PIPc study: development of indicators of potentially inappropriate prescribing in children (PIPc) in primary care using a modified Delphi technique

Objective There is limited evidence regarding the quality of prescribing for children in primary care. Several prescribing criteria (indicators) have been developed to assess the appropriateness of prescribing in older and middle-aged adults but few are relevant to children. The objective of this study was to develop a set of prescribing indicators that can be applied to prescribing or dispensing data sets to determine the prevalence of potentially inappropriate prescribing in children (PIPc) in primary care settings.


Design Two-round modified Delphi consensus method.


Setting Irish and UK general practice.


Participants A project steering group consisting of academic and clinical general practitioners (GPs) and pharmacists was formed to develop a list of indicators from literature review and clinical expertise. 15 experts consisting of GPs, pharmacists and paediatricians from the Republic of Ireland and the UK formed the Delphi panel.


Results 47 indicators were reviewed by the project steering group and 16 were presented to the Delphi panel. In the first round of this exercise, consensus was achieved on nine of these indicators. Of the remaining seven indicators, two were removed following review of expert panel comments and discussion of the project steering group. The second round of the Delphi process focused on the remaining five indicators, which were amended based on first round feedback. Three indicators were accepted following the second round of the Delphi process and the remaining two indicators were removed. The final list consisted of 12 indicators categorised by respiratory system (n=6), gastrointestinal system (n=2), neurological system (n=2) and dermatological system (n=2).


Conclusions The PIPc indicators are a set of prescribing criteria developed for use in children in primary care in the absence of clinical information. The utility of these criteria will be tested in further studies using prescribing databases.

Public Consultation on the development of a National Cancer Strategy for 2016-2025

The Minister for Health Leo Varadkar has announced that a new National Cancer Strategy is to be developed. This will be the third cancer strategy, covering the period 2016 to 2025. A Cancer Strategy Steering Group has been established to advise the Department on the development of the Strategy. It is anticipated that the work of the Steering Group will be completed by the end of 2015, when it will make recommendations on a draft Strategy to the Minister. The implementation of a new strategy will commence in 2016. (Further information is available at: http://health.gov.ie/blog/press-release/steering-group-to-develop-national-cancer-strategy-2016-2025).

Bridging Perspectives

People’s ability to change their social and economic circumstances may be constrained by various forms of social, cultural and political domination. Thus to consider a social actor’s particular lifeworld in which the research is embedded assists in the understanding of how and why different trajectories of change occur or are hindered and how those changes fundamentally affect livelihood opportunities and constraints. In seeking to fulfill this condition this thesis adopted an actor-oriented approach to the study of rural livelihoods. A comprehensive livelihoods study requires grasping how social reality is being historically constituted. That means to understand how the interaction of modes of production and symbolical reproduction produces the socio-space. Research is here integrated to action through the facilitation of farmer groups. The overall aim of the groups was to prompt agency, as essential conditions to build more resilient livelihoods. The smallholder farmers in the Mabalane District of Mozambique are located in a remote semi-arid area. Their livelihoods customarily depend at least as much on livestock as on (mostly) rain-fed food crops. Increased climate variability exerts pressure on the already vulnerable production system. An extensive 10-month duration of participant observation divided into 3 periods of fieldwork structured the situated multi-method approach that drew on a set of interview categories. The actor-oriented appraisal of livelihoods worked in building a mutually shared definition of the situation. This reflection process was taken up by the facilitation of the farmer groups, one in Mabomo and one in Mungazi, which used an inquiry iteratively combining individual interviews and facilitated group meetings. Integration of action and reflection was fundamental for group constitution as spaces for communicative action. They needed to be self-organized and to achieve understanding intersubjectively, as well as to base action on cooperation and coordination. Results from this approach focus on how learning as collaboratively generated was enabled, or at times hindered, in (a) selecting meaningful options to test; (b) in developing mechanisms for group functioning; and (c) in learning from steering the testing of options. The study of livelihoods looked at how the different assets composing livelihoods are intertwined and how the increased severity of dry spells is contributing to escalated food insecurity. The reorganization of the social space, as households moved from scattered homesteads to form settlements, further exerts pressure on the already scarce natural resource-based livelihoods. Moreover, this process disrupted a normative base substantiating the way that the use of resources is governed. Hence, actual livelihood strategies and response mechanisms turn to diversification through income-generating activities that further increase pressure on the resource-base in a rather unsustainable way. These response mechanisms are, for example, the increase in small-livestock keeping, which has easier conversion to cash, and charcoal production. The latter results in ever more precarious living and working conditions. In the majority of the cases such responses are short-term and reduce future opportunities in a downward spiral of continuously decreasing assets. Thus, by indicating the failure of institutions in the mediation of smallholders’ adaptive capabilities, the livelihood assessment in Mabomo and Mungazi sheds light on the complex underlying structure of present day social vulnerability, linking the macro-context to the actual situation. To assist in breaking this state of “subordination”, shaped by historical processes, weak institutions and food insecurity, the chosen approach to facilitation of farmer groups puts farmer knowledge at the center of an evolving process of intersubjective co-construction of knowledge towards emancipation.

