The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study

Objectives: To assess the impact of a closed-loop electronic prescribing, automated dispensing, barcode patient identification and electronic medication administration record (EMAR) system on prescribing and administration errors, confirmation of patient identity before administration, and staff time. Design, setting and participants: Before-and-after study in a surgical ward of a teaching hospital, involving patients and staff of that ward. Intervention: Closed-loop electronic prescribing, automated dispensing, barcode patient identification and EMAR system. Main outcome measures: Percentage of new medication orders with a prescribing error, percentage of doses with medication administration errors (MAEs) and percentage given without checking patient identity. Time spent prescribing and providing a ward pharmacy service. Nursing time on medication tasks. Results: Prescribing errors were identified in 3.8% of 2450 medication orders pre-intervention and 2.0% of 2353 orders afterwards (p<0.001; χ2 test). MAEs occurred in 7.0% of 1473 non-intravenous doses pre-intervention and 4.3% of 1139 afterwards (p = 0.005; χ2 test). Patient identity was not checked for 82.6% of 1344 doses pre-intervention and 18.9% of 1291 afterwards (p<0.001; χ2 test). Medical staff required 15 s to prescribe a regular inpatient drug pre-intervention and 39 s afterwards (p = 0.03; t test). Time spent providing a ward pharmacy service increased from 68 min to 98 min each weekday (p = 0.001; t test); 22% of drug charts were unavailable pre-intervention. Time per drug administration round decreased from 50 min to 40 min (p = 0.006; t test); nursing time on medication tasks outside of drug rounds increased from 21.1% to 28.7% (p = 0.006; χ2 test). Conclusions: A closed-loop electronic prescribing, dispensing and barcode patient identification system reduced prescribing errors and MAEs, and increased confirmation of patient identity before administration. Time spent on medication-related tasks increased.

The impact of a closed-loop electronic prescribing and automated dispensing system on the ward pharmacist’s time and activities

Objective To assess the impact of a closed-loop electronic prescribing and automated dispensing system on the time spent providing a ward pharmacy service and the activities carried out. Setting Surgical ward, London teaching hospital. Method All data were collected two months pre- and one year post-intervention. First, the ward pharmacist recorded the time taken each day for four weeks. Second, an observational study was conducted over 10 weekdays, using two-dimensional work sampling, to identify the ward pharmacist's activities. Finally, medication orders were examined to identify pharmacists' endorsements that should have been, and were actually, made. Key findings Mean time to provide a weekday ward pharmacy service increased from 1 h 8 min to 1 h 38 min per day (P = 0.001; unpaired t-test). There were significant increases in time spent prescription monitoring, recommending changes in therapy/monitoring, giving advice or information, and non-productive time. There were decreases for supply, looking for charts and checking patients' own drugs. There was an increase in the amount of time spent with medical and pharmacy staff, and with 'self'. Seventy-eight per cent of patients' medication records could be assessed for endorsements pre- and 100% post-intervention. Endorsements were required for 390 (50%) of 787 medication orders pre-intervention and 190 (21%) of 897 afterwards (P < 0.0001; chi-square test). Endorsements were made for 214 (55%) of endorsement opportunities pre-intervention and 57 (30%) afterwards (P < 0.0001; chi-square test). Conclusion The intervention increased the overall time required to provide a ward pharmacy service and changed the types of activity undertaken. Contact time with medical and pharmacy staff increased. There was no significant change in time spent with patients. Fewer pharmacy endorsements were required post-intervention, but a lower percentage were actually made. The findings have important implications for the design, introduction and use of similar systems.

