Medicines reconciliation in comparison with NICE guidelines across secondary care mental health organisations

Background Medicines reconciliation-identifying and maintaining an accurate list of a patient's current medications-should be undertaken at all transitions of care and available to all patients. Objective A self-completion web survey was conducted for chief pharmacists (or equivalent) to evaluate medicines reconciliation levels in secondary care mental health organisations. Setting The survey was sent to secondary care mental health organisations in England, Scotland, Northern Ireland and Wales. Method The survey was launched via Bristol Online Surveys. Quantitative data was analysed using descriptive statistics and qualitative data was collected through respondents free-text answers to specific questions. Main outcomes measure Investigate how medicines reconciliation is delivered, incorporate a clear description of the role of pharmacy staff and identify areas of concern. Results Forty-two (52 % response rate) surveys were completed. Thirty-seven (88.1 %) organisations have a formal policy for medicines reconciliation with defined steps. Results show that the pharmacy team (pharmacists and pharmacy technicians) are the main professionals involved in medicines reconciliation with a high rate of doctors also involved. Training procedures frequently include an induction by pharmacy for doctors whilst the pharmacy team are generally trained by another member of pharmacy. Mental health organisations estimate that nearly 80 % of medicines reconciliation is carried out within 24 h of admission. A full medicines reconciliation is not carried out on patient transfer between mental health wards; instead quicker and less exhaustive variations are implemented. 71.4 % of organisations estimate that pharmacy staff conduct daily medicine reconciliations for acute admission wards (Monday to Friday). However, only 38 % of organisations self-report to pharmacy reconciling patients' medication for other teams that admit from primary care. Conclusion Most mental health organisations appear to be complying with NICE guidance on medicines reconciliation for their acute admission wards. However, medicines reconciliation is conducted less frequently on other units that admit from primary care and rarely completed on transfer when it significantly differs to that on admission. Formal training and competency assessments on medicines reconciliation should be considered as current training varies and adherence to best practice is questionable.

On the thermal stabilization of carbon-supported SiO2 catalysts by phosphorus:evaluation in the oxidative dehydrogenation of ethylbenzene to styrene and a comparison with relevant catalysts

A strategy to enhance the thermal stability of C/SiO2 hybrids for the O2-based oxidative dehydrogenation of ethylbenzene to styrene (ST) by P addition is proposed. The preparation consists of the polymerization of furfuryl alcohol (FA) on a mesoporous precipitated SiO2. The polymerization is catalyzed by oxalic acid (OA) at 160 °C (FA:OA = 250). Phosphorous was added as H3PO4 after the polymerization and before the pyrolysis that was carried out at 700 °C and will extend the overall activation procedure. Estimation of the apparent activation energies reveals that P enhances the thermal stability under air oxidation, which is a good indication for the ODH tests. Catalytic tests show that the P/C/SiO2 hybrids are readily active, selective and indeed stable in the applied reactions conditions for 60 h time on stream. Coke build-up during the reaction attributed to the P-based acidity is substantial, leading to a reduction of the surface area and pore volume. The comparison with a conventional MWCNT evidences that the P/C/SiO2 hybrids are more active and selective at high temperatures (450–475 °C) while the difference becomes negligible at lower temperature. However, the comparison with reference P/SiO2 counterparts shows a very similar yield than the hybrids but more selective to ST. The benefit of the P/C/SiO2 hybrid is the lack of stabilization period, which is observed for the P/SiO2 to create an active coke overlayer. For long term operation, P/SiO2 appears to be a better choice in terms of selectivity, which is crucial for commercialization.

Beta-amyloid deposition in the temporal lobe of patients with dementia with Lewy bodies:Comparison with non-demented cases and Alzheimer's disease

β-Amyloid (Aβ) deposition in regions of the temporal lobe in patients with dementia with Lewy bodies (DLB) was compared with elderly, non-demented (ND) cases and with Alzheimer's disease (AD). The distribution, density and clustering patterns of diffuse, primitive and classic Aβ deposits were similar in 'pure' DLB and ND cases. The distribution of Aβ deposits and the densities of the diffuse and primitive deposits were similar in 'mixed' DLB/AD cases compared with AD. However, the density of the classic deposits was significantly lower in DLB/AD compared with AD. In addition, the primitive Aβ deposits occurred more often in small, regularly spaced clusters in the tissue and less often in a single large cluster in DLB/AD compared with 'pure' AD. These results suggest that pure DLB and AD are distinct disorders which can coexist in some patients. However, the Aβ pathology of DLB/AD cases is not identical to that observed in patients with AD alone. (C) 2000 S. Karger AG, Basel.

