The prevalence and nature of prescribing and monitoring errors in English general practice – a retrospective case note review

Objective To determine the prevalence and nature of prescribing and monitoring errors in general practices in England. Design Retrospective case note review of unique medication items prescribed over a 12 month period to a 2% random sample of patients. Mixed effects logistic regression was used to analyse the data. Setting Fifteen general practices across three primary care trusts in England. Data sources Examination of 6048 unique prescription items prescribed over the previous 12 months for 1777 patients. Main outcome measures Prevalence of prescribing and monitoring errors, and severity of errors, using validated definitions. Results Prescribing and/or monitoring errors were detected in 4.9% (296/6048) of all prescription items (95% confidence interval 4.4 - 5.5%). The vast majority of errors were of mild to moderate severity, with 0.2% (11/6048) of items having a severe error. After adjusting for covariates, patient-related factors associated with an increased risk of prescribing and/or monitoring errors were: age less than 15 (Odds Ratio (OR) 1.87, 1.19 to 2.94, p=0.006) or greater than 64 years (OR 1.68, 1.04 to 2.73, p=0.035), and higher numbers of unique medication items prescribed (OR 1.16, 1.12 to 1.19, p<0.001). Conclusion Prescribing and monitoring errors are common in English general practice, although severe errors are unusual. Many factors increase the risk of error. Having identified the most common and important errors, and the factors associated with these, strategies to prevent future errors should be developed based on the study findings.

BIM: innovation in design management, influence and challenges of implementation

The construction industry is widely being criticised as a fragmented industry. There are mounting calls for the industry to change. The espoused change calls for collaboration as well as embracing innovation in the process of design, construction and across the supply chain. Innovation and the application of emerging technologies are seen as enablers for integrating the processes ‘integrating the team’ such as building information modelling (BIM). A questionnaire survey was conducted to ascertain change in construction with regard to design management, innovation and the application of BIM as cutting edge pathways for collaboration. The respondents to the survey were from an array of designations across the construction industry such as construction managers, designers, engineers, design coordinators, design managers, architects, architectural technologists and surveyors. There was a general agreement by most respondents that the design team was responsible for design management in their organisation. There is a perception that the design manager and the client are the catalyst for advancing innovation. The current state of industry in terms of incorporating BIM technologies is posing a challenge as well as providing an opportunity for accomplishment. BIM technologies provide a new paradigm shift in the way buildings are designed, constructed and maintained. This paradigm shift calls for rethinking the curriculum for educating building professionals, collectively.

Fashion magazines: design implications of focus and perception variance between Chinese and UK females

A growing segment of Chinese women are willing to spend a high percentage of their income on fashion related products, however there appears to be concern over the quality of Chinese fashion magazines. Concern can be focused in two major issues: i) fashion magazine design, and ii) pictorial and textual distribution of content. This paper investigates how human factors (i.e. social norms and individual differences) influence fashion magazine design/format preferences, and investigates the difference in readership patterns between British and Chinese Women. Our study identifies significant differences between UK and Chinese readership; which has an impact on magazine viewing patterns and content preference.

Results of PMIP2 coupled simulations of the mid-Holocene and Last Glacial Maximum, Part 1: experiments and large-scale features

A set of coupled ocean-atmosphere simulations using state of the art climate models is now available for the Last Glacial Maximum and the Mid-Holocene through the second phase of the Paleoclimate Modeling Intercomparison Project (PMIP2). This study presents the large-scale features of the simulated climates and compares the new model results to those of the atmospheric models from the first phase of the PMIP, for which sea surface temperature was prescribed or computed using simple slab ocean formulations. We consider the large-scale features of the climate change, pointing out some of the major differences between the different sets of experiments. We show in particular that systematic differences between PMIP1 and PMIP2 simulations are due to the interactive ocean, such as the amplification of the African monsoon at the Mid-Holocene or the change in precipitation in mid-latitudes at the LGM. Also the PMIP2 simulations are in general in better agreement with data than PMIP1 simulations.