The propagation mechanism of a vortex on the β plane

The propagation velocity and propagation mechanism for vortices on a β plane are determined for a reduced-gravity model by integrating the momentum equations over the β plane. Isolated vortices, vortices in a background current, and initial vortex propagation from rest are studied. The propagation mechanism for isolated anticyclones as well as cyclones, which has been lacking up to now, is presented. It is shown that, to first order, the vortex moves to generate a Coriolis force on the mass anomaly of the vortex to compensate for the force on the vortex due to the variation of the Coriolis parameter. Only the mass anomaly of the vortex is of importance, because the Coriolis force due to the motion of the bulk of the layer moving with the vortex is almost fully compensated by the Coriolis force on the motion of the exterior flow. Because the mass anomaly of a cyclone is negative the force and acceleration have opposite sign. The role of dipolar structures in steadily moving vortices is discussed, and it is shown that their overall structure is fixed by the steady westward motion of the mass anomaly. Furthermore, it is shown that reduced-gravity vortices are not advected with a background flow. The reason for this behavior is that the background flow changes the ambient vorticity gradient such that the vortex obtains an extra self-propagation term that exactly cancels the advection by the background flow. Last, it is shown that a vortex initially at rest will accelerate equatorward first, after which a westward motion is generated. This result is independent of the sign of the vortex.

Observed and simulated precursors of stratospheric polar vortex anomalies in the Northern Hemisphere

The Northern Hemisphere stratospheric polar vortex is linked to surface weather. After Stratospheric Sudden Warmings in winter, the tropospheric circulation is often nudged towards the negative phase of the Northern Annular Mode (NAM) and the North Atlantic Oscillation (NAO). A strong stratospheric vortex is often associated with subsequent positive NAM/NAO conditions. For stratosphere–troposphere associations to be useful for forecasting purposes it is crucial that changes to the stratospheric vortex can be understood and predicted. Recent studies have proposed that there exist tropospheric precursors to anomalous vortex events in the stratosphere and that these precursors may be understood by considering the relationship between stationary wave patterns and regional variability. Another important factor is the extent to which the inherent variability of the stratosphere in an atmospheric model influences its ability to simulate stratosphere–troposphere links. Here we examine the lower stratosphere variability in 300-year pre-industrial control integrations from 13 coupled climate models. We show that robust precursors to stratospheric polar vortex anomalies are evident across the multi-model ensemble. The most significant tropospheric component of these precursors consists of a height anomaly dipole across northern Eurasia and large anomalies in upward stationary wave fluxes in the lower stratosphere over the continent. The strength of the stratospheric variability in the models was found to depend on the variability of the upward stationary wave fluxes and the amplitude of the stationary waves.

A conserved basic loop in hepatitis C virus p7 protein is required for amantadine-sensitive ion channel activity in mammalian cells but is dispensable for localization to mitochondria

We previously identified the function of the hepatitis C virus (HCV) p7 protein as an ion channel in artificial lipid bilayers and demonstrated that this in vitro activity is inhibited by amantadine. Here we show that the ion channel activity of HCV p7 expressed in mammalian cells can substitute for that of influenza virus M2 in a cell-based assay. This was also the case for the p7 from the related virus, bovine viral diarrhoea virus (BVDV). Moreover, amantadine was shown to abrogate HCV p7 function in this assay at a concentration that specifically inhibits M2. Mutation of a conserved basic loop located between the two predicted trans-membrane alpha helices rendered HCV p7 non-functional as an ion channel. The intracellular localization of p7 was unaffected by this mutation and was found to overlap significantly with membranes associated with mitochondria. Demonstration of p7 ion channel activity in cellular membranes and its inhibition by amantadine affirm the protein as a target for future anti-viral chemotherapy.

Solid-phase synthesis of an A-B loop mimetic of the C epsilon 3 domain of human IgE: macrocyclization by Sonogashira coupling

The solid-phase synthesis of a cyclic peptide containing the 21-residue epitope found in the A-B loop of the Cepsilon3 domain of human immunoglobulin E has been carried out. The key macrocyclization step to form the 65-membered ring is achieved in similar to15% yield via an "on-resin" Sonogashira coupling reaction which concomitantly installs a diphenylacetylene amino acid conformational constraint within the loop.

Evolving features-algorithms knowledge map to support NIDS data intelligence and learning loop architecting – a generalised approach to NIDS pattern feature space knowledge processing

This paper describes a proposed new approach to the Computer Network Security Intrusion Detection Systems (NIDS) application domain knowledge processing focused on a topic map technology-enabled representation of features of the threat pattern space as well as the knowledge of situated efficacy of alternative candidate algorithms for pattern recognition within the NIDS domain. Thus an integrative knowledge representation framework for virtualisation, data intelligence and learning loop architecting in the NIDS domain is described together with specific aspects of its deployment.

