Pressure-relieving equipment: promoting its correct use amongst nurses via differing modes of educational delivery

Aims and objectives. To examine the impact of written and verbal education on bed-making practices, in an attempt to reduce the prevalence of pressure ulcers. Background. The Department of Health has set targets for a 5% reduction per annum in the incidence of pressure ulcers. Electric profiling beds with a visco-elastic polymer mattress are a new innovation in pressure ulcer prevention; however, mattress efficacy is reduced by tightly tucking sheets around the mattress. Design. A prospective randomized pre/post-test experimental design. Methods. Ward managers at a teaching hospital were approached to participate in the study. Two researchers independently examined the tightness of the sheets around the mattresses. Wards were randomized to one of two groups. Groups A and B received written education. In addition, group B received verbal education on alternate days for one week. Beds were re-examined one month later. One researcher was blinded to the educational delivery received by the wards. Results. Twelve wards agreed to participate in the study and 245 beds were examined. Before education, 113 beds (46%) had sheets tucked correctly around the mattresses. Following education, this increased to 215 beds (87.8%) (chi(2) = 68.03, P < 0.001). There was no significant difference in the number of correctly made beds between the two different education groups: 100 (87.72%) beds correctly made in group A vs. 115 (87.79%) beds in group B (chi(2) = 0, P 0.987). Conclusions. Clear, concise written instruction improved practice but verbal education was not additionally beneficial. Relevance to clinical practice. Nurses are receptive to clear, concise written evidence regarding pressure ulcer prevention and incorporate this into clinical practice.

Diet, ageing and genetic factors in the pathogenesis of diverticular disease

Diverticular disease (DD) is an age-related disorder of the large bowel which may affect half of the population over the age of 65 in the UK. This high prevalence ranks it as one of the most common bowel disorders in western nations. The majority of patients remain asymptomatic but there are associated life-threatening co-morbidities, which, given the large numbers of people with DD, translates into a considerable number of deaths per annum. Despite this public health burden, relatively little seems to be known about either the mechanisms of development or causality. In the 1970s, a model of DD formulated the concept that diverticula occur as a consequence of pressureinduced damage to the colon wall amongst those with a low intake of dietary fiber. In this review, we have examined the evidence regarding the influence of ageing, diet, inflammation and genetics on DD development. We argue that the evidence supporting the barotrauma hypothesis is largely anecdotal. We have also identified several gaps in the knowledge base which need to be filled before we can complete

Energy generation and consumption in Ghana

Electricity consumption in Ghana is estimated to be increasing by 10% per annum due to the demand from the growing population. However, current sources of production (hydro and thermal facilities) generate only 66% of the current demand. Considering current trends, it is difficult to substantiate these basic facts, because of the lack of information. As a result, research into the existing sources of generating electricity, electricity consumption and prospective projects has been performed. This was achieved using three key techniques; review of literature, empirical studies and modelling. The results presented suggest that, current annual installed capacity of energy generation (i.e. 1960 MW) must be increased to 9,405.59 MW, assuming 85% plant availability. This is then capable to coop with the growing demand and it would give access to the entire population as well as support commercial and industrial activities for the growth of the economy. The prospect of performing this research is with the expectation to present an academic research agenda for further exploration into the subject area, without which the growth of the country would be stagnant.

CPD records for revalidation: assessing fitness-to-practise using ‘revalidation standards’ and an Outcomes Framework