Creep and recovery of magnetorheological fluids: experiments and simulations

A direct comparative study on the creep-recovery behavior of conventional MR fluids is carried out using magnetorheometry and particle-level simulations. Two particle concentrations are investigated (ϕ=0.05 and 0.30) at two different magnetic field strengths (53 kA•m-1 and 173 kA•m-1) in order to match the yield stresses developed in both systems for easier comparison. Simulations are mostly started with random initial structures with some additional tests of using preassembled single chains in the low concentration case. Experimental and simulation data are in good qualitative agreement. The results demonstrate three regions in the creep curves: i) In the initial viscoelastic region, the chain-like (at ϕ=0.05) or percolated three-dimensional network (at ϕ=0.30) structures fill up the gap and the average cluster size remains constant; ii) Above a critical strain of 10 %, in the retardation region, these structures begin to break and rearrange under shear. At large enough imposed stress values, they transform into thin sheet-like or thick lamellar structures, depending on the particle concentration; iii) Finally in the case of larger strain values either the viscosity diverges (at low stress values) or reaches a constant low value (at high stress values), showing a clear bifurcation behavior. For stresses below the bifurcation point the MR fluid is capable to recover the strain by a certain fraction. However, no recovery is observed for large stress values.

Prostate cancer: important steps and considerations in the design of therapeutic vaccines

Vaccine-based immunotherapy can increase the overall survival of patients with advanced prostate cancer. However, the efficacy of vaccine-elicited anticancer immune responses is heavily influenced by the physical, nutritional, and psychological status of the patient. Given their importance, these parameters should be carefully considered for the design of future clinical trials testing this immunotherapeutic paradigm in prostate cancer patients.

Aspects of designing and evaluating seasonal-to-interannual Arctic sea-ice prediction systems

Using lessons from idealised predictability experiments, we discuss some issues and perspectives on the design of operational seasonal to inter-annual Arctic sea-ice prediction systems. We first review the opportunities to use a hierarchy of different types of experiment to learn about the predictability of Arctic climate. We also examine key issues for ensemble system design, such as: measuring skill, the role of ensemble size and generation of ensemble members. When assessing the potential skill of a set of prediction experiments, using more than one metric is essential as different choices can significantly alter conclusions about the presence or lack of skill. We find that increasing both the number of hindcasts and ensemble size is important for reliably assessing the correlation and expected error in forecasts. For other metrics, such as dispersion, increasing ensemble size is most important. Probabilistic measures of skill can also provide useful information about the reliability of forecasts. In addition, various methods for generating the different ensemble members are tested. The range of techniques can produce surprisingly different ensemble spread characteristics. The lessons learnt should help inform the design of future operational prediction systems.

Design of a unified data with business rules storage model for OLTP and OLAP systems

This paper reviews the literature concerning the practice of using Online Analytical Processing (OLAP) systems to recall information stored by Online Transactional Processing (OLTP) systems. Such a review provides a basis for discussion on the need for the information that are recalled through OLAP systems to maintain the contexts of transactions with the data captured by the respective OLTP system. The paper observes an industry trend involving the use of OLTP systems to process information into data, which are then stored in databases without the business rules that were used to process information and data stored in OLTP databases without associated business rules. This includes the necessitation of a practice, whereby, sets of business rules are used to extract, cleanse, transform and load data from disparate OLTP systems into OLAP databases to support the requirements for complex reporting and analytics. These sets of business rules are usually not the same as business rules used to capture data in particular OLTP systems. The paper argues that, differences between the business rules used to interpret these same data sets, risk gaps in semantics between information captured by OLTP systems and information recalled through OLAP systems. Literature concerning the modeling of business transaction information as facts with context as part of the modelling of information systems were reviewed to identify design trends that are contributing to the design quality of OLTP and OLAP systems. The paper then argues that; the quality of OLTP and OLAP systems design has a critical dependency on the capture of facts with associated context, encoding facts with contexts into data with business rules, storage and sourcing of data with business rules, decoding data with business rules into the facts with the context and recall of facts with associated contexts. The paper proposes UBIRQ, a design model to aid the co-design of data with business rules storage for OLTP and OLAP purposes. The proposed design model provides the opportunity for the implementation and use of multi-purpose databases, and business rules stores for OLTP and OLAP systems. Such implementations would enable the use of OLTP systems to record and store data with executions of business rules, which will allow for the use of OLTP and OLAP systems to query data with business rules used to capture the data. Thereby ensuring information recalled via OLAP systems preserves the contexts of transactions as per the data captured by the respective OLTP system.

