Informing people about the risks and benefits of medicines: implications for the safe and effective use of medicinal products

Providing effective information about drug risks and benefits has become a major challenge for health professionals, as many people are ill equipped to understand, retain and use the information effectively. This paper reviews the growing evidence that people’s understanding (and health behaviour) is not only affected by the content of medicines information, but also by the particular way in which it is presented. Such presentational factors include whether information is presented verbally or numerically, framed positively or negatively, whether risk reductions are described in relative or absolute terms (and baseline information included), and whether information is personalized or tailored in any way. It also looks at how understanding is affected by the order in which information is presented, and the way in which it is processed. The paper concludes by making a number of recommendations for providers of medicines information, about both the content and presentation of such information, that should enhance safe and effective medicines usage.

Perceptions of the risks and benefits of medicines in patients with rheumatoid arthritis and other painful musculoskeletal conditions

Objectives. To examine beliefs about medication risks and benefits in patients attending a specialist rheumatology clinic for pain-related conditions. Methods. Eighty-one patients (37 first attendees and 44 existing clinic patients) completed a written questionnaire which asked about current treatments, perceived effectiveness, main risks and benefits, and compliance. Results. Existing clinic patients perceived medications to be more effective and more risky than did the new patients, although both groups rated risks to be moderately low. The main perceived risks were adverse side-effects, although patients reported only moderately low levels of experiencing such effects. Conclusions. In contrast to some other studies, many of our patients were aware of medication risks and were prepared to accept them provided benefits were seen to be high. Existing clinic patients were more aware of risks and benefits, and reported higher compliance levels than new patients, possibly as a result of the hospital education programme. Future studies should evaluate the effects of the programme more systematically.

A lightweight technique for assessing risks in requirements analysis

A simple and practical technique for assessing the risks, that is, the potential for error, and consequent loss, in software system development, acquired during a requirements engineering phase is described. The technique uses a goal-based requirements analysis as a framework to identify and rate a set of key issues in order to arrive at estimates of the feasibility and adequacy of the requirements. The technique is illustrated and how it has been applied to a real systems development project is shown. How problems in this project could have been identified earlier is shown, thereby avoiding costly additional work and unhappy users.

Untitled (Abstraction of Labour Time/ External Recurrence/Monad)

Commissioned print. Artist of the Month Club: February, 2010. January Curator: Mark Beasley. Invisible Exports Gallery, New York. Archival Inkjet Print on metallic silver polyester, 841 x 643mm. Edition of 50 + 10ap. Subsequently exhibited in the following exhibition: 'A Unicorn Basking in the Light of Three Glowing Suns' The Devos Art Museum School of Art & Design at Northern Michigan University October 8 – November 14, 2010 Curated by Anthony Elms and Philip von Zweck

Untitled (Abstraction of labour time eternal recurrence monad)

An AHRC funded project titled: Picturing ideas? Visualising and Synthesising Ideas as art (2009-10). Outputs including: 4 exhibitions; 4 publications; 3 papers; 2 largescale backlit digital prints; 1 commissioned print. (See Additional Information) ----ABSTRACT: Utilising the virtuality of digital imagery this practice-led project explored the possibility of the cross-articulation between text and image and the bridging or synthesising potential of the visual affect of ideas. A series of digital images were produced 'picturing' or 'visualising' philosophical ideas derived from the writings of the philosopher Giles Deleuze, as remodellings of pre-existing philosophical ideas; developed through dialogues and consultation with specialists in the fields from which the ideas were drawn (philosophy, psychology, film) as well as artists and theorists concerned with ideas of 'mental imagery' and visualisation. Final images were produced as a synthesis (or combination) of these visualisations and presented in the format of large scale, backlit digital prints at a series of prestigious international exhibitions (see details above). Evaluation took the form of a four page illustrated text in Frieze magazine (August 2009) and three papers delivered at University of Ulster, Goldsmiths College of Art and Loughborough University. The project also included the publication of a catalogue essay (EAST 09) and an illustrated poem (in the Dark Monarch publication). A print version of the image was commissioned by Invisible Exports Gallery, New York and subsequently exhibited in The Devos Art Museum, School of Art & Design at Northern Michigan University and in a publication edited by Cedar Lewisohn for Tate Publishing. The project was funded by an AHRC practice-led grant (17K) and Arts Council of England award (1.5K). The outputs, including high profile, publicly accessible exhibitions, prestigious publications and conference papers ensured the dissemination of the research to a wide range of audiences, including scholars/researchers across the arts and humanities engaged in practice-based and interdisciplinary theoretical work (in particular in the fields of contemporary art and art theory and those working on the integration of art and theory/philosophy/psychology) but also the wider audience for contemporary art.

A novel method for assessing risks to pollinators from plant protection products using honeybees as a model species

Pollination is one of the most important ecosystem services in agroecosystems and supports food production. Pollinators are potentially at risk being exposed to pesticides and the main route of exposure is direct contact, in some cases ingestion, of contaminated materials such as pollen, nectar, flowers and foliage. To date there are no suitable methods for predicting pesticide exposure for pollinators, therefore official procedures to assess pesticide risk are based on a Hazard Quotient. Here we develop a procedure to assess exposure and risk for pollinators based on the foraging behaviour of honeybees (Apis mellifera) and using this species as indicator representative of pollinating insects. The method was applied in 13 European field sites with different climatic, landscape and land use characteristics. The level of risk during the crop growing season was evaluated as a function of the active ingredients used and application regime. Risk levels were primarily determined by the agronomic practices employed (i.e. crop type, pest control method, pesticide use), and there was a clear temporal partitioning of risks through time. Generally the risk was higher in sites cultivated with permanent crops, such as vineyard and olive, than in annual crops, such as cereals and oil seed rape. The greatest level of risk is generally found at the beginning of the growing season for annual crops and later in June–July for permanent crops.