Background: Currently, all pharmacists and technicians registered with the Royal Pharmaceutical Society of Great Britain must complete a minimum of nine Continuing Professional Development (CPD) record (entries) each year. From September 2010 a new regulatory body, the General Pharmaceutical Council, will oversee the regulation (including revalidation) of all pharmacy registrants in Great Britain. CPD may provide part of the supporting evidence that a practitioner submits to the regulator as part of the revalidation process. Gaps in knowledge necessitated further research to examine the usefulness of CPD in a pharmacy revalidation Project aims: The overall aims of this project were to summarise pharmacy professionals’ past involvement in CPD, examine the usability of current CPD entries for the purpose of revalidation, and to examine the impact of ‘revalidation standards’ and a bespoke Outcomes Framework on the conduct and construction of CPD entries for future revalidation of pharmacy professionals. We completed a comprehensive review of the literature, devised, validated and tested the impact of a new CPD Outcomes Framework and related training material in an empirical investigation involving volunteer pharmacy professionals and also spoke with our participants to bring meaning and understanding to the process of CPD conduct and recording and to gain feedback on the study itself. Key findings: The comprehensive literature review identified perceived barriers to CPD and resulted in recommendations that could potentially rectify pharmacy professionals’ perceptions and facilitate participation in CPD. The CPD Outcomes Framework can be used to score CPD entries Compared to a control (CPD and ‘revalidation standards’ only), we found that training participants to apply the CPD Outcomes Framework resulted in entries that scored significantly higher in the context of a quantitative method of CPD assessment. Feedback from participants who had received the CPD Outcomes Framework was positive and a number of useful suggestions were made about improvements to the Framework and related training. Entries scored higher because participants had consciously applied concepts linked to the CPD Outcomes Framework whereas entries scored low where participants had been unable to apply the concepts of the Framework for a variety of reasons including limitations posed by the ‘Plan & Record’ template. Feedback about the nature of the ‘revalidation standards’ and their application to CPD was not positive and participants had not in the main sought to apply the standards to their CPD entries – but those in the intervention group were more likely to have referred to the revalidation standards for their CPD. As assessors, we too found the process of selecting and assigning ‘revalidation standards’ to individual CPD entries burdensome and somewhat unspecific. We believe that addressing the perceived barriers and drawing on the facilitators will help deal with the apparent lack of engagement with the revalidation standards and have been able to make a set of relevant recommendations. We devised a model to explain and tell the story of CPD behaviour. Based on the concepts of purpose, action and results, the model centres on explaining two types of CPD behaviour, one following the traditional CE pathway and the other a more genuine CPD pathway. Entries which scored higher when we applied the CPD Outcomes Framework were more likely to follow the CPD pathway in the model above. Significant to our finding is that while participants following both models of practice took part in this study, the CPD Outcomes Framework was able to change people’s CPD behaviour to make it more inline with the CPD pathway. The CPD Outcomes Framework in defining the CPD criteria, the training pack in teaching the basis and use of the Framework and the process of assessment in using the CPD Outcomes Framework, would have interacted to improve participants’ CPD through a collective process. Participants were keen to receive a curriculum against which certainly CE-type activities could be conducted and another important observation relates to whether CE has any role to play in pharmacy professionals’ revalidation. We would recommend that the CPD Outcomes Framework is used in the revalidation of pharmacy professionals in the future provided the requirement to submit 9 CPD entries per annum is re-examined and expressed more clearly in relation to what specifically participants are being asked to submit – i.e. the ratio of CE to CPD entries. We can foresee a benefit in setting more regular intervals which would act as deadlines for CPD submission in the future. On the whole, there is value in using CPD for the purpose of pharmacy professionals’ revalidation in the future.

Molecular barley breeding

Breeding progress in barley yield in the UK is being sustained at a rate in the order of 1% per annum against a background of declining seed sales. Commercial barley breeders are largely concentrating upon the elite local gene pool but with genotypic evidence suggesting that there is still considerable variation between current recommended cultivars, even those produced as half-sibs by the same breeder. Marker Assisted Selection (MAS) protocols could be substituted for conventional selection for a number of major-gene targets but, in the majority of cases, conventional selection is more resource efficient. Results from current QTL mapping studies have not yet identified sufficiently robust and validated targets for UK barley breeders to adopt MAS to assist in the selection of complex traits such as yield and malting quality. Results from multiple population mapping amongst the elite gene pool being utilised by breeders and from association studies of elite germplasm tested as part of the UK recommended list trial process do, however, show some promise.

