Prevalence and Causes of Prescribing ErrorsL The PRescribing Outcomes for Trainee Doctors Engaged in Clinical Training (PROTECT) Study

Objectives: Study objectives were to investigate the prevalence and causes of prescribing errors amongst foundation doctors (i.e. junior doctors in their first (F1) or second (F2) year of post-graduate training), describe their knowledge and experience of prescribing errors, and explore their self-efficacy (i.e. confidence) in prescribing.

Method: A three-part mixed-methods design was used, comprising: prospective observational study; semi-structured interviews and cross-sectional survey. All doctors prescribing in eight purposively selected hospitals in Scotland participated. All foundation doctors throughout Scotland participated in the survey. The number of prescribing errors per patient, doctor, ward and hospital, perceived causes of errors and a measure of doctors’ self-efficacy were established.

Results: 4710 patient charts and 44,726 prescribed medicines were reviewed. There were 3364 errors, affecting 1700 (36.1%) charts (overall error rate: 7.5%; F1:7.4%; F2:8.6%; consultants:6.3%). Higher error rates were associated with : teaching hospitals (p,0.001), surgical (p = ,0.001) or mixed wards (0.008) rather thanmedical ward, higher patient turnover wards (p,0.001), a greater number of prescribed medicines (p,0.001) and the months December and June (p,0.001). One hundred errors were discussed in 40 interviews. Error causation was multi-factorial; work environment and team factors were particularly noted. Of 548 completed questionnaires (national response rate of 35.4%), 508 (92.7% of respondents) reported errors, most of which (328 (64.6%) did not reach the patient. Pressure from other staff, workload and interruptions were cited as the main causes of errors. Foundation year 2 doctors reported greater confidence than year 1 doctors in deciding the most appropriate medication regimen.

Conclusions: Prescribing errors are frequent and of complex causation. Foundation doctors made more errors than other doctors, but undertook the majority of prescribing, making them a key target for intervention. Contributing causes included work environment, team, task, individual and patient factors. Further work is needed to develop and assess interventions that address these.

Characterisation of pavement profile heights using accelerometer readings and a combinatorial optimisation technique

Pavement surface profiles induce dynamic ride responses in vehicles which can potentially be used to classify road surface roughness. A novel method is proposed for the characterisation of pavement roughness through an analysis of vehicle accelerations. A combinatorial optimisation technique is applied to the determination of pavement profile heights based on measured accelerations at and above the vehicle axle. Such an approach, using low-cost inertial sensors, would provide an inexpensive alternative to the costly laser-based profile measurement vehicles. The concept is numerically validated using a half-car roll dynamic model to infer measurements of road profiles in both the left and right wheel paths.

Clonal complex Pseudomonas aeruginosa in horses

Pseudomonas aeruginosa is associated with infectious endometritis in horses. Although infectious endometritis is often considered a venereal infection, there is relatively limited genotypic-based evidence to support this mode of transmission. The study sought to determine the relatedness between genital P. aeruginosa isolates collected from a limited geographical region using molecular strain typing. Enterobacterial repetitive intergenic consensus PCR typing was performed on 93 isolates collected between 2005 and 2009 from 2058 thoroughbred horses (including 18 stallions) at 66 studs. While P. aeruginosa was not detected in the stallions, 53/93 (57%) mares harbouring P. aeruginosa had clonally related strains, which included a single dominant genotype detected in 42 (45%) mares from 13 different studs. These novel findings suggest that most equine genital P. aeruginosa infections in this region may have been acquired from mechanisms other than direct horse to horse transmission. Instead, other potential acquisition pathways, as well as strain specific adaptation to the equine genital tract, should be investigated.

Balls to the wall: How acoustic information from a ball in motion guides interceptive movement in people with Parkinson’s disease

Previous research has shown that Parkinson's disease (PD) patients can increase the speed of their movement when catching a moving ball compared to when reaching for a static ball (Majsak et al., 1998). A recent model proposed by Redgrave et al. (2010) explains this phenomenon with regard to the dichotomic organization of motor loops in the basal ganglia circuitry and the role of sensory micro-circuitries in the control of goal-directed actions. According to this model, external visual information that is relevant to the required movement can induce a switch from a habitual control of movement toward an externally-paced, goal-directed form of guidance, resulting in augmented motor performance (Bienkiewicz et al., 2013). In the current study, we investigated whether continuous acoustic information generated by an object in motion can enhance motor performance in an arm reaching task in a similar way to that observed in the studies of Majsak et al. (1998, 2008). In addition, we explored whether the kinematic aspects of the movement are regulated in accordance with time to arrival information generated by the ball's motion as it reaches the catching zone. A group of 7 idiopathic PD (6 male, 1 female) patients performed a ball-catching task where the acceleration (and hence ball velocity) was manipulated by adjusting the angle of the ramp. The type of sensory information (visual and/or auditory) specifying the ball's arrival at the catching zone was also manipulated. Our results showed that patients with PD demonstrate improved motor performance when reaching for a ball in motion, compared to when stationary. We observed how PD patients can adjust their movement kinematics in accordance with the speed of a moving target, even if vision of the target is occluded and patients have to rely solely on auditory information. We demonstrate that the availability of dynamic temporal information is crucial for eliciting motor improvements in PD. Furthermore, these effects appear independent from the sensory modality through-which the information is conveyed. 

