The causes of prescribing errors in English general practices: a qualitative study

Aim: To examine the causes of prescribing and monitoring errors in English general practices and provide recommendations for how they may be overcome. Design: Qualitative interview and focus group study with purposive sampling and thematic analysis informed by Reason’s accident causation model. Participants: General practice staff participated in a combination of semi-structured interviews (n=34) and six focus groups (n=46). Setting: Fifteen general practices across three primary care trusts in England. Results: We identified seven categories of high-level error-producing conditions: the prescriber, the patient, the team, the task, the working environment, the computer system, and the primary-secondary care interface. Each of these was further broken down to reveal various error-producing conditions. The prescriber’s therapeutic training, drug knowledge and experience, knowledge of the patient, perception of risk, and their physical and emotional health, were all identified as possible causes. The patient’s characteristics and the complexity of the individual clinical case were also found to have contributed to prescribing errors. The importance of feeling comfortable within the practice team was highlighted, as well as the safety of general practitioners (GPs) in signing prescriptions generated by nurses when they had not seen the patient for themselves. The working environment with its high workload, time pressures, and interruptions, and computer related issues associated with mis-selecting drugs from electronic pick-lists and overriding alerts, were all highlighted as possible causes of prescribing errors and often interconnected. Conclusion: This study has highlighted the complex underlying causes of prescribing and monitoring errors in general practices, several of which are amenable to intervention.

Interactive sensory objects for improving access to heritage

In this project we explore how to enhance the experience and understanding of cultural heritage in museums and heritage sites by creating interactive multisensory objects collaboratively with artists, technologists and people with learning disabilities. We focus here on workshops conducted during the first year of a three year project in which people with learning disabilities each constructed a 'sensory box' to represent their experiences of Speke Hall, a heritage site in the UK. The box is developed further in later workshops which explore aspects of physicality and how to appeal to the entire range of senses, making use of Arduino technology and basic sensors to enable an interactive user experience.

Comparison of D-region Doppler drift winds measured by the SuperDARN Finland HF radar over an annual cycle using the Kiruna VHF meteor radar

The SuperDARN chain of oblique HF radars has provided an opportunity to generate a unique climatology of horizontal winds near the mesopause at a number of high latitude locations, via the Doppler shifted echoes from sources of ionisation in the D-region. Ablating meteor trails form the bulk of these targets, but other phenomena also contribute to the observations. Due to the poor vertical resolution of the radars, care must be taken to reduce possible biases from sporadic-E layers and Polar Mesospheric Summer echoes that can affect the effective altitude of the geophysical parameters being observed. Second, there is strong theoretical and observational evidence to suggest that the radars are picking up echoes from the backward looking direction that will tend to reduce the measured wind strengths. The effect is strongly frequency dependent, resulting in a 20% reduction at 12 MHz and a 50% reduction at 10 MHz. A comparison of the climatologies observed by the Super-DARN Finland radar between September 1999 and September 2000 and that obtained from the adjacent VHF meteor radar located at Kiruna is also presented. The agreement between the two instruments was very good. Extending the analysis to the SuperDARN Iceland East radar indicated that the principles outlined above could be applied successfully to the rest of the SuperDARN network.

Sustainable urban metabolism as a link between bio-physical sciences and urban planning: the BRIDGE project

Urban metabolism considers a city as a system with flows of energy and material between it and the environment. Recent advances in bio-physical sciences provide methods and models to estimate local scale energy, water, carbon and pollutant fluxes. However, good communication is required to provide this new knowledge and its implications to endusers (such as urban planners, architects and engineers). The FP7 project BRIDGE (sustainaBle uRban plannIng Decision support accountinG for urban mEtabolism) aimed to address this gap by illustrating the advantages of considering these issues in urban planning. The BRIDGE Decision Support System (DSS) aids the evaluation of the sustainability of urban planning interventions. The Multi Criteria Analysis approach adopted provides a method to cope with the complexity of urban metabolism. In consultation with targeted end-users, objectives were defined in relation to the interactions between the environmental elements (fluxes of energy, water, carbon and pollutants) and socioeconomic components (investment costs, housing, employment, etc.) of urban sustainability. The tool was tested in five case study cities: Helsinki, Athens, London, Florence and Gliwice; and sub-models were evaluated using flux data selected. This overview of the BRIDGE project covers the methods and tools used to measure and model the physical flows, the selected set of sustainability indicators, the methodological framework for evaluating urban planning alternatives and the resulting DSS prototype.

