Factors affecting human reliability in the chemical process industry

This research was concerned with identifying factors which may influence human reliability within chemical process plants - these factors are referred to as Performance Shaping Factors (PSFs). Following a period of familiarization within the industry, a number of case studies were undertaken covering a range of basic influencing factors. Plant records and site `lost time incident reports' were also used as supporting evidence for identifying and classifying PSFs. In parallel to the investigative research, the available literature appertaining to human reliability assessment and PSFs was considered in relation to the chemical process plan environment. As a direct result of this work, a PSF classification structure has been produced with an accompanying detailed listing. Phase two of the research considered the identification of important individual PSFs for specific situations. Based on the experience and data gained during phase one, it emerged that certain generic features of a task influenced PSF relevance. This led to the establishment of a finite set of generic task groups and response types. Similarly, certain PSFs influence some human errors more than others. The result was a set of error type key words, plus the identification and classification of error causes with their underlying error mechanisms. By linking all these aspects together, a comprehensive methodology has been forwarded as the basis of a computerized aid for system designers. To recapitulate, the major results of this research have been: One, the development of a comprehensive PSF listing specifically for the chemical process industries with a classification structure that facilitates future updates; and two, a model of identifying relevant SPFs and their order of priority. Future requirements are the evaluation of the PSF listing and the identification method. The latter must be considered both in terms of `useability' and its success as a design enhancer, in terms of an observable reduction in important human errors.

Bioequivalence of sustained release theophylline formulations

The bioequivalence of sustained release theophylline formulations, marketed in the United Kingdom, has been investigated in relation to the co-administration of food in both single dose and steady state volunteer studies. The effect of food on pharmacokinetic parameters and their clinical relevance was researched. Experimentation using drug induced modification of gastric motility to ascertain the component influences of the rate of gastric emptying on the absorption of theophylline from sustained release formulations was conducted. Prolongation of time to maximum plasma theophylline concentration by food reported in the literature and its clinical importance was investigated in once daily compared with twice daily administration of sustained release theophylline formulations and smoking habit. The correlation between saliva and plasma theophylline concentrations as a means of developing a non-invasive sampling techniques was examined. Data obtained from in vitro dissolution studies was compared with in vivo results. This thesis has shown no significant differences occurred in the pharmacokinetic parameters measured between sustained release formulations available in the United Kingdom. The investigations into the influence of food on prolongation of time to maximum plasma theophylline concentration and other measured pharmacokinetic parameters demonstrated no important pharmacokinetic or clinical effects. Smoking adults taking sustained release theophylline formulations had similar drug clearances to those reported in the literature for smokers taking plain uncoated theophylline formulations. KEY WORDS Bioequivalence Theophylline Sustained Release Food Pharmacokinetics RONALD PURKISS SUBMITTED FOR

Improvements to the arc-spraying process

After a brief review of the various forms of thermal spraying equipment and processes, descriptions of the basic principles involved and the general functions for which thermally sprayed coatings are used are given. The background of the collaborating company, Metallisation, is described and their position in the overall market discussed, providing a backdrop against which the appropriateness of various project options might be judged. Current arc-spraying equipment is then examined, firstly in terms of the workings of their constituent parts and subsequently by examining the effects of changes in design and in operating parameters both upon equipment operation and the coatings produced. Published literature relating to these matters is reviewed. Literature relating to the production, comminution and propulsion of the particles which form the spray is discussed as are the mechanisms involved at impact with the substrate. Literature on the use of rockets for thermal spraying and induction heating as a process for feedstock melting are also reviewed. Three distinct options for further study are derived and preliminary tests and costings made to allow one option alone, the use of rocket acceleration, to go forward to the experimental phase. A suitable rocket burner was developed, tested and incorporated into an arc-spray system so that the sprayability of the whole could be assessed. Coatings were made using various parameters and these are compared with coatings produced by a standard system. Coatings were examined for macro and micro hardness, cohesive strength, porosity and by microstructural examination. The results indicate a high degree of similarity between the coatings produced by the standard system and the high velocity system. This was surprising in view of the very different atomising media and velocities. Possible causes for this similarity and the general behaviour of this new system and the standard system are discussed before the study reaches its conclusions in not proving the hypothesis that an increase in particle velocity would improve the mechanical properties of arc-sprayed steel coatings. KEY WORDS: Sprayed metal coatings, Electric arc spraying, High velocity flame spraying, Sprayed coating properties