Genome-wide association study for sight-threatening diabetic retinopathy reveals association with genetic variation near the GRB2 gene

AIMS/HYPOTHESIS: Diabetic retinopathy is a serious complication of diabetes mellitus and can lead to blindness. A genetic component, in addition to traditional risk factors, has been well described although strong genetic factors have not yet been identified. Here, we aimed to identify novel genetic risk factors for sight-threatening diabetic retinopathy using a genome-wide association study.

METHODS: Retinopathy was assessed in white Australians with type 2 diabetes mellitus. Genome-wide association analysis was conducted for comparison of cases of sight-threatening diabetic retinopathy (n = 336) with diabetic controls with no retinopathy (n = 508). Top ranking single nucleotide polymorphisms were typed in a type 2 diabetes replication cohort, a type 1 diabetes cohort and an Indian type 2 cohort. A mouse model of proliferative retinopathy was used to assess differential expression of the nearby candidate gene GRB2 by immunohistochemistry and quantitative western blot.

RESULTS: The top ranked variant was rs3805931 with p = 2.66 × 10(-7), but no association was found in the replication cohort. Only rs9896052 (p = 6.55 × 10(-5)) was associated with sight-threatening diabetic retinopathy in both the type 2 (p = 0.035) and the type 1 (p = 0.041) replication cohorts, as well as in the Indian cohort (p = 0.016). The study-wide meta-analysis reached genome-wide significance (p = 4.15 × 10(-8)). The GRB2 gene is located downstream of this variant and a mouse model of retinopathy showed increased GRB2 expression in the retina.

CONCLUSIONS/INTERPRETATION: Genetic variation near GRB2 on chromosome 17q25.1 is associated with sight-threatening diabetic retinopathy. Several genes in this region are promising candidates and in particular GRB2 is upregulated during retinal stress and neovascularisation.

51 Pegasi - a planet-bearing Maunder minimum candidate

We observed 51 Peg, the first detected planet-bearing star, in a 55 ks XMM-Newton pointing and in 5 ks pointings each with Chandra HRC-I and ACIS-S. The star has a very low count rate in the XMM observation, but is clearly visible in the Chandra images due to the detectors' different sensitivity at low X-ray energies. This allows a temperature estimate for 51 Peg's corona of T⪉ 1 MK; the detected ACIS-S photons can be plausibly explained by emission lines of a very cool plasma near 200 eV. The constantly low X-ray surface flux and the flat-activity profile seen in optical Ca II data suggest that 51 Peg is a Maunder minimum star; an activity enhancement due to a Hot Jupiter, as proposed by recent studies, seems to be absent. The star's X-ray fluxes in different instruments are consistent with the exception of the HRC Imager, which might have a larger effective area below 200 eV than given in the calibration.

The "Eco" and "Low-carbon" promise: a critical review of China's experience

The scale and speed of China’s urbanization translate into major challenges for sustainability. Could the ‘eco-city’ and ‘low-carbon’ agendas, and the promotion of related pilot cities drive Chinese urban practice towards more environmentally sustainable solutions? We explore this question through a critical review of experience in China, identifying problems relating to the development of space, the treatment of scale and the pursuit of efficiency (the ‘space-scale-efficiency nexus’). China seeks sustainable solutions through eco and low-carbon agendas, but our review finds that current efforts fall short of expectations, and problematic patterns are repeated. We propose that a geo-administrative notion of functional regions could provide a strategic framework to address the range of design, physical and administrative planning problems, ensuring that eco-city and low-carbon city pilots result in comprehensive solutions that can be effectively replicated.

