winds from a middle atmosphere general circulation model (the Canadian Middle Atmosphere Model) are used to compare and contrast the nature of tracer evolution in the stratosphere and mesosphere. It is found that the concept of chaotic advection is relevant in the stratosphere but not in the mesosphere. The explanation for this behavior is the increased strength of gravity wave activity in the mesosphere as compared with the stratosphere, which leads to shallower kinetic energy spectra on synoptic scales and a much shorter Eulerian correlation time. The shallower kinetic energy spectra imply that tracer evolution in the mesosphere is spectrally local, in contrast with the spectrally nonlocal regime that prevails in the stratosphere. This means that tracer advection calculations in the mesosphere are controlled primarily by the gravity wave spectrum and are intrinsically resolution dependent.

Early and late stimulus-evoked cortical hemodynamic responses provide insight into the neurogenic nature of neurovascular coupling

Understanding neurovascular coupling is a prerequisite for the interpretation of results obtained from modern neuroimaging techniques. This study investigated the hemodynamic and neural responses in rat somatosensory cortex elicited by 16 seconds electrical whisker stimuli. Hemodynamics were measured by optical imaging spectroscopy and neural activity by multichannel electrophysiology. Previous studies have suggested that the whisker-evoked hemodynamic response contains two mechanisms, a transient ‘backwards’ dilation of the middle cerebral artery, followed by an increase in blood volume localized to the site of neural activity. To distinguish between the mechanisms responsible for these aspects of the response, we presented whisker stimuli during normocapnia (‘control’), and during a high level of hypercapnia. Hypercapnia was used to ‘predilate’ arteries and thus possibly ‘inhibit’ aspects of the response related to the ‘early’ mechanism. Indeed, hemodynamic data suggested that the transient stimulus-evoked response was absent under hypercapnia. However, evoked neural responses were also altered during hypercapnia and convolution of the neural responses from both the normocapnic and hypercapnic conditions with a canonical impulse response function, suggested that neurovascular coupling was similar in both conditions. Although data did not clearly dissociate early and late vascular responses, they suggest that the neurovascular coupling relationship is neurogenic in origin.

History teachers’ thinking about the nature of their subject

This paper addresses how secondary history teachers view the nature and purposes of their subject and how they think these views impact on their practice. Data were collected through individual qualitative interviews with eleven UK history teachers at the start of their careers. Their views on the nature of history are broadly empiricist with postmodern perspectives having been less influential. Their rationales for the subject emphasise broader educational purposes. The case for further emphasis on subject understandings in teacher education is made through a consideration of the implications of a lack of emphasis of more postmodern perspectives on classroom practice.

(Re)enchanting geography? The nature of being critical and the character of critique in human geography

Enchantment is a term frequently used by human geographers to express delight, wonder or that which cannot be simply explained. However, it is a concept that has yet to be subject to sustained critique, specifically how it can be used to progress geographic thought and praxis. This paper makes sense of, and space for, the unintelligibility of enchantment in order to encourage a less repressed, more cheerful way of engaging with the geographies of the world. We track back through our disciplinary heritage to explore how geographers have employed enchantment as a force through which the world inspires affective attachment. We review the terrain of the debate surrounding recent geographical engagements with enchantment, focusing on the nature of being critical and the character of critique in human geography, offering a new ‘enchanted’ stance to our geographical endeavours. We argue that the moment of enchantment has not passed with the current challenging climate; if anything, it is more pressing.

Nature of vegetation and building morphology characteristics across a city: influence on shadow patterns and mean radiant temperatures in London

Vegetation and building morphology characteristics are investigated at 19 sites on a north-south LiDAR transect across the megacity of London. Local maxima of mean building height and building plan area density at the city centre are evident. Surprisingly, the mean vegetation height (zv3) is also found to be highest in the city centre. From the LiDAR data various morphological parameters are derived as well as shadow patterns. Continuous images of the effects of buildings and of buildings plus vegetationon sky view factor (Ψ) are derived. A general reduction of Ψ is found, indicating the importance of including vegetation when deriving Ψ in urban areas. The contribution of vegetation to the shadowing at ground level is higher during summer than in autumn. Using these 3D data the influence on urban climate and mean radiant temperature (T mrt ) is calculated with SOLWEIG. The results from these simulations highlight that vegetation can be most effective at reducing heat stress within dense urban environments in summer. The daytime average T mrt is found to be lowest in the densest urban environments due to shadowing; foremost from buildings but also from trees. It is clearly shown that this method could be used to quantify the influence of vegetation on T mrt within the urban environment. The results presented in this paper highlight a number of possible climate sensitive planning practices for urban areas at the local scale (i.e. 102- 5 × 103 m).