Climate change and the risks associated with delayed breeding in a tropical wild bird population

There is growing evidence of changes in the timing of important ecological events, such as flowering in plants and reproduction in animals, in response to climate change, with implications for population decline and biodiversity loss. Recent work has shown that the timing of breeding in wild birds is changing in response to climate change partly because individuals are remarkably flexible in their timing of breeding. Despite this work, our understanding of these processes in wild populations remains very limited and biased towards species from temperate regions. Here, we report the response to changing climate in a tropical wild bird population using a long-term dataset on a formerly critically endangered island endemic, the Mauritius kestrel. We show that the frequency of spring rainfall affects the timing of breeding, with birds breeding later in wetter springs. Delays in breeding have consequences in terms of reduced reproductive success as birds get exposed to risks associated with adverse climatic conditions later on in the breeding season, which reduce nesting success. These results, combined with the fact that frequency of spring rainfall has increased by about 60 per cent in our study area since 1962, imply that climate change is exposing birds to the stochastic risks of late reproduction by causing them to start breeding relatively late in the season.

The risks of investing in the real estate markets of the asian region

The Asian region has become a focus of attention for investors in recent years. Due to the strong economic performance of the region, the higher expected returns in the area compared with Europe and the USA and the additional diversification benefits investment in the region would offer. Nonetheless many investors have doubts about the prudence of investing in such areas. In particular it may be felt that the expected returns offered in the countries of the Asian region are not sufficient to compensate investors for the increased risks of investing in such markets. These risks can be categorised into under four headings: investment risk, currency risk, political risk, and institutional risk. This paper analyses each of these risks in turn to see if they are sufficiently large to deter real estate investment in the region in general or in a particular country.

Lyme borreliosis in the UK: ecology and risks to domestic animals and man

The different associations of Borrelia burgdorferi sensu lato spirochaetes with their natural reservoir hosts and tick vectors are slowly being unravelled. This review discusses the interactions of different genospecies of Lyme borreliosis spirochaetes and their differing tick vectors, vertebrate reservoirs and 'accidental hosts'. Particular reference is made to spirochaete-host interactions and occurrence of pathological consequences. Attention is focused on the unique prevalence of enzoonotic cycles in operation within the UK. Risk factors for acquiring Lyme borreliosis in man are discussed. (C) 2001 Lippincott Williams & Wilkins.

Predicting the risks from climate change to forage and crop production for animal feed

Climate change is expected to bring warmer temperatures, changes to rainfall patterns, and increased frequency of extreme weather. Projections of climate impacts on feed crops show that there will likely be opportunities for increased productivity as well as considerable threats to crop productivity in different parts of the world over the next 20 to 50 years. On balance, we anticipate substantial risks to the volume, volatility, and quality of animal feed supply chains from climate change. Adaptation strategies and investment informed by high quality research at the interface of crop and animal science will be needed, both to respond to climate change and to meet the increasing demand for animal products expected over the coming decades.

Assessing continental-scale risks for generalist and specialist pollinating bee species under climate change

Increased risks of extinction to populations of animals and plants under changing climate have now been demonstrated for many taxa. This study assesses the extinction risks to species within an important genus of pollinating bees (Colletes: Apidae) by estimating the expected changes in the area and isolation of suitable habitat under predicted climatic condition for 2050. Suitable habitat was defined on the basis of the presence of known forage plants as well as climatic suitability. To investigate whether ecological specialisation was linked to extinction risk we compared three species which were generalist pollen foragers on several plant families with three species which specialised on pollen from a single plant species. Both specialist and generalist species showed an increased risk of extinction with shifting climate, and this was particularly high for the most specialised species (Colletes anchusae and C. wolfi). The forage generalist C. impunctatus, which is associated with Boreo-Alpine environments, is potentially threatened through significant reduction in available climatic niche space. Including the distribution of the principal or sole pollen forage plant, when modelling the distribution of monolectic or narrowly oligolectic species, did not improve the predictive accuracy of our models as the plant species were considerably more widespread than the specialised bees associated with them.

Climate-driven spatial mismatches between British orchards and their pollinators: increased risks of pollination deficits

Understanding how climate change can affect crop-pollinator systems helps predict potential geographical mismatches between a crop and its pollinators, and therefore identify areas vulnerable to loss of pollination services. We examined the distribution of orchard species (apples, pears, plums and other top fruits) and their pollinators in Great Britain, for present and future climatic conditions projected for 2050 under the SRES A1B Emissions Scenario. We used a relative index of pollinator availability as a proxy for pollination service. At present there is a large spatial overlap between orchards and their pollinators, but predictions for 2050 revealed that the most suitable areas for orchards corresponded to low pollinator availability. However, we found that pollinator availability may persist in areas currently used for fruit production, but which are predicted to provide sub-optimal environmental suitability for orchard species in the future. Our results may be used to identify mitigation options to safeguard orchard production against the risk of pollination failure in Great Britain over the next 50 years; for instance choosing fruit tree varieties that are adapted to future climatic conditions, or boosting wild pollinators through improving landscape resources. Our approach can be readily applied to other regions and crop systems, and expanded to include different climatic scenarios.