Design challenges for electronic medication administration record systems in residential aged care facilities: A formative evaluation

Introduction Electronic medication administration record (eMAR) systems are promoted as a potential intervention to enhance medication safety in residential aged care facilities (RACFs). The purpose of this study was to conduct an in-practice evaluation of an eMAR being piloted in one Australian RACF before its roll out, and to provide recommendations for system improvements. Methods A multidisciplinary team conducted direct observations of workflow (n=34 hours) in the RACF site and the community pharmacy. Semi-structured interviews (n=5) with RACF staff and the community pharmacist were conducted to investigate their views of the eMAR system. Data were analysed using a grounded theory approach to identify challenges associated with the design of the eMAR system. Results The current eMAR system does not offer an end-to-end solution for medication management. Many steps, including prescribing by doctors and communication with the community pharmacist, are still performed manually using paper charts and fax machines. Five major challenges associated with the design of eMAR system were identified: limited interactivity; inadequate flexibility; problems related to information layout and semantics; the lack of relevant decision support; and system maintenance issues.We suggest recommendations to improve the design of the eMAR system and to optimize existing workflows. Discussion Immediate value can be achieved by improving the system interactivity, reducing inconsistencies in data entry design and offering dedicated organisational support to minimise connectivity issues. Longer-term benefits can be achieved by adding decision support features and establishing system interoperability requirements with stakeholder groups (e.g. community pharmacies) prior to system roll out. In-practice evaluations of technologies like eMAR system have great value in identifying design weaknesses which inhibit optimal system use.

Interactions of nandrolone and psychostimulant drugs on central monoaminergic systems

It has been hypothesized that abuse of supra-therapeutic doses of anabolic androgenic steroids (AASs) can lead to dependence and function as a gateway to abuse of other drugs. This is supported by behavioral studies on animal models and psychiatric evaluations of human subjects, although their neurochemical effects remain largely unknown. A large body of evidence suggests that the ability of the drugs to induce a strong elevation of extracellular dopamine (DA) levels in the nucleus accumbens (NAc), especially, plays a crucial role in their reinforcing effects. -- This study had four main aims. The first was to explore the effects of nandrolone decanoate on dopaminergic and serotonergic activities in the brains of rats. The second aim was to assess whether or not nandrolone pre-exposure modulates the acute neurochemical and behavioral effects of psychostimulant drugs in experimental animals. The third was to investigate if the AAS-pre-treatment induced changes in brain reward circuitry are reversible. And the fourth main goal was to evaluate the role of androgen and estrogen receptors in the modulation of the dopaminergic and serotonergic effects of acute injections of stimulant drugs by sub-chronic nandrolone treatment. The results showed that nandrolone decanoate at doses, high enough to induce erythropoiesis, significantly increased the levels of DOPAC and 5-HT in the cerebral cortex. Co-administration of AAS and psychostimulant drugs showed that the increase in extracellular DA and 5-HT concentration evoked by amphetamine, MDMA and cocaine in the NAc was attenuated dose-dependently by pretreatment with nandrolone. Nandrolone pre-exposure also attenuated the ability of stimulants to cause increased stereotyped behavior and locomotor activity. Despite the significant decrease in nandrolone concentration in blood, the attenuation of cocaine’s effects remained unchanged after a fairly long period without nandrolone, suggesting that nandrolone effects could be long lasting. Blockade of androgen receptors with flutamide abolished the attenuating effect of nandrolone pretreatment on amphetamine-induced elevation of extracellular DA concentration. --- In conclusion, the results show that AAS-pretreatment is able to inhibit the reward-related neurochemical and behavioral effects of amphetamine, MDMA and cocaine in experimental animals. Furthermore, it seems that these effects could be long lasting and it appears that the ability of nandrolone to modulate reward-related effects of stimulants is dependent on activation of androgen receptors.