Continuation of Benchmark Project - Phase IV, 1999 Calendar Year, 2000

This is the final Report to the Iowa DOT Offices of Construction and the Highway Division for the calendar year 1999 research project entitled - Continuation of Benchmarking Project: Phase IV. This project continues efforts started in 1995 with the development of a performance measurement system. The performance measurements were used to identify areas that required improvement and process improvement teams (PITs) were launched to make recommendations for improvement. This report provides a brief historical background, documents Benchmark Steering Team Activities, describes measurement activities including the employee survey and collection of non-survey data. Then a retrospective of past PIT activities is given, which sets the stage for the substantial increase in PIT activity that occurred during the winter of 1998/9. Finally, the report closes with suggestions for future directions in Benchmarking Activity.

U.S. Highway 20 Corridor Development Study, Report B: Improvement Alternatives, Costs and Traffic, 1992

In February the U.S. 20 Corridor Development Study's Steering Committee met to review Report A. At that meeting the Committee selected seven alternatives to be evaluated from a cost and traffic perspective. This report, Report B, presents the cost and traffic evaluation of these seven alternatives. This Report B and its cost and traffic estimates will be reviewed at the next Steering Committee meeting. At that time it is possible that, based on the traffic and cost estimates, one or more of the alternatives will be eliminated from further consideration. After that meeting the Consultant will initiate the more in-depth analyses, including the economic feasibility

Finite Element Modeling of Spiral Frequency Steerable Acoustic Transducers (FSATs) for guided waves based Structural Health Monitoring of plate-like structures

Structural Health Monitoring (SHM) is an emerging area of research associated to improvement of maintainability and the safety of aerospace, civil and mechanical infrastructures by means of monitoring and damage detection. Guided wave structural testing method is an approach for health monitoring of plate-like structures using smart material piezoelectric transducers. Among many kinds of transducers, the ones that have beam steering feature can perform more accurate surface interrogation. A frequency steerable acoustic transducer (FSATs) is capable of beam steering by varying the input frequency and consequently can detect and localize damage in structures. Guided wave inspection is typically performed through phased arrays which feature a large number of piezoelectric transducers, complexity and limitations. To overcome the weight penalty, the complex circuity and maintenance concern associated with wiring a large number of transducers, new FSATs are proposed that present inherent directional capabilities when generating and sensing elastic waves. The first generation of Spiral FSAT has two main limitations. First, waves are excited or sensed in one direction and in the opposite one (180 ̊ ambiguity) and second, just a relatively rude approximation of the desired directivity has been attained. Second generation of Spiral FSAT is proposed to overcome the first generation limitations. The importance of simulation tools becomes higher when a new idea is proposed and starts to be developed. The shaped transducer concept, especially the second generation of spiral FSAT is a novel idea in guided waves based of Structural Health Monitoring systems, hence finding a simulation tool is a necessity to develop various design aspects of this innovative transducer. In this work, the numerical simulation of the 1st and 2nd generations of Spiral FSAT has been conducted to prove the directional capability of excited guided waves through a plate-like structure.

