Protocol for the PINCER trial: a cluster randomised trial comparing the effectiveness of a pharmacist-led IT-based intervention with simple feedback in reducing rates of clinically important errors in medicines management in general practices

Background: Medication errors are an important cause of morbidity and mortality in primary care. The aims of this study are to determine the effectiveness, cost effectiveness and acceptability of a pharmacist-led information-technology-based complex intervention compared with simple feedback in reducing proportions of patients at risk from potentially hazardous prescribing and medicines management in general (family) practice. Methods: Research subject group: "At-risk" patients registered with computerised general practices in two geographical regions in England. Design: Parallel group pragmatic cluster randomised trial. Interventions: Practices will be randomised to either: (i) Computer-generated feedback; or (ii) Pharmacist-led intervention comprising of computer-generated feedback, educational outreach and dedicated support. Primary outcome measures: The proportion of patients in each practice at six and 12 months post intervention: - with a computer-recorded history of peptic ulcer being prescribed non-selective non-steroidal anti-inflammatory drugs - with a computer-recorded diagnosis of asthma being prescribed beta-blockers - aged 75 years and older receiving long-term prescriptions for angiotensin converting enzyme inhibitors or loop diuretics without a recorded assessment of renal function and electrolytes in the preceding 15 months. Secondary outcome measures; These relate to a number of other examples of potentially hazardous prescribing and medicines management. Economic analysis: An economic evaluation will be done of the cost per error avoided, from the perspective of the UK National Health Service (NHS), comparing the pharmacist-led intervention with simple feedback. Qualitative analysis: A qualitative study will be conducted to explore the views and experiences of health care professionals and NHS managers concerning the interventions, and investigate possible reasons why the interventions prove effective, or conversely prove ineffective. Sample size: 34 practices in each of the two treatment arms would provide at least 80% power (two-tailed alpha of 0.05) to demonstrate a 50% reduction in error rates for each of the three primary outcome measures in the pharmacist-led intervention arm compared with a 11% reduction in the simple feedback arm. Discussion: At the time of submission of this article, 72 general practices have been recruited (36 in each arm of the trial) and the interventions have been delivered. Analysis has not yet been undertaken.

Integrated optics for nulling interferometry in the thermal infrared

Modal filtering is based on the capability of single-mode waveguides to transmit only one complex amplitude function to eliminate virtually any perturbation of the interfering wavefronts, thus making very high rejection ratios possible in a nulling interferometer. In the present paper we focus on the progress of Integrated Optics in the thermal infrared [6-20 mu m] range, one of the two candidate technologies for the fabrication of Modal Filters, together with fiber optics. In conclusion of the European Space Agency's (ESA) "Integrated Optics for Darwin" activity, etched layers of clialcogenide material deposited on chalcogenide glass substrates was selected among four candidates as the technology with the best potential to simultaneously meet the filtering efficiency, absolute and spectral transmission, and beam coupling requirements. ESA's new "Integrated Optics" activity started at mid-2007 with the purpose of improving the technology until compliant prototypes can be manufactured and validated, expectedly by the end of 2009. The present paper aims at introducing the project and the components requirements and functions. The selected materials and preliminary designs, as well as the experimental validation logic and test benches are presented. More details are provided on the progress of the main technology: vacuum deposition in the co-evaporation mode and subsequent etching of chalcogenide layers. In addition., preliminary investigations of an alternative technology based on burying a chalcogenide optical fiber core into a chalcogenide substrate are presented. Specific developments of anti-reflective solutions designed for the mitigation of Fresnel losses at the input and output surface of the components are also introduced.

Interference filters and coatings for mid-infrared astronomy (8-30µm)

The VISIR instrument for the European Southern Observatory (ESO) Very Large Telescope (VLT) is a thermal-infrared imager and spectrometer currently being developed by the French Service d'Astrophysique of CEA Saclay, and Dutch NFRA ASTRON Dwingeloo consortium. This cryogenic instrument will employ precision infrared bandpass filters in the N-( =7.5-14µm) and Q-( =16-28µm) band mid-IR atmospheric windows to study interstellar and circumstellar environments crucial for star and planetary formation theories. As the filters in these mid-IR wavelength ranges are of interest to many astronomical cryogenic instruments, a worldwide astronomical filter consortium was set up with participation from 12 differing institutes, each requiring instrument specific filter operating environments and optical metrology. This paper describes the design and fabrication methods used to manufacture these astronomical consortium filters, including the rationale for the selection of multilayer coating designs, temperature-dependant optical properties of the filter materials and FTIR spectral measurements showing the changes in passband and blocking performance on cooling to <50K. We also describe the development of a 7-14µm broadband antireflection coating deposited on Ge lenses and KRS-5 grisms for cryogenic operation at 40K

The temperature-dependent spectral properties of filter substrate materials in the far-infrared (6-40 mu m)

This paper presents the experimental results on the low temperature absorption and dispersion properties for a variety of frequently used infrared filter substrate materials. Index of refraction (n) and transmission spectra are presented for a range of temperatures 300-50 K for the Group IV materials silicon (Si) and germanium (Ge), and Group II-VI materials zinc selenide (ZnSe), zinc sulphide (ZnS) and cadmium telluride (CdTe). (C) 2003 Elsevier B.V. All rights reserved.

