Prevalence, Nature, Severity and Risk Factors for Prescribing Errors in Hospital Inpatients: Prospective Study in 20 UK Hospitals

Introduction: It has been suggested that doctors in their first year of post-graduate training make a disproportionate number of prescribing errors.

Obkective: This study aimed to compare the prevalence of prescribing errors made by first-year post-graduate doctors with that of errors by senior doctors and non-medical prescribers and to investigate the predictors of potentially serious prescribing errors.

Methods: Pharmacists in 20 hospitals over 7 prospectively selected days collected data on the number of medication orders checked, the grade of prescriber and details of any prescribing errors. Logistic regression models (adjusted for clustering by hospital) identified factors predicting the likelihood of prescribing erroneously and the severity of prescribing errors.

Results: Pharmacists reviewed 26,019 patients and 124,260 medication orders; 11,235 prescribing errors were detected in 10,986 orders. The mean error rate was 8.8 % (95 % confidence interval [CI] 8.6-9.1) errors per 100 medication orders. Rates of errors for all doctors in training were significantly higher than rates for medical consultants. Doctors who were 1 year (odds ratio [OR] 2.13; 95 % CI 1.80-2.52) or 2 years in training (OR 2.23; 95 % CI 1.89-2.65) were more than twice as likely to prescribe erroneously. Prescribing errors were 70 % (OR 1.70; 95 % CI 1.61-1.80) more likely to occur at the time of hospital admission than when medication orders were issued during the hospital stay. No significant differences in severity of error were observed between grades of prescriber. Potentially serious errors were more likely to be associated with prescriptions for parenteral administration, especially for cardiovascular or endocrine disorders.

Conclusions: The problem of prescribing errors in hospitals is substantial and not solely a problem of the most junior medical prescribers, particularly for those errors most likely to cause significant patient harm. Interventions are needed to target these high-risk errors by all grades of staff and hence improve patient safety.

Assessment of reserve effect in a marine protected area: the case study of the Professor Luiz Saldanha Marine Park (Portugal)

Dissertação de mest., Biologia Marinha (Ecologia e Conservação Marinhas), Faculdade de Ciências e Tecnologia, Univ. do Algarve, 2011

O piloto aviador militar : traços disposicionais, características adaptativas e história de vida

Tese de doutoramento, Psicologia (Psicologia da Social), Universidade de Lisboa, Faculdade de Psicologia, 2015

Jewish Identity in the Modern World: Its Nature and Dynamics, pt. 3

Jewish identity and its development through the Enlightenment, Antisemitism and Zionism.

Jewish Identity in the Modern World: Its Nature and Dynamics, pt. 2

Discussion of Jewish Identity and its development through the Enlightenment, Antisemitism and Zionism.

Jewish Identity in the Modern World: Its Nature and Dynamics, pt. 1

Discussion of the development of Jewish identity, considering the Enlightenment, Antisemitism, and Zionism.

Examining Chinese Tourists’ Nature-based Tourism Participantion Behavior: Incorporating Environmental Concern into a Constraint-Negotiation Modela

Finding the balance between economic development and preservation of the natural environment is a challenging yet important task. This is a particularly pressing issue in the case of China, as it is the largest and fastest-growing market for tourism. The purpose of this research is to examine Chinese tourists’ participation in nature-based, tourism activities by incorporating tourists’ environmental concern, measured by a revised New Environmental Paradigm (NEP) scale, into a tourism constraint-negotiation model. The responses of 409 Chinese tourists show environmental concern will positively affect tourists’ motivation, which, in turn, will affect their negotiation strategy and ultimately their participation behavior. The theoretical and managerial implications of this study are discussed in the context of the tourism literature.

The effect of playground and nature-based interventions on physical activity and self-esteem in UK school children

School playtime provides opportunities for children to engage in physical activity (PA). Playground playtime interventions designed to increase PA have produced differing results. However, nature can also promote PA, through the provision of large open spaces for activity. The purpose of this study is to determine which playtime interventions are most effective at increasing moderate-to-vigorous physical activity (MVPA) and if this varies by school location. Fifty-two children from an urban and rural school participated in a playground sports (PS) and nature-based orienteering intervention during playtime for one week. MVPA was assessed the day before and on the final day of the interventions using accelerometers. Intervention type (p < 0.05) and school location (p < 0.001) significantly influenced MVPA; with PS increasing MVPA more than nature-based orienteering. Urban children seemed to respond to the interventions more positively; however, differences in baseline MVPA might influence these changes. There was a positive correlation for fitness and MVPA during PS (r = 0.32; p < 0.05), but not nature-based orienteering (p > 0.05). The provision of PS influences PA the most; however, a variety of interventions are required to engage less fit children in PA.

Self-esteem mediates the relationship between connectedness to nature and body appreciation in women, but not men

Connectedness to nature (i.e., an affective and experiential connection to nature) is known to have a positive effect on psychological well-being, but its specific associations with body image have not been fully examined. To attend to this oversight, we conducted a preliminary investigation of associations between connectedness to nature and body appreciation. A total of 380 British adults completed measures of connectedness to nature, body appreciation, and self-esteem. Bivariate correlations revealed significant positive associations between all variables in women. In men, body appreciation was significantly correlated with self-esteem, but not connectedness to nature. Mediation analysis showed that, in women, self-esteem fully mediated the relationship between connectedness to nature and body appreciation. In men, body appreciation was significantly associated with self-esteem, but not connectedness to nature. These results point to a potential route for improving body image among women through connectedness to nature and self-esteem, but further research is necessary.

The Wilderness Expedition: An effective life course intervention to improve young peoples well-being and connectedness to nature

It is well understood that wilderness expeditions improve well-being; however, there is little supporting quantitative data. The aim of this study was to measure the impact of wilderness expeditions on self-esteem (SE) and connectedness to nature (CN) and assess whether benefits varied according to participant and expedition characteristics. SE and CN were assessed pre– and post–wilderness expeditions in 130 adolescents using Rosenberg’s SE scale and the state CN scale. Two-way ANOVA revealed significant increases in SE and CN (p < .001) as a result of single expeditions. There was also an interaction effect of expedition and gender on SE (p < .05). Males had a higher SE at the start but female SE increased most. Linear regression revealed that living environment, gender, and the length and location of the expedition did not contribute to changes in SE and CN. Regular contact with natural environments will improve adolescent well-being, with the largest improvements in females.

Energy and reserve provision dispatch considering distributed generation and demand response

In competitive electricity markets with deep concerns at the efficiency level, demand response programs gain considerable significance. In the same way, distributed generation has gained increasing importance in the operation and planning of power systems. Grid operators and utilities are taking new initiatives, recognizing the value of demand response and of distributed generation for grid reliability and for the enhancement of organized spot market´s efficiency. Grid operators and utilities become able to act in both energy and reserve components of electricity markets. This paper proposes a methodology for a joint dispatch of demand response and distributed generation to provide energy and reserve by a virtual power player that operates a distribution network. The proposed method has been computationally implemented and its application is illustrated in this paper using a 32 bus distribution network with 32 medium voltage consumers.