Selective functionalisation of Re6 cluster anionic units:from hexa-hydroxo [Re6Q8(OH)6]4− (Q = S, Se) to neutral trans-[Re6Q8L4L′2] hybrid building blocks

The reaction of [Re6Q8(OH)6]4- (Q = S, Se) with p-tertbutylpyridine (TBP) in water leads to neutral trans-[Re6Q8(TBP)4(OH)2] whose hydroxyl reactivity with carboxylic acid and TBP exchange reaction with functional pyridine have been investigated.

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.

Using DEA and simulation in guiding operating units to improved performance

The potential for the use of DEA and simulation in a mutually supporting role in guiding operating units to improved performance is presented. An analysis following a three-stage process is suggested. Stage one involves obtaining the data for the DEA analysis. This can be sourced from historical data, simulated data or a combination of the two. Stage two involves the DEA analysis that identifies benchmark operating units. In the third stage simulation can now be used in order to offer practical guidance to operating units towards improved performance. This can be achieved by the use of sensitivity analysis of the benchmark unit using a simulation model to offer direct support as to the feasibility and efficiency of any variations in operating practices to be tested. Alternatively, the simulation can be used as a mechanism to transmit the practices of the benchmark unit to weaker performing units by building a simulation model of the weaker unit to the process design of the benchmark unit. The model can then compare performance of the current and benchmark process designs. Quantifying improvement in this way provides a useful driver to any process change initiative that is required to bring the performance of weaker units up to the best in class. © 2005 Operational Research Society Ltd. All rights reserved.

Using secondary knowledge to support decision tree classification of retrospective clinical data

Retrospective clinical data presents many challenges for data mining and machine learning. The transcription of patient records from paper charts and subsequent manipulation of data often results in high volumes of noise as well as a loss of other important information. In addition, such datasets often fail to represent expert medical knowledge and reasoning in any explicit manner. In this research we describe applying data mining methods to retrospective clinical data to build a prediction model for asthma exacerbation severity for pediatric patients in the emergency department. Difficulties in building such a model forced us to investigate alternative strategies for analyzing and processing retrospective data. This paper describes this process together with an approach to mining retrospective clinical data by incorporating formalized external expert knowledge (secondary knowledge sources) into the classification task. This knowledge is used to partition the data into a number of coherent sets, where each set is explicitly described in terms of the secondary knowledge source. Instances from each set are then classified in a manner appropriate for the characteristics of the particular set. We present our methodology and outline a set of experiential results that demonstrate some advantages and some limitations of our approach. © 2008 Springer-Verlag Berlin Heidelberg.

Product design in the context of the social needs in less industrialised economies

This thesis is related to the subject of technical innovation, specifically to the activity of design in microenterprises operating in less industrialised economies. Design here is understood as a process, which is not the sole domain of formally trained categories such as engineers, architects or industrial designers. The 'professional boundary' discussion in this investigation is perceived as secondary as, in this context, products are designed, copied or adapted by workers, entrepreneurs themselves, or directly by the poor community. Design capacity at this level is considered to be important both in relation to the conception of capital and consumer goods and to the building up of technical knowledge. Although professional design emerged in Latin America little over three decades ago, this activity has remained marginalised throughout industry. Design activity tends to be concentrated in some product categories in the formalised industrial sector. For microenterprises operating informally, industrial design appears to be unknown. The existing literature pays little attention to 'informal design' capacity. Other areas of knowledge, such as development economies, recognise the importance of microenterprises and technological capability but neglect the potential role of industrial design in small manufacturing units. The management literature, though it focuses on technical innovation and design, has also paid little attention to 'informal design'. In less industrialised economies this neglect is felt by the lack of programmes specifically tailored to create or stimulate 'informal design'. There is a need for recognition of 'informal design' capacity and for the implementation of programmes which specifically target design as a central activity in the manufacturing firm, independent of their size and technological capability. Addressing 'design by the poor for the poor', requires a down-to-earth approach.