The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study

Objectives: To assess the impact of a closed-loop electronic prescribing, automated dispensing, barcode patient identification and electronic medication administration record (EMAR) system on prescribing and administration errors, confirmation of patient identity before administration, and staff time. Design, setting and participants: Before-and-after study in a surgical ward of a teaching hospital, involving patients and staff of that ward. Intervention: Closed-loop electronic prescribing, automated dispensing, barcode patient identification and EMAR system. Main outcome measures: Percentage of new medication orders with a prescribing error, percentage of doses with medication administration errors (MAEs) and percentage given without checking patient identity. Time spent prescribing and providing a ward pharmacy service. Nursing time on medication tasks. Results: Prescribing errors were identified in 3.8% of 2450 medication orders pre-intervention and 2.0% of 2353 orders afterwards (p<0.001; χ2 test). MAEs occurred in 7.0% of 1473 non-intravenous doses pre-intervention and 4.3% of 1139 afterwards (p = 0.005; χ2 test). Patient identity was not checked for 82.6% of 1344 doses pre-intervention and 18.9% of 1291 afterwards (p<0.001; χ2 test). Medical staff required 15 s to prescribe a regular inpatient drug pre-intervention and 39 s afterwards (p = 0.03; t test). Time spent providing a ward pharmacy service increased from 68 min to 98 min each weekday (p = 0.001; t test); 22% of drug charts were unavailable pre-intervention. Time per drug administration round decreased from 50 min to 40 min (p = 0.006; t test); nursing time on medication tasks outside of drug rounds increased from 21.1% to 28.7% (p = 0.006; χ2 test). Conclusions: A closed-loop electronic prescribing, dispensing and barcode patient identification system reduced prescribing errors and MAEs, and increased confirmation of patient identity before administration. Time spent on medication-related tasks increased.

The politics of CAP reform: Trade negotiations, institutional settings and blame avoidance

In this article we argue that the conclusion of the GATT Uruguay Round Agreement on Agriculture and the subsequent role of the WTO has changed the international context of CAP policy-making. However, comparing the three latest CAP reforms, we demonstrate that pressures on the CAP arising from international trade negotiations cannot alone account for the way in which the EU responds in terms of CAP reform. The institutional setting within which the reform package was determined also played a crucial role. Contrary to conventional wisdom, the CoAM seems to be a more conducive setting than the European Council for undertaking substantial reform of the CAP. We suggest that the choice of institutional setting is influenced by the desire of farm ministers and of heads of state or government to avoid blame for unpopular decisions. When CAP reform is an integral part of a broader package, farm ministers pass the final decision to the European Council and when CAP reform is defined as a separate issue the European Council avoids involvement.

Logit models for identifying the factors that influence the uptake of new 'no-tillage' technologies by farmers in the rice-wheat and the cotton-wheat farming systems of Pakistan's Punjab

In the 'rice-wheat' and the 'cotton-wheat' farming systems of Pakistan's Punjab, late planting of wheat is a perennial problem due to often delayed harvesting of the previously planted and late maturing rice and cotton crops. This leaves very limited time for land preparation for 'on-time' planting of wheat. 'No-tillage' technologies that reduce the turn-round time for wheat cultivation after rice and cotton have been developed, but their uptake has not been as expected.-This paper attempts to determine the farm and farmer characteristics and other socio-economic factors that influence the adoption of 'no-tillage' technologies'. Logit models were developed for the analysis undertaken. In the 'cotton-wheat' system personal characteristics like education, tenancy status, attitude towards risk implied in the use of new technologies and contact with extension agents are the main factors that affect adoption. As regards the 'rice-wheat' system, resource endowments such as farm size, access to a 'no-tillage' drill, clayey soils and the area sown to the rice-wheat sequence along with tenancy and contact with extension agents were dominant in explaining adoption. (C) 2002 Elsevier Science Ltd. All rights reserved.

The impact of an insecticide on insect flower visitation and pollination in an agricultural landscape

1 Pesticides are considered a threat to pollinators but little is known about the potential impacts of their widespread use on pollinators. Less still is known about the impacts on pollination, comprising the ecosystem service that pollinators provide to wildflowers and crops. 2 The present study measured flower visitation and pollination in an agricultural landscape, by placing potted flowering plants (Petunia sp.) in vine fields sprayed with a highly toxic insecticide (fenitrothion). During two sampling rounds, insect visitors to the petunias were observed and measures of pollination were recorded by counting and weighing seeds. 3 In the earlier sampling round, a lower species richness of insect visitors was observed in fields that had received an early application of insecticide. No negative impacts were found from later applications. The results obtained suggest a greater potential harm to insect pollinators and flower visitation as a result of insecticide application early in the season. 4 No reduction in pollination was found in fields that received an early insecticide application. Pollination was greater with two insecticide applications between sampling rounds rather than one application. 5 In the present study system, insecticide application had a negative effect on pollinators but a possible positive effect on pollination services. In some cases, it may be that actions for conserving biodiversity will not benefit pollination services to all plants.

Incense and insensibility: Austin on the 'non-seriousness' of poetry

What is at stake when J. L. Austin calls poetry ‘non-serious’, and sidelines it in his speech act theory? (I). Standard explanations polarize sharply along party lines: poets (e.g. Geoffrey Hill) and critics (e.g. Christopher Ricks) are incensed, while philosophers (e.g. P. F. Strawson; John Searle) deny cause (II). Neither line is consistent with Austin's remarks, whose allusions to Plato, Aristotle and Frege are insufficiently noted (III). What Austin thinks is at stake is confusion, which he corrects apparently to the advantage of poets (IV). But what is actually at stake is the possibility of commitment and poetic integrity. We should reject what Austin offers (V).

