Errors associated with preparation of adult and paediatric parenteral nutrition in UK hospital pharmacies

Rationale: In UK hospitals, the preparation of all total parenteral nutrition (TPN) products must be made in the pharmacy as TPNs are categorised as high-risk injectables (NPSA/2007/20). The National Aseptic Error Reporting Scheme has been collecting data on pharmacy compounding errors in the UK since August 2003. This study reports on types of error associated with the preparation of TPNs, including the stage at which these were identified and potential and actual patient outcomes. Methods: Reports of compounding errors for the period 1/2004 - 3/2007 were analysed on an Excel spreadsheet. Results: Of a total of 3691 compounding error reports, 674 (18%) related to TPN products; 548 adult vs. 126 paediatric. A significantly higher proportion of adult TPNs (28% vs. 13% paediatric) were associated with labelling errors and a significantly higher proportion of paediatric TPNs (25% vs. 15% adult) were associated with incorrect transcriptions (Chi-Square Test; p<0.005). Labelling errors were identified equally by pharmacists (42%) and technicians (48%) with technicians detecting mainly at first check and pharmacists at final check. Transcription errors were identified mainly by technicians (65% vs. 27% pharmacist) at first check. Incorrect drug selection (13%) and calculation errors (9%) were associated with adult and paediatric TPN preparations in the same ratio. One paediatric TPN error detected at first check was considered potentially catastrophic; 31 (5%) errors were considered of major and 38 (6%) of moderate potential consequence. Five errors (2 moderate, 1 minor) were identified during or after administration. Conclusions: While recent UK patient safety initiatives are aimed at improving the safety of injectable medicines in clinical areas, the current study highlights safety problems that exist within pharmacy production units. This could be used in the creation of an error management tool for TPN compounding processes within hospital pharmacies.

The expert teacher of English

The Expert Teacher of English is for all passionate teachers – both novice and expert - who aspire to become outstanding professionals. It considers what we mean by ‘expert’ and ‘expertise’, explores concepts that are vital to understanding what expertise in teaching is ‘for’, and discusses the characteristics of excellent teaching. As increasing attention is being paid to the concept of the professional who can model excellent teaching and mentor and develop others, it provides a critical analysis of The Advanced Skills Teacher and the Excellent Teacher, as well as the Chartered Teacher in Scotland and the ‘highly accomplished teacher’ in the US. Drawing on the views, ideas and experiences of a group of skilful teachers, The Expert Teacher of English aims to stimulate personal and professional development, help you reflect on the concept of expertise, and support you as you develop as a highly accomplished teacher.

Preparation and properties of gallaborane, GaBH6: structure of the gaseous molecule H2Ga(μ-H)2BH2 as determined by vibrational, electron diffraction, and ab initio studies, and structure of the crystalline solid at 110 K as determined by x-ray diffraction``

Gallaborane (GaBH6, 1), synthesized by the metathesis of LiBH4 with [H2GaCl]n at ca. 250 K, has been characterized by chemical analysis and by its IR and 1H and 11B NMR spectra. The IR spectrum of the vapor at low pressure implies the presence of only one species, viz. H2Ga(μ-H)2BH2, with a diborane-like structure conforming to C2v symmetry. The structure of this molecule has been determined by gas-phase electron diffraction (GED) measurements afforced by the results of ab initio molecular orbital calculations. Hence the principal distances (rα in Å) and angles ( α in deg) are as follows: r(Ga•••B), 2.197(3); r(Ga−Ht), 1.555(6); r(Ga−Hb), 1.800(6); r(B−Ht), 1.189(7); r(B−Hb), 1.286(7); Hb−Ga−Hb, 71.6(4); and Hb−B−Hb, 110.0(5) (t = terminal, b = bridging). Aggregation of the molecules occurs in the condensed phases. X-ray crystallographic studies of a single crystal at 110 K reveal a polymeric network with helical chains made up of alternating pseudotetrahedral GaH4 and BH4 units linked through single hydrogen bridges; the average Ga•••B distance is now 2.473(7) Å. The compound decomposes in the condensed phases at temperatures exceeding ca. 240 K with the formation of elemental Ga and H2 and B2H6. The reactions with NH3, Me3N, and Me3P are also described.

