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 Internet's unexploited path diversity

The connectivity of the Internet at the Autonomous System level is influenced by the network operator policies implemented. These in turn impose a direction to the announcement of address advertisements and, consequently, to the paths that can be used to reach back such destinations. We propose to use directed graphs to properly represent how destinations propagate through the Internet and the number of arc-disjoint paths to quantify this network's path diversity. Moreover, in order to understand the effects that policies have on the connectivity of the Internet, numerical analyses of the resulting directed graphs were conducted. Results demonstrate that, even after policies have been applied, there is still path diversity which the Border Gateway Protocol cannot currently exploit.

The directions taken by young people on leaving compulsory education:a study in two Birmingham schools

The thesis addresses the relative importance of factors affecting working-class school-leavers' post-compulsory education transitions into post-sixteen education, training, employment and unemployment. It focuses on school-leavers choosing to enter the labour market, whether successfully or not and the influences affecting this choice. Methodologically, the longitudinal approach followed young people from before they left school to a period of months after. Discrepancies between young people's intended and actual destinations emphasised the diverse influences on post-sixteen transitions. These influences were investigated through a dynamic multi-method approach, drawing from quantitative and qualitative methodologies providing depth and insight while locating the research within a structural framework, allowing a comparison with local and national trends. Two crucial factors of school and gender affected young people's intended and actual post-sixteen directions. School policy, including treatment of disaffected pupils and recruitment to a large, on-site sixth form, influenced the number of pupils opting to continue their education. Girls were more likely to continue education after the end of compulsory schooling and gave different reasons to boys for doing so. Family and peer groups were influential, helping young people develop a 'horizon for action' incorporating habitus and subjective preferences that specified acceptable post-sixteen directions. These influences operated within the context of the local labour market. Perception of the latter rather than actual conditions informed post-sixteen decisions; however, labour market reality influenced the success of the school-leavers' endeavours. The research found that the economics-based rational choice model of decision-making did not apply to many working class school-leavers. The cohort made pragmatically rational decisions dependent on their 'horizon for action'. based on partial, occasionally inaccurate information. Policy recommendations consider the careers service and structure or school sixth forms as aiding successful transitions from compulsory education into education, employment or training. The maintenance allowance may be ineffectual in tackling its objective of social inclusion.

Foreign direct investment and corruption

In the last few decades, the world has witnessed an enormous growth in the volume of foreign direct investment (FDI). The global stock of FDI reached US$ 7.5 trillion in 2003 and accounted for 11% of world Gross Domestic Product, up from 7% in 1990. The sales of multinational enterprises at around US$ 19 trillion were more than double the level of world exports. Substantial FDI inflows went into transition countries. Inflows into one of the region's largest recipient, the Russian Federation, almost doubled, enabling Russia to become one of the five top FDI destinations in 2005-2006. FDI inflows in Russia have increased almost threefold from 13.6% in 2003 to 35% in 2007. In 2003, these flows were twice greater than those into China; whilst in 2007 they were six times larger. Russia's FDI inflows were also about 2.5 times greater than those of Brazil. Efficient government institutions are argued by many economists to foster FDI and growth as a result. However, the magnitude of this effect has yet to be measured. This thesis takes a Political Economy approach to explore, empirically, the potential impact of malfunctioning governmental institutions, proxied by three indices of perceived corruption, on FDI stocks accumulation/distribution within Russia over the period of 2002-2004. Using a regional data-set it concentrates on three areas relating to FDI. Firstly, it considers the significance, the size and the sign of the impact of perceived corruption on accumulation of FDI stocks within Russia. Secondly, it quantifies the impact of perceived corruption on the volume of FDI stocks simultaneously estimating the impact of the investment in public capital such as telecommunications and transportation networks on FDI in the presence of corruption. In particular, it addresses the question whether more corrupt regions in Russia are also those that could have accumulated more of FDI stocks, and investigates whether those 'more corrupt' regions would have had lower level of public capital investment. Finally, it examines whether decentralisation increases or decreases corruption and whether a larger extent of decentralisation has a positive or negative impact on FDI (stocks). The results of three studies are as follows. Firstly, along with market potential, corruption is found to be one of the key factors in explaining FDI distribution within Russia between 2002 and 2004. Secondly, corruption on average is found to be related to FDI positively suggesting that it may act as speed money: to save their time foreign direct investors might be willing to bribe the regional authorities so to move in front of the bureaucratic lines. Thirdly, although when corruption is controlled for, the impact of the latter on unobservable FDI is found to be on average positive, no association between FDI and public investment is observed with the only exception of transportation infrastructure (i.e., railway). The results might suggest therefore that it is possible that not only regions with high levels of perceived corruption attract more FDI but also that expansions in public capital investments are not accompanied by an increase of the volume of FDI (stocks) in regions with high levels of corruption. This casts some doubt on the productivity of the investment in public capital in these regions as it might be that bureaucrats may prefer to use these infrastructural projects for rent extraction. Finally, we find decentralisation to have a significant and positive impact on both FDI stock accumulation and corruption, suggesting that local governments may spend more on public goods to make the area more attractive to foreign investors but at the same time they may be interested into extracting rents from foreign investors. These results support the idea that the regulation of FDI is associated with and facilitated by a larger public sector, which distorts competition and introduces opportunities for rent-seeking by particular economic and political factors.

