Medication -related adverse events in older people with dementia:causes and possible solutions

This submission for a PhD by previously published work is based upon six publications in peer reviewed journals, reflecting a 9-year research programme. My research has shown, in a coherent and original way, the difficulty in treating people with dementia with safe and effective medication whilst providing research-founded guidance to develop mechanisms to optimise medication choice and minimise iatrogenic events. A wide range of methods, including systematic reviews, meta-analysis, randomised controlled trials (RCTs), quantitative research and mixed methods were used to generate the data, which supported the exploration of three themes. The first theme, to understand the incidence and causes of medication errors in dementia services, identified that people with dementia may be more susceptible to medication-related iatrogenic disease partly due to inherent disease-related characteristics. One particular area of concern is the use of anti-psychotics to treat the Behavioural and Psychological Symptoms of Dementia (BPSD). The second and third themes, respectively, investigated a novel pharmacological and health services intervention to limit anti-psychotic usage. The second phase found that whilst the glutamate receptor blocker memantine showed some promise, further research was clearly required. The third phase found that anti-psychotic usage in dementia may be higher than official figures suggest and that medication review linking primary and secondary care can limit such usage. My work has been widely cited, reflecting a substantial contribution to the field, in terms of our understanding of the causes of, and possible solutions to limit, medication-related adverse events in people with dementia. More importantly, this work has already informed clinical practice, patients, carers and policy makers by its demonstrable impact on health policy. In particular my research has identified key lines of enquiry for future work and for the development of my own personal research programme to reduce the risk associated with medication in this vulnerable population.

A verifiable solution to the MEG inverse problem

Magnetoencephalography (MEG) is a non-invasive brain imaging technique with the potential for very high temporal and spatial resolution of neuronal activity. The main stumbling block for the technique has been that the estimation of a neuronal current distribution, based on sensor data outside the head, is an inverse problem with an infinity of possible solutions. Many inversion techniques exist, all using different a-priori assumptions in order to reduce the number of possible solutions. Although all techniques can be thoroughly tested in simulation, implicit in the simulations are the experimenter's own assumptions about realistic brain function. To date, the only way to test the validity of inversions based on real MEG data has been through direct surgical validation, or through comparison with invasive primate data. In this work, we constructed a null hypothesis that the reconstruction of neuronal activity contains no information on the distribution of the cortical grey matter. To test this, we repeatedly compared rotated sections of grey matter with a beamformer estimate of neuronal activity to generate a distribution of mutual information values. The significance of the comparison between the un-rotated anatomical information and the electrical estimate was subsequently assessed against this distribution. We found that there was significant (P < 0.05) anatomical information contained in the beamformer images across a number of frequency bands. Based on the limited data presented here, we can say that the assumptions behind the beamformer algorithm are not unreasonable for the visual-motor task investigated.

An analysis of returned medicines in primary care

Objective: The number of pharmaceutical items issued on prescription is continually rising and contributing to spiralling healthcare costs. Although there is some data highlighting the quantity, in terms of weight of medicines returned specifically to community pharmacies, little is known about the specific details of such returns or other destinations for wasted medications. This pilot study has been designed to investigate the types and amounts of medicines returned to both general practices (GPs) and associated local community pharmacies determining the reasons why these medicines have been returned. Method: The study was conducted in eight community pharmacies and five GP surgeries within East Birmingham over a 4-week period. Main outcome Measure: Reason for return and details of returned medication. Results: A total of 114 returns were made during the study: 24 (21.1) to GP surgeries and 90 (78.9) to community pharmacies. The total returns comprised 340 items, of which 42 (12.4) were returned to GPs and 298 (87.6) to pharmacies, with the mean number of items per return being 1.8 and 3.3, respectively. Half of the returns in the study were attributed to the doctor changing or stopping the medicine; 23.7 of returns were recorded as excess supplies or clearout often associated with patients' death and 3.5 of returns were related to adverse drug reactions. Cardiovascular drugs were most commonly returned, amounting to 28.5 of the total drugs returned during the study. Conclusions: The results from this pilot study indicate that unused medicines impose a significant financial burden on the National Health Service as well as a social burden on the United Kingdom population. Further studies are examining the precise nature of returned medicines and possible solutions to these issues. © Springer 2005.

