Is 15 per cent very common? Informing people about the risks of medication side effects

Objectives - To assess the general public's interpretation of the verbal descriptors for side effect frequency recommended for use in medicine information leaflets by a European Union (EU) guideline, and to examine the extent to which differences in interpretation affect people's perception of risk and their judgments of intention to comply with the prescribed treatment. Method - Two studies used a controlled empirical methodology in which people were presented with a hypothetical, but realistic, scenario about visiting their general practitioner and being prescribed medication. They were given an explanation that focused on the side effects of the medicine, together with information about the probability of occurrence using either numerical percentages or the corresponding EU verbal descriptors. Interpretation of the descriptors was assessed. In study 2, participants were also required to make various judgments, including risk to health and intention to comply. Key findings - In both studies, use of the EU recommended descriptors led to significant overestimations of the likelihood of particular side effects occurring. Study 2 further showed that the "overestimation" resulted in significantly increased ratings of perceived severity of side effects and risk to health, as well as significantly reduced ratings of intention to comply, compared with those for people who received the probability information in numerical form. Conclusion - While it is recognised that the current findings require replication in a clinical setting, the European and national authorities should suspend the use of the EU recommended terms until further research is available to allow the use of an evidence-based approach.

Predicting mesh density for adaptive modelling of the global atmosphere

The shallow water equations are solved using a mesh of polygons on the sphere, which adapts infrequently to the predicted future solution. Infrequent mesh adaptation reduces the cost of adaptation and load-balancing and will thus allow for more accurate mapping on adaptation. We simulate the growth of a barotropically unstable jet adapting the mesh every 12 h. Using an adaptation criterion based largely on the gradient of the vorticity leads to a mesh with around 20 per cent of the cells of a uniform mesh that gives equivalent results. This is a similar proportion to previous studies of the same test case with mesh adaptation every 1–20 min. The prediction of the mesh density involves solving the shallow water equations on a coarse mesh in advance of the locally refined mesh in order to estimate where features requiring higher resolution will grow, decay or move to. The adaptation criterion consists of two parts: that resolved on the coarse mesh, and that which is not resolved and so is passively advected on the coarse mesh. This combination leads to a balance between resolving features controlled by the large-scale dynamics and maintaining fine-scale features.

Institutional sustainability: at what price? UNDP and the new cost-sharing model in Brazil

By the turn of the twenty-first century, UNDP had embraced a new form of funding based on ‘cost-sharing’, with this source accounting for 51 per cent of the organisation’s total expenditure worldwide in 2000. Unlike the traditional donor - recipient relationship so common with development projects, the new cost-sharing modality has created a situation whereby UNDP local offices become ‘subcontractors’ and agencies of the recipient countries become ‘clients’. This paper explores this transition in the context of Brazil, focusing on how the new modality may have compromised UNDP’s ability to promote Sustainable Human Development, as established in its mandate. The great enthusiasm for this modality within the UN system and its potential application to other developing countries increase the importance of a systematic assessment of its impact and developmental consequences.

The importance of the diurnal and annual cycle of air traffic for contrail radiative forcing

Air traffic condensation trails, or contrails, are believed to have a net atmospheric warming effect(1), although one that is currently small compared to that induced by other sources of human emissions. However, the comparably large growth rate of air traffic requires an improved understanding of the resulting impact of aircraft radiative forcing on climate(2). Contrails have an effect on the Earth's energy balance similar to that of high thin ice clouds(3). Their trapping of outgoing longwave radiation emitted by the Earth and atmosphere (positive radiative forcing) is partly compensated by their reflection of incoming solar radiation (negative radiative forcing). On average, the longwave effect dominates and the net contrail radiative forcing is believed to be positive(1,2,4). Over daily and annual timescales, varying levels of air traffic, meteorological conditions, and solar insolation influence the net forcing effect of contrails. Here we determine the factors most important for contrail climate forcing using a sophisticated radiative transfer model(5,6) for a site in southeast England, located in the entrance to the North Atlantic flight corridor. We find that night-time flights during winter (December to February) are responsible for most of the contrail radiative forcing. Night flights account for only 25 per cent of daily air traffic, but contribute 60 to 80 per cent of the contrail forcing. Further, winter flights account for only 22 per cent of annual air traffic, but contribute half of the annual mean forcing. These results suggest that flight rescheduling could help to minimize the climate impact of aviation.

