Reducing medicines waste in the community

There is increasing concern at the amount and cost of prescribed medicines that are unused or wasted and then have to be disposed of. Previous studies have used health promotion and Dispose Unwanted Medicines Properly campaigns targeted at the patient to describe and quantify the annual cost of waste. The reasons patients return unused drugs to pharmacies have also been explored. The paper focuses on patient explanations for not needing medication; categorized as: over-collection in the past, self-management strategies, changes in medical condition, other changes in patient circumstances, or the repeat medicines policy at the surgery. The aim of the original study was to make a measurable change in prescribed medicines with a reduction in medicines wastage, whilst at the same time achieving improved standards of pharmaceutical care. Information on patient needs and behaviour came from consultation in the pharmacy monitoring forms and interview. The study was based on two medical practices in the West Midlands, UK, comparing an outer city and an inner city population. The participants were general practitioners, pharmacists and 350 repeat prescription patients. Prescriptions were issued for two three-month periods. The outcome was that 23.8% of the prescribed items were not dispensed, at a value of £13.1K, 58% of the medications that would be expected to be regularly supplied were collected. The study suggests that closer professional management at the point of dispensing and an understanding of patient experiences can help reduce the amount of unwanted medication collected by patients.

Development of a prescribing indicator for objective quantification of antibiotic usage in secondary care

Objectives: To compare the recognized defined daily dose per 100 bed-days (DDD/100 bed-days) measure with the defined daily dose per finished consultant episode (DDD/FCE) in a group of hospitals with a variety of medicines management strategies. To compare antibiotic usage using the above indicators in hospitals with and without electronic prescribing systems. Methods: Twelve hospitals were used in the study. Nine hospitals were selected and split into three cohorts (three high-scoring, three medium-scoring and three low-scoring) by their 2001 medicines management self-assessment scores (MMAS). An additional cohort of three electronic prescribing hospitals was included for comparison. MMAS were compared to antibiotic management scores (AMS) developed from a questionnaire relating specifically to control of antibiotics. FCEs and occupied bed-days were obtained from published statistics and statistical analyses of the DDD/100 bed-days and DDD/FCE were carried out using SPSS. Results: The DDD/100 bed-days varied from 81.33 to 189.37 whilst the DDD/FCE varied from 2.88 to 7.43. The two indicators showed a high degree of correlation with r = 0.74. MMAS were from 9 to 22 (possible range 0-23) and the AMS from 2 to 13 (possible range 0-22). The two scores showed a high degree of correlation with r = 0.74. No correlation was established between either indicator and either score. Conclusions: The WHO indicator for medicines utilization, DDD/100 bed-days, exhibited the same level of conformity as that exhibited from the use of the DDD/FCE indicating that the DDD/FCE is a useful additional indicator for identifying hospitals which require further study. The MMAS can be assumed to be an accurate guide to antibiotic medicines management controls. No relationship has been found between a high degree of medicines management control and the quantity of antibiotic prescribed. © The British Society for Antimicrobial Chemotherapy; 2004 all rights reserved.

Computer integrated manufacturing (CIM) and the principle of business control

In response to the increasing international competitiveness, many manufacturing businesses are rethinking their management strategies and philosophies towards achieving a computer integrated environment. The explosive growth in Advanced Manufacturing Technology (AMI) has resulted in the formation of functional "Islands of Automation" such as Computer Aided Design (CAD), Computer Aided Manufacturing (CAM), Computer Aided Process Planning (CAPP) and Manufacturing Resources Planning (MRPII). This has resulted in an environment which has focussed areas of excellence and poor overall efficiency, co-ordination and control. The main role of Computer Integrated Manufacturing (CIM) is to integrate these islands of automation and develop a totally integrated and controlled environment. However, the various perceptions of CIM, although developing, remain focussed on a very narrow integration scope and have consequently resulted in mere linked islands of automation with little improvement in overall co-ordination and control. This thesis, that is the research described within, develops and examines a more holistic view of CIM, which is based on the integration of various business elements. One particular business element, namely control, has been shown to have a multi-facetted and underpinning relationship with the CIM philosophy. This relationship impacts various CIM system design aspects including the CIM business analysis and modelling technique, the specification of systems integration requirements, the CIM system architectural form and the degree of business redesign. The research findings show that fundamental changes to CIM system design are required; these are incorporated in a generic CIM design methodology. The affect and influence of this holistic view of CIM on a manufacturing business has been evaluated through various industrial case study applications. Based on the evidence obtained, it has been concluded that this holistic, control based approach to CIM can provide a greatly improved means of achieving a totally integrated and controlled business environment. This generic CIM methodology will therefore make a significant contribution to the planning, modelling, design and development of future CIM systems.