The effects of ionising radiation on polypropylene

The interaction of ionising radiation with polymers is described and the literature relating; to the effects on polypropylene is reviewed. Oxidative and free radical reactions are discussed with particular reference to post-irradiationeffects.Isotactic and atactic polypropylene were δ and electron irradiated to doses of up to 20 megarad. Irradiations weremainly made in air. A series of other polymers were also irradiated in a preliminary survey. Molar mass measurements are used to measure the radiationyield for chain scission G (s). Irradiation at room temperature causes significantly more chain scission than at 195K. Additional chain scission occurs on storage following irradiation at 195 K. Free radical concentrations are determined by electron spin resonance, and the decay rates measured. The radical formed in air is a peroxy radical and in vacuo is a hydrocarbon radical. At77K in vacuo the radical is -CH2 - C* (CH3) - CH2 - but additional radicals are produced on warning to room temperature. The effects of increasing tenparature on radicals formed in air are described. Electron spin resonance studies on atactic polypropylene,and isotactic polypropylene in hydrogen, sulphur dioxide and nitric oxide are reported.. The melting temperatures, spherulite growth rates, and isothermal crystallisation rates of irradiated polypropylene are compared to those of the non-irradiated polymer. Crystallisation is found to proceed with an Avrami integer n = 2. At a given crystallisation temperature, the overall crystallisation rate of irradiated polymer is less than the non-irradiated, but spherulite growth rates are identical. Thermogravimetric analysis is used to assess the thermal stability of irradiated polypropylene in nitrogen, air and oxygen. Hydroperoxide analysis is used to show that several molecules of oxygen are absorbed for each initial radical, and that hydroperoxides continue to be formed for a long period following irradiation. Possible solutions for minimising irradiation and post-irradiation degradation are suggested, together with some problems for further study.

Ultrasonic inspection of austenitic stainless steel weldments

Ultrasonic waves interact in a complex manner with the metallurgical structure of austenitic weldments resulting in ambiguity when interpreting reflections and at times in misinterpretation of defect positions. In this work, current knowledge of the structure of austenitic welds is outlined, and the influence of this structure on the propagation of ultrasonic waves is reviewed. Using an established and highly accurate technique, data on velocity variations as a function of the angle between the direction of soundwave propagation and the axes of preferred grain orientation existing in such welds, are experimentally obtained. These results and existing theory are used to provide quantitative evidence of (i) anisotropy factors in austenitic welds, (ii) beam skewing effects for different wave modes and polarizations, and (iii) the extent of acoustic impedance mismatch between parent and weld metals. The existence of "false" indications is demonstrated, and suggestions are made into their nature. The effectiveness of conventional transverse wave techniques for inspecting artificial and real defects existing in austenitic weldments is experimentally investigated, the limitations are demonstrated, and possible solutions are proposed. The possibilities offered by the use of longitudinal angle probes for ultrasonic inspection of real and artificial defects existing in austenitic weldments are experimentally investigated, and parameters such as probe angle, frequency and scanning position are evaluated. Detailed work has been carried out on the interaction of ultrasound with fatigue and corrosion-fatigue cracks in the weld metal and the heat affected zones (HAZs) of 316 and 347 types of austenitic weldments, together with the influence of elastic compressive stresses, defect topography and defect geometry. Practical applications of all results are discussed, and more effective means of ultrasonic inspection of austenitic weldments are suggested.