The impact of a closed-loop electronic prescribing and automated dispensing system on the ward pharmacist’s time and activities

Objective To assess the impact of a closed-loop electronic prescribing and automated dispensing system on the time spent providing a ward pharmacy service and the activities carried out. Setting Surgical ward, London teaching hospital. Method All data were collected two months pre- and one year post-intervention. First, the ward pharmacist recorded the time taken each day for four weeks. Second, an observational study was conducted over 10 weekdays, using two-dimensional work sampling, to identify the ward pharmacist's activities. Finally, medication orders were examined to identify pharmacists' endorsements that should have been, and were actually, made. Key findings Mean time to provide a weekday ward pharmacy service increased from 1 h 8 min to 1 h 38 min per day (P = 0.001; unpaired t-test). There were significant increases in time spent prescription monitoring, recommending changes in therapy/monitoring, giving advice or information, and non-productive time. There were decreases for supply, looking for charts and checking patients' own drugs. There was an increase in the amount of time spent with medical and pharmacy staff, and with 'self'. Seventy-eight per cent of patients' medication records could be assessed for endorsements pre- and 100% post-intervention. Endorsements were required for 390 (50%) of 787 medication orders pre-intervention and 190 (21%) of 897 afterwards (P < 0.0001; chi-square test). Endorsements were made for 214 (55%) of endorsement opportunities pre-intervention and 57 (30%) afterwards (P < 0.0001; chi-square test). Conclusion The intervention increased the overall time required to provide a ward pharmacy service and changed the types of activity undertaken. Contact time with medical and pharmacy staff increased. There was no significant change in time spent with patients. Fewer pharmacy endorsements were required post-intervention, but a lower percentage were actually made. The findings have important implications for the design, introduction and use of similar systems.

Sociology, Gender and Educational Aspirations: Girls and their Ambitions

This study helps develop an overall understanding as to why some students achieve where others don't. Debate on the effects of class on educational attainment is well documented and typically centres on the reproductive nature of class whilst studies of the effect of class on educational aspirations also predict outcomes that see education reinforcing and reproducing a student's class background.Despite a number of government initiatives to help raise higher education participation to 50 per cent by 2010, for the working class numbers have altered little. Using data from an ethnographic case study of a low-achieving girls school, the author explores aspirations and argues that whilst class is very powerful in explaining educational attainment, understanding educational aspirations is somewhat more complex. The purpose of this book, therefore, is to question and challenge popular assumptions surrounding class-based theory in making sense of girls' aspirations and to question the usefulness of the continued over reliance of such broad categorisations by both academics and policy makers

How could construction supply chain benefit from RFID/GPS integration: a knowledge management perspective

Construction materials and equipment are essential building blocks of every construction project and may account for 50-60 per cent of the total cost of construction. The rate of their utilization, on the other hand, is the element that most directly relates to a project progress. A growing concern in the industry that inadequate efficiency hinders its success could thus be accommodated by turning construction into a logistic process. Although mostly limited, recent attempts and studies show that Radio Frequency IDentification (RFID) applications have significant potentials in construction. However, the aim of this research is to show that the technology itself should not only be used for automation and tracking to overcome the supply chain complexity but also as a tool to generate, record and exchange process-related knowledge among the supply chain stakeholders. This would enable all involved parties to identify and understand consequences of any forthcoming difficulties and react accordingly before they cause major disruptions in the construction process. In order to achieve this aim the study focuses on a number of methods. First of all it develops a generic understanding of how RFID technology has been used in logistic processes in industrial supply chain management. Secondly, it investigates recent applications of RFID as an information and communication technology support facility in construction logistics for the management of construction supply chain. Based on these the study develops an improved concept of a construction logistics architecture that explicitly relies on integrating RFID with the Global Positioning System (GPS). The developed conceptual model architecture shows that categorisation provided through RFID and traceability as a result of RFID/GPS integration could be used as a tool to identify, record and share potential problems and thus vastly improve knowledge management processes within the entire supply chain. The findings thus clearly show a need for future research in this area.

Does gym use impact upon nutritional knowledge?