The effects of new technology on employment structures in the service sector

This thesis explores the interrelationships between the labour process, the development of technology and patterns of gender differentiation. The introduction of front office terminals into building society branches forms the focus of the research. Case studies were carried out in nine branches, three each from three building societies. Statistical data for the whole movement and a survey of ten of the top thirty societies provided the context for the studies. In the process of the research it became clear that it was not technology itself but the way that it was used, that was the main factor in determining outcomes. The introduction of new technologies is occurring at a rapid pace, facilitated by continuing high growth rates, although front office technology could seldom be cost justified. There was great variety between societies in their operating philosophies and their reasons for and approach to computerisation, but all societies foresaw an ultimate saving in staff. Computerisation has resulted in the deskilling of the cashiering role and increased control over work at all stages. Some branch managers experienced a decrease in autonomy and an increase in control over their work. Subsequent to this deskilling there has been a greatly increased use of part time staff which has enabled costs to be reduced. There has also been a polarisation between career and non-career staff which, like the use of part time staff, has occurred along gender lines. There is considerable evidence that societies' policies, structures and managerial attitudes continue to directly and indirectly discriminate against women. It is these practices which confine women to lower grades and ensure their dependence on the family and which create the pool of cheap skilled labour that societies so willingly exploit by increasing part time work. Gender strategies enter management strategies throughout the operations of the organisation.

The antecedents of prosocial service behaviours:an empirical investigation

Frontline employee attitudes and behaviours during service encounters influence customers' perceptions of service quality. For this reason, the identification of variables that influence service behaviours is important. Much remains unknown about the factors affecting service behaviours in service settings. This study investigates service employees' attitudinal (job satisfaction and organisational commitment) and behavioural (prosocial service behaviours) responses to management strategies (internal communication, professional development and empowerment). One hundred and eighty-eight service employees contributed data, which were analysed using a structural modelling methodology. The authors found that management strategies influence service behaviours directly but the mediating role of job attitudes is not supported.

Topic continuity in informal conversations between native and non-native speakers of English

Topic management by non-native speakers (NNSs) during informal conversations has received comparatively little attention from researchers, and receives surprisingly little attention in second language learning and teaching. This article reports on one of the topic management strategies employed by international students during informal, social interactions with native-speaker peers, exploring the process of maintaining topic continuity following temporary suspensions of topics. The concept of side sequences is employed to illustrate the nature of different types of topic suspension, as well as the process of jointly negotiating a return to the topic. Extracts from the conversations show that such sequences were not exclusively occasioned by language difficulties, and that the non-native speaker participants were able to effect successful returns to the main topic of the conversations.

Tourette's syndrome

Tourette’s syndrome is a tic disorder that is often associated with behavioural symptoms. Diagnostic criteria are based on the presence of both motor and vocal tics; because of its varied presentations, the syndrome has the potential to be misdiagnosed. Prevalence is higher than commonly assumed; coprolalia is relatively rare (10-30%) and not required for diagnosis. The syndrome can cause serious distress and compromise health related quality of life. The main management strategies include psychoeducation, behavioural techniques, and drugs. Service provision is patchy even in developed countries and patients of all ages often “fall through the net” between neurology and psychiatry.

Professionalism and quality in European business courses:utilising research to enhance student learning and promote employability - a pan-European study

This..paper provides a comparative analysis of Quality Management and standards in four European countries, (the UK, Austria, Slovenia and Romania) and in doing so addresses the gap in academic knowledge about how the introduction and implementation of Quality Management Strategies can both facilitate and enhance student learning within Universities.