Modélisation pour l'imagerie des composites par ondes guidées

Parmi les méthodes les plus utilisées en inspection embarquée des structures (Structural Health Monitoring ou SHM), les techniques d’imagerie basées sur un modèle de propagation sont de plus en plus répandues. Pour les techniques d'imagerie basées sur un modèle de propagation, bien que ces techniques montent en popularité, la complexité des matériaux composites réduit grandement leur performance en détection d'endommagements comparativement aux démonstrations précédentes de leur potentiel sur des matériaux isotropes. Cette limitation dépend entre autres des hypothèses simplificatrices souvent posées dans les modèles utilisés et peut entraîner une augmentation des faux positifs et une réduction de la capacité de ces techniques à détecter des endommagements. Afin de permettre aux techniques d'imagerie basées sur un modèle d'offrir une performance équivalente à celle obtenue précédemment sur les structures métalliques, il est nécessaire d'exploiter des modèles de propagation considérant la dynamique complexe des ondes dans ce type de structures. Cette thèse présente les travaux effectués sur la modélisation de la propagation des ondes guidées dans les matériaux composites. En première partie, une amélioration simple des modèles de génération et de propagation est proposée afin de permettre de mieux reconstruire les signaux générés et propagés sur une structure composite. Par la suite, le potentiel de la technique « Excitelet » à détecter et positionner adéquatement un ou plusieurs endommagements sur un matériau, peu importe son empilement (d’un composite unidirectionnel à un matériau isotrope), est démontré tant pour le mode A[indice inférieur 0] que le mode S[indice inférieur 0]. Les résultats obtenus numériquement et expérimentalement démontrent une corrélation directe entre l'amélioration des modèles mathématiques derrière les techniques d'imagerie et la robustesse des techniques pour ce qui est de la précision sur le positionnement du dommage et du niveau de corrélation obtenu. Parmi les améliorations à la technique d'imagerie « Excitelet » proposées, une amélioration significative des résultats en imagerie est démontrée en considérant la distribution de cisaillement plan sous l’émetteur, ce qui est une nouveauté par rapport aux travaux de recherche précédents en imagerie. La performance de la technique d'imagerie via la modélisation de la propagation d'ondes guidées dans les laminés multicouches transverses isotropes est par la suite démontrée. Les équations de l'élasticité en 3D sont utilisées pour bien modéliser le comportement dispersif des ondes dans les composites, et cette formulation est par la suite implantée dans la technique d'imagerie « Excitelet ». Les résultats démontrent que l'utilisation d'une formulation mathématique plus avancée permet d'augmenter la précision quant au positionnement des dommages et à l'amplitude de la corrélation obtenue lors de la détection d'un dommage. Une analyse exhaustive de la sensibilité de la technique d’imagerie et de la propagation d’ondes aux conditions environnementales et à la présence de revêtement sur la structure est présentée en dernière partie. Les résultats obtenus montrent que la considération de la propagation complexe dans la formulation d’imagerie ainsi que la caractérisation des propriétés mécaniques « a priori » de l’imagerie améliorent la robustesse de la technique et confèrent à la technique « Excitelet » la capacité de détecter et positionner précisément un endommagement, peu importe le type de structure.

Moving together – conditions for intercultural development at a highly diverse Swedish school

This thesis is a case study of a primary school in a highly diverse urban neighbourhood in Sweden. Basic pre-conditions for intercultural school development are studied by examining the overall organisation of teaching, learning and opportunities for collaboration in the investigated case. The study focuses on the targeted support measures to enhance learning for students with an immigrant background: Mother tongue instruction, Swedish as a Second Language, and tutoring in the mother tongue, as well as looking at pedagogical support provided by the school library. The latter has a mission to promote learning and inclusion, where non-native speakers of Swedish are a prioritised group. Communities of practice linked to the work organisation at a meso-level are investigated, and the collaborative relationships between professional groups at the school involved in the various support measures. Teacher relationships and categorisations implied by support measures impact the learning spaces that are shaped for students and the teaching spaces within which teachers work. Collaborative opportunities and convergence of concerns in the teaching spaces combine to shape the overall space for intercultural development. The raw data for the case study consists of interviews, national policy documents and additional information on local work organisation gained through documents and observations. Four articles resulted from the case study, each focusing a specific support measure. An overarching analysis is then made of findings from these articles and the other dimensions of the investigation. The analysis describes the organisation in terms of monocultural or intercultural school cultures, pointing to significant characteristics of the landscapes of practice, with respect to their overall implications for the spaces of school development. In the discussion, findings are considered in relation to research on professional development in education, collaboration, democracy and inclusive schooling. The relative positioning of languages and cultures is given particular attention, to ascertain if the school culture is monocultural or intercultural in the sense given by Lahdenperä (2008), and to what extent it could enable intercultural development. Such positioning plays a role interms of affordances for identity, participation and engagement discussed by Wenger (1998). This case study should be understood against the wider background of recent social developments in Europe linked to globalisation and technological changes. It is argued that looking at the concrete specifics which facilitate or obstruct school development, and simultaneously reflecting on how the different forms of teaching interrelate in the overall organisation and in policy may provide a useful vantage point from which structural changes can be contemplated.The discussion underlines the importance of the physical localisation of activities, continuity in personal contacts and time available for joint pedagogical reflection, as basic conditions for effective intercultural dialogue in the organisation. Finally, the impact of policy is considered, looking at connections between levels of policy, expressed in official steering documents, and conditions for teaching and learning at the level of an individual school.