Optimising the feedback loop of a millimetre-wave absolute photoacoustic power meter using H-infinity control synthesis

An H-infinity control strategy has been developed for the design of controllers used in feedback controlled electrical substitution measurements (FCESM). The methodology has the potential to provide substantial improvements in both response time and resolution of a millimetre-wave absolute photoacoustic power meter.

Vermillion Vortex

An animated film commissioned and screened by Art Review Magazine on their website (Oct-Dec 2010), and a double page comic strip (Art Review, Oct 2010. The project addresses a key problem with contemporary debates regarding ideas of ‘performativity’ and ‘fictioning’ (Foucault/Deleuze/Butler) whereby the structural requirement for an ‘End’ pre-determines or back-codes the ‘story’ or progression of events leading up to this ‘End’ and therefore cuts against the potentials claimed for ‘performance’ and ‘performativity’. Film credits Primary soundtrack: Music: Rose Kallal. Spoken word: Mark Beasley Voices: Katie Barrington, Marnie Watts, Maria Deegan & John Russell Sound engineer: Bob Geal PLUS Special bonus track: (after 'The End'): 'Strychnine Motive' (2011) by Gum Takes Tooth

Calibration of closed loop controllers for setting impedances in force-reflecting systems

This paper discusses a new method of impedance control that has been successfully implemented on the master robot of a teleoperation system. The method involves calibrating the robot to quantify the effect of adjustable controller parameters on the impedances along its different axes. The empirical equations relating end-effector impedance to the controller's feedback gains are obtained by performing system identification tests along individual axes of the robot. With these equations, online control of end-effector stiffness and damping is possible without having to monitor joint torques or solving complex algorithms. Hard contact conditions and compliant interfaces have been effectively demonstrated on a telemanipulation test-bed using appropriate combinations of stiffness and damping settings obtained by this method.

The structure and evolution of the stratospheric vortex in response to natural forcings

The structure and evolution of the Arctic stratospheric polar vortex is assessed during opposing phases of, primarily, the El Niño–Southern Oscillation (ENSO) and the Quasi-Biennial Oscillation (QBO), but the 11 year solar cycle and winters following large volcanic eruptions are also examined. The analysis is performed by taking 2-D moments of vortex potential vorticity (PV) fields which allow the area and centroid of the vortex to be calculated throughout the ERA-40 reanalysis data set (1958–2002). Composites of these diagnostics for the different phases of the natural forcings are then considered. Statistically significant results are found regarding the structure and evolution of the vortex during, in particular, the ENSO and QBO phases. When compared with the more traditional zonal mean zonal wind diagnostic at 60°N, the moment-based diagnostics are far more robust and contain more information regarding the state of the vortex. The study details, for the first time, a comprehensive sequence of events which map the evolution of the vortex during each of the forcings throughout an extended winter period.

Value management and post-occupancy evaluation: closing the loop

This paper considers the relationship between value management and facilities management. The findings are particularly relevant to large client organisations which procure new buildings on a regular basis. It is argued that the maximum effectiveness of value management can only be achieved if it is used in conjunction with an ongoing commitment to post-occupancy evaluation. SMART value management is seen to provide the means of ensuring that an individual building design is in alignment with the client’s strategic property needs. However, it is also necessary to recognise that an organisation’s strategic property needs will continually be in a state of change. Consequentially, economic and functional under-performance can only be avoided by a regular performance audit of existing property stock in accordance with changing requirements. Such a policy will ensure ongoing competitiveness through organisational learning. While post-occupancy evaluation represents an obvious additional service to be provided by value management consultants, it is vital that the necessary additional skills are acquired. Process management skills and social science research techniques are clearly important. However, there is also a need to improve mechanisms for data manipulation. Success can only be achieved if equal attention is given to issues of process, structure and content.