Purpose – The purpose of this paper is to investigate gym and non-gym users' use and understanding of nutrition labels. Design/methodology/approach – A consumer survey in the form of a questionnaire conducted in the Greater London area in February/March 2005. Subject recruitment process took place in both a gym and university setting. Frequency tables and ?2-test are used to assess relationships between variables (p=0.05). Findings – The resulting sample consisted of 187 subjects, with predominance of females and gym users. Of the subjects, 88 per cent reported to at least occasionally read nutrition labels, with higher reading rates amongst women, irrespective of gym user status. Total and saturated fats are the most often information viewed on labels, however the overall knowledge of the calorie content of fat is low, with 53 per cent of subjects responding saturated fat contains more calories per gram when compared with other types of fats. This paper does not find significant differences in the use and understanding of nutrition labels between gym and non-gym users, but highlights the publics' continued lack of understanding of nutrition labels. Originality/value – This paper is unique as it investigates whether there is any difference between gym/non-gym users' use and interpretation of use of nutrition labels. It finds gender impacted more on nutritional labels knowledge than gym user's status. This points to a gender issue and questions the quality of information available to the general public. This paper is valuable as it highlights and identifies an area that requires further research and assessment, and is therefore useful to key stakeholders responsible for public health nutrition.

Costs to farmers of a tuberculosis breakdown

An on-farm survey of 151 cattle farmers who had experienced a bovine tuberculosis (Mycobacterium bovis) breakdown on their farms was undertaken in 2003 to assess the costs associated with the breakdown. In 90 per cent of cases the cost was estimated to be less than 18,513 pound for dairy herds and less than El 1,462 for beef herds, but with a range from 229 pound to 103,817 pound. The main cost was the slaughter of reactor cattle. For the majority of the farmers, the compensation payments seemed to meet most of the costs of their breakdowns, although a majority was still left with net losses.

Biodiversity versus emergencies: the impact of restocking on animal genetic resources after disaster

Restocking is a favoured option in supporting livelihoods after a disaster. With the depletion of local livestock populations, the introduction of new species and breeds will clearly affect biodiversity. Nevertheless, the impact of restocking on Animal Genetic Resources has been largely ignored. The aim of this paper, therefore, is to examine the consequences of restocking on biodiversity via a simple model. Utilising a hypothetical project based on cattle, the model demonstrates that more than one-third of the population was related to the original restocked animals after three generations. Under conditions of random breed selection, the figure declined to 20 per cent. The tool was then applied to a donor-led restocking project implemented in Bosnia-Herzegovina. By restocking primarily with Simmental cattle, the model demonstrated that the implementation of a single restocking project is likely to have accelerated the decline of the indigenous Busa breed by a further nine per cent. Thus, greater awareness of the long-term implications of restocking on biodiversity is required.

Bio-diversity versus emergencies: the impact of restocking on animal genetic resources after disaster

Restocking is a favoured option in supporting livelihoods after a disaster. With the depletion of local livestock populations, the introduction of new species and breeds will clearly affect biodiversity. Nevertheless, the impact of restocking on Animal Genetic Resources has been largely ignored. The aim of this paper, therefore, is to examine the consequences of restocking on biodiversity via a simple model. Utilising a hypothetical project based on cattle, the model demonstrates that more than one-third of the population was related to the original restocked animals after three generations. Under conditions of random breed selection, the figure declined to 20 per cent. The tool was then applied to a donor-led restocking project implemented in Bosnia-Herzegovina. By restocking primarily with Simmental cattle, the model demonstrated that the implementation of a single restocking project is likely to have accelerated the decline of the indigenous Buşa breed by a further nine per cent. Thus, greater awareness of the long-term implications of restocking on biodiversity is required.

Prevalence of subclinical mastitis and associated risk factors in smallholder dairy cows in Tanzania

A cross-sectional study was carried out on 200 randomly selected farms in each of the Iringa and Tanga regions of Tanzania to estimate the prevalence and risk factors for subclinical mastitis in dairy cows kept by smallholders. Subclinical mastitis was assessed using the California mastitis test (CMT), and by the bacteriological culture of 1500 milk samples collected from 434 clinically normal cows. The percentages of the cows (and quarters) with subclinical mastitis were 75.9 per cent (46.2 per cent) when assessed by the CMT and 43.8 per cent (24.3 per cent) when assessed by culture. Factors significantly associated with an increased risk of a CMT-positive quarter were Boran breed (odds radio [OR]=3.51), a brought-in cow (rather than homebred) (OR=2.39), peak milk yield, and age. The stripping method of hand milking was associated with a significantly lower prevalence Of CMT-positive quarters (OR=0.51). The CMT-positive cows were more likely to be culture positive (OR=4.51), as were brought-in (OR=2.10) and older cows.