Statistical analysis of eight surface ozone measurement series for various sites in Ireland

Data from various stations having different measurement record periods between 1988 and 2007 are analyzed to investigate the surface ozone concentration, long-term trends, and seasonal changes in and around Ireland. Time series statistical analysis is performed on the monthly mean data using seasonal and trend decomposition procedures and the Box-Jenkins approach (autoregressive integrated moving average). In general, ozone concentrations in the Irish region are found to have a negative trend at all sites except at the coastal sites of Mace Head and Valentia. Data from the most polluted Dublin city site have shown a very strong negative trend of −0.33 ppb/yr with a 95% confidence limit of 0.17 ppb/yr (i.e., −0.33 ± 0.17) for the period 2002−2007, and for the site near the city of Cork, the trend is found to be −0.20 ± 0.11 ppb/yr over the same period. The negative trend for other sites is more pronounced when the data span is considered from around the year 2000 to 2007. Rural sites of Wexford and Monaghan have also shown a very strong negative trend of −0.99 ± 0.13 and −0.58 ± 0.12, respectively, for the period 2000−2007. Mace Head, a site that is representative of ozone changes in the air advected from the Atlantic to Europe in the marine planetary boundary layer, has shown a positive trend of about +0.16 ± 0.04 ppb per annum over the entire period 1988−2007, but this positive trend has reduced during recent years (e.g., in the period 2001−2007). Cluster analysis for back trajectories are performed for the stations having a long record of data, Mace Head and Lough Navar. For Mace Head, the northern and western clean air sectors have shown a similar positive trend (+0.17 ± 0.02 ppb/yr for the northern sector and +0.18 ± 0.02 ppb/yr for the western sector) for the whole period, but partial analysis for the clean western sector at Mace Head shows different trends during different time periods with a decrease in the positive trend since 1988 indicating a deceleration in the ozone trend for Atlantic air masses entering Europe.

Response of the Atlantic meridional overturning circulation to a reversal of greenhouse gas increases

The reversibility of the Atlantic meridional overturning circulation (AMOC) is investigated in multi-model experiments using global climate models (GCMs) where CO2 concentrations are increased by 1 or 2 % per annum to 2× or 4× preindustrial conditions. After a period of stabilisation the CO2 is decreased back to preindustrial conditions. In most experiments when the CO2 decreases, the AMOC recovers before becoming anomalously strong. This "overshoot" is up to an extra 18.2Sv or 104 % of its preindustrial strength, and the period with an anomalously strong AMOC can last for several hundred years. The magnitude of this overshoot is shown to be related to the build up of salinity in the subtropical Atlantic during the previous period of high CO2 levels. The magnitude of this build up is partly related to anthropogenic changes in the hydrological cycle. The mechanisms linking the subtropical salinity increase to the subsequent overshoot are analysed, supporting the relationship found. This understanding is used to explain differences seen in some models and scenarios. In one experiment there is no overshoot because there is little salinity build up, partly as a result of model differences in the hydrological cycle response to increased CO2 levels and partly because of a less aggressive scenario. Another experiment has a delayed overshoot, possibly as a result of a very weak AMOC in that GCM when CO2 is high. This study identifies aspects of overshoot behaviour that are robust across a multi-model and multi-scenario ensemble, and those that differ between experiments. These results could inform an assessment of the real-world AMOC response to decreasing CO2.

Magnetic resonance imaging of a randomized controlled trial investigating predictors of recovery following psychological treatment in adolescents with moderate to severe unipolar depression: study protocol for Magnetic Resonance - Improving Mood with Psychoanalytic and Cognitive Therapies (MR-IMPACT)

Background Major depressive disorders (MDD) are a debilitating and pervasive group of mental illnesses afflicting many millions of people resulting in the loss of 110 million working days and more than 2,500 suicides per annum. Adolescent MDD patients attending NHS clinics show high rates of recurrence into adult life. A meta-analysis of recent research shows that psychological treatments are not as efficacious as previously thought. Modest treatment outcomes of approximately 65% of cases responding suggest that aetiological and clinical heterogeneity may hamper the better use of existing therapies and discovery of more effective treatments. Information with respect to optimal treatment choice for individuals is lacking, with no validated biomarkers to aid therapeutic decision-making. Methods/Design Magnetic resonance-Improving Mood with Psychoanalytic and Cognitive Therapies, the MR-IMPACT study, plans to identify brain regions implicated in the pathophysiology of depressions and examine whether there are specific behavioural or neural markers predicting remission and/or subsequent relapse in a subsample of depressed adolescents recruited to the IMPACT randomised controlled trial (Registration # ISRCTN83033550). Discussion MR-IMPACT is an investigative biomarker component of the IMPACT pragmatic effectiveness trial. The aim of this investigation is to identify neural markers and regional indicators of the pathophysiology of and treatment response for MDD in adolescents. We anticipate that these data may enable more targeted treatment delivery by identifying those patients who may be optimal candidates for therapeutic response.