Cooled infrared filters and dichroics for the James Webb Space Telescope Mid-Infrared Instrument

The cooled infrared filters and dichroic beam splitters manufactured for the Mid-Infrared Instrument are key optical components for the selection and isolation of wavelengths in the study of astrophysical properties of stars, galaxies, and other planetary objects. We describe the spectral design and manufacture of the precision cooled filter coatings for the spectrometer (7 K) and imager (9 K). Details of the design methods used to achieve the spectral requirements, selection of thin film materials, deposition technique, and testing are presented together with the optical layout of the instrument. (C) 2008 Optical Society of America.

High-performance infrared narrow-bandpass filters for the Indian National Satellite System meteorological instrument (INSAT-3D)

This paper describes the design and manufacture of a set of precision cooled (210K) narrow-bandpass filters for the infrared imager and sounder on the Indian Space Research Organisation (ISRO) INSAT-3D meteorological satellite. We discuss the basis for the choice of multilayer coating designs and materials for 21 differing filter channels, together with their temperature-dependence, thin film deposition technologies, substrate metrology, and environmental durability performance. (C) 2008 Optical Society of America.

Reversible ageing effects in cryogenically cooled infrared filter radiometers

In this paper we report the observation of drifts in the responsivity of cryogenically cooled InSb detector-based infrared filter radiometers which have very strong wavelength dependence. These drifts can result in the increase or decrease of the response of the filter radiometers by over 5%. The origin of these variations was investigated and was shown to arise due to a thin film of ice formed on the multi-layer bandpass filter used to define the spectral response of the filter radiometer. The thin layer of ice interacts with the characteristics of the filter (which itself consists of a number of thin layers) and modifies the filter spectral transmission thus modifying the response of the filter radiometer of which the filter is part of. These observations are particularly relevant to space instruments which use infrared filter radiometers for earth observation. Debris from the spacecraft engines is known to accumulate on cold surfaces of instruments carried on board. The deposition of this debris on cold filters can modify the spectral response of the instruments, which use these filters to define a spectral response. Crown Copyright (c) 2004 Published by Elsevier B.V. All rights reserved.

Infrared filters and coatings for the High Resolution Dynamics Limb Sounder (6-18µm)

This paper describes the spectral design and manufacture of the narrow bandpass filters and 6-18µm broadband antireflection coatings for the 21-channel NASA EOS-AURA High Resolution Dynamics Limb Sounder (HIRDLS). A method of combining the measured spectral characteristics of each filter and antireflection coating, together with the spectral response of the other optical elements in the instrument to obtain a predicted system throughput response is presented. The design methods used to define the filter and coating spectral requirements, choice of filter materials, multilayer designs and deposition techniques are discussed.

Ferric and ferrous iron in nitroso-myoglobin: computer simulations of stable and metastable states and their infrared spectra

The binding of NO to iron is involved in the biological function of many heme proteins. Contrary to ligands like CO and O-2, which only bind to ferrous (Fe-II) iron, NO binds to both ferrous and ferric (Fe-II) iron. In a particular protein, the natural oxidation state can therefore be expected to be tailored to the required function. Herein, we present an ob initio potential-energy surface for ferric iron interacting with NO. This potential-energy surface exhibits three minima corresponding to eta'-NO coordination (the global minimum), eta(1)-ON coordination and eta(2) coordination. This contrasts with the potential-energy surface for Fe-II-NO, which ex- hibits only two minima (the eta(2) coordination mode for Fe-II is a transition state, not a minimum). In addition, the binding energies of NO are substantially larger for Fe-III than for Fe-II. We have performed molecular dynamics simulations for NO bound to ferric myoglobin (Mb(III)) and compare these with results obtained for Mb(II). Over the duration of our simulations (1.5 ns), all three binding modes are found to be stable at 200 K and transiently stable at 300 K, with eventual transformation to the eta(1)-NO global-minimum conformation. We discuss the implication of these results related to studies of rebinding processes in myoglobin.