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.

Case study: object and ground point separation on a river bank using airborne based LIDAR data

In the past decade, airborne based LIght Detection And Ranging (LIDAR) has been recognised by both the commercial and public sectors as a reliable and accurate source for land surveying in environmental, engineering and civil applications. Commonly, the first task to investigate LIDAR point clouds is to separate ground and object points. Skewness Balancing has been proven to be an efficient non-parametric unsupervised classification algorithm to address this challenge. Initially developed for moderate terrain, this algorithm needs to be adapted to handle sloped terrain. This paper addresses the difficulty of object and ground point separation in LIDAR data in hilly terrain. A case study on a diverse LIDAR data set in terms of data provider, resolution and LIDAR echo has been carried out. Several sites in urban and rural areas with man-made structure and vegetation in moderate and hilly terrain have been investigated and three categories have been identified. A deeper investigation on an urban scene with a river bank has been selected to extend the existing algorithm. The results show that an iterative use of Skewness Balancing is suitable for sloped terrain.

Knowledge-elicitation and data-mining: fusing human and industrial plant information

Knowledge-elicitation is a common technique used to produce rules about the operation of a plant from the knowledge that is available from human expertise. Similarly, data-mining is becoming a popular technique to extract rules from the data available from the operation of a plant. In the work reported here knowledge was required to enable the supervisory control of an aluminium hot strip mill by the determination of mill set-points. A method was developed to fuse knowledge-elicitation and data-mining to incorporate the best aspects of each technique, whilst avoiding known problems. Utilisation of the knowledge was through an expert system, which determined schedules of set-points and provided information to human operators. The results show that the method proposed in this paper was effective in producing rules for the on-line control of a complex industrial process. (C) 2005 Elsevier Ltd. All rights reserved.

Secondary school teachers' perspectives on teaching about topics that bridge science and religion

The question of where to locate teaching about the relationships between science and religion has produced a long-running debate. Currently, Science and Religious Education (RE) are statutory subjects in England and are taught in secondary schools by different teachers. This paper reports on an interview study in which 16 teachers gave their perceptions of their roles and responsibilities when teaching topics that bridge science and religion and the extent to which they collaborated with teachers in the other subject area. We found that in this sample, teachers reported very little collaboration between the curriculum areas. Although the science curriculum makes no mention of religion, all the science teachers said that their approaches to such topics were affected by their recognition that some pupils hold religious beliefs. All the RE teachers reported struggling to ensure students know of a range of views about how science and religion relate. The paper concludes with a discussion about implications for curriculum design and teacher training.

How remote are R&D labs? Distance factors and international innovative activities

This paper shows that value creation by multinational enterprises (MNEs) is the result of activities where geographic distance effects can be overcome. We submit that geographic distance has a relatively low impact on international research and development (R&D) investments, owing to the spiky nature of innovation, and to the unique ability of MNEs to absorb and transfer knowledge on a global scale. On the one hand, MNEs need to set up their labs as close as possible to specialized technology clusters where valuable knowledge is concentrated, largely regardless of distance from their home base. On the other, MNEs have historically developed technical and organizational competencies that enable them to transfer knowledge within their internal networks and across technology clusters at relatively low cost. Using data on R&D and manufacturing investments of 6320 firms in 59 countries, we find that geographic distance has a lower negative impact on the probability of setting up R&D than manufacturing plants. Furthermore, once measures of institutional proximity are accounted for, MNEs are equally likely to set up R&D labs in nearby or in more remote locations. This result is driven by MNEs based in Triad countries, whereas for non-Triad MNEs the effect of geographic distance on cross-border R&D is negative and significant.

Exploitation of Geostationary Earth Radiation Budget data using simulations from a numerical weather prediction model: Methodology and data validation