The spatial patterns of prion protein deposits in Creutzfeldt-Jakob disease:Comparison with β-amyloid deposits in Alzheimer's disease

Similar pathological processes may be involved in the deposition of extracellular proteins in the brains of patients with Creutzfeldt-Jakob disease (CJD) and Alzheimer's disease (AD). Hence, this study compared the spatial patterns of prion protein (PrP) deposits in the cerebral cortex and hippocampus in cases of sporadic CJD with those of β-amyloid (Aβ) deposits in sporadic AD. PrP and Aβ deposits were aggregated into clusters and, in 90% of brain areas in CJD and 57% in AD, the clusters were regularly distributed parallel to the tissue boundary. In a significant proportion of cortical analyses, the mean diameter of the clusters of PrP and Aβ deposits were similar to those of the cells of origin of the cortico-cortical pathways. Aβ deposits in AD were distributed more frequently in larger-sized clusters than PrP deposits in CJD. In addition, in the hippocampus and dentate gyrus, clustering of Aβ deposits was observed in AD but PrP deposits were rare in these regions in CJD. The size, location and distribution of the extracellular protein deposits within the cortex of both disorders was consistent with the degeneration of the cortico-cortical pathways. Furthermore, spread of the pathology along these pathways may be a pathogenic feature common to CJD and AD. © 2001 Elsevier Science Ireland Ltd.

Symmetric and asymmetric evaluation of the Tokamap in comparison with direct symplectic integration

Comparing the Poincaré plots of the Tokamap and the underlying Hamiltonian system reveals large differences. This stems from the particular choice of evaluation of the singular perturbations present in the system (a series of δ functions). A symmetric evaluation approach is proposed and shown to yield results that almost perfectly match the Hamiltonian system. © 2005 The American Physical Society.

Laminar distribution of amyloid-beta (Abeta) deposits in dementia with Lewy bodies: comparison with Alzheimer's disease

Significant amyloid-beta (Abeta) deposition in cases of dementia with Lewy bodies (DLB) may represent concurrent Alzheimer's disease (AD). To test this hypothesis, the laminar distribution of the diffuse, primitive, and classic Abeta deposits was studied in the frontal and temporal cortex in cases of DLB and were compared with AD. In DLB, the diffuse and primitive deposits exhibited two common patterns of distribution; either maximum density occurred in the upper cortical laminae or a bimodal distribution was present with density peaks in the upper and lower laminae. In addition, a bimodal distribution of the classic deposits was observed in approximately half of the cortical areas analysed. A number of differences in the laminar distributions of Abeta deposits were observed in DLB and AD. First, the proportion of the primitive relative to the diffuse and classic deposits present was lower in DLB compared with AD. Second, the primitive deposits were more frequently bimodally distributed in DLB. Third, the density of the diffuse deposits reached a maximum lower in the cortical profile in AD. These data suggest differences in the pattern of cortical degeneration in the two disorders and therefore, DLB cases with significant Abeta pathology may not represent the coexistence of DLB and AD.

'Growth rings' in crustose lichens:comparison with directly measured growth rates and implications for lichenometry

Some species of crustose lichens, such as Ochrolechia parella (L.) Massal., exhibit concentric marginal rings, which may represent an alternative technique of measuring growth rates and potentially, a new lichenometric dating method. To examine this hypothesis, the agreement and correlation between ring widths and directly measured annual radial growth rates (RaGR, mm a^-1) were studied in 24 thalli of O. parella in north Wales, UK, using digital photography and image analysis. Variation in ring width was observed at different locations around a thallus, between thalli, and from year to year. The best agreement and correlation between ring width and lichen growth rates was between mean width of the outer two rings (measured in 2011) and mean RaGR (in 2009/10). The O. parella data suggest that mean width of the youngest two growth rings, averaged over a sample of thalli, is a predictor of recent growth rates and therefore could be used in lichenometry. Potential applications include as a convenient method of comparing lichen growth rates on surfaces in different environmental settings; and as an alternative method of constructing lichen growth-rate curves, without having to revisit the same lichen thalli over many years. However, care is needed when using growth rings to estimate growth rates as: growth ring widths may not be stable; ring widths exhibit spatial and temporal variation; rings may not represent 1-year's growth in all thalli; and adjacent rings may not always represent successive year's growth.