The throughput order of multicast traffics with physical-layer network coding in random wireless ad hoc networks

This paper attempts to address the effectiveness of physical-layer network coding (PNC) on the throughput improvement for multi-hop multicast in random wireless ad hoc networks (WAHNs). We prove that the per session throughput order with PNC is tightly bounded as T((nvmR (n))-1) if m = O(R-2 (n)), where n is the total number of nodes, R(n) is the communication range, and m is the number of destinations for each multicast session. We also show that per-session throughput order with PNC is tight bounded as T(n-1), when m = O(R-2(n)). The results of this paper imply that PNC cannot improve the throughput order of multicast in random WAHNs, which is different from the intuition that PNC may improve the throughput order as it allows simultaneous signal access and combination.

Direction of outward FDI of EMNEs:evidence from the Indian pharmaceutical sector

This article seeks to add to the small but growing literature of emerging-market multinational enterprises (EMNEs). Using two linked large firm-level databases, it seeks to explore the determinants of outward investment of Indian pharmaceutical companies, distinguishing between developed- versus developing-country destinations. It specifically examines the impact of two firm-level characteristics that embody “non-OLI” [ownership, location, and internalization] firm-specific capabilities of EMNEs. The finding of this study is that family firms are keen on investing in other developing countries but much less so in developed countries. However, international linkages in the form of foreign investors offset this.

An adaptive IEEE 802.15.4 data transmission scheme for smart grid applications

IEEE 802.15.4 networks (also known as ZigBee networks) has the features of low data rate and low power consumption. In this paper we propose an adaptive data transmission scheme which is based on CSMA/CA access control scheme, for applications which may have heavy traffic loads such as smart grids. In the proposed scheme, the personal area network (PAN) coordinator will adaptively broadcast a frame length threshold, which is used by the sensors to make decision whether a data frame should be transmitted directly to the target destinations, or follow a short data request frame. If the data frame is long and prone to collision, use of a short data request frame can efficiently reduce the costs of the potential collision on the energy and bandwidth. Simulation results demonstrate the effectiveness of the proposed scheme with largely improve bandwidth and power efficiency. © 2011 Springer-Verlag.

Germany:a changing country of immigration

Despite being one of Europe's most significant destinations for migration, Germany has long wrestled with the notion that it may or may not be a 'country of immigration'. Approaching this question from a positive rather than a normative perspective, this article explores how Germany is changing in this respect, by examining changes over the past two decades in terms of migration flows, the policy framework and the degree of societal and institutional adaptation to migration. It argues that Germany has become much more diverse and also notes the major policy developments that have taken place after the change of government in 1998. While the dominant theme of migration policy has moved on from prevention to integration, Germany's impending demographic transformation poses a major new challenge, which will require governments to look once again to more active recruitment of labour migration. © 2013 Association for the Study of German Politics.

The role of transport and mobility in the health of older people

The world's population is ageing. Older people are healthier and more active than previous generations. Living in a hypermobile world, people want to stay connected to dispersed communities as they age. Staying connected to communities and social networks enables older people to contribute and connect with society and is associated with positive mental and physical health, facilitating independence and physical activity while reducing social isolation. Changes in physiology and cognition associated with later life mean longer journeys may have to be curtailed. A shift in focus is needed to fully explore older people, transport and health; a need to be multidisciplinary in approach and to embrace social sciences and arts and humanities. A need to embrace different types of mobilities is needed for a full understanding of ageing, transport and health, moving from literal or corporeal through virtual and potential to imaginative mobility, taking into account aspirations and emotions. Mobility in later life is more than a means of getting to destinations and includes more affective or emotive associations. Cycling and walking are facilitated not just by improving safety but through social and cultural norms. Car driving can be continued safely in later life if people make appropriate and informed decisions about when and how to stop driving; stringent testing of driver ability and skill has as yet had little effect on safety. Bus use facilitates physical activity and keeps people connected but there are concerns for the future viability of buses. The future of transport may be more community led and involve more sharing of transport modes.

Human resource management in China and India

The first decade of the twenty-first century has witnessed further growth in emerging markets, which is significantly influencing the global economic landscape. For the first time in almost two hundred years, it is in this decade that the emerging economies have caught up with, and raced ahead of, the developed ones in terms of gross domestic product. This is a trend that is likely to continue for some time as many of the developed economies struggle to recover from the global financial crisis. In particular, China and India as two fast growing economies are significantly contributing to the world economic growth and are the flag bearers of this transformation. Acknowledged as favourite destinations for global manufacturing (China) and services (India) related outsourcing, both nations offer huge growth opportunities in most products and services. However, in order to sustain their phenomenal economic growth of the past decades, both countries are facing a number of challenges to their human resource management (HRM). From a macro perspective, these issues tend to appear similar (e.g., attraction and retention of talent), but given the significant sociocultural, institutional, political, legal and other differences between the two nations, the logics underpinning the approaches to managing human resources issues appear somewhat different. This chapter therefore aims to highlight the key forces determining the nature of HRM in China and India. The chapter consists of three main sections, in addition to the Introduction and Conclusions.