Implementation challenges of application of radio frequency identification (RFID) in warehouse

Warehouse is an essential component in the supply chain, linking the chain partners and providing them with functions of product storage, inbound and outbound operations along with value-added processes. Allocation of warehouse resources should be efficient and effective to achieve optimum productivity and reduce operational costs. Radio frequency identification (RFID) is a technology capable of providing real-time information about supply chain operations. It has been used by warehousing and logistic enterprises to achieve reduced shrinkage, improved material handling and tracking as well as increased accuracy of data collection. However, both academics and practitioners express concerns about challenges to RFID adoption in the supply chain. This paper provides a comprehensive analysis of the problems encountered in RFID implementation at warehouses, discussing the theoretical and practical adoption barriers and causes of not achieving full potential of the technology. Lack of foreseeable return on investment (ROI) and high costs are the most commonly reported obstacles. Variety of standards and radio wave frequencies are identified as source of concern for decision makers. Inaccurate performance of the RFID within the warehouse environment is examined. Description of integration challenges between warehouse management system and RFID technology is given. The paper discusses the existing solutions to technological, investment and performance RFID adoption barriers. Factors to consider when implementing the RFID technology are given to help alleviate implementation problems. By illustrating the challenges of RFID in the warehouse environment and discussing possible solutions the paper aims to help both academics and practitioners to focus on key areas constituting an obstacle to the technology growth. As more studies will address these challenges, the realisation of RFID benefits for warehouses and supply chain will become a reality.

Knowledge management in knowledge intensive service networks:a strategic management approach

Purpose – The main purpose of this paper is to analyze knowledge management in service networks. It analyzes the knowledge management process and identifies related challenges. The authors take a strategic management approach instead of a more technology-oriented approach, since it is believed that managerial problems still remain after technological problems are solved. Design/methodology/approach – The paper explores the literature on the topic of knowledge management as well as the resource (or knowledge) based view of the firm. It offers conceptual insights and provides possible solutions for knowledge management problems. Findings – The paper discusses several possible solutions for managing knowledge processes in knowledge-intensive service networks. Solutions for knowledge identification/generation, knowledge application, knowledge combination/transfer and supporting the evolution of tacit network knowledge include personal and technological aspects, as well as organizational and cultural elements. Practical implications – In a complex environment, knowledge management and network management become crucial for business success. It is the task of network management to establish routines, and to build and regularly refresh meta-knowledge about the competencies and abilities that exist within the network. It is suggested that each network partner should be rated according to the contribution to the network knowledge base. Based on this rating, a particular network partner is a member of a certain knowledge club, meaning that the partner has access to a particular level of network knowledge. Such an established routine provides strong incentives to add knowledge to the network's knowledge base Originality/value – This paper is a first attempt to outline the problems of knowledge management in knowledge-intensive service networks and, by so doing, to introduce strategic management reasoning to the discussion.

Extracting interactions between proteins from the literature

During the last decade, biomedicine has witnessed a tremendous development. Large amounts of experimental and computational biomedical data have been generated along with new discoveries, which are accompanied by an exponential increase in the number of biomedical publications describing these discoveries. In the meantime, there has been a great interest with scientific communities in text mining tools to find knowledge such as protein-protein interactions, which is most relevant and useful for specific analysis tasks. This paper provides a outline of the various information extraction methods in biomedical domain, especially for discovery of protein-protein interactions. It surveys methodologies involved in plain texts analyzing and processing, categorizes current work in biomedical information extraction, and provides examples of these methods. Challenges in the field are also presented and possible solutions are discussed.

From biomedical literature to knowledge:mining protein-protein interactions

To date, more than 16 million citations of published articles in biomedical domain are available in the MEDLINE database. These articles describe the new discoveries which accompany a tremendous development in biomedicine during the last decade. It is crucial for biomedical researchers to retrieve and mine some specific knowledge from the huge quantity of published articles with high efficiency. Researchers have been engaged in the development of text mining tools to find knowledge such as protein-protein interactions, which are most relevant and useful for specific analysis tasks. This chapter provides a road map to the various information extraction methods in biomedical domain, such as protein name recognition and discovery of protein-protein interactions. Disciplines involved in analyzing and processing unstructured-text are summarized. Current work in biomedical information extracting is categorized. Challenges in the field are also presented and possible solutions are discussed.