Verification of the indoor GPS system, by comparison with calibrated coordinates and by angular reference

This paper details work carried out to verify the dimensional measurement performance of the Indoor GPS (iGPS) system; a network of Rotary-Laser Automatic Theodolites (R-LATs). Initially tests were carried out to determine the angular uncertainties on an individual R-LAT transmitter-receiver pair. A method is presented of determining the uncertainty of dimensional measurement for a three dimensional coordinate measurement machine. An experimental procedure was developed to compare three dimensional coordinate measurements with calibrated reference points. The reference standard used to calibrate these reference points was a fringe counting interferometer with the multilateration technique employed to establish three dimensional coordinates. This is an extension of the established technique of comparing measured lengths with calibrated lengths. The method was found to be practical and able to establish that the expanded uncertainty of the basic iGPS system was approximately 1 mm at a 95% confidence level. Further tests carried out on a highly optimized version of the iGPS system have shown that the coordinate uncertainty can be reduced to 0.25 mm at a 95% confidence level.

Estimation of uncertainty in three-dimensional coordinate measurement by comparison with calibrated points

This paper details a method of estimating the uncertainty of dimensional measurement for a three-dimensional coordinate measurement machine. An experimental procedure was developed to compare three-dimensional coordinate measurements with calibrated reference points. The reference standard used to calibrate these reference points was a fringe counting interferometer with a multilateration-like technique employed to establish three-dimensional coordinates. This is an extension of the established technique of comparing measured lengths with calibrated lengths. Specifically a distributed coordinate measurement device was tested which consisted of a network of Rotary-Laser Automatic Theodolites (R-LATs), this system is known commercially as indoor GPS (iGPS). The method was found to be practical and was used to estimate that the uncertainty of measurement for the basic iGPS system is approximately 1 mm at a 95% confidence level throughout a measurement volume of approximately 10 m × 10 m × 1.5 m. © 2010 IOP Publishing Ltd.

Verification of the indoor gps system by comparison with points calibrated using a network of laser tracker measurements

This paper details a method of determining the uncertainty of dimensional measurement for a three dimensional coordinate measurement machine. An experimental procedure was developed to compare three dimensional coordinate measurements with calibrated reference points. The reference standard used to calibrate these reference points was a fringe counting interferometer with the multilateration technique employed to establish three dimensional coordinates. This is an extension of the established technique of comparing measured lengths with calibrated lengths. Specifically a distributed coordinate measurement device was tested which consisted of a network of Rotary-Laser Automatic Theodolites (R-LATs), this system is known commercially as indoor GPS (iGPS). The method was found to be practical and able to establish that the expanded uncertainty of the basic iGPS system was approximately 1 mm at a 95% confidence level. © Springer-Verlag Berlin Heidelberg 2010.

Transmission comparison of ultra-long Raman fibre laser based amplification with first and dual order Raman amplification using 10×118 Gbit/s DP-QPSK

Experimental investigations of 10×118 Gbit/s DP-QPSK WDM transmission using three types of distributed Raman amplification techniques are presented. Novel ultra-long Raman fibre laser based amplification with second order counter-propagated pumping is compared with conventional first order and dual order counter-pumped Raman amplification. We demonstrate that URFL based amplification can extend the transmission reach up to a distance of 7520 km in comparison with 5010 km and 6180 km using first order and dual order Raman amplification respectively. © 2014 IEEE.

The interaction of sodium chlorite with phospholipids and glutathione:a comparison of effects in vitro, in mammalian and in microbial cells

In this study the interaction of the preservative sodium chlorite with unsaturated lipids and glutathione was investigated, in comparison with peroxides, sodium hypochlorite, and benzalkonium chloride. The aim was to determine whether the action of sodium chlorite could involve membrane lipid damage or antioxidant depletion, and how this related to toxicity in both mammalian and microbial cells. The treatment of phospholipids with chlorite yielded low levels of hydroperoxides, but sodium chlorite oxidized the thiol-containing antioxidant glutathione to its disulfide form very readily in vitro, with a 1:4 oxidant:GSH stoichiometry. In cultured cells, sodium chlorite also caused a substantial depletion of intracellular glutathione, whereas lipid oxidation was not very prominent. Sodium chlorite had a lower toxicity to ocular mammalian cells than benzalkonium chloride, which could be responsible for the different effects of long-term application in the eye. The fungal cells, which were most resistant to sodium chlorite, maintained higher percentage levels of intracellular glutathione during treatment than the mammalian cells. The results show that sodium chlorite can cause oxidative stress in cells, and suggest that cell damage is more likely to be due to interaction with thiol compounds than with cell membrane lipids. The study also provides important information about the differential resistance of ocular cells and microbes to various preservatives and oxidants.