Extreme weather events and construction SMEs:vulnerability, impacts and responses

Purpose – The UK experienced a number of Extreme Weather Events (EWEs) during recent years and a significant number of businesses were affected as a result. With the intensity and frequency of weather extremes predicted in the future, enhancing the resilience of businesses, especially of Small and Medium-sized Enterprises (SMEs), who are considered as highly vulnerable, has become a necessity. However, little research has been undertaken on how construction SMEs respond to the risk of EWEs. In seeking to help address this dearth of research, this investigation sought to identify how construction SMEs were being affected by EWEs and the coping strategies being used. Design/methodology/approach – A mixed methods research design was adopted to elicit information from construction SMEs, involving a questionnaire survey and case study approach. Findings – Results indicate a lack of coping strategies among the construction SMEs studied. Where the coping strategies have been implemented, these were found to be extensions of their existing risk management strategies rather than radical measures specifically addressing EWEs. Research limitations/implications – The exploratory survey focused on the Greater London area and was limited to a relatively small sample size. This limitation is overcome by conducting detailed case studies utilising two SMEs whose projects were located in EWE prone localities. The mixed method research design adopted benefits the research by presenting more robust findings. Practical implications – A better way of integrating the potential of EWEs into the initial project planning stage is required by the SMEs. This could possibly be achieved through a better risk assessment model supported by better EWE prediction data. Originality/value – The paper provides an original contribution towards the overarching agenda of resilience of SMEs and policy making in the area of EWE risk management. It informs both policy makers and practitioners on issues of planning and preparedness against EWEs.

Managing imbalanced supply chain relationships for sustainability:a power perspective

This study adopts a power perspective to investigate sustainable supply chain relationships and specifically uses resource-dependence theory (RDT) to critically analyze buyer-supplier-supplier relationships. Empirical evidence is provided, extending the RDT model in this context. The concept of power relationships is explored through a qualitative study of a multinational company and agricultural growers in the UK food industry that work together to implement sustainable practices. We look at multiple triadic relationships involving a large buyer and its small suppliers to investigate how relative power affects the implementation of sustainable supply-management practices. The study highlights that power as dependence is relevant to understanding compliance in sustainable supply chains and to identifying appropriate relationship-management strategies to build more sustainable supply chains. We show the influences of power on how players manage their relationships and how it affects organizational responses to the implementation of sustainability initiatives. Power notably influences the sharing of sustainability-related risks and value between supply chain partners. From a managerial perspective, the study contributes to developing a better understanding of how power can become an effective way to achieve sustainability goals. This article offers insights into the way in which a large organization works with small and medium size enterprises to implement sustainable practices and shows how power management-that is, the way in which power is used-can support or hinder effective cooperation around sustainability in the supply chain. © 2014 Decision Sciences Institute.

The effects of Gilles de la Tourette syndrome and other chronic tic disorders on quality of life across the lifespan:a systematic review

Gilles de la Tourette syndrome (GTS) and other chronic tic disorders are neurodevelopmental conditions characterized by the presence of tics and associated behavioral problems. Whilst converging evidence indicates that these conditions can affect patients' quality of life (QoL), the extent of this impairment across the lifespan is not well understood. We conducted a systematic literature review of published QoL studies in GTS and other chronic tic disorders to comprehensively assess the effects of these conditions on QoL in different age groups. We found that QoL can be perceived differently by child and adult patients, especially with regard to the reciprocal contributions of tics and behavioral problems to the different domains of QoL. Specifically, QoL profiles in children often reflect the impact of co-morbid attention-deficit and hyperactivity symptoms, which tend to improve with age, whereas adults' perception of QoL seems to be more strongly affected by the presence of depression and anxiety. Management strategies should take into account differences in age-related QoL needs between children and adults with GTS or other chronic tic disorders.

Pharmacology and therapeutic implications of current drugs for type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is a global epidemic that poses a major challenge to health-care systems. Improving metabolic control to approach normal glycaemia (where practical) greatly benefits long-term prognoses and justifies early, effective, sustained and safety-conscious intervention. Improvements in the understanding of the complex pathogenesis of T2DM have underpinned the development of glucose-lowering therapies with complementary mechanisms of action, which have expanded treatment options and facilitated individualized management strategies. Over the past decade, several new classes of glucose-lowering agents have been licensed, including glucagon-like peptide 1 receptor (GLP-1R) agonists, dipeptidyl peptidase 4 (DPP-4) inhibitors and sodium/glucose cotransporter 2 (SGLT2) inhibitors. These agents can be used individually or in combination with well-established treatments such as biguanides, sulfonylureas and thiazolidinediones. Although novel agents have potential advantages including low risk of hypoglycaemia and help with weight control, long-term safety has yet to be established. In this Review, we assess the pharmacokinetics, pharmacodynamics and safety profiles, including cardiovascular safety, of currently available therapies for management of hyperglycaemia in patients with T2DM within the context of disease pathogenesis and natural history. In addition, we briefly describe treatment algorithms for patients with T2DM and lessons from present therapies to inform the development of future therapies.