건설 프로젝트 프로세스 관리 효율화를 위한 영국과 미국의 BIM 현황 분석

World-wide efforts have been made to adopt BIM (Building Information Modelling) to improve the efficiency of construction project management processes lively. BIM means a shared digitized expression which provides a reliable source to make an informed decision over a physical or a functional character across all construction sectors including design, civil engineering and plant construction. The Korean Public Procurement Service mandates to use BIM for over 50 billion won public construction projects from 2012, and this will be extended to every project initiated by the Korean Public Procurement Service from 2016. This paper aims not only to investigate potential barriers which can be faced at the initial stage of BIM adoption, but also to explore possible solutions against them. For doing this, the BIM utilization strategies and action plans by US and UK public sectors which adopt BIM earlier than Korea were analysed. Based on the results of comparative analysis between US and UK, the proper guideline for BIM adoption in Korea will be suggested.

Biomedical relation extraction:from binary to complex

Biomedical relation extraction aims to uncover high-quality relations from life science literature with high accuracy and efficiency. Early biomedical relation extraction tasks focused on capturing binary relations, such as protein-protein interactions, which are crucial for virtually every process in a living cell. Information about these interactions provides the foundations for new therapeutic approaches. In recent years, more interests have been shifted to the extraction of complex relations such as biomolecular events. While complex relations go beyond binary relations and involve more than two arguments, they might also take another relation as an argument. In the paper, we conduct a thorough survey on the research in biomedical relation extraction. We first present a general framework for biomedical relation extraction and then discuss the approaches proposed for binary and complex relation extraction with focus on the latter since it is a much more difficult task compared to binary relation extraction. Finally, we discuss challenges that we are facing with complex relation extraction and outline possible solutions and future directions.

A review of the effects of distributed energy resources and power-electronic controlled loading on distribution network stability

This paper looks at potential distribution network stability problems under the Smart Grid scenario. This is to consider distributed energy resources (DERs) e.g. renewable power generations and intelligent loads with power-electronic controlled converters. The background of this topic is introduced and potential problems are defined from conventional power system stability and power electronic system stability theories. Challenges are identified with possible solutions from steady-state limits, small-signal, and large-signal stability indexes and criteria. Parallel computation techniques might be included for simulation or simplification approaches are required for a largescale distribution network analysis.

Policy ideas through the prism of knowledge regimes and framing

Policymakers are often confronted with problems that involve ambiguity and uncertainty (Zahariadis, 2003). In order to make sense of such problems and to identify possible solutions, they are on the lookout for policy ideas.

Review on protection issues of low-voltage distribution network with multiple powerelectronic-converter-interfaced distribution energy resources

The realisation of an eventual low-voltage (LV) Smart Grid with a complete communication infrastructure is a gradual process. During this evolution the protection scheme of distribution networks should be continuously adapted and optimised to fit the protection and cost requirements at the time. This paper aims to review practices and research around the design of an effective, adaptive and economical distribution network protection scheme. The background of this topic is introduced and potential problems are defined from conventional protection theories and new Smart Grid technologies. Challenges are identified with possible solutions defined as a pathway to the ultimate flexible and reliable LV protection systems.

Zinc regeneration in rechargeable zinc-air fuel cells:a review

Zinc-air fuel cells (ZAFCs) present a promising energy source with a competing potential with the lithium-ion battery and even with proton-exchange membrane fuel cells (PEMFCs) for applications in next generation electrified transport and energy storage. The regeneration of zinc is essential for developing the next-generation, i.e., electrochemically rechargeable ZAFCs. This review aims to provide a comprehensive view on both theoretical and industrial platforms already built hitherto, with focus on electrode materials, electrode and electrolyte additives, solution chemistry, zinc deposition reaction mechanisms and kinetics, and electrochemical zinc regeneration systems. The related technological challenges and their possible solutions are described and discussed. A summary of important R&D patents published within the recent 10 years is also presented.