Double coupling reactions of 3,4-bis(stannyl)furanone: facile preparation of diaryl- and dibenzylfuranones

The palladium-catalyzed cross-coupling reaction of 3,4-bis(tributylstannyl)furan-2(5H)-one using chelating ligand or polar solvent gives mixtures of single and double coupled products, even when one equivalent of halide coupling partner is used. After optimization, the double coupling reaction was shown to be general, with the use of two equivalents of aryl iodides giving 3,4-disubstituted furanones, The reaction using benzyl bromides proceeds at lower temperatures than the corresponding coupling using aryl iodides, giving dibenzylfuranones. The methodology has been exemplified in a synthesis of (+/-)-hinokinin.

The first preparation of beta-lactones by radical cyclization

beta-Lactones have, for the first time, been prepared by 4-exo-trig radical cyclization. Thus, alpha-ethenoyloxy radicals react in the presence of tributylstannane in a photothermal process to give beta-lactones. Highest yields were obtained when groups capable of stabilizing a carboncentered radical were present at the 3-position of the alkenoate acceptor.

Low-temperature sol-gel preparation of ordered nanoparticles of tungsten carbide/oxide

Tungsten carbide/oxide particles have been prepared by the gel precipitation of tungstic acid in the presence of an organic gelling agent [10% ammonium poly(acrylic acid) in water, supplied by Ciba Specialty Chemicals]. The feed solution; a homogeneous mixture of sodium tungstate and ammonium poly(acrylic acid) in water, was dropped from a 1-mm jet into hydrochloric acid saturated hexanol/concentrated hydrochloric acid to give particles of a mixture of tungstic acid and poly(acrylic acid), which, after drying in air at 100 degrees C and heating to 900 degrees C in argon for 2 h, followed by heating in carbon dioxide for a further 2 h and cooling, gives a mixture of WO, WC, and a trace of NaxWO3, with the carbon for the formation of WC being provided by the thermal carbonization of poly(acrylic acid). The pyrolyzed product is friable and easily broken down in a pestle and mortar to a fine powder or by ultrasonics, in water, to form a stable colloid. The temperature of carbide formation by this process is significantly lower (900 degrees C) than that reported for the commercial preparation of tungsten carbide, typically > 1400 degrees C. In addition, the need for prolonged grinding of the constituents is obviated because the reacting moieties are already in intimate contact on a molecular basis. X-ray diffraction, particle sizing, transmission electron microscopy, surface area, and pore size distribution studies have been carried out, and possible uses are suggested. A flow diagram for the process is described.

Preparation and ring-opening reactions of N,O-bis(diphenylphosphinyl) hydroxymethylaziridine ('Di-Dpp')

N,O-bis(diphenylphosphinyl)-2-(hydroxymethyl)aziridine ('DiDpp', 1) is efficiently prepared from 2-aminoethane-1,3-diol: this activated aziridine undergoes two sequential reactions with copper(I)-modified Grignard reagents, yielding alpha-branched N-Dpp amines in good yield. (C) 2003 Elsevier Science Ltd. All rights reserved.

Preparation of nanomagnetic absorbent for partition coefficient measurement

In this paper, we report a new method based on supercritical carbon dioxide (scCO(2)) to fill and distribute the porous magnetic nanoparticles with n-octanol in a homogeneous manner. The high solubility of n-octanol in scCO(2) and high diffusivity and permeability of the fluid allow efficient delivery of n-octanol into the porous magnetic nanoparticles. Thus, the n-octanol-loaded magnetic nanoparticles can be readily dispersed into aqueous buffer (pH 7.40) to form a homogenous suspension consisting of nano-sized n-octanol droplets. We refer this suspension as the n-octanol stock solution. The n-octanol stock solution is then mixed with bulk aqueous phase (pH 7.40) containing an organic compound prior to magnetic separation. The small-size of the particles and the efficient mixing enable a rapid establishment of the partition equilibrium of the organic compound between the solid supported n-octanol nano-droplets and the bulk aqueous phase. UV-vis spectrophotometry is then applied to determine the concentration of the organic compound in the aqueous phase both before and after partitioning (after magnetic separation). As a result, log D values of organic compounds of pharmaceutical interest determined by this modified method are found to be in excellent agreement with the literature data. (c) 2006 Elsevier B.V. All rights reserved.