The role of air–sea coupling in the simulation of the Madden–Julian oscillation in the Hadley Centre model

The role of air–sea coupling in the simulation of the Madden–Julian oscillation (MJO) is explored using two configurations of the Hadley Centre atmospheric model (AGCM), GA3.0, which differ only in F, a parameter controlling convective entrainment and detrainment. Increasing F considerably improves deficient MJO-like variability in the Indian and Pacific Oceans, but variability in and propagation through the Maritime Continent remains weak. By coupling GA3.0 in the tropical Indo-Pacific to a boundary-layer ocean model, KPP, and employing climatological temperature corrections, well resolved air–sea interactions are simulated with limited alterations to the mean state. At default F, when GA3.0 has a poor MJO, coupling produces a stronger MJO with some eastward propagation, although both aspects remain deficient. These results agree with previous sensitivity studies using AGCMs with poor variability. At higher F, coupling does not affect MJO amplitude but enhances propagation through the Maritime Continent, resulting in an MJO that resembles observations. A sensitivity experiment with coupling in only the Indian Ocean reverses these improvements, suggesting coupling in the Maritime Continent and West Pacific is critical for propagation. We hypothesise that for AGCMs with a poor MJO, coupling provides a “crutch” to artificially augment MJO-like activity through high-frequency SST anomalies. In related experiments, we employ the KPP framework to analyse the impact of air–sea interactions in the fully coupled GA3.0, which at default F shows a similar MJO to uncoupled GA3.0. This is due to compensating effects: an improvement from coupling and a degradation from mean-state errors. Future studies on the role of coupling should carefully separate these effects.

Understanding unconscionability in proprietary estoppel

In a series of recent cases, courts have reasserted unconscionability as the basis of proprietary estoppel and in doing so have moved away from the structured form of discretion envisaged in the classic Taylors Fashions formula. In light of these developments, this paper traces the use of unconscionability in estoppel and examines the changing role attributed to the concept. In a parallel development, in exercising their remedial discretion once a claim to estoppel has been established, the courts have emphasised the foundation of estoppel in unconscionability to assert the need for proportionality between the detriment and remedy as ‘the most essential requirement’. Collectively, the cases demonstrate a lack of transparency or consistency, which raises concerns that the courts are descending into a form of individualised discretion. These developments are of particular concern as they come at a time when commentators are predicting a ‘boom’ in estoppel to follow the introduction of electronic conveyancing.

Conscience, discretion and the creation of property rights

This paper considers the utility of the concept of conscience or unconscionable conduct as a contemporary rationale for intervention in two principles applied where a person seeks to renege on an informal agreement relating to land: the principle in Rochefoucauld v Boustead; and transfers 'subject to' rights in favour of a claimant. By analysing the concept in light of our current understanding of the nature of judicial discretion and the use of general principles, it responds to arguments that unconscionability is too general a concept on which to base intervention. In doing so, it considers the nature of the discretion that is actually in issue when the court intervenes through conscience in these principles. However, the paper questions the use of constructive trusts as a response to unconscionability. It argues that there is a need, in limited circumstances, to separate the finding of unconscionability from the imposition of a constructive trust. In these limited circumstances, once unconscionability is found, the courts should have a discretion as to the remedy, modelled on that developed in the context of proprietary estoppel. The message underlying this paper is that many of the concerns expressed about unconscionability that have led to suggestions of alternative rationales for intervention can in fact be addressed whilst retaining an unconscionability analysis. Unconscionability remains a preferable rationale for intervention as it provides a common thread that links apparently separate principles and can assist our understanding of their scope.

Housing or property? The dynamics of housing policy and property principles in the right to buy

This paper examines the interplay and tension between housing law and policy and property law, in the specific context of the right to buy (RTB). It focuses on funding arrangements between the RTB tenant and another party. It first examines how courts determine the parties' respective entitlements in the home, highlighting the difficulty of categorising, under traditional property law principles, a contribution in the form of the statutory discount conferred on the RTB tenant. Secondly, it considers possible exploitation of the RTB scheme, both at the macro level of exploitation of the policy underpinning the legislation and, at the micro level, of exploitation of the tenant. The measures contained in the Housing Act 2004 intended to curb exploitation of the RTB are analysed to determine what can be considered to be legitimate and illegitimate uses of the scheme. It is argued that, despite the government's implicit approval, certain funding arrangements by non-resident relatives fail to give effect to the spirit of the scheme.

Low cost home ownership: legal issues of the shared ownership lease

Analysis of the decision in Richardson v Midland Heart Ltd (formally Focus Homes Options) [2008] L&TR 31

The "value" of property rights in social security law

This article provides a critical examination of the way that property rules are applied judicially in the context of social security law concerned with the assessment of capital, and especially in connection with the determination of ownership and the valuation of assets, which can have a critical bearing on entitlement to various means-tested benefits.