The skin safety model: Reconceptualizing skin vulnerability in older patients

Purpose: To develop a unique skin safety model (SSM) that offers a new and unified perspective on the diverse yet interconnected antecedents that contribute to a spectrum of potential iatrogenic skin injuries in older hospitalized adults. Organizing Construct: Discussion paper. Methods: A literature search of electronic databases was conducted for published articles written in English addressing skin integrity and iatrogenic skin injury in elderly hospital patients between 1960 and 2014. Findings: There is a multiplicity of literature outlining the etiology, prevention, and management of specific iatrogenic skin injuries. Complex and interrelated factors contribute to iatrogenic skin injury in the older adult, including multiple comorbidities, factors influencing healthcare delivery, and acute situational stressors. A range of injuries can result when these factors are com- plicated by skin irritants, pressure, shear, or friction; however, despite skin injuries sharing multiple ntecedents, no unified overarching skin safety conceptual model has been published. Conclusions: The SSM presented in this article offers a new, unified framework that encompasses the spectrum of antecedents to skin vulnerability as well as the spectrum of iatrogenic skin injuries that may be sustained by older acute care patients. Current skin integrity frameworks address prevention and management of specific skin injuries. In contrast, the SSM recognizes the complex interplay of patient and system factors that may result in a range of iatrogenic skin injuries. Skin safety is reconceptualized into a single model that has the potential for application at the individual patient level, as well as health-care systems and governance levels. Clinical Relevance: Skin safety is concerned with keeping skin safe from any iatrogenic skin injury, and remains an ongoing challenge for healthcare providers. A conceptual framework that encompasses all of the factors that may contribute to a range of iatrogenic skin injuries is essential, and guides the clinician in maintaining skin integrity in the vulnerable older patient.

Alcohol and depression

"A large proportion of people who experience drug problems also experience a range of mental health problems. Similarly, many people who experience mental health problems engage in hazardous drug use. The experience of these co-occurring disorders increases use of treatment services, but is associated with poorer prognosis. The implementation of effective responses has been hindered by the disaggregated systems of care that have been adopted in many countries; many problems are the outcome of poorly organised systems of care that do not reflect the needs of a large proportion of clients who experience various problems. There is a dearth of quality research to guide the development of evidence-based responses to co-occurring drug and mental health problems. This book introduces the reader to the issues, guided by a series of questions. These encourage the reader to consider the evidence about the nature and prevalence of co-occurring disorders and the challenges they create for individuals, the community and service providers. The diverse range of expertise of the contributors provides the opportunity to consider the challenges of navigating the various systems of care from the perspective of consumers, parents and clinicians. Researchers and clinicians examine the available evidence about the links between the various disorders and discuss the implications for treatment through a series of case studies. The reader is guided through evidence-based clinical decision-making. The editor and contributors argue that, while our knowledge and expertise is improving, there is a need to better resource and integrate treatment services to foster the adoption of evidence-based and effective responses. Poor systems of care don’t necessarily cause co-occurring mental health and drug problems, but they can contribute to poor outcomes."--Publisher website

Safety of Repair, Maintenance, Minor Alteration, and Addition (RMAA) Works: A New Focus of Construction Safety

"Safety of RMAA works is an almost uncharted topic of rising importance internationally. Small construction contractors are particularly dependant on RMAA work, especially during times of recession, and they undertake more risks on these jobs than large companies do. This book is based on unique international research and consultancy projects which detail, investigate, and suggest solutions to the specific challenges of safety in RMAA works, based on case studies. Starting with an overview of safety in the wider construction industries of developed countries, the first half of this book also provides a comprehensive summary of relevant rules, regulations, and the resulting safety performances. The systems in the UK, US and Hong Kong are described and contrasted, giving the reader an understanding of how different regulatory approaches have yielded a variety of results. From this solid introduction, specific problems observed in RMAA work are examined through case studies, with reference to the underlying cultural and demographic factors, and a variety of practical engineering and management solutions are explored. This important and practical international work is essential reading for postgraduate students of health and safety in construction, construction project management, or construction in developing countries, as well as policy-makers and construction project managers."--Publisher website

Evaluation of solute-solvent interactions from solvent blue-shifts of n → π* transitions of C=O, C=S, NO2 and N=N groups: hydrogen bond energies of various donor-acceptor systems

