An evaluation of the epidemiology of medication discrepancies and clinical significance of medicines reconciliation in children admitted to hospital

Aims: To determine the incidence of unintended medication discrepancies in paediatric patients at the time of hospital admission; evaluate the process of medicines reconciliation; assess the benefit of medicines reconciliation in preventing clinical harm. Method: A 5 month prospective multisite study. Pharmacists at four English hospitals conducted admission medicines reconciliation in children using a standardised data collection form. A discrepancy was defined as a difference between the patient's preadmission medication (PAM), compared with the initial admission medication orders written by the hospital doctor. The discrepancies were classified into intentional and unintentional discrepancies. The unintentional discrepancies were assessed for potential clinical harm by a team of healthcare professionals, which included doctors, pharmacists and nurses. Results: Medicines reconciliation was conducted in 244 children admitted to hospital. 45% (109/244) of the children had at least one unintentional medication discrepancy between the PAM and admission medication order. The overall results indicated that 32% (78/244) of patients had at least one clinically significant unintentional medication discrepancy with potential to cause moderate 20% (50/244) or severe 11% (28/244) harm. No single source of information provided all the relevant details of a patient's medication history. Parents/carers provided the most accurate details of a patient's medication history in 81% of cases. Conclusions: This study demonstrates that in the absence of medicines reconciliation, children admitted to hospitals across England are at risk of harm from unintended medication discrepancies at the transition of care from the community to hospital. No single source of information provided a reliable medication history.

Editorial

This second issue of Knowledge Management Research & Practice (KMRP) continues the international nature of the first issue, with papers from authors based on four different continents. There are five regular papers, plus the first of what is intended to be an occasional series of 'position papers' from respected figures in the knowledge management field, who have specific issues they wish to raise from a personal standpoint. The first two regular papers are both based on case studies. The first is 'Aggressively pursuing knowledge management over two years: a case study a US government organization' by Jay Liebowitz. Liebowitz is well known to both academics and practictioners as an author on knowledge management and knowledge based systems. Government departments in many Western countries must soon face up to the problems that will occur as the 'baby boomer' generation reaches retirement age over the next decade. This paper describes how one particular US government organization has attempted to address this situation (and others) through the introduction of a knowledge management initiative. The second case study paper is 'Knowledge creation through the synthesizing capability of networked strategic communities: case study on new product development in Japan' by Mitsuru Kodama. This paper looks at the importance of strategic communities - communities that have strategic relevance and support - in knowledge management. Here, the case study organization is Nippon Telegraph and Telephone Corporation (NTT), a Japanese telecommunication firm. The third paper is 'Knowledge management and intellectual capital: an empirical examination of current practice in Australia' by Albert Zhou and Dieter Fink. This paper reports the results of a survey carried out in 2001, exploring the practices relating to knowledge management and intellectual capital in Australia and the relationship between them. The remaining two regular papers are conceptual in nature. The fourth is 'The enterprise knowledge dictionary' by Stuart Galup, Ronald Dattero and Richard Hicks. Galup, Dattero and Hicks propose the concept of an enterprise knowledge dictionary and its associated knowledge management system architecture as offering the appropriate form of information technology to support various different types of knowledge sources, while behaving as a single source from the user's viewpoint. The fifth and final regular paper is 'Community of practice and metacapabilities' by Geri Furlong and Leslie Johnson. This paper looks at the role of communities of practice in learning in organizations. Its emphasis is on metacapabilities - the properties required to learn, develop and apply skills. This discussion takes work on learning and core competences to a higher level. Finally, this issue includes a position paper 'Innovation as an objective of knowledge management. Part I: the landscape of management' by Dave Snowden. Snowden has been highly visible in the knowledge management community thanks to his role as the Director of IBM Global Services' Canolfan Cynefin Centre. He has helped many government and private sector organizations to consider their knowledge management problems and strategies. This, the first of two-part paper, is inspired by the notion of complexity. In it, Snowden calls for what he sees as a 20th century emphasis on designed systems for knowledge management to be consigned to history, and replaced by a 21st century emphasis on emergence. Letters to the editor on this, or any other topic related to knowledge management research and practice, are welcome. We trust that you will find the contributions stimulating, and again invite you to contribute your own paper(s) to future issues of KMRP.

