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.

The simulation of peak and delayed ENSO teleconnections

There is much evidence that El Niño and La Niña lead to significant atmospheric seasonal predictability across much of the globe. However, despite successful predictions of tropical Pacific SSTs, atmospheric seasonal forecasts have had limited success. This study investigates model errors in the Hadley Centre Atmospheric Model version 3 (HadAM3) by analyzing composites of similar El Niño and La Niña events at their peak in December–January–February (DJF) and through their decay in March–April–May (MAM). The large-scale, tropical ENSO teleconnections are modeled accurately by HadAM3 during DJF but the strongest extratropical teleconnection, that in the North Pacific during winter, is modeled inaccurately. The Aleutian low is frequently observed to shift eastward during El Niño but the modeled response always consists of a deepening of the low without a shift. This is traced to small errors in the sensitivity of precipitation to SST in the tropical Pacific, which does not display enough variability so that the precipitation is always too high over the warmest SSTs. This error is reduced when vertical resolution is increased from 19 to 30 levels but enhanced horizontal resolution does not improve the simulation further. In MAM, following the peak of an El Niño or La Niña, atmospheric anomalies are observed to decay rapidly. The modeled ENSO response in DJF persists into MAM, making the extratropical anomalies in MAM too strong. This inaccuracy is again likely to be due to the high modeled sensitivity of tropical Pacific precipitation to SST, which is not significantly improved with enhanced vertical or horizontal resolution in MAM.

Hardening of concrete with a planned delayed ettringite formation

Delayed ettringite formation (DEF) in cementitious materials is widely considered as a harmful chemical reaction that causes extensive damages in hardened concrete. However, preventative measures and possible improvements in general are not extensively studied and require further attention. In this study was presented an investigation into a type of controlled DEF in places of finely dispersed crystallisation nuclei and provide evidence that the process may improve compressive strength of cementitious materials. The Alkali-Silica Reaction (ASR) in hydrated concrete was achieved with the addition of fly ash and was further accelerated with the Duggan’s test. Achieved strengths and monitoring of microstructure development conducted with electronic microscopy revealed that growth of ettringite crystals in the nuclei led to harmless internal compressive stresses, expansion of hydrated concrete and overall strengthening of the concrete matrix.

The representation of delayed intentions: a prospective subject-performed task?

To-be-enacted material is more accessible in tests of recognition and lexical decision than material not intended for action (T. Goschke J. Kuhl, 1993; R. L. Marsh, J. L. Hicks, & M. L. Bink, 1998). This finding has been attributed to the superior status of intention-related information. The current article explores an alternative (action-superiority) account that draws parallels between the intended enactment effect (IEE) and the subject-performed task effect. Using 2 paradigms, the authors observed faster recognition latencies for both enacted and to-be-enacted material. It is crucial to note that there was no evidence of an IEE for items that had already been executed during encoding. The IEE was also eliminated when motor processing was prevented after verbal encoding. These findings suggest an overlap between overt and intended enactment and indicate that motor information may be activated for verbal material in preparation for subsequent execution.

Motor brain regions are involved in the encoding of delayed intentions: a fMRI study

In studies of prospective memory, recall of the content of delayed intentions is normally excellent, probably because they contain actions that have to be enacted at a later time. Action words encoded for later enactment are more accessible from memory than those encoded for later verbal report [Freeman, J.E., and Ellis, J.A. 2003a. The representation of delayed intentions: A prospective subject-performed task? Journal of Experimental Psychology: Learning, Memory, and Cognition, 29, 976-992.]. As this higher assessibility is lost when the intended actions have to be enacted during encoding, or when a motor interference task is introduced concurrent to intention encoding, Freeman and Ellis suggested that the advantage of to-be-enacted actions is due to additional preparatory motor operations during encoding. Accordingly, in a fMRI study with 10 healthy young participants, we investigated whether motor brain regions are differentially activated during verbal encoding of actions for later enactment with the right hand in contrast to verbal encoding of actions for later verbal report. We included an additional condition of verbal encoding of abstract verbs for later verbal report to investigate whether the semantic motor information inherent in action verbs in contrast to abstract verbs activates motor brain regions different from those involved in the verbal encoding of actions for later enactment. Differential activation for the verbal encoding of to-be-enacted actions in contrast to to-be-reported actions was found in brain regions known to be involved in covert motor preparation for hand movements, i.e. the postcentral gyrus, the precuneus, the dorsal and ventral premotor cortex, the posterior middle temporal gyrus and the inferior parietal lobule. There was no overlap between these brain regions and those differentially activated during the verbal encoding of actions in contrast to abstract verbs for later verbal report. Consequently, the results of this fMRI study suggest the presence of preparatory motor operations during the encoding of delayed intentions requiring a future motor response, which cannot be attributed to semantic information inherent to action verbs. (c) 2006 Elsevier B.V. All rights reserved.

Video activity extraction and reporting with incremental unsupervised learning

The present work presents a new method for activity extraction and reporting from video based on the aggregation of fuzzy relations. Trajectory clustering is first employed mainly to discover the points of entry and exit of mobiles appearing in the scene. In a second step, proximity relations between resulting clusters of detected mobiles and contextual elements from the scene are modeled employing fuzzy relations. These can then be aggregated employing typical soft-computing algebra. A clustering algorithm based on the transitive closure calculation of the fuzzy relations allows building the structure of the scene and characterises the ongoing different activities of the scene. Discovered activity zones can be reported as activity maps with different granularities thanks to the analysis of the transitive closure matrix. Taking advantage of the soft relation properties, activity zones and related activities can be labeled in a more human-like language. We present results obtained on real videos corresponding to apron monitoring in the Toulouse airport in France.

Proposed best practice for statisticians in the reporting and publication of pharmaceutical industry-sponsored clinical trials

In this paper we set out what we consider to be a set of best practices for statisticians in the reporting of pharmaceutical industry-sponsored clinical trials. We make eight recommendations covering: author responsibilities and recognition; publication timing; conflicts of interest; freedom to act; full author access to data; trial registration and independent review. These recommendations are made in the context of the prominent role played by statisticians in the design, conduct, analysis and reporting of pharmaceutical sponsored trials and the perception of the reporting of these trials in the wider community.

The potential for bias in reporting of industry-sponsored clinical trials

Concerns about potentially misleading reporting of pharmaceutical industry research have surfaced many times. The potential for duality (and thereby conflict) of interest is only too clear when you consider the sums of money required for the discovery, development and commercialization of new medicines. As the ability of major, mid-size and small pharmaceutical companies to innovate has waned, as evidenced by the seemingly relentless decline in the numbers of new medicines approved by Food and Drug Administration and European Medicines Agency year-on-year, not only has the cost per new approved medicine risen: so too has the public and media concern about the extent to which the pharmaceutical industry is open and honest about the efficacy, safety and quality of the drugs we manufacture and sell. In 2005 an Editorial in Journal of the American Medical Association made clear that, so great was their concern about misleading reporting of industry-sponsored studies, henceforth no article would be published that was not also guaranteed by independent statistical analysis. We examine the precursors to this Editorial, as well as its immediate and lasting effects for statisticians, for the manner in which statistical analysis is carried out, and for the industry more generally.