Compensation and Rewards for Environmental Services (CRES) and efficient design of contracts in developing countries. Behavioral insights from a natural field experiment

The use of economic incentives for biodiversity (mostly Compensation and Reward for Environmental Services including Payment for ES) has been widely supported in the past decades and became the main innovative policy tools for biodiversity conservation worldwide. These policy tools are often based on the insight that rational actors perfectly weigh the costs and benefits of adopting certain behaviors and well-crafted economic incentives and disincentives will lead to socially desirable development scenarios. This rationalist mode of thought has provided interesting insights and results, but it also misestimates the context by which ‘real individuals’ come to decisions, and the multitude of factors influencing development sequences. In this study, our goal is to examine how these policies can take advantage of some unintended behavioral reactions that might in return impact, either positively or negatively, general policy performances. We test the effect of income's origin (‘Low effort’ based money vs. ‘High effort’ based money) on spending decisions (Necessity vs. Superior goods) and subsequent pro social preferences (Future pro-environmental behavior) within Madagascar rural areas, using a natural field experiment. Our results show that money obtained under low effort leads to different consumption patterns than money obtained under high efforts: superior goods are more salient in the case of low effort money. In parallel, money obtained under low effort leads to subsequent higher pro social behavior. Compensation and rewards policies for ecosystem services may mobilize knowledge on behavioral biases to improve their design and foster positive spillovers on their development goals.

Future, Fortune, and the graphic design of information

This is a study of graphic information designed for Future Books/Future magazine (UK) and Fortune magazine (USA) in the years immediately after the Second World War. It highlights work made by the Isotype Institute for Future, which is then situated against contributions by Abram Games and F. H. K. Henrion. Similar work in Fortune under the art editorship of Will Burtin is discussed in a parallel account, drawing on examples by him and by others including György Kepes, Matthew Liebowitz, Alex Steinweiss and Ladislav Sutnar. Attention is drawn to links and relationships between to the two periodicals and the graphic information published in both. Further comparisons are made between underlying editorial and design strategies pursued by Otto Neurath (Isotype Institute) and Will Burtin. An argument is made for recognising the little-known innovations of Future alongside the long-acknowledged innovations of Fortune.

Start-up rheometry of highly polydisperse magnetorheological fluids: experiments and simulations

An extensive experimental and simulation study is carried out in conventional magnetorheological fluids formulated by dispersion of mixtures of carbonyl iron particles having different sizes in Newtonian carriers. Apparent yield stress data are reported for a wide range of polydispersity indexes (PDI) from PDI = 1.63 to PDI = 3.31, which for a log-normal distribution corresponds to the standard deviation ranging from to . These results demonstrate that the effect of polydispersity is negligible in this range in spite of exhibiting very different microstructures. Experimental data in the magnetic saturation regime are in quantitative good agreement with particle-level simulations under the assumption of dipolar magnetostatic forces. The insensitivity of the yield stresses to the polydispersity can be understood from the interplay between the particle cluster size distribution and the packing density of particles inside the clusters.