The Evaluation of health and safety auditing systems

The specific objective of the research was to evaluate proprietary audit systems. Proprietary audit systems comprise question sets containing approximately 500 questions dealing with selected aspects of health and safety management. Each question is allotted a number of points and an organisation seeks to judge its health and safety performance by the overall score achieved in the audit. Initially it was considered that the evaluation method might involve comparing the proprietary audit scores with other methods of measuring safety performance. However, what appeared to be missing in the first instance was information that organisations could use to compare the contrast question set content against their own needs. A technique was developed using the computer database FileMaker Pro. This enables questions in an audit to be sorted into categories using a process of searching for key words. Questions that are not categorised by word searching can be identified and sorted manually. The process can be completed in 2-3 hours which is considerably faster than manual categorisation of questions which typically takes about 10 days. The technique was used to compare and contrast three proprietary audits: ISRS, CHASE and QSA. Differences and similarities between these audits were successfully identified. It was concluded that in general proprietary audits need to focus to a greater extent on identifying strengths and weaknesses in occupational health and safety management systems. To do this requires the inclusion of more probing questions which consider whether risk control measures are likely to be successful.

The servitization of manufacturing:a review of literature and reflection on future challenges

Purpose – The purpose of this paper is to report the state-of-the-art of servitization by presenting a clinical review of literature currently available on the topic. The paper aims to define the servitization concept, report on its origin, features and drivers and give examples of its adoption along with future research challenges. Design/methodology/approach – In determining the scope of this study, the focus is on articles that are central and relevant to servitization within a wider manufacturing context. The methodology consists of identifying relevant publication databases, searching these using a wide range of key words and phrases associated with servitization, and then fully reviewing each article in turn. The key findings and their implications for research are all described. Findings – Servitization is the innovation of an organisation's capabilities and processes to shift from selling products to selling integrated products and services that deliver value in use. There are a diverse range of servitization examples in the literature. These tend to emphasize the potential to maintain revenue streams and improve profitability. Practical implications – Servitization does not represent a panacea for manufactures. However, it is a concept of significant potential value, providing routes for companies to move up the value chain and exploit higher value business activities. There is little work to date that can be used to help practitioners. Originality/value – This paper provides a useful review of servitization and a platform on which to base more in-depth research into the broader topic of service-led competitive strategy by drawing on the work from other related research communities.

Resveratrol and the eye:activity and molecular mechanisms

Purpose: Alcohol consumption is inversely correlated with the incidence of cardiovascular disease. It is thought that red wine is specifically responsible for these cardiovascular benefits, due to its ability to reduce vascular inflammation, facilitate vasorelaxation, and inhibit angiogenesis. This is because of its high polyphenolic content. Resveratrol is the main biologically active polyphenol within red wine. Owing to its vascular-enhancing properties, resveratrol may be effective in the microcirculation of the eye, thereby helping prevent ocular diseases such as age-related macular degeneration, diabetic retinopathy, and glaucoma. Such conditions are accountable for worldwide prevalence of visual loss. Method: A review of the relevant literature was conducted on the ScienceDirect, Web of Science, and PubMed databases. Key words used to carry out the searches included 'red wine', 'polyphenols', 'resveratrol', 'eye' and 'ocular'. Articles relating to the effects of resveratrol on the eye were reviewed. Results: The protective effects of resveratrol within the eye are extensive. It has been demonstrated to have anti-oxidant, anti-apoptotic, anti-tumourogenic, anti-inflammatory, anti-angiogenic and vasorelaxant properties. There are potential benefits of resveratrol supplementation across a wide range of ocular diseases. The molecular mechanisms underlying these protective actions are diverse. Conclusion: Evidence suggests that resveratrol may have potential in the treatment of several ocular diseases. However, while there are many studies indicating plausible biological mechanisms using animal models and in-vitro retinal cells there is a paucity of human research. The evidence base for the use of resveratrol in the management of ocular diseases needs to be increased before recommendations can be made for the use of resveratrol as an ocular supplement. © 2014 Springer-Verlag.

Use of Google as a tool to aid diagnosis by optometry students

Background: Previous work has shown that medical problems can be diagnosed by practitioners using Google. The aim of this study was to determine whether optometry students would benefit from using Google when diagnosing eye diseases. Methods: Participants were given symptoms and signs and instructed to list three key words and use them to search Aston University e-Library and Google UK. Results: Aston University e-Library only search resulted in correct diagnosis in 16 of 60 simulated cases. Aston e-Library plus Google search resulted in correct diagnosis in 31 of 60 simulated cases. Conclusion: Google is a useful aid to help optometry students improve their success rate when diagnosing eye conditions.