Determination of the Pu autoionizing level angular momenta by a multistep excitation with linearly polarized laser light

The modified polarization spectroscopy method was applied for determination of angular momenta of autoionizing states of Pu in multistep resonance ionization processes. In comparison with the known one, our method does not require circular polarization at all, only linear polarizations are needed. This simplicity was reached using a three-dimensional excitation geometry. Angular momenta of nine new autoionizing ²⁴²Pu states were determined. The method suggested could be applied for efficiency improvement in multistep RIMS applications as well as for the odd-even isotope separation for elements with a J = 0 ground state (Pu, Yb, Sm etc.).

Aspects of the learner's dictionary with special reference to advanced Pakistani learners of English

The present work is an empirical investigation into the lq`reference skills' of Pakistani learners and their language needs on semantic, phonetic, lexical and pragmatic levels in the dictionary. The introductory chapter discusses the relatively problematic nature of lexis in comparison with the other aspects in EFL learning and spells out the aim of this study. Chapter two provides an analytical survey of the various types of research undertaken in different contexts of the dictionary and explains the eclectic approach adopted in the present work. Chapter three studies the `reference skills' of this category of learners in the background of highly sophisticated information structure of learners' dictionaries under evaluation and suggests some measures for improvement in this context. Chapter four considers various criteria, eg. pedagogic, linguistic and sociolinguistic for determining the macro-structure of learner's dictionary with a focus on specific Ll speakers. Chapter five is concerned with various aspects of the semantic information provided in the dictionaries matched against the needs of Pakistani learners with regard to both comprehension and production. The type, scale and presentation of grammatical information in the dictionary is analysed in chapter six with the object of discovering their role and utility for the learner. Chapter seven explores the rationale for providing phonological information, the extent to which this guidance is vital and the problems of phonetic symbols employed in the dictionaries. Chapter eight brings into perspective the historical background of English-Urdu bilingual lexicography and evalutes the currently popular bilingual dictionaries among the student community, with the aim of discovering the extent to which they have taken account of the modern tents of lexicography and investigating their validity as a useful reference tool in the learning of English language. The final chapter concludes the findings of individual aspects in a coherent fashion to assess the viability of the original hypothesis that learners' dictionaries if compiled with a specific set of users in mind would be more useful.

An investigation of the emerging system of host government participation in the international oil industry with particular reference to Libyan participation arrangements

This study has been conceived with the primary objective of identifying and evaluating the financial aspects of the transformation in country/company relations of the international oil industry from the traditional concessionary system to the system of governmental participation in the ownership and operation of oil concessions. The emphasis of the inquiry was placed on assembling a case study of the oil exploitation arrangements of Libya. Through a comprehensive review of the literature, the sociopolitical factors surrounding the international oil business were identified and examined in an attempt to see their influence on contractual arrangements and particularly to gauge the impact of any induced contractual changes on the revenue benefit accruing to the host country from its oil operations. Some comparative analyses were made in the study to examine the viability of the Libyan participation deals both as an investment proposal and as a system of conducting oil activities in the country. The analysis was carried out in the light of specific hypotheses to assess the relative impact of the participation scheme in comparison with the alternative concessionary model on the net revenue resulting to the government from oil operations and the relative effect on the level of research and development within the industry. A discounted cash flow analysis was conducted to measure inputs and outputs of the comparative models and judge their revenue benefits. Then an empirical analysis was carried out to detect any significant behavioural changes in the exploration and development effort associated with the different oil exploitation systems. Results of the investigation of revenues support the argument that the mere introduction of the participation system has not resulted in a significant revenue benefit to the host government. Though there has been a significant increase in government revenue, associated with the period following the emergence of the participation agreements, this increase was mainly due to socio-economic factors other than the participation scheme. At the same time the empirical results have shown an association of the participation scheme with a decline of the oil industry's research and development efforts.