Radical cations of end-capped tetrathienoacenes and their p-dimerization controlled by the nature of a-substituents and counterion concentration

Radical cations of a soluble rigid tetrathienoacene are capable of forming stable p-dimer dications at ambient temperature when the short backbone becomes extended with conjugated thiophene-2-yl substituents in the a-positions. On the other hand, simple attachment of methyl groups on the a-carbon of the external thiophen-2-yl rings proved sufficient to inhibit the dimerization. Stable radical cationswere also exclusively formed for tetrathienoacene derivatives end-capped with bulky TIPS and phenyl substituents.

Concessionary nature of public-private partnerships in Russia and Kazakhstan: a critical review

This article provides a critical overview of Public-Private Partnerships (PPPs) in Russia and Kazakhstan and examines the rationale underpinning such partnerships. The analysis discusses the reasons why governments in Russia and Kazakhstan focus principally on concessions as a form of PPP and goes on to provide a critical assessment of the key approaches and situational factors relating to concessions in these two countries. The article finds that external globalization impulses pressed Russia and Kazakhstan to align their policies and institutions with western orthodoxy and perceived international best practice. An ever-increasing emphasis on use of PPPs has been a key feature of this alignment. However, the governments of Russia and Kazakhstan have increasingly resorted to concessions as progress with the development and implementation of Western style PPP models has stalled. This article concludes that the governments of Russia and Kazakhstan have demonstrated an overly optimistic approach to PPP and as a result may have substantially understated their overall concessional risks and costs. Features of Russian and Kazakhstani PPP arrangements such as ambiguity in output specification and extensive reliance on government subsidies, combined with lack of expertise of private partners, may significantly decrease concession benefits.

Emotion regulation meets emotional attention: the influence of emotion suppression on emotional attention depends on the nature of the distracters

Recent evidence has suggested a crucial role of people’s current goals in attention to emotional information. This asks for research investigating how and what kinds of goals shape emotional attention. The present study investigated how the goal to suppress a negative emotional state influences attention to emotion-congruent events. After inducing disgust, we instructed participants to suppress all feelings of disgust during a subsequent dot probe task. Attention to disgusting images was modulated by the sort of distracter that was presented in parallel with disgusting imagery. When disgusting images were presented together with neutral images, emotion suppression was accompanied by a tendency to attend to disgusting images. However, when disgusting images were shown with positive images that allow coping with disgust (i.e., images representing cleanliness), attention tended away from disgusting images and toward images representing cleanliness. These findings show that emotion suppression influences the allocation of attention but that the successful avoidance of emotion-congruent events depends on the availability of effective distracters.

Nature of autobiographical memory that facilitates improvement of negative moods

Sakaki, M. (2005). Persons in negative moods often recall their positive experiences to alleviate their affective states. This study investigated the nature of autobiographical memories that facilitate improvement of negative moods. More specifically, it examined the relations between participants' subjective moods and the three natures of recalled memories (the current positivity, the past positivity, and the importance). After 67 participants were induced either negative or neutral moods, they were asked to recall five positive experiences and to rate their affective states. Results indicated that the more important memories participants recalled, the more positive moods they reported after recollection, and that these effects of the importance of autobiographical memories were observed in both negative and neutral moods. In contrast, neither the current positivity of memories nor the past positivity of memories significantly influenced participant's moods in both negative and neutral moods. The mechanism by which the importance of autobiographical memory affects moods was discussed.

On the quasi-periodic nature of magnetopause flux transfer events

The recurrence rate of flux transfer events (FTEs) observed near the dayside magnetopause is discussed. A survey of magnetopause observations by the ISEE satellites shows that the distribution of the intervals between FTE signatures has a mode value of 3 min, but is highly skewed, having upper and lower decile values of 1.5 min and 18.5 min, respectively. The mean value is found to be 8 min, consistent with previous surveys of magnetopause data. The recurrence of quasi-periodic events in the dayside auroral ionosphere is frequently used as evidence for an association with magnetopause FTEs, and the distribution of their repetition intervals should be matched to that presented here if such an association is to be confirmed. A survey of 1 year's 15-s data on the interplanetary magnetic field (IMF) suggests that the derived distribution could arise from fluctuations in the IMF Bz component, rather than from a natural oscillation frequency of the magnetosphere-ionosphere system.