Guiding schools to improved performance using data envelopment analysis:an illustration with data from a local education authority

The educational process is characterised by multiple outcomes such as the achievement of academic results of various standards and non-academic achievements. This paper shows how data envelopment analysis (DEA) can be used to guide secondary schools to improved performance through role-model identification and target setting in a way which recognises the multi-outcome nature of the education process and reflects the relative desirability of improving individual outcomes. The approach presented in the paper draws from a DEA-based assessment of the schools of a local education authority carried out by the authors. Data from that assessment are used to illustrate the approach presented in the paper. (Key words: Data envelopment analysis, education, target setting.)

Epidemiology of medication discrepancies upon hospital admission in children - a systematic review

Objectives: NICE/NPSA excluded children under 16 from their guidance concerning medicines reconciliation (MR) upon admission.1 Our aims and objectives of conducting the literature review was to identify the epidemiology of medication discrepancies upon admission, transfer and discharge in children, and if they require MR. Method: Six bibliographical databases (Medline, Embase, CINAHL, International Pharmaceutical Abstracts, Web of Science and Biosis Previews) and selected key words were used to find epidemiological studies on medication discrepancies in children upon hospital admission, transfer and discharge (key words included ‘medication discrepancy’; ‘medication reconciliation’; ‘hospital admission’; ‘hospital discharge’; ‘hospital transfer’); studies where the data for children could be extracted were included. Results: From the 1239 articles found (in May 2011), eight of the articles had extractable paediatric information, (five from Canada, two from USA, one from UK). Five of the studies involved discrepancies on admission, one involved discrepancies on admission and transfer, one involved discrepancies at transfer and one considered discharge. The reference point used to compare against the admission, transfer and the discharge order differed in each of the studies. Four studies used a rating scale to assess the clinical significance of the discrepancies to demonstrate the potential adverse clinical outcome of patients in the absence of clinical intervention. Two studies2 3 used a rating scale that was used in adults.4 A study of paediatric neurosurgical patients found that initial hospital prescriptions for children differed from the preadmission prescriptions in 39% of occasions and 50% of all prescribing variations had the potential to cause moderate or severe discomfort or clinical deterioration.2 A study by Coffey et al in general paediatric admissions in Canada showed 22% of patients experienced at least one discrepancy and 29% of the discrepancies had the potential to cause moderate or severe discomfort or clinical deterioration.3 By comparison an epidemiological study in discrepancies in adults on admission had 38.6% of the discrepancies identified with a potential to cause moderate or severe discomfort or clinical deterioration.4 All the studies involved small samples or specific patient groups such as medically complex patients. However all of the studies demonstrated that discrepancies occurred among paediatric populations during transitions in care settings and mentioned MR as an intervention. Conclusion: The results have shown that discrepancies of medication upon hospital admission, transfer and discharge occur regularly in children. With only one published study in the UK looking at hospital admission in children, and no published articles on the incidence and epidemiology of medication discrepancies upon hospital transfer or discharge further research is required in a wider paediatric population. Further work is also required to define the required interventions to improve practice.

The training experience of primary care pharmacists

Objectives — To map the tasks, activities and training provision for primary care pharmacists (PCPs) and to identify perceived future training needs. Methods — Survey undertaken in 1998/1999 using a pre-piloted, postal, self-completion questionnaire to two samples of PCPs. Setting — PCPs in (a) the West Midlands and (b) England (outside West Midlands). Key findings — The response rate was 66 per cent. A majority (68 per cent) had worked in the role for less than two years. Eighty per cent had some form of continuing education or training for the role although only 50 per cent had a formal qualification. Over two-thirds had contributed to the funding of their training, with one-third providing all funding. Seventy-four per cent of PCPs agreed that pharmacists should go through a procedure to ensure competence (accreditation) before being allowed to work for a general medical practice or primary care group. Views on the need for formal education/training prior to work differed: 82 per cent of those with formal qualifications, but only 46 per cent of those without, considered that this should be a requirement. There was general agreement that training/education had met training needs. Views on future training closely reflected previous training experiences, with a focus upon pharmaceutical roles rather than upon generic skill development and the acquisition of management skills. Conclusions — The study provides a snapshot in time of the experience of pioneer PCPs and the training available to them. PCPs will need further training or updating if they are to provide the wider roles required by the developing needs of the National Health Service. Consideration should be given to formal recognition of the training of PCPs in order to assure competence. The expectation that pharmacists should fund their own training is likely to be a barrier to uptake of training and uncertainties over funding will militate against consistency of training.

