Errors associated with the preparation of aseptic products in UK hospital pharmacies: lessons from the national aseptic error reporting scheme

Background Pharmacy aseptic units prepare and supply injectables to minimise risks. The UK National Aseptic Error Reporting Scheme has been collecting data on pharmacy compounding errors, including near-misses, since 2003. Objectives The cumulative reports from January 2004 to December 2007, inclusive, were analysed. Methods The different variables of product types, error types, staff making and detecting errors, stage errors detected, perceived contributory factors, and potential or actual outcomes were presented by cross-tabulation of data. Results A total of 4691 reports were submitted against an estimated 958 532 items made, returning 0.49% as the overall error rate. Most of the errors were detected before reaching patients, with only 24 detected during or after administration. The highest number of reports related to adult cytotoxic preparations (40%) and the most frequently recorded error was a labelling error (34.2%). Errors were mostly detected at first check in assembly area (46.6%). Individual staff error contributed most (78.1%) to overall errors, while errors with paediatric parenteral nutrition appeared to be blamed on low staff levels more than other products were. The majority of errors (68.6%) had no potential patient outcomes attached, while it appeared that paediatric cytotoxic products and paediatric parenteral nutrition were associated with greater levels of perceived patient harm. Conclusions The majority of reports were related to near-misses, and this study highlights scope for examining current arrangements for checking and releasing products, certainly for paediatric cytotoxic and paediatric parenteral nutrition preparations within aseptic units, but in the context of resource and capacity constraints.

British public policy and multinationals during the “Dollar Gap” era, 1945–1960

This article examines the role of British exchange and import controls in stimulating the dramatic increase in overseas (particularly American) multinationals in Britain from the end of the Second World War to the late 1950s, together with the ways in which the government used controls to regulate the foreign direct investment (FDI) inflow. Exchange controls were both an important stimulus to inward investment and a powerful and flexible means of regulating its volume and character. Government was relatively successful in using these powers to maximize the dollar balance and industrial benefits of FDI to Britain, given initially severe dollar and capacity constraints, and in liberalizing policy once these constraints receded and competition from other FDI hosts intensified.

Adaptive constraints for feature tracking

In this paper extensions to an existing tracking algorithm are described. These extensions implement adaptive tracking constraints in the form of regional upper-bound displacements and an adaptive track smoothness constraint. Together, these constraints make the tracking algorithm more flexible than the original algorithm (which used fixed tracking parameters) and provide greater confidence in the tracking results. The result of applying the new algorithm to high-resolution ECMWF reanalysis data is shown as an example of its effectiveness.

Weak constraints in four-dimensional variational data assimilation

The formulation of four-dimensional variational data assimilation allows the incorporation of constraints into the cost function which need only be weakly satisfied. In this paper we investigate the value of imposing conservation properties as weak constraints. Using the example of the two-body problem of celestial mechanics we compare weak constraints based on conservation laws with a constraint on the background state.We show how the imposition of conservation-based weak constraints changes the nature of the gradient equation. Assimilation experiments demonstrate how this can add extra information to the assimilation process, even when the underlying numerical model is conserving.

Layer-by-layer electrostatic entrapment of protein molecules on superparamagnetic nanoparticle: new strategy to enhance adsorption capacity and maintain biological activity

There is a recent interest to use inorganic-based magnetic nanoparticles as a vehicle to carry biomolecules for various biophysical applications, but direct attachment of the molecules is known to alter their conformation leading to attenuation in activity. In addition, surface immobilization has been limited to monolayer coverage. It is shown that alternate depositions of negatively charged protein molecules, typically bovine serum albumin (BSA) with a positively charged aminocarbohydrate template such as glycol chitosan (GC) on magnetic iron oxide nanoparticle surface as a colloid, are carried out under pH 7.4. Circular dichroism (CD) clearly reveals that the secondary structure of the entrapped BSA sequential depositions in this manner remains totally unaltered which is in sharp contrast to previous attempts. Probing the binding properties of the entrapped BSA using small molecules (Site I and Site II drug compounds) confirms for the first time the full retention of its biological activity as compared with native BSA, which also implies the ready accessibility of the entrapped protein molecules through the porous overlayers. This work clearly suggests a new method to immobilize and store protein molecules beyond monolayer adsorption on a magnetic nanoparticle surface without much structural alteration. This may find applications in magnetic recoverable enzymes or protein delivery.