Post occupancy evaluation of a building employing windcatchers for summer ventilation

A combined windcatcher and light pipe (SunCatcher) was installed in the seminar room at the University of Reading, UK. Monitoring of indoor environment in real weather conditions was conducted to evaluate the application of windcatchers for natural ventilation. In addition, a subjective occupancy survey was undertaken. External weather conditions and internal indoor air quality indicators were recorded. The “tracer-gas decay” method using SF6 was used to establish air change rate for various conditions. The results indicated that the ventilation rate achieved through the windcatcher depends on the difference between internal and external air temperatures, and on wind speed and direction, in agreement with other published work in the area. The indoor air quality parameters were found to be within acceptable levels when the windcatcher was in operation. The measured air change rate was between 1.5ac/h and 6.8ac/h. Occupants’ questionnaires showed 75 per cent satisfaction with the internal conditions and welcomed the installation of the systems in UK buildings.

Application of computer-aided facilities management (CAFM) for intelligent buildings operation

Purpose – The purpose of this paper is to investigate the concepts of intelligent buildings (IBs), and the opportunities offered by the application of computer-aided facilities management (CAFM) systems. Design/methodology/approach – In this paper definitions of IBs are investigated, particularly definitions that are embracing open standards for effective operational change, using a questionnaire survey. The survey further investigated the extension of CAFM to IBs concepts and the opportunities that such integrated systems will provide to facilities management (FM) professionals. Findings – The results showed variation in the understanding of the concept of IBs and the application of CAFM. The survey showed that 46 per cent of respondents use a CAFM system with a majority agreeing on the potential of CAFM in delivery of effective facilities. Research limitations/implications – The questionnaire survey results are limited to the views of the respondents within the context of FM in the UK. Practical implications – Following on the many definitions of an IB does not necessarily lead to technologies of equipment that conform to an open standard. This open standard and documentation of systems produced by vendors is the key to integrating CAFM with other building management systems (BMS) and further harnessing the application of CAFM for IBs. Originality/value – The paper gives experience-based suggestions for both demand and supply sides of the service procurement to gain the feasible benefits and avoid the currently hindering obstacles, as the paper provides insight to the current and future tools for the mobile aspects of FM. The findings are relevant for service providers and operators as well.

Commercial reviews in the tender process of contractors

Purpose – The purpose of this paper is to show the extent to which clients amend standard form contracts in practice, the locus of the amendments, and how contractors respond to the amendments when putting together a bid. Design/methodology/approach – Four live observational case studies were carried out in two of the top 20 UK construction firms. The whole process used to review the proposed terms and conditions of the contract was shadowed using participant observation, interview and documentary analysis. Findings – All four cases showed strong evidence of amendments relating mostly to payment and contractual aspects: 83 amendments in Case Study 1 (CS1), 80 in CS2, 15 in CS3 and 29 in CS4. This comprised clauses that were modified (37 per cent), substituted (23 per cent), deleted (7 per cent) and new additions (33 per cent). Risks inherent in the amendments were mostly addressed through contractual rather than price mechanisms, to reflect commercial imperatives. “Qualifications” and “clarifications” were included in the tender submissions for post-tender negotiations. Thus, the amendments did not necessarily influence price. There was no evidence of a “standard-form contract“ being used as such, although clients may draw on published “standard-form contracts” to derive the forms of contract actually used in practice. Practical implications – Contractors should pay attention to clauses relating to contractual and financial aspects when reviewing tender documents. Clients should draft equitable payment and contractual terms and conditions to reduce risk of dispute. Indeed, it is prudent for clients not to pass on inestimable risks. Originality/value – A better understanding of the extent and locus of amendments in standard form contracts, and how contractors respond, is provided.