A versenyképesség aktuális kérdései a pénzügyekben - Összefoglaló a pénzügyi kutatócsoport munkájáról = Current issues of competitiveness - Summary on the work of the Finance research team

A pénzügy kutatócsoport a TÁMOP-4.2.1.B-09/1/KMR-2010-0005 azonosítójú projektjében igen szerteágazó elemzési munkát végzett. Rámutattunk, hogy a különböző szintű gazdasági szereplők megnövekedett tőkeáttétele egyértelműen a rendszerkockázat növekedéséhez vezet, hiszen nő az egyes szereplők csődjének valószínűsége. Ha a tőkeáttételt eltérő mértékben és ütemben korlátozzák az egyes szektorokban, országokban akkor a korlátozást később bevezető szereplők egyértelműen versenyelőnyhöz jutnak. Az egyes pénzügyi intézmények tőkeallokációját vizsgálva kimutattuk, hogy a különféle divíziók közt mindig lehetséges a működés fedezetésül szolgáló tőkét (kockázatot) úgy felosztani, hogy a megállapodás felmondás egyik érintettnek se álljon érdekében. Ezt azonban nem lehet minden szempontból igazságosan megtenni, így egyes üzletágak versenyhátrányba kerülhetnek, ha a konkurens piaci szereplők az adott tevékenységet kevésbé igazságtalanul terhelték meg. Kimutattunk, hogy az egyes nyugdíjpénztárak befektetési tevékenységének eredményességére nagy hatással van a magánnyugdíjpénztárak tevékenységének szabályozása. Ezek a jogszabályok a társadalom hosszú távú versenyképességére vannak hatással. Rámutattunk arra is, hogy a gazdasági válság előtt a hazai bankok sem voltak képesek ügyfeleik kockázatviselő képességét helyesen megítélni, ráadásul jutalékrendszerük nem is tette ebben érdekelté azokat. Számos vizsgálatunk foglalkozott a magyar vállalatok versenyképességének alakulásával is. Megvizsgáltuk a különféle adónemek, árfolyamkockázatok és finanszírozási politikák versenyképességet befolyásoló hatását. Külön kutatás vizsgálta a kamatlábak ingadozásának és az hitelekhez kapcsolódó eszközfedezet meglétének vállalati értékre gyakorolt hatásait. Rámutattunk a nemfizetés növekvő kockázatára, és áttekintettük a lehetséges és a ténylegesen alkalmazott kezelési stratégiákat is. Megvizsgáltuk azt is, hogy a tőzsdei cégek tulajdonosai miként használják ki az osztalékfizetéshez kapcsolódó adóoptimalizálási lehetőségeket. Gyakorlati piaci tapasztalataik alapján az adóelkerülő kereskedést a befektetők a részvények egy jelentős részénél végrehajtják. Külön kutatás foglakozott a szellemi tőke hazai vállalatoknál játszott szerepéről. Ez alapján a cégek a problémát 2009-ben lényegesen magasabb szakértelemmel kezelték, mint öt esztendővel korábban. Rámutattunk arra is, hogy a tulajdonosi háttér lényeges hatást gyakorolhat arra, ahogyan a cégek célrendszerüket felépítik, illetve ahogy az intellektuális javakra tekintenek. _____ The Finance research team has covered a wide range of research fields while taking part at project TÁMOP-4.2.1.B-09/1/KMR-2010-0005. It has been shown that the increasing financial gearing at the different economic actors clearly leads to growth in systematic risk as the probability of bankruptcy climbs upwards. Once the leverage is limited at different levels and at different points in time for the different sectors, countries introducing the limitations later gain clearly a competitive advantage. When investigating the leverage at financial institutions we found that the capital requirement of the operation can always be divided among divisions so that none of them would be better of with cancelling the cooperation. But this cannot be always done fairly from all point of view meaning some of the divisions may face a competitive disadvantage if competitors charge their similar division less unfairly. Research has also shown that the regulation of private pension funds has vital effect on the profitability of the investment activity of the funds. These laws and regulations do not only affect the funds themselves but also the competitiveness of the whole society. We have also fund that Hungarian banks were unable to estimate correctly the risk taking ability of their clients before the economic crisis. On the top of that the bank were not even interested in that due to their commission based income model. We also carried out several research on the competitiveness of the Hungarian firms. The effect of taxes, currency rate risks, and financing policies on competitiveness has been analysed in detail. A separate research project was dedicated to the effect of the interest rate volatility and asset collaterals linked to debts on the value of the firm. The increasing risk of non-payment has been underlined and we also reviewed the adequate management strategies potentially available and used in real life. We also investigated how the shareholders of listed companies use the tax optimising possibilities linked to dividend payments. Based on our findings on the Hungarian markets the owners perform the tax evading trades in case of the most shares. A separate research has been carried out on the role played by intellectual capital. After that the Hungarian companies dealt with the problem in 2009 with far higher proficiency than five years earlier. We also pointed out that the ownership structure has a considerable influence on how firms structure their aims and view their intangible assets.