A case study of the Tatweer school system in Saudi Arabia: the perceptions of leaders and teachers

School reform is a major concern in many countries that seek to improve their educational systems and enhance their performances. In consequence, many global schemes, theories, studies, attempts, and programmes have been introduced to promote education in recent years. Saudi Arabia is one of these countries that implemented educational change by introducing many initiatives. The Tatweer Programme is one of these initiatives and is considered as a major recent reform. The main purpose of this study is to investigate this reform in depth by examining the perceptions and experiences of the Tatweer leaders and teachers to find out which extent they have been enabled to be innovative, and to examine the types of leadership and decision-making that have been undertaken by such schools. This study adopted a qualitative case study that employed interviews, focus groups and documentary analysis. The design of the study has been divided into two phases; the first phase was the feasibility study and the second phase was the main study. The research sample of the feasibility study was head teachers, educational experts and Tatweer Unit’s members. The sample of the main study was three Tatweer schools, Tatweer Unit members and one official of Tatweer Project in Riyadh. The findings of this study identified the level of autonomy in managing the school; the Tatweer schools’ system is semi-autonomous when it comes to the internal management, but it lacks autonomy when it comes to staff appointment, student assessment, and curriculum development. In addition, the managerial work has been distributed through teams and members; the Excellence Team plays a critical role in school effectiveness leading an efficient change. Moreover, Professional Learning Communities have been used to enhance the work within Tatweer schools. Finally the findings show that there have been major shifts in the Tatweer schools’ system; the shifting from centralisation to semi-decentralisation; from the culture of the individual to the culture of community; from the traditional school to one focused on self-evaluation and planning; from management to leadership; and from an isolated school being open to society. These shifts have impacted positively on the attitudes of students, parents and staff.

Design and analysis of a haptic device design for large and fast movements

Haptic devices tend to be kept small as it is easier to achieve a large change of stiffness with a low associated apparent mass. If large movements are required there is a usually a reduction in the quality of the haptic sensations which can be displayed. The typical measure of haptic device performance is impedance-width (z-width) but this does not account for actuator saturation, usable workspace or the ability to do rapid movements. This paper presents the analysis and evaluation of a haptic device design, utilizing a variant of redundant kinematics, sometimes referred to as a macro-micro configuration, intended to allow large and fast movements without loss of impedance-width. A brief mathematical analysis of the design constraints is given and a prototype system is described where the effects of different elements of the control scheme can be examined to better understand the potential benefits and trade-offs in the design. Finally, the performance of the system is evaluated using a Fitts’ Law test and found to compare favourably with similar evaluations of smaller workspace devices.

Impact of socioeconomic and clinical factors on child oral health-related quality of life (COHRQoL)

Child oral health-related quality of life (COHRQoL) has been increasingly assessed; however, few studies appraised the influence of socioeconomic status on COHRQoL in developing countries. This study assessed the relationship of COHRQoL with socioeconomic backgrounds and clinical factors. This study followed a cross-sectional design, with a multistage random sample of 792 schoolchildren aged 12 years, representative of Santa Maria, a southern city in Brazil. Participants completed the Brazilian version of the Child Perceptions Questionnaire (CPQ(11-14)), their parents or guardians answered questions on socioeconomic status, and a dental examination provided information on the prevalence of caries, dental trauma and occlusion. The assessment of association used hierarchically adjusted Poisson regression models. Higher impacts on COHRQoL were observed for children presenting with untreated dental caries (RR 1.20; 95% CI 1.07-1.35) and maxillary overjet (RR 1.19; 95% CI 1.02-1.40). Socioeconomic factors also associated with COHRQoL; poorer scores were reported by children whose mothers have not completed primary education (RR 1.30; 95% CI 1.17-1.44) and those with lower household income (RR 1.13; 95% CI 1.02-1.26). Poor socioeconomic standings and poor dental status have a negative impact on COHRQoL; reducing health inequalities may demand dental programmes and policies targeting deprived population.