Evaluation of the Heart of Birmingham teaching Primary Care Trust (HoBtPCT): My Choice Weight Management Programme:report commissioned by Heart of Birmingham teaching Primary Care Trust

This report details an evaluation of the My Choice Weight Management Programme undertaken by a research team from the School of Pharmacy at Aston University. The My Choice Weight Management Programme is delivered through community pharmacies and general practitioners (GPs) contracted to provide services by the Heart of Birmingham teaching Primary Care Trust. It is designed to support individuals who are ‘ready to change’ by enabling the individual to work with a trained healthcare worker (for example, a healthcare assistant, practice nurse or pharmacy assistant) to develop a care plan designed to enable the individual to lose 5-10% of their current weight. The Programme aims to reduce adult obesity levels; improve access to overweight and obesity management services in primary care; improve diet and nutrition; promote healthy weight and increased levels of physical activity in overweight or obese patients; and support patients to make lifestyle changes to enable them to lose weight. The Programme is available for obese patients over 18 years old who have a Body Mass Index (BMI) greater than 30 kg/m2 (greater than 25 kg/m2 in Asian patients) or greater than 28 kg/m2 (greater than 23.5 kg/m2 in Asian patients) in patients with co-morbidities (diabetes, high blood pressure, cardiovascular disease). Each participant attends weekly consultations over a twelve session period (the final iteration of these weekly sessions is referred to as ‘session twelve’ in this report). They are then offered up to three follow up appointments for up to six months at two monthly intervals (the final of these follow ups, taking place at approximately nine months post recruitment, is referred to as ‘session fifteen’ in this report). A review of the literature highlights the dearth of published research on the effectiveness of primary care- or community-based weight management interventions. This report may help to address this knowledge deficit. A total of 451 individuals were recruited on to the My Choice Weight Management Programme. More participants were recruited at GP surgeries (n=268) than at community pharmacies (n=183). In total, 204 participants (GP n=102; pharmacy n=102) attended session twelve and 82 participants (GP n=22; pharmacy 60) attended session fifteen. The unique demographic characteristics of My Choice Weight Management Programme participants – participants were recruited from areas with high levels of socioeconomic deprivation and over four-fifths of participants were from Black and Minority Ethnic groups; populations which are traditionally underserved by healthcare interventions – make the achievements of the Programme particularly notable. The mean weight loss at session 12 was 3.8 kg (equivalent to a reduction of 4.0% of initial weight) among GP surgery participants and 2.4 kg (2.8%) among pharmacy participants. At session 15 mean weight loss was 2.3 kg (2.2%) among GP surgery participants and 3.4 kg (4.0%) among pharmacy participants. The My Choice Weight Management Programme improved the general health status of participants between recruitment and session twelve as measured by the validated SF-12 questionnaire. While cost data is presented in this report, it is unclear which provider type delivered the Programme more cost-effectively. Attendance rates on the Programme were consistently better among pharmacy participants than among GP participants. The opinions of programme participants (both those who attended regularly and those who failed to attend as expected) and programme providers were explored via semi-structured interviews and, in the case of the participants, a selfcompletion postal questionnaire. These data suggest that the Programme was almost uniformly popular with both the deliverers of the Programme and participants on the Programme with 83% of questionnaire respondents indicating that they would be happy to recommend the Programme to other people looking to lose weight. Our recommendations, based on the evidence provided in this report, include: a. Any consideration of an extension to the study also giving comparable consideration to an extension of the Programme evaluation. The feasibility of assigning participants to a pharmacy provider or a GP provider via a central allocation system should also be examined. This would address imbalances in participant recruitment levels between provider type and allow for more accurate comparison of the effectiveness in the delivery of the Programme between GP surgeries and community pharmacies by increasing the homogeneity of participants at each type of site and increasing the number of Programme participants overall. b. Widespread dissemination of the findings from this review of the My Choice Weight Management Project should be undertaken through a variety of channels. c. Consideration of the inclusion of the following key aspects of the My Choice Weight Management Project in any extension to the Programme: i. The provision of training to staff in GP surgeries and community pharmacies responsible for delivery of the Programme prior to patient recruitment. ii. Maintaining the level of healthcare staff input to the Programme. iii. The regular schedule of appointments with Programme participants. iv. The provision of an increased variety of printed material. d. A simplification of the data collection method used by the Programme commissioners at the individual Programme delivery sites.