The relationship between diffuse spectral reflectance of the soil and its cation exchange capacity is scale-dependent

Diffuse reflectance spectroscopy (DRS) is increasingly being used to predict numerous soil physical, chemical and biochemical properties. However, soil properties and processes vary at different scales and, as a result, relationships between soil properties often depend on scale. In this paper we report on how the relationship between one such property, cation exchange capacity (CEC), and the DRS of the soil depends on spatial scale. We show this by means of a nested analysis of covariance of soils sampled on a balanced nested design in a 16 km × 16 km area in eastern England. We used principal components analysis on the DRS to obtain a reduced number of variables while retaining key variation. The first principal component accounted for 99.8% of the total variance, the second for 0.14%. Nested analysis of the variation in the CEC and the two principal components showed that the substantial variance components are at the > 2000-m scale. This is probably the result of differences in soil composition due to parent material. We then developed a model to predict CEC from the DRS and used partial least squares (PLS) regression do to so. Leave-one-out cross-validation results suggested a reasonable predictive capability (R2 = 0.71 and RMSE = 0.048 molc kg− 1). However, the results from the independent validation were not as good, with R2 = 0.27, RMSE = 0.056 molc kg− 1 and an overall correlation of 0.52. This would indicate that DRS may not be useful for predictions of CEC. When we applied the analysis of covariance between predicted and observed we found significant scale-dependent correlations at scales of 50 and 500 m (0.82 and 0.73 respectively). DRS measurements can therefore be useful to predict CEC if predictions are required, for example, at the field scale (50 m). This study illustrates that the relationship between DRS and soil properties is scale-dependent and that this scale dependency has important consequences for prediction of soil properties from DRS data

Seeing things: perception, experience and the constraints of excavation

Recent attempts to problematize archaeological fieldwork concerned with excavation at the expense of surface survey, and with questions of procedure more than interpretations of the past. In fact these two kinds of fieldwork offer quite different possibilities and suffer from different constraints. Thought must be given to ways in which they can be combined if they are to make a real contribution to social archaeology. The argument is illustrated by a project carried out at a megalithic cemetery in Scotland.

Analysis of Phytochemical Composition and Chemoprotective Capacity of Rocket (Eruca sativa and Diplotaxis tenuifolia) Leafy Salad Following Cultivation in Different Environments

Consumption of green leafy vegetables is associated with reduced risk of several types of cancer and cardiovascular disease. These beneficial effects are attributed to a range of phytochemicals including flavonoids and glucosinolates, both of which are found in high levels in Brassicaceous crops. Rocket is the general name attributed to cultivars of Eruca sativa and Diplotaxis tenufolia, known as salad rocket and wild rocket, respectively. We have shown that different light levels during the cultivation period of these crops have a significant impact on the levels of flavonoids present in the crop at harvest, with over 15-fold increase achieved in quercetin, isorhamnetin, and cyanidin in high light conditions. Postharvest storage further affects the levels of both flavonoids and glucosinolates, with cyanidin increasing during shelf life and some glucosinolates, such as glucoiberverin, being reduced over the same storage period. In vitro assays using human colon cell lines demonstrate that glucosinolate-rich extracts of Eruca sativa cv. Sky, but not Diplotaxis tenufolia cv. Voyager, confer significant resistance to oxidative stress on the cells, which is indicative of the chemoprotective properties of the leaves from this species. Our findings indicate that both pre and postharvest environment and genotypic selection, when developing new lines of Brassicaceous vegetables, are important considerations with the goal of improving human nutrition and health.