Extended range interferometry using a coherence tuned synthesised dual wavelength technique with multimode fibres

We describe in the letter a technique for making extended-range interferometric measurements with a coherence multiplexed system by means of a variation on the dual-wavelength technique. The interferometer is illuminated with a single source and the two wavelengths are synthesised at the output by means of an interference filter.

Network lifetime maximization with cross-layer design in wireless sensor networks

This paper investigates a cross-layer design approach for minimizing energy consumption and maximizing network lifetime (NL) of a multiple-source and single-sink (MSSS) WSN with energy constraints. The optimization problem for MSSS WSN can be formulated as a mixed integer convex optimization problem with the adoption of time division multiple access (TDMA) in medium access control (MAC) layer, and it becomes a convex problem by relaxing the integer constraint on time slots. Impacts of data rate, link access and routing are jointly taken into account in the optimization problem formulation. Both linear and planar network topologies are considered for NL maximization (NLM). With linear MSSS and planar single-source and single-sink (SSSS) topologies, we successfully use Karush-Kuhn-Tucker (KKT) optimality conditions to derive analytical expressions of the optimal NL when all nodes are exhausted simultaneously. The problem for planar MSSS topology is more complicated, and a decomposition and combination (D&C) approach is proposed to compute suboptimal solutions. An analytical expression of the suboptimal NL is derived for a small scale planar network. To deal with larger scale planar network, an iterative algorithm is proposed for the D&C approach. Numerical results show that the upper-bounds of the network lifetime obtained by our proposed optimization models are tight. Important insights into the NL and benefits of cross-layer design for WSN NLM are obtained.

Control of second-life hybrid battery energy storage system based on modular boost-multilevel buck converter

To fully utilize second-life batteries on the grid system, a hybrid battery scheme needs to be considered for several reasons: the uncertainty over using a single source supply chain for second-life batteries, the differences in evolving battery chemistry and battery configuration by different suppliers to strive for greater power levels, and the uncertainty of degradation within a second-life battery. Therefore, these hybrid battery systems could have widely different module voltage, capacity, and initial state of charge and state of health. In order to suitably integrate and control these widely different batteries, a suitable multimodular converter topology and an associated control structure are required. This paper addresses these issues proposing a modular boost-multilevel buck converter based topology to integrate these hybrid second-life batteries to a grid-tie inverter. Thereafter, a suitable module-based distributed control architecture is introduced to independently utilize each converter module according to its characteristics. The proposed converter and control architecture are found to be flexible enough to integrate widely different batteries to an inverter dc link. Modeling, analysis, and experimental validation are performed on a single-phase modular hybrid battery energy storage system prototype to understand the operation of the control strategy with different hybrid battery configurations.

Large scale fabrication of nitrogen vacancy-embedded diamond nanostructures for single-photon source applications

Some color centers in diamond can serve as quantum bits which can be manipulated with microwave pulses and read out with laser, even at room temperature. However, the photon collection efficiency of bulk diamond is greatly reduced by refraction at the diamond/air interface. To address this issue, we fabricated arrays of diamond nanostructures, differing in both diameter and top end shape, with HSQ and Cr as the etching mask materials, aiming toward large scale fabrication of single-photon sources with enhanced collection efficiency made of nitrogen vacancy (NV) embedded diamond. With a mixture of O2 and CHF3 gas plasma, diamond pillars with diameters down to 45 nm were obtained. The top end shape evolution has been represented with a simple model. The tests of size dependent single-photon properties confirmed an improved single-photon collection efficiency enhancement, larger than tenfold, and a mild decrease of decoherence time with decreasing pillar diameter was observed as expected. These results provide useful information for future applications of nanostructured diamond as a single-photon source.

Extended-range, low coherence dual wavelength interferometry using a superfluorescent fibre source and chirped fibre Bragg gratings

We describe an all-fibre, passive scheme for making extended range interferometric measurements based on the dual wavelength technique. The coherence tuned interferometer network is illuminated with a single superfluorescent fibre source at 1.55 µm and the two wavelengths are synthesised at the output by means of chirped fibre Bragg gratings. We demonstrate an unambiguous sensing range of 270 µm, with a dynamic range of 2.7 × 10 5.