Effects of non-polar, polar and proton-donating solvents on the n → π* transitions of C=O, C=S, NO2 and N=N groups have been investigated. The shifts of the absorption maxima in non-polar and polar solvents have been related to the electrostatic interactions between solute and solvent molecules, by employing the theory of McRAE. In solvents which can donate protons the solvent shifts are mainly determined by solute-solvent hydrogen bonding. Isobestic points have been found in the n → π* bonds of ethylenetrithio-carbonate in heptane-alcohol and heptane-chloroform solvent systems, indicating the existence of equilibria between the hydrogen bonded and the free species of the solute. Among the different proton-donating solvents studied water produces the largest blue-shifts. The blue-shifts in alcohols decrease in the order 2,2,2-trifluoroethanol, methanol, ethanol, isopropanol and t-butanol, the blue-shift in trifluoroethanol being nearly equal to that in water. This trend is exactly opposite to that for the self-association of alcohols. It is suggested that electron-withdrawing groups not merely decrease the extent of self-association of alcohols, but also increase the ability to donate hydrogen bonds. The approximate hydrogen-bond energies for several donor-acceptor systems have been estimated. In a series of aliphatio ketones and nitro compounds studied, the blue-shifts and consequently the hydrogen bond energies decrease with the decrease in the electron-withdrawing power of the alkyl groups. It is felt that electron-withdrawing groups render the chromophores better proton acceptors, and the alcohols better donors. A linear relationship between n → π* transition frequency and the infrared frequency of ethylenetrithiocarbonate has been found. It is concluded that stabilization of the electronic ground states of solute molecules by electrostatic and/or hydrogen-bond interactions determines the solvent shifts.

Response of nonlinear systems to narrow-band excitation

The hardening cubic spring oscillator is studied under narrow-band gaussian excitation. Equivalent linearization leads to multiple steady states. The realizability of the solution is discussed through stochastic stability analysis. Theoretical results are supported by numerical simulation.

Secure Concurrency Control in Firm Real-Time Database Systems

Many real-time database applications arise in electronic financial services, safety-critical installations and military systems where enforcing security is crucial to the success of the enterprise. For real-time database systems supporting applications with firm deadlines, we investigate here the performance implications, in terms of killed transactions, of guaranteeing multilevel secrecy. In particular, we focus on the concurrency control (CC) aspects of this issue. Our main contributions are the following: First, we identify which among the previously proposed real-time CC protocols are capable of providing covert-channel-free security. Second, using a detailed simulation model, we profile the real-time performance of a representative set of these secure CC protocols for a variety of security-classified workloads and system configurations. Our experiments show that a prioritized optimistic CC protocol, OPT-WAIT, provides the best overall performance. Third, we propose and evaluate a novel "dual-CC" approach that allows the real-time database system to simultaneously use different CC mechanisms for guaranteeing security and for improving real-time performance. By appropriately choosing these different mechanisms, concurrency control protocols that provide even better performance than OPT-WAIT are designed. Finally, we propose and evaluate GUARD, an adaptive admission-control policy designed to provide fairness with respect to the distribution of killed transactions across security levels. Our experiments show that GUARD efficiently provides close to ideal fairness for real-time applications that can tolerate covert channel bandwidths of upto one bit per second.

Diffusion coefficients for selected binary liquid systems: cyclohexanes and n-alkyl alcohols

In the present work the integral diffusion coefficients are estimated by using the diaphragm cell technique. The diffusion coefficients are measured at various compositions for two sets binary systems: one of cyclohexane and n-paraffinic alcohols and the other of methylcyclohexane and n-paraffinic alcohols. The alcohols used are seven members of homologous series of n-paraffinic alcohols from ethanol to octanol. The maximum possible error in the experimental diffusion coefficient could be 8% for both the cyclohexane-n-alkyl alcohol system and methylcyclohexane-n-alkyl alcohol system. A correlation for each of the two sets of binary systems is given. The maximum deviation in the correlations was less than 6.5 and 3.5% for cyclohexane-n-alkyl alcohols and methylcyclohexane-n-alkyl alcohols, respectively.

Two beam photoluminescence of PbS quantum dots in polyvinyl alcohol

We report the effect of dual beam excitation on the photoluminescence (PL) from PbS quantum dots in polyvinyl alcohol by using two excitation lasers, namely Ar+ (514.5 nm) and He-Ne laser (670 nm). Both sources of excitation gave similar PL spectra around 1.67 eV (related to shallow traps) and 1.1 eV (related to deep traps). When both lasers were used at the same time, we found that the PL induced by each of the lasers was partly quenched by the illumination of the other laser. The proposed mechanism of this quenching effect involves traps that are populated by one specific laser excitation, being photo-ionized by the presence of the other laser. Temperature, laser intensity and modulation frequency dependent quenching efficiencies are presented in this paper. This reversible modulation has potential for optical switching and memory device applications. (C) 2010 Elsevier B.V. All rights reserved.