Evaluating the Bank of England density forecasts of inflation

We consider evaluating the UK Monetary Policy Committee's inflation density forecasts using probability integral transform goodness-of-fit tests. These tests evaluate the whole forecast density. We also consider whether the probabilities assigned to inflation being in certain ranges are well calibrated, where the ranges are chosen to be those of particular relevance to the MPC, given its remit of maintaining inflation rates in a band around per annum. Finally, we discuss the decision-based approach to forecast evaluation in relation to the MPC forecasts

Avoiding a bad apple: insect pollination enhances fruit quality and economic value

Insect pollination is important for food production globally and apples are one of the major fruit crops which are reliant on this ecosystem service. It is fundamentally important that the full range of benefits of insect pollination to crop production are understood, if the costs of interventions aiming to enhance pollination are to be compared against the costs of the interventions themselves. Most previous studies have simply assessed the benefits of pollination to crop yield and ignored quality benefits and how these translate through to economic values. In the present study we examine the influence of insect pollination services on farmgate output of two important UK apple varieties; Gala and Cox. Using field experiments, we quantify the influence of insect pollination on yield and importantly quality and whether either may be limited by sub-optimal insect pollination. Using an expanded bioeconomic model we value insect pollination to UK apple production and establish the potential for improvement through pollination service management. We show that insects are essential in the production of both varieties of apple in the UK and contribute a total of £36.7 million per annum, over £6 million more than the value calculated using more conventional dependence ratio methods. Insect pollination not only affects the quantity of production but can also have marked impacts on the quality of apples, influencing size, shape and effecting their classification for market. These effects are variety specific however. Due to the influence of pollination on both yield and quality in Gala, there is potential for insect pollination services to improve UK output by up to £5.7 million per annum. Our research shows that continued pollinator decline could have serious financial implications for the apple industry but there is considerable scope through management of wild pollinators or using managed pollinator augmentation, to improve the quality of production. Furthermore, we show that it is critically important to consider all production parameters including quality, varietal differences and management costs when valuing the pollination service of any crop so investment in pollinator management can be proportional to its contribution.

Pollination deficits in UK apple orchards

Apple production in the UK is worth over £100 million per annum and this production is heavily dependent on insect pollination. Despite its importance, it is not clear which insect pollinators carry out the majority of this pollination. Furthermore, it is unknown whether current UK apple production, in terms of both yield and quality, suffers pollination deficits and whether production value could be increased through effective management of pollination services. The present study set out to address some of these unknowns and showed that solitary bee activity is high in orchards and that they could be making a valuable contribution to pollination. Furthermore, fruit set and apple seed number were found to be suffering potential pollination deficits although these were not reflected in apple quality. Deficits could be addressed through orchard management practices to improve the abundance and diversity of wild pollinators. Such practices include provision of additional floral resources and nesting habitats as well as preservation of semi-natural areas. The cost effectiveness of such strategies would need to be understood taking into account the potential gains to the apple industry.

Can the Iberian floristic diversity withstand near-future climate change?

We assess how effectively the current network of protected areas (PAs) across the Iberian Peninsula will conserve plant diversity under near-future (2020) climate change. We computed 3267 MAXENT environmental niche models (ENMs) at 1-km spatial resolution for known Iberian plant species under two climate scenarios (1950-2000 baseline & 2020). To predict near-future species distributions across the network of Iberian and Balearics PAs, we combined projections of species’ ENMs with simulations of propagule dispersal by using six scenarios of annual dispersal rates (no dispersal, 0.1 km, 0.5 km, 1 km, 2 km and unlimited). Mined PA grid cell values for each species were then analyzed. We forecast 3% overall floristic diversity richness loss by 2020. The habitat of regionally extant species will contract on average by 13.14%. Niche movement exceeds 1 km per annum for 30% of extant species. While the southerly range margin of northern plant species retracts northward at 8.9 km per decade, overall niche movement is more easterly and westerly than northerly. There is little expansion of the northern range margin of southern plant species even under unlimited dispersal. Regardless of propagule dispersal rate, altitudinal niche movement of +25 m per decade is strongest for northern species. Pyrenees flora is most vulnerable to near-future climate change with many northern plant species responding by shifting their range westerly and easterly rather than northerly. Northern humid habitats will be particularly vulnerable to near-future climate change. Andalusian National Parks will become important southern biodiversity refuges. With limited human intervention (particularly in the Pyrenees), we conclude that floristic diversity in Iberian PAs should withstand near-future climate change.