Analysis of Automotive Cybersecurity - Attack surfaces and users’ privacy concerns

Modern automobiles are no longer just mechanical tools. The electronics and computing services they are shipping with are making them not less than a computer. They are massive kinetic devices with sophisticated computing power. Most of the modern vehicles are made with the added connectivity in mind which may be vulnerable to outside attack. Researchers have shown that it is possible to infiltrate into a vehicle’s internal system remotely and control the physical entities such as steering and brakes. It is quite possible to experience such attacks on a moving vehicle and unable to use the controls. These massive connected computers can be life threatening as they are related to everyday lifestyle. First part of this research studied the attack surfaces in the automotive cybersecurity domain. It also illustrated the attack methods and capabilities of the damages. Online survey has been deployed as data collection tool to learn about the consumers’ usage of such vulnerable automotive services. The second part of the research portrayed the consumers’ privacy in automotive world. It has been found that almost hundred percent of modern vehicles has the capabilities to send vehicle diagnostic data as well as user generated data to their manufacturers, and almost thirty five percent automotive companies are collecting them already. Internet privacy has been studies before in many related domain but no privacy scale were matched for automotive consumers. It created the research gap and motivation for this thesis. A study has been performed to use well established consumers privacy scale – IUIPC to match with the automotive consumers’ privacy situation. Hypotheses were developed based on the IUIPC model for internet consumers’ privacy and they were studied by the finding from the data collection methods. Based on the key findings of the research, all the hypotheses were accepted and hence it is found that automotive consumers’ privacy did follow the IUIPC model under certain conditions. It is also found that a majority of automotive consumers use the services and devices that are vulnerable and prone to cyber-attacks. It is also established that there is a market for automotive cybersecurity services and consumers are willing to pay certain fees to avail that.

The flexible citizen: education and citizenship

This paper considers the recent focus on citizenship within education by taking curricular reform within Scottish secondary schooling and its linkage with higher education as a case study. In Scotland the Curriculum for Excellence reform places citizenship as one of the four main capacities that pupils must work towards as part of their education. This is echoed to some extent within higher education through the Enhancement Theme reforms and the focus on graduate attributes. A unifying theme in these reforms is the need for students to work across different disciplines, to develop a cross-disciplinary perspective on the world by, for example, considering issues of sustainability in relation to scientific or technological developments. In this model of curriculum development teaching staff are considered as agents of change, enabling learners to develop their sense of citizenship in response to a fast-paced world of innovation and change. This kind of change is objectified as a need that must be responded to and met if tomorrow’s citizens are to be able to not only cope, but thrive in the world in which they inhabit. As such, the citizen is positioned as an ongoing project, as something to be worked at and worked on. However, this kind of notion of agency cloaks an neoliberal ideological construction of the citizen as a flexible resource for society, and usually in relation to economic output. The paper seeks to subject this construction of the citizen to critical scrutiny in relation to the idea that, in education, learners are developing their ability to be creative and enquiring in order to be adaptive to change.

Quantum Otto heat engine based on a multiferroic chain working substance

We study a quantum Otto engine operating on the basis of a helical spin-1/2 multiferroic chain with strongly coupled magnetic and ferroelectric order parameters. The presence of a finite spin chirality in the working substance enables steering of the cycle by an external electric field that couples to the electric polarization. We observe a direct connection between the chirality, the entanglement and the efficiency of the engine. An electric-field dependent threshold temperature is identified, above which the pair correlations in the system, as quantified by the thermal entanglement, diminish. In contrast to the pair correlations, the collective many-body thermal entanglement is less sensitive to the electric field, and in the high temperature limit converges to a constant value. We also discuss the correlations between the threshold temperature of the pair entanglement, the spin chirality and the minimum of the fidelities in relation to the electric and magnetic fields. The efficiency of the quantum Otto cycle shows a saturation plateau with increasing electric field amplitude.

Priorities for future intensive care research in the UK: results of a James Lind Alliance Priority Setting Partnership.