Observational constraints on past attributable warming and predictions of future global warming

This paper investigates the impact of aerosol forcing uncertainty on the robustness of estimates of the twentieth-century warming attributable to anthropogenic greenhouse gas emissions. Attribution analyses on three coupled climate models with very different sensitivities and aerosol forcing are carried out. The Third Hadley Centre Coupled Ocean - Atmosphere GCM (HadCM3), Parallel Climate Model (PCM), and GFDL R30 models all provide good simulations of twentieth-century global mean temperature changes when they include both anthropogenic and natural forcings. Such good agreement could result from a fortuitous cancellation of errors, for example, by balancing too much ( or too little) greenhouse warming by too much ( or too little) aerosol cooling. Despite a very large uncertainty for estimates of the possible range of sulfate aerosol forcing obtained from measurement campaigns, results show that the spatial and temporal nature of observed twentieth-century temperature change constrains the component of past warming attributable to anthropogenic greenhouse gases to be significantly greater ( at the 5% level) than the observed warming over the twentieth century. The cooling effects of aerosols are detected in all three models. Both spatial and temporal aspects of observed temperature change are responsible for constraining the relative roles of greenhouse warming and sulfate cooling over the twentieth century. This is because there are distinctive temporal structures in differential warming rates between the hemispheres, between land and ocean, and between mid- and low latitudes. As a result, consistent estimates of warming attributable to greenhouse gas emissions are obtained from all three models, and predictions are relatively robust to the use of more or less sensitive models. The transient climate response following a 1% yr(-1) increase in CO2 is estimated to lie between 2.2 and 4 K century(-1) (5-95 percentiles).

African climate change: Taking the shorter route

Numerous factors are associated with poverty and underdevelopment in Africa, including climate variability. Rainfall, and climate more generally, are implicated directly in the United Nations “Millennium Development Goals” to eradicate extreme poverty and hunger, and reduce child mortality and incidence of diseases such as malaria by the target date of 2015. But, Africa is not currently on target to meet these goals. We pose a number of questions from a climate science perspective aimed at understanding this background: Is there a common origin to factors that currently constrain climate science? Why is it that in a continent where human activity is so closely linked to interannual rainfall variability has climate science received little of the benefit that saw commercialization driving meteorology in the developed world? What might be suggested as an effective way for the continent to approach future climate variability and change? We make the case that a route to addressing the challenges of climate change in Africa rests with the improved management of climate variability. We start by discussing the constraints on climate science and how they might be overcome. We explain why the optimal management of activities directly influenced by interannual climate variability (which include the development of scientific capacity) has the potential to serve as a forerunner to engagement in the wider issue of climate change. We show this both from the perspective of the climate system and the institutions that engage with climate issues. We end with a thought experiment that tests the benefits of linking climate variability and climate change in the setting of smallholder farmers in Limpopo Province, South Africa.

Dispersal capacity and diet breadth modify the response of wild bees to habitat loss

Habitat loss poses a major threat to biodiversity, and species-specific extinction risks are inextricably linked to life-history characteristics. This relationship is still poorly documented for many functionally important taxa, and at larger continental scales. With data from five replicated field studies from three countries, we examined how species richness of wild bees varies with habitat patch size. We hypothesized that the form of this relationship is affected by body size, degree of host plant specialization and sociality. Across all species, we found a positive species–area slope (z ¼ 0.19), and species traits modified this relationship. Large-bodied generalists had a lower z value than small generalists. Contrary to predictions, small specialists had similar or slightly lower z value compared with large specialists, and small generalists also tended to be more strongly affected by habitat loss as compared with small specialists. Social bees were negatively affected by habitat loss (z ¼ 0.11) irrespective of body size. We conclude that habitat loss leads to clear shifts in the species composition of wild bee communities.