The graduate teacher programme in England: mentor training, quality assurance and the findings of inspection

In its recent report on the Graduate Teacher Programme (GTP), an employment-based route to Qualified Teacher Status (QTS) in England, the Government's Office for Standards in Education found that, although almost all trainees meet the standards required to qualify, too often they do so at an adequate level, rather than achieving the high levels of which they should be capable. The underlying reason for this is the quality of mentoring provided in the schools. The inspectors concluded that schoolbased trainers are often not adequately prepared for their role in implementing wide-ranging training programmes for trainee teachers. Despite this generally bleak picture, Ofsted concluded that 'the minority of cases of good practice in the training programmes and of high quality teaching by trainees indicate that the GTP can be an effective alternative route for training teachers'™. This article considers the strengths and weaknesses of the Graduate Teacher Programme, introduced in January 1998, and also reports on a small-scale project, funded by the Teacher Training Agency (TTA), the key objective of which was to strengthen the existing partnerships by improving the quality of school-based tutor training and continuous professional development of staff.

Student-teachers' perspectives on positive and negative social processes in schools

In recent years, the Standards for Qualified Teacher Status in England have placed new emphasis on student-teachers' ability to become integrated into the 'corporate life of the school' and to work with other professionals. Little research, however, has been carried out into how student-teachers perceive the social processes and interactions that are central to such integration during their initial teacher education school placements. This study aims to shed light on these perceptions. The data, gathered from 23 student-teachers through interviews and reflective writing, illustrate the extent to which the participants perceived such social processes as supporting or obstructing their development as teachers. Signals of inclusion, the degree of match or mismatch in students' and school colleagues' role expectations, and the social awareness of both school and student-teacher emerged as crucial factors in this respect. The student-teachers' accounts show their social interactions with school staff to be meaningful in developing their 'teacher self' and to be profoundly emotionally charged. The implications for mentor and student-teacher role preparation are discussed in this article.

In-service training needs in an African context: a study of headteacher and teacher perspectives in the Gucha District of Kenya

Improving the quality of teaching is an educational priority in Kenya, as in many developing countries. The present paper considers various aspects of in-service education, including views on the effectiveness of in-service, teacher and headteacher priorities in determining in-service needs and the constraints on providing in-service courses. These issues are examined though an empirical study of 30 secondary headteachers and 109 teachers in a district of Kenya. The results show a strong felt need for in-service provision together with a firm belief in the efficacy of in-service in raising pupil achievement. Headteachers had a stronger belief in the need for in-service for their teachers than did the teachers themselves. The priorities of both headteachers and teachers were dominated by the external pressures of the schools, in particular the pressures for curriculum innovation and examination success. The resource constraints on supporting attendance at in-service courses were the major problems facing headteachers. The results reflect the difficulties that responding to an externally driven in-service agenda creates in a context of scarce resources.

Teacher self-perceptions of effectiveness: a study in a district of Kenya

Background and purpose: The paper reports a study of the perceptions of teachers in secondary schools in the Gucha district of Kenya of their own effectiveness, the structure of their self-perceptions, variations in self-perceived effectiveness and the relationship between self-perceptions of effectiveness and the examination performance of their students. Design and methods: Data were based on questionnaires completed by 109 English and mathematics teachers from a random sample of 30 schools in the Gucha district of Kenya. Pupil examination results were also collected from the schools. Results: Three dimensions of self-perceived effectiveness emerged from a factor analysis. These were: pedagogic process, personal and affective aspects of teaching and effectiveness with regard to pupil performance. Teachers tended to rate themselves relatively highly with regard to the first two, process-oriented, dimensions but less highly on the third, outcome-oriented, dimension. Self-ratings for pupil outcomes correlated with pupil examination performance at school level. Conclusions: The results show that these teachers can have a sense of themselves as competent classroom performers and educational professionals without necessarily having a strong sense of efficacy with regard to pupil outcomes.

Formative assessment in teacher education: the development of a diagnostic language test for trainee teachers of German

This article describes the development and validation of a diagnostic test of German and its integration in a programme of formative assessment during a one-year initial teacher-training course. The test focuses on linguistic aspects that cause difficulty for trainee teachers of German as a foreign language and assesses implicit and explicit grammatical knowledge as well as students' confidence in this knowledge. Administration of the test to 57 German speakers in four groups (first-year undergraduates, fourth-year undergraduates, postgraduate trainees, and native speakers) provided evidence of its reliability and validity.