‘The Claims of Epic: Overcoming historical distance in the Homeric versions of Derek Walcott and Michael Longley’

This book chapter compares the translation strategies of two contemporay poets, Derek Walcott and Michael Longley, as they attempt versions or rewrites of Homeric epic.

The use of land-sea warming contrast under climate change to improve impact metrics

A favoured method of assimilating information from state-of-the-art climate models into integrated assessment models of climate impacts is to use the transient climate response (TCR) of the climate models as an input, sometimes accompanied by a pattern matching approach to provide spatial information. More recent approaches to the problem use TCR with another independent piece of climate model output: the land-sea surface warming ratio (φ). In this paper we show why the use of φ in addition to TCR has such utility. Multiple linear regressions of surface temperature change onto TCR and φ in 22 climate models from the CMIP3 multi-model database show that the inclusion of φ explains a much greater fraction of the inter-model variance than using TCR alone. The improvement is particularly pronounced in North America and Eurasia in the boreal summer season, and in the Amazon all year round. The use of φ as the second metric is beneficial for three reasons: firstly it is uncorrelated with TCR in state-of-the-art climate models and can therefore be considered as an independent metric; secondly, because of its projected time-invariance, the magnitude of φ is better constrained than TCR in the immediate future; thirdly, the use of two variables is much simpler than approaches such as pattern scaling from climate models. Finally we show how using the latest estimates of φ from climate models with a mean value of 1.6—as opposed to previously reported values of 1.4—can significantly increase the mean time-integrated discounted damage projections in a state-of-the-art integrated assessment model by about 15 %. When compared to damages calculated without the inclusion of the land-sea warming ratio, this figure rises to 65 %, equivalent to almost 200 trillion dollars over 200 years.

In the shadow of Grexit: the Greek election of 17 June 2012

This article provides an overview and analysis of the Greek June 2012 elections. Placing the elections within the broader framework of the Greek socio-political and economic context, it discusses the electoral campaign and results, juxtaposing them to the 6 May electoral round. The election results confirmed many of the trends of the previous round, including electoral volatility, the fragmentation of the party system and the rise of anti-establishment forces. The main difference was the entrenchment of the pro- versus anti- bailout division and the prominence of the question of Greece’s continued Eurozone membership.

Review of the formulation of present‐generation stratospheric chemistry‐climate models and associated external forcings

The goal of the Chemistry‐Climate Model Validation (CCMVal) activity is to improve understanding of chemistry‐climate models (CCMs) through process‐oriented evaluation and to provide reliable projections of stratospheric ozone and its impact on climate. An appreciation of the details of model formulations is essential for understanding how models respond to the changing external forcings of greenhouse gases and ozonedepleting substances, and hence for understanding the ozone and climate forecasts produced by the models participating in this activity. Here we introduce and review the models used for the second round (CCMVal‐2) of this intercomparison, regarding the implementation of chemical, transport, radiative, and dynamical processes in these models. In particular, we review the advantages and problems associated with approaches used to model processes of relevance to stratospheric dynamics and chemistry. Furthermore, we state the definitions of the reference simulations performed, and describe the forcing data used in these simulations. We identify some developments in chemistry‐climate modeling that make models more physically based or more comprehensive, including the introduction of an interactive ocean, online photolysis, troposphere‐stratosphere chemistry, and non‐orographic gravity‐wave deposition as linked to tropospheric convection. The relatively new developments indicate that stratospheric CCM modeling is becoming more consistent with our physically based understanding of the atmosphere.

What happens to precocious readers’ performance by the age of 11 years?

This paper reports on the progress made by a group of fourteen 11-year-old children who had been originally identified as being precocious readers before they started primary school at the age of 5-years. The data enable comparisons to be made with the performance of the children when they were younger so that a six year longitudinal analysis can be made. The children who began school as precocious readers continued to make progress in reading accuracy, rate and comprehension, thereby maintaining their superior performance relative to a comparison group. However, their progress appeared to follow the same developmental trajectory as that of the comparison group. Measures of phonological awareness showed that there are long term, stable individual differences which correlated with all measures of reading. The children who were reading precociously early showed significantly higher levels of phonological awareness than the comparison children. In addition, they showed the same levels of performance on this task as a further group of high achieving young adults. A positive effect of being able to read at precociously early age was identified in the significantly higher levels of receptive vocabulary found amongst the these children. The analyses indicated that rises in receptive vocabulary resulted from reading performance rather than the other way round

Settlement patterns in the late Mesolithic of western Scotland: the implications of Bayesian analysis of radiocarbon dates and inter-site technological comparisons

The character of settlement patterns within the late Mesolithic communities of north-west Europe is a topic of substantial debate. An important case study concerns the five shell middens on the island of Oronsay, Inner Hebrides, western Scotland. Two conflicting interpretations have been proposed: the evidence from seasonality indicators and stable isotope analysis of human bones has been used to support a model of year-round settlement on this small island; alternatively, the middens have been interpreted as resulting from short-term intermittent visits to Oronsay within a regionally mobile settlement pattern. We contribute to this debate by describing Storakaig, a newly discovered site on the nearby island of Islay, undertaking a Bayesian chronological analysis and providing evidence for technological continuity between Oronsay and sites elsewhere in the region. While this new evidence remains open to alternative interpretation, we suggest that it makes regional mobility rather than year-round settlement on Oronsay a more viable interpretation for the Oronsay middens. Our analysis also confirms the likely overlap of the late Mesolithic with the earliest Neolithic within western Scotland.