Relationship between happiness, stress and musculoskeletal disorders in portuguese dentists

Tese de doutoramento, Medicina Dentária (Dentisteria Conservadora), Universidade de Lisboa, Faculdade de Medicina Dentária, 2016

Assessment of non-steroidal anti-inflammatory and analgesic pharmaceuticals in seawaters of North of Portugal: Occurrence and environmental risk

The occurrence of seven pharmaceuticals and two metabolites belonging to non-steroidal anti-inflammatory drugs and analgesics therapeutic classes was studied in seawaters. A total of 101 samples covering fourteen beaches and five cities were evaluated in order to assess the spatial distribution of pharmaceuticals among north Portuguese coast. Seawaters were selected in order to embrace different bathing water quality (excellent, good and sufficient). Acetaminophen, ketoprofen and the metabolite hydroxyibuprofen were detected in all the seawater samples at maximum concentrations of 584, 89.7 and 287 ng L− 1, respectively. Carboxyibuprofen had the highest seawater concentration (1227 ng L− 1). The temporal distribution of the selected pharmaceuticals during the bathing season showed that, in general, higher concentrations were detected in August and September. The environmental risk posed by the pharmaceuticals detected in seawaters towards different trophic levels (fish, daphnids and algae) was also assessed. Only diclofenac showed hazard quotients above one for fish, representing a potential risk for aquatic organisms. These results were observed in seawaters classified as excellent bathing water. Additional data is needed in order to support the identification and prioritization of risks posed by pharmaceuticals in marine environment.

Estructura especiológica de los subsistemas dermesal costero y pelagial costero. Prospección E/E Huamanga 9611-12

Se analiza la composición especiológica y distribución de las capturas obtenidas en la Prospección Pesquera Costera efectuada entre Punta Malpelo (03°30,32 'S; 80°33,36 'W), sur de Puerto Pizarro, y bahía Grande (11°12,46 'S; 77°43,20 'W), al norte de Huacho. Se capturaron 115 especies: 86 peces, 17 crustáceos, 6 moluscos, 3 equinodermos, un cnidario, un sálpido y un poliqueto. Los recursos demersales, con lances de arrastre de fondo, efectuados entre las Puntas Malpelo y Malabrigo (07°43,05 'S, 79°38,75 'W), tuvieron la mayor diversidad (113 especies) y la mayor captura (11 639,4 kg de pesca) destacando por sus volúmenes, tres especies que representaron el 74% de la pesca de arrastre: la merluza (Merluccius gayi peruanus con 6.508,1 kg) seguida del falso volador (Prionotus stephanophrys con 1.603,85 kg) y la anchoveta blanca (Anchoa nasus con 499,85 kg). Los recursos pelágicos se capturaron en menor volumen (581,2 kg), y dos especies constituyeron el 95,3% del total: la anchoveta (Engraulis ringens con 251,95 kg) y el bagre con faja (Galeichthys peruvianus con 301,7 kg).

Biología y Pesquería de Ethmidium maculatum “machete” procedente de la pesca artesanal en la Región La Libertad durante el 2010

Se determinaron las características de la Biología y Pesquería de Ethmidium maculatum “machete” procedente de la pesca artesanal en la Región La Libertad durante el 2010. Se trabajó con una base de datos de 1 508 individuos, obtenidos al azar de los desembarques artesanales de Caleta Puerto Morín, Puerto Salaverry, Caleta Huanchaco, Puerto Malabrigo y Puerto Pacasmayo. Para el análisis biológico se consideraron 10 ejemplares máximo por rango de talla. Para determinar el alimento y hábitos alimentarios se realizaron análisis de estimación porcentual y frecuencia de ocurrencia; para determinar las características reproductivas, se analizaron los estadios de madurez gonadal e índice gonadosomático; se determinó el grado de bienestar mediante el factor de condición de Fulton; las constantes de crecimiento fueron calculadas mediante el uso del software FISAT II. La talla media de captura fue inferior a la talla mínima legal establecida. Se tipificó a la especie en estudio como zooplanctonófaga. La proporción sexual fue favorable a las hembras; predominó el estadio desovante y la especie evidenció actividad reproductiva con mayor intensidad a fines de invierno. El crecimiento para hembras y machos fue alométrico. Se reportó un volumen de desembarque de 26 779 kg, y las principales zonas de pesca fueron: Chao, El Carmelo, Buenos Aires, Las Delicias, Salaverry, Los Brujos y Huanchaco.

Traité de mécanique : statique, cinématique, dynamique, hydraulique, résistance des matériaux, chaudières à vapeur, moteurs à vapeur et à gaz. Dynamique et hydraulique / par L. Arnal,...

Collection : Encyclopédie théorique et pratique des connaissances civiles et militaires ; partie 1, livre 8