We describe a new methodology for comparing satellite radiation budget data with a numerical weather prediction (NWP) model. This is applied to data from the Geostationary Earth Radiation Budget (GERB) instrument on Meteosat-8. The methodology brings together, in near-real time, GERB broadband shortwave and longwave fluxes with simulations based on analyses produced by the Met Office global NWP model. Results for the period May 2003 to February 2005 illustrate the progressive improvements in the data products as various initial problems were resolved. In most areas the comparisons reveal systematic errors in the model's representation of surface properties and clouds, which are discussed elsewhere. However, for clear-sky regions over the oceans the model simulations are believed to be sufficiently accurate to allow the quality of the GERB fluxes themselves to be assessed and any changes in time of the performance of the instrument to be identified. Using model and radiosonde profiles of temperature and humidity as input to a single-column version of the model's radiation code, we conduct sensitivity experiments which provide estimates of the expected model errors over the ocean of about ±5–10 W m−2 in clear-sky outgoing longwave radiation (OLR) and ±0.01 in clear-sky albedo. For the more recent data the differences between the observed and modeled OLR and albedo are well within these error estimates. The close agreement between the observed and modeled values, particularly for the most recent period, illustrates the value of the methodology. It also contributes to the validation of the GERB products and increases confidence in the quality of the data, prior to their release.

The effects of difficulty and gain versus loss on vocal physiology and acoustics

To examine the basis of emotional changes to the voice, physiological and electroglottal measures were combined with acoustic speech analysis of 30 men performing a computer task in which they lost or gained points under two levels of difficulty. Predictions of the main effects of difficulty and reward on the voice were not borne out by the data. Instead, vocal changes depended largely on interactions between gain versus loss and difficulty. The rate at which the vocal folds open and close (fundamental frequency; f0) was higher for loss than for gain when difficulty was high, but not when difficulty was low. Electroglottal measures revealed that f0 changes corresponded to shorter glottal open times for the loss conditions. Longer closed and shorter open phases were consistent with raised laryngeal tension in difficult loss conditions. Similarly, skin conductance indicated higher sympathetic arousal in loss than gain conditions, particularly when difficulty was high. The results provide evidence of the physiological basis of affective vocal responses, confirming the utility of measuring physiology and voice in the study of emotion.

Modeling of relationships between weather and Septoria tritici epidemics on winter wheat: A critical approach

Two models for predicting Septoria tritici on winter wheat (cv. Ri-band) were developed using a program based on an iterative search of correlations between disease severity and weather. Data from four consecutive cropping seasons (1993/94 until 1996/97) at nine sites throughout England were used. A qualitative model predicted the presence or absence of Septoria tritici (at a 5% severity threshold within the top three leaf layers) using winter temperature (January/February) and wind speed to about the first node detectable growth stage. For sites above the disease threshold, a quantitative model predicted severity of Septoria tritici using rainfall during stern elongation. A test statistic was derived to test the validity of the iterative search used to obtain both models. This statistic was used in combination with bootstrap analyses in which the search program was rerun using weather data from previous years, therefore uncorrelated with the disease data, to investigate how likely correlations such as the ones found in our models would have been in the absence of genuine relationships.

Oxidation of oleic acid at the air-water interface and its potential effects on cloud critical supersaturations

The oxidation of organic films on cloud condensation nuclei has the potential to affect climate and precipitation events. In this work we present a study of the oxidation of a monolayer of deuterated oleic acid (cis-9-octadecenoic acid) at the air-water interface by ozone to determine if oxidation removes the organic film or replaces it with a product film. A range of different aqueous sub-phases were studied. The surface excess of deuterated material was followed by neutron reflection whilst the surface pressure was followed using a Wilhelmy plate. The neutron reflection data reveal that approximately half the organic material remains at the air-water interface following the oxidation of oleic acid by ozone, thus cleavage of the double bond by ozone creates one surface active species and one species that partitions to the bulk (or gas) phase. The most probable products, produced with a yield of similar to(87 +/- 14)%, are nonanoic acid, which remains at the interface, and azelaic acid (nonanedioic acid), which dissolves into the bulk solution. We also report a surface bimolecular rate constant for the reaction between ozone and oleic acid of (7.3 +/- 0.9) x 10(-11) cm(2) molecule s(-1). The rate constant and product yield are not affected by the solution sub-phase. An uptake coefficient of ozone on the oleic acid monolayer of similar to 4 x 10(-6) is estimated from our results. A simple Kohler analysis demonstrates that the oxidation of oleic acid by ozone on an atmospheric aerosol will lower the critical supersaturation needed for cloud droplet formation. We calculate an atmospheric chemical lifetime of oleic acid of 1.3 hours, significantly longer than laboratory studies on pure oleic acid particles suggest, but more consistent with field studies reporting oleic acid present in aged atmospheric aerosol.