Continuous-wave ultraviolet light induced fiber Bragg gratings in few- and single-mode microstructured polymer optical fibers

Reported are observations and measurements of the inscription of fibre Bragg gratings in two different types of microstructured polymer optical fibre: few-moded and endlessly single mode. Contrary to FBG inscription in silica microstructured fibre, where high energy laser pulses are a prerequisite, we have successfully used a low power CW laser source operating at 325nm to produce 1-cm long gratings with a reflection peak at 1570 nm. Peak reflectivities of more than 10% have been observed.

Topographic mapping and source localization of the pattern onset visual evoked magnetic response

The topography of the visual evoked magnetic response (VEMR) to a pattern onset stimulus was investigated using 4 check sizes and 3 contrast levels. The pattern onset response consists of three early components within the first 200ms, CIm, CIIm and CIIIm. The CIIm is usually of high amplitude and is very consistent in latency within a subject. Half field (HF) stimuli produce their strongest response over the contralateral hemisphere; the RHF stimulus exhibiting a lower positivity (outgoing field) and an upper negativity (ingoing field), rotated towards the midline. LHF stimulation produced the opposite response, a lower negative and an upper positive. Larger check sizes produce a single area of ingoing and outgoing field while smaller checks produce on area of ingoing and outgoing field over each hemisphere. Latency did not appear to vary with change in contrast but amplitudes increased with increasing contrast. A more detailed topographic study incorporating source localisation procedures suggested a source for CIIm - 4cm below the scalp, close to the midline with current flowing towards the lateral surface. Similar depth and position estimates but with opposite polarity were obtained for the pattern shift P100m previously. Hence, the P100m and the CIIm may originate in similar areas of visual cortex but reveal different aspects of visual processing. © 1992 Human Sciences Press, Inc.

Topographic mapping and source localization of the pattern reversal visual evoked magnetic response

The topography of the visual evoked magnetic response (VEMR) to pattern reversal stimulation was studied in four normal subjects using a single channel BTI magnetometer. VEMRs were recorded from 20 locations over the occipital scalp and the topographic distribution of the most consistent component (P100M) studied. A single dipole in a sphere model was fitted to the data. Topographic maps were similar when recorded two months apart on the same subject to the same stimulus. Half field (HF) stimulation elicited responses from sources on the medial surface of the calcarine fissure mainly in the contralateral hemisphere as predicted by the cruciform model. The full field (FF) responses to large checks were approximately the sum of the HF responses. However, with small checks, FF stimulation appeared to activate a different combination of sources than the two HFs. In addition, HF topography was more consistent between subjects than FF for small check sizes. Topographic studies of the VEMR may help to explain the analogous visual evoked electrical response and will be essential to define optimal recording positions for clinical applications.

The integration of multi-source data to improve the classification of remotely sensed images

The number of remote sensing platforms and sensors rises almost every year, yet much work on the interpretation of land cover is still carried out using either single images or images from the same source taken at different dates. Two questions could be asked of this proliferation of images: can the information contained in different scenes be used to improve the classification accuracy and, what is the best way to combine the different imagery? Two of these multiple image sources are MODIS on the Terra platform and ETM+ on board Landsat7, which are suitably complementary. Daily MODIS images with 36 spectral bands in 250-1000 m spatial resolution and seven spectral bands of ETM+ with 30m and 16 days spatial and temporal resolution respectively are available. In the UK, cloud cover may mean that only a few ETM+ scenes may be available for any particular year and these may not be at the time of year of most interest. The MODIS data may provide information on land cover over the growing season, such as harvest dates, that is not present in the ETM+ data. Therefore, the primary objective of this work is to develop a methodology for the integration of medium spatial resolution Landsat ETM+ image, with multi-temporal, multi-spectral, low-resolution MODIS \Terra images, with the aim of improving the classification of agricultural land. Additionally other data may also be incorporated such as field boundaries from existing maps. When classifying agricultural land cover of the type seen in the UK, where crops are largely sown in homogenous fields with clear and often mapped boundaries, the classification is greatly improved using the mapped polygons and utilising the classification of the polygon as a whole as an apriori probability in classifying each individual pixel using a Bayesian approach. When dealing with multiple images from different platforms and dates it is highly unlikely that the pixels will be exactly co-registered and these pixels will contain a mixture of different real world land covers. Similarly the different atmospheric conditions prevailing during the different days will mean that the same emission from the ground will give rise to different sensor reception. Therefore, a method is presented with a model of the instantaneous field of view and atmospheric effects to enable different remote sensed data sources to be integrated.