This James Lind Alliance (JLA) Priority Setting Partnership aimed to identify and prioritise unanswered questions about adult intensive care that are important to people who have been critically ill, their families, and the health professionals who care for them. Consensus techniques (modified Delphi and Nominal Group) were used to generate suggestions using online and postal surveys. Following verification and iterative editorial review, research topics were constructed from these suggestions. These topics were presented in a second online and postal survey for rating. A Nominal Group of 21 clinicians, patients and family representatives subsequently met to rank the most important research topics and produce a prioritised list. The project was coordinated by a representative Steering Group and independently overseen by the JLA. The initial survey and review of the literature generated over 1,300 suggestions. Preliminary editing and verification permitted us to encapsulate these suggestions within 151 research topics. Iterative review by members of the Steering Group produced 37 topic statements, subsequently rated by participants. Using the mode to determine importance, 19 topics were presented to the group from which a ‘top three’ intensive care research priorities were identified and a further nine topics were prioritised. By applying and adapting the JLA methodology to focus on an area of care rather than to a single disease, we have provided a means to ensure that patients, their families and professionals materially contribute to the prioritisation of intensive care research in the UK.

Puupolttoaineen varastonhallinta- ja hankintamalli

Työssä luodaan energiapuun varastonhallintamalli ja hankintamalli energiantuotantolaitoksen näkökulmasta sekä kuvataan kustannustehokkaita ja toimitusvarmoja vaihtoehtoja puupolttoaineen varastoinnille ja haketukselle. Varastonhallintamallissa keskitytään varastotason hallintamenetelmiin toimintaympäristössään. Hankintamalli määrittää oman varaston ja suoran laitostoimituksen suhteen sekä auttaa pohtimaan strategisen hankinnan merkitystä hankinnan toteuttamiseen ja hankintakanavien valintaan. Työ antaa vastauksia koko hankintatoiminnan toteutukseen ja hallitsemiseen. Varastonhallintamallin skenaariotarkastelussa selvisi, että yrityksen oma varasto vaatii 18 – 37 % varmuusvaraston suhteessa käyttövarastoon. Hankintamallin mukaan oman varaston kannattavimman puupolttoainejakeen hankintaetäisyys voisi olla keskimäärin korkeintaan 96 km. Tarpeen, saatavuuden, jakeiden kustannustasojen ja toimintaympäristön mahdollisuuksien ollessa selvillä, on mahdollista tehdä päätöksiä hankintakanavista ja varmuusvarastoista kustannustehokkuuden perusteella. Yrityksen polttoainemäärien ohjauksen toteutukseen vaaditaan kehittämistoimia. Oman toimintaympäristön vakiointi ja toimintamallien dokumentointi on tärkeää tiedonjaon, toimitussopimusten mitoittamisen ja toiminnan kehittämisen kannalta. Toiminnan pullonkaulojen vähentäminen ja puupolttoaineen ohjaaminen kustannustehokkaimpien haketusketjujen kautta mahdollisimman tehokkaasti synnyttävät kustannussäästöjä toimitusketjussa.

Executive order no. 2016-13

This executive order by Governor Nikki R. Haley establishes the South Carolina Community Development Block Grant Steering Committee to advise the South Carolina Department of Commerce on the development of the South Carolina State Action Plan and oversee its implementation for the disbursement of the Community Development Block Grant - Disaster Relief funds due to the historic flooding in October of 2015, leading to widespread damage to homes across the state

Integración de Arbotix, Raspberry Pi y motores Dynamixel Ax-12+ para un robot humanoide que busca y patea pelotas

En este artículo se presenta a DeBuPa (Detección Búsqueda Pateo) un humanoide de tamaño pequeño (38 cm de alto) construido con las piezas del kit Bioloid. Del kit se ha excluido la tarjeta CM-510 para sustituirla por la tarjeta controladora Arbotix, que será la que controle los 16 motores Dynamixel Ax-12+ (para mover al robot) y 2 servomotores analógicos (para mover la cámara). Además se ha agregado un mini computador Raspberry Pi, con su cámara, para que el robot pueda detectar y seguir la pelota de forma autónoma. Todos estos componentes deben ser coordinados para que se logre cumplir la tarea de detectar, seguir y patear la pelota. Por ello se hace necesaria la comunicación entre la Arbotix y la Raspberry Pi. La herramienta empleada para ello es el framework ROS (Robot Operating System). En la Raspberry Pi se usa el lenguaje C++ y se ejecuta un solo programa encargado de captar la imagen de la cámara, filtrar y procesar para encontrar la pelota, tomar la decisión de la acción a ejecutar y hacer la petición a la Arbotix para que dé la orden a los motores de ejecutar el movimiento. Para captar la imagen de la cámara se ha utilizado la librería RasPiCam CV. Para filtrar y procesar la imagen se ha usado las librerías de OpenCV. La Arbotix, además de controlar los motores, se encarga de monitorizar que el robot se encuentre balanceado, para ello usa el sensor Gyro de Robotis. Si detecta un desbalance de un cierto tamaño puede saber si se ha caído y levantarse.