A worksite nutrition education program increased firefighters' knowledge and resulted in healthier attitudes toward fad diets

The effectiveness of a worksite nutrition education program to improve firefighters' knowledge and weight management strategies was evaluated. One hundred fifty Miami-Dade Fire Rescue workers recruited for the study were randomly assigned to an intervention or a control group. The intervention group attended four 30-minute worksite nutrition education sessions. A nutrition knowledge test completed by both groups before and after the intervention showed no significant differences between groups for pre-intervention nutrition knowledge. The post-intervention increase in nutrition knowledge was significantly greater (p < 0.001) for the intervention group (16.8% ± 8.2) compared to the control group (4% ± 8.9). No significant pre-intervention difference was found between the groups' predilection toward a ketogenic diet. A statistically significant (p < 0.01) reduction was seen in the intervention group's willingness (0.57 ± 1.06) to use this diet compared to the control group (0.02 ± 0.99). Results indicate that worksite nutrition education can improve firefighters' knowledge and weight reduction strategies. ^

Computational modeling of intermediate temperature proton exchange membrane (PEM) fuel cells

A two-phase three-dimensional computational model of an intermediate temperature (120--190°C) proton exchange membrane (PEM) fuel cell is presented. This represents the first attempt to model PEM fuel cells employing intermediate temperature membranes, in this case, phosphoric acid doped polybenzimidazole (PBI). To date, mathematical modeling of PEM fuel cells has been restricted to low temperature operation, especially to those employing Nafion ® membranes; while research on PBI as an intermediate temperature membrane has been solely at the experimental level. This work is an advancement in the state of the art of both these fields of research. With a growing trend toward higher temperature operation of PEM fuel cells, mathematical modeling of such systems is necessary to help hasten the development of the technology and highlight areas where research should be focused.^ This mathematical model accounted for all the major transport and polarization processes occurring inside the fuel cell, including the two phase phenomenon of gas dissolution in the polymer electrolyte. Results were presented for polarization performance, flux distributions, concentration variations in both the gaseous and aqueous phases, and temperature variations for various heat management strategies. The model predictions matched well with published experimental data, and were self-consistent.^ The major finding of this research was that, due to the transport limitations imposed by the use of phosphoric acid as a doping agent, namely low solubility and diffusivity of dissolved gases and anion adsorption onto catalyst sites, the catalyst utilization is very low (∼1--2%). Significant cost savings were predicted with the use of advanced catalyst deposition techniques that would greatly reduce the eventual thickness of the catalyst layer, and subsequently improve catalyst utilization. The model also predicted that an increase in power output in the order of 50% is expected if alternative doping agents to phosphoric acid can be found, which afford better transport properties of dissolved gases, reduced anion adsorption onto catalyst sites, and which maintain stability and conductive properties at elevated temperatures.^