Classification in e-procurement

Three coupled knowledge transfer partnerships used pattern recognition techniques to produce an e-procurement system which, the National Audit Office reports, could save the National Health Service £500 m per annum. An extension to the system, GreenInsight, allows the environmental impact of procurements to be assessed and savings made. Both systems require suitable products to be discovered and equivalent products recognised, for which classification is a key component. This paper describes the innovative work done for product classification, feature selection and reducing the impact of mislabelled data.

Farmers’ perceptions of the effectiveness of the Cocoa Disease and Pest Control Programme (CODAPEC) in Ghana and its effects on poverty reduction

The study examined the contribution of the Cocoa Disease and Pest Control Programme (CODAPEC), which is a cocoa production-enhancing government policy, to reducing poverty and raising the living standards of cocoa farmers in Ghana. One hundred and fifty (150) cocoa farmers were randomly selected from five communities in the Bibiani-Anhwiaso-Bekwai district of the Western Region of Ghana and interviewed using structured questionnaires. Just over half of the farmers (53%) perceived the CODAPEC programme as being effective in controlling pests and diseases, whilst 56.6% felt that their yields and hence livelihoods had improved. In some cases pesticides or fungicides were applied later in the season than recommended and this had a detrimental effect on yields. To determine the level of poverty amongst farmers, annual household consumption expenditure was used as a proxy indicator. The study found that 4.7% of cocoa farmers were extremely poor having a total annual household consumption expenditure of less than GH¢ 623.10 ($310.00) while 8.0% were poor with less than GH¢ 801.62 ($398.81). An amount of money ranging from GH¢ 20.00 ($9.95) to GH¢ 89.04 ($44.29) per annum was needed to lift the 4.7% of cocoa farmers out of extreme poverty, which could be achieved through modest increases in productivity. The study highlighted how agricultural intervention programmes, such as CODAPEC, have the potential to contribute to improved farmer livelihoods.

Caesium, potassium and ammonium distributions in different organs of tropical plants

In the present work the distribution of ions in aboveground plant parts was studied in order to establish the suitability of using radiocaesium as a tracer for the plant absorption of nutrients, such as potassium (K(+)) and ammonium (NH(4)(+)). We present the results for the distributions of (137)Cs, (40)K and NH(4)(+) from four tropical plant species: lemon (Citrus aurantifolia), orange (Citrus sinensis), guava (Psidium guajava) and chili pepper (Capsicum frutescens). Activity concentrations of (137)Cs and (40)K were measured by gamma spectrometry and concentrations of free NH(4)(+) ions by a colorimetric method. Similarly to potassium and ammonium, caesium showed a high mobility within the plants, exhibiting the highest values of concentration in the growing parts of the tree (fruits, new leaves, twigs, and barks). A significant correlation between activity concentrations of (137)Cs and (40)K was observed in these tropical plants. The K/Cs discrimination ratios were approximately equal to unity in different compartments of each individual plant, suggesting that caesium could be a good tracer for (40)K in tropical woody fruit species. Despite the similarity observed for the behaviour of caesium and ammonium in the newly grown plant compartments, (137)Cs was not well correlated with NH(4)(+). Significant temporal changes in the NH(4)(+) concentrations were observed during the development of fruits, while the (137)Cs activity concentration alterations were not of great importance, indicating, therefore, that Cs(+) and free NH(4)(+) ions could have distinct concentration ratios for each particular plant organ. (C) 2008 Elsevier B.V. All rights reserved.