Hand somatosensory subcortical and cortical sources assessed by functional source separation:an EEG study

We propose a novel electroencephalographic application of a recently developed cerebral source extraction method (Functional Source Separation, FSS), which starts from extracranial signals and adds a functional constraint to the cost function of a basic independent component analysis model without requiring solutions to be independent. Five ad-hoc functional constraints were used to extract the activity reflecting the temporal sequence of sensory information processing along the somatosensory pathway in response to the separate left and right median nerve galvanic stimulation. Constraints required only the maximization of the responsiveness at specific latencies following sensory stimulation, without taking into account that any frequency or spatial information. After source extraction, the reliability of identified FS was assessed based on the position of single dipoles fitted on its retroprojected signals and on a discrepancy measure. The FS positions were consistent with previously reported data (two early subcortical sources localized in the brain stem and thalamus, the three later sources in cortical areas), leaving negligible residual activity at the corresponding latencies. The high-frequency component of the oscillatory activity (HFO) of the extracted component was analyzed. The integrity of the low amplitude HFOs was preserved for each FS. On the basis of our data, we suggest that FSS can be an effective tool to investigate the HFO behavior of the different neuronal pools, recruited at successive times after median nerve galvanic stimulation. As FSs are reconstructed along the entire experimental session, directional and dynamic HFO synchronization phenomena can be studied.

Effect of calcium source on structure and properties of sol-gel derived bioactive glasses

The aim was to determine the most effective calcium precursor for synthesis of sol-gel hybrids and for improving homogeneity of sol-gel bioactive glasses. Sol-gel derived bioactive calcium silicate glasses are one of the most promising materials for bone regeneration. Inorganic/organic hybrid materials, which are synthesized by incorporating a polymer into the sol-gel process, have also recently been produced to improve toughness. Calcium nitrate is conventionally used as the calcium source, but it has several disadvantages. Calcium nitrate causes inhomogeneity by forming calcium-rich regions, and it requires high temperature treatment (>400 C) for calcium to be incorporated into the silicate network. Nitrates are also toxic and need to be burnt off. Calcium nitrate therefore cannot be used in the synthesis of hybrids as the highest temperature used in the process is typically 40-60 C. Therefore, a different precursor is needed that can incorporate calcium into the silica network and enhance the homogeneity of the glasses at low (room) temperature. In this work, calcium methoxyethoxide (CME) was used to synthesize sol-gel bioactive glasses with a range of final processing temperatures from 60 to 800 C. Comparison is made between the use of CME and calcium chloride and calcium nitrate. Using advanced probe techniques, the temperature at which Ca is incorporated into the network was identified for 70S30C (70 mol % SiO, 30 mol % CaO) for each of the calcium precursors. When CaCl was used, the Ca did not seem to enter the network at any of the temperatures used. In contrast, Ca from CME entered the silica network at room temperature, as confirmed by X-ray diffraction, Si magic angle spinning nuclear magnetic resonance spectroscopy, and dissolution studies. CME should be used in preference to calcium salts for hybrid synthesis and may improve homogeneity of sol-gel glasses.

Extended-range, low coherence dual wavelength interferometry using a superfluorescent fibre source and chirped fibre Bragg gratings

We describe an all-fibre, passive scheme for making extended range interferometric measurements based on the dual wavelength technique. The coherence tuned interferometer network is illuminated with a single superfluorescent fibre source at 1.55 μm and the two wavelengths are synthesised at the output by means of chirped fibre Bragg gratings. We demonstrate an unambiguous sensing range of 270 μm, with a dynamic range of 2.7 × 105.

A multiwavelength low-power wavelength-locked slotted Fabry-Perot laser source for WDM applications

Wavelength-locking of a multiwavelength stabilized slotted Fabry-Perot (SFP) laser to a single-mode laser source is experimentally demonstrated. The SFP resonates at channels spaced by similar to 8 nm between 1510 and 1565 nm over a wide range of temperatures and drive currents. Under low-power (<- 20 dBm) external optical injection, wavelength-locking with a sidemode suppression ratio (SMSR) > 25 dB is achieved. A locking width of > 25 GHz and SMSR > 30 dB can be achieved for each locked wavelength channel at injection power > - 16 dBm.