Measurement of key compositional parameters in two species of energy grass by Fourier transform infrared spectroscopy

Two energy grass species, switch grass, a North American tuft grass, and reed canary grass, a European native, are likely to be important sources of biomass in Western Europe for the production of biorenewable energy. Matching chemical composition to conversion efficiency is a primary goal for improvement programmes and for determining the quality of biomass feed-stocks prior to use and there is a need for methods which allow cost effective characterisation of chemical composition at high rates of sample through-put. In this paper we demonstrate that nitrogen content and alkali index, parameters greatly influencing thermal conversion efficiency, can be accurately predicted in dried samples of these species grown under a range of agronomic conditions by partial least square regression of Fourier transform infrared spectra (R2 values for plots of predicted vs. measured values of 0.938 and 0.937, respectively). We also discuss the prediction of carbon and ash content in these samples and the application of infrared based predictive methods for the breeding improvement of energy grasses.

The role of analogy in spelling in English primary school children - a partial intervention study

The English writing system is notoriously irregular in its orthography at the phonemic level. It was therefore proposed that focusing beginner-spellers’ attention on sound-letter relations at the sub-syllabic level might improve spelling performance. This hypothesis was tested in Experiments 1 and 2 using a ‘clue word’ paradigm to investigate the effect of analogy teaching intervention / non-intervention on the spelling performance of an experimental group and controls. The results overall showed the intervention to be effective in improving spelling, and this effect to be enduring. Experiment 3 demonstrated a greater application of analogy in spelling, when clue words, which participants used in analogy to spell test words, remained in view during testing. A series of regression analyses, with spelling entered as the criterion variable and age, analogy and phonological plausibility (PP) as predictors, showed both analogy and PP to be highly predictive of spelling. Experiment 4 showed that children could use analogy to improve their spelling, even without intervention, by comparing their performance in spelling words presented in analogous categories or in random lists. Consideration of children’s patterns of analogy use at different points of development showed three age groups to use similar patterns of analogy, but contrasting analogy patterns for spelling different words. This challenges stage theories of analogy use in literacy. Overall the most salient units used in analogy were the rime and, to a slightly lesser degree, the onset-vowel and vowel. Finally, Experiment 5 showed analogy and phonology to be fairly equally influential in spelling, but analogy to be more influential than phonology in reading. Five separate experiments therefore found analogy to be highly influential in spelling. Experiment 5 also considered the role of memory and attention in literacy attainment. The important implications of this research are that analogy, rather than purely phonics-based strategy, is instrumental in correct spelling in English.

Pseudoislets as primary islet replacements for research:report on a symposium at King's College London, London UK

Laboratory-based research aimed at understanding processes regulating insulin secretion and mechanisms underlying ß-cell dysfunction and loss in diabetes often makes use of rodents, as these processes are in many respects similar between rats/mice and humans. Indeed, a rough calculation suggests that islets have been isolated from as many as 150,000 rodents to generate the data contained within papers published in 2009 and the first four months of 2010. Rodent use for islet isolation has been mitigated, to a certain extent, by the availability of a variety of insulin-secreting cell lines that are used by researchers world-wide. However, when maintained as monolayers the cell lines do not replicate the robust, sustained secretory responses of primary islets which limits their usefulness as islet surrogates. On the other hand, there have been several reports that configuration of MIN6 ß-cells, derived from a mouse insulinoma, as three-dimensional cell clusters termed ‘pseudoislets’ largely recapitulates the function of primary islet ß-cells. The Diabetes Research Group at King’s College London has been using the MIN6 pseudoislet model for over a decade and they hosted a symposium on “Pseudoislets as primary islet replacements for research”, which was funded by the UK National Centre for the Replacement, Refinement and Reduction of Animals in Research (NC3Rs), in London on 15th and 16th April 2010. This small, focused meeting was conceived as an opportunity to consolidate information on experiences of working with pseudoislets between different UK labs, and to introduce the theory and practice of pseudoislet culture to laboratories working with islets and/or ß-cell lines but who do not currently use pseudoislets. This short review summarizes the background to the development of the cell line-derived pseudoislet model, the key messages arising from the symposium and emerging themes for future pseudoislet research.

Medication error in mental health:implications for primary care

Medication errors are associated with significant morbidity and people with mental health problems may be particularly susceptible to medication errors due to various factors. Primary care has a key role in improving medication safety in this vulnerable population. The complexity of services, involving primary and secondary care and social services, and potential training issues may increase error rates, with physical medicines representing a particular risk. Service users may be cognitively impaired and fail to identify an error placing additional responsibilities on clinicians. The potential role of carers in error prevention and medication safety requires further elaboration. A potential lack of trust between service users and clinicians may impair honest communication about medication issues leading to errors. There is a need for detailed research within this field.