Estimation of time variant reliability of randomly parametered non-linear vibrating systems

The problem of time variant reliability analysis of randomly parametered and randomly driven nonlinear vibrating systems is considered. The study combines two Monte Carlo variance reduction strategies into a single framework to tackle the problem. The first of these strategies is based on the application of the Girsanov transformation to account for the randomness in dynamic excitations, and the second approach is fashioned after the subset simulation method to deal with randomness in system parameters. Illustrative examples include study of single/multi degree of freedom linear/non-linear inelastic randomly parametered building frame models driven by stationary/non-stationary, white/filtered white noise support acceleration. The estimated reliability measures are demonstrated to compare well with results from direct Monte Carlo simulations. (C) 2014 Elsevier Ltd. All rights reserved.

Innovative reaction systems for acetal (1,1 diethoxy butane) production from renewable sources

370 p.: il., graf.

Analytical efficiency evaluation of a network mobility management protocol for Intelligent Transportation Systems

One of the major concerns in an Intelligent Transportation System (ITS) scenario, such as that which may be found on a long-distance train service, is the provision of efficient communication services, satisfying users' expectations, and fulfilling even highly demanding application requirements, such as safety-oriented services. In an ITS scenario, it is common to have a significant amount of onboard devices that comprise a cluster of nodes (a mobile network) that demand connectivity to the outside networks. This demand has to be satisfied without service disruption. Consequently, the mobility of the mobile network has to be managed. Due to the nature of mobile networks, efficient and lightweight protocols are desired in the ITS context to ensure adequate service performance. However, the security is also a key factor in this scenario. Since the management of the mobility is essential for providing communications, the protocol for managing this mobility has to be protected. Furthermore, there are safety-oriented services in this scenario, so user application data should also be protected. Nevertheless, providing security is expensive in terms of efficiency. Based on this considerations, we have developed a solution for managing the network mobility for ITS scenarios: the NeMHIP protocol. This approach provides a secure management of network mobility in an efficient manner. In this article, we present this protocol and the strategy developed to maintain its security and efficiency in satisfactory levels. We also present the developed analytical models to analyze quantitatively the efficiency of the protocol. More specifically, we have developed models for assessing it in terms of signaling cost, which demonstrates that NeMHIP generates up to 73.47% less signaling compared to other relevant approaches. Therefore, the results obtained demonstrate that NeMHIP is the most efficient and secure solution for providing communications in mobile network scenarios such as in an ITS context.

Integrated Sensor Systems for Vessels of Opportunity, National Oceanographic Centre, Southampton, UK, October 10-12,2006 : workshop proceedings

The use of self-contained, low-maintenance sensor systems installed on commercial vessels is becoming an important monitoring and scientific tool in many regions around the world. These systems integrate data from meteorological and water quality sensors with GPS data into a data stream that is automatically transferred from ship to shore. To begin linking some of this developing expertise, the Alliance for Coastal Technologies (ACT) and the European Coastal and Ocean Observing Technology (ECOOT) organized a workshop on this topic in Southampton, United Kingdom, October 10-12, 2006. The participants included technology users, technology developers, and shipping representatives. They collaborated to identify sensors currently employed on integrated systems, users of this data, limitations associated with these systems, and ways to overcome these limitations. The group also identified additional technologies that could be employed on future systems and examined whether standard architectures and data protocols for integrated systems should be established. Participants at the workshop defined 17 different parameters currently being measured by integrated systems. They identified that diverse user groups utilize information from these systems from resource management agencies, such as the Environmental Protection Agency (EPA), to local tourism groups and educational organizations. Among the limitations identified were instrument compatibility and interoperability, data quality control and quality assurance, and sensor calibration andlor maintenance frequency. Standardization of these integrated systems was viewed to be both advantageous and disadvantageous; while participants believed that standardization could be beneficial on many levels, they also felt that users may be hesitant to purchase a suite of instruments from a single manufacturer; and that a "plug and play" system including sensors from multiple manufactures may be difficult to achieve. A priority recommendation and conclusion for the general integrated sensor system community was to provide vessel operators with real-time access to relevant data (e.g., ambient temperature and salinity to increase efficiency of water treatment systems and meteorological data for increased vessel safety and operating efficiency) for broader system value. Simplified data displays are also required for education and public outreach/awareness. Other key recommendations were to encourage the use of integrated sensor packages within observing systems such as 100s and EuroGOOS, identify additional customers of sensor system data, and publish results of previous work in peer-reviewed journals to increase agency and scientific awareness and confidence in the technology. Priority recommendations and conclusions for ACT entailed highlighting the value of integrated sensor systems for vessels of opportunity through articles in the popular press, and marine science. [PDF contains 28 pages]