Training pharmacists to deliver a complex information technology intervention (PINCER) using the principles of educational outreach and root cause analysis

Objective: To describe the training undertaken by pharmacists employed in a pharmacist-led information technology-based intervention study to reduce medication errors in primary care (PINCER Trial), evaluate pharmacists’ assessment of the training, and the time implications of undertaking the training. Methods: Six pharmacists received training, which included training on root cause analysis and educational outreach, to enable them to deliver the PINCER Trial intervention. This was evaluated using self-report questionnaires at the end of each training session. The time taken to complete each session was recorded. Data from the evaluation forms were entered onto a Microsoft Excel spreadsheet, independently checked and the summary of results further verified. Frequencies were calculated for responses to the three-point Likert scale questions. Free-text comments from the evaluation forms and pharmacists’ diaries were analysed thematically. Key findings: All six pharmacists received 22 hours of training over five sessions. In four out of the five sessions, the pharmacists who completed an evaluation form (27 out of 30 were completed) stated they were satisfied or very satisfied with the various elements of the training package. Analysis of free-text comments and the pharmacists’ diaries showed that the principles of root cause analysis and educational outreach were viewed as useful tools to help pharmacists conduct pharmaceutical interventions in both the study and other pharmacy roles that they undertook. The opportunity to undertake role play was a valuable part of the training received. Conclusions: Findings presented in this paper suggest that providing the PINCER pharmacists with training in root cause analysis and educational outreach contributed to the successful delivery of PINCER interventions and could potentially be utilised by other pharmacists based in general practice to deliver pharmaceutical interventions to improve patient safety.

The Carnegie curve

The Earth’s fair weather atmospheric electric field shows, in clean air, an average daily variation which follows universal time, globally independent of the measurement position. This single diurnal cycle variation (maximum around 19UT and minimum around 03UT) is widely known as the Carnegie curve, after the geophysical survey vessel of the Carnegie Institution of Washington on which the original measurement campaigns demonstrating the universal time variation were undertaken. The Carnegie curve’s enduring importance is in providing a reference variation against which atmospheric electricity measurements are still compared; it is believed to originate from regular daily variations in atmospheric electrification associated with the different global disturbed weather regions. Details of the instrumentation, measurement principles and data obtained on the Carnegie’s seventh and final cruise are reviewed here, also deriving new harmonic coefficients allowing calculation of the Carnegie curve for different seasons. The additional harmonic analysis now identifies changes in the phasing of the maximum and minimum in the Carnegie curve, which shows a systematic seasonal variation, linked to the solstices and equinoxes, respectively.

Rossby number expansions, slaving principles, and balance dynamics

We consider the problem of constructing balance dynamics for rapidly rotating fluid systems. It is argued that the conventional Rossby number expansion—namely expanding all variables in a series in Rossby number—is secular for all but the simplest flows. In particular, the higher-order terms in the expansion grow exponentially on average, and for moderate values of the Rossby number the expansion is, at best, useful only for times of the order of the doubling times of the instabilities of the underlying quasi-geostrophic dynamics. Similar arguments apply in a wide class of problems involving a small parameter and sufficiently complex zeroth-order dynamics. A modified procedure is proposed which involves expanding only the fast modes of the system; this is equivalent to an asymptotic approximation of the slaving relation that relates the fast modes to the slow modes. The procedure is systematic and thus capable, at least in principle, of being carried to any order—unlike procedures based on truncations. We apply the procedure to construct higher-order balance approximations of the shallow-water equations. At the lowest order quasi-geostrophy emerges. At the next order the system incorporates gradient-wind balance, although the balance relations themselves involve only linear inversions and hence are easily applied. There is a large class of reduced systems associated with various choices for the slow variables, but the simplest ones appear to be those based on potential vorticity.

The Copenhagen principles on the handling of detainees: implications for the procedural regulation of internment

The Copenhagen Principles on the Handling of Detainees in International Military Operations were released in October 2012 after a five-year long process involving states and certain organizations. The Principles address a number of issues concerning the handling and transfer of detainees. They apply in military operations conducted by states abroad in the context of non-international armed conflicts and peace operations. This article focuses on those principles that address the procedural regulation of internment (ie preventive, security detention), as it is here that the current law is particularly unclear. On the one hand, the treaty provisions applicable in non-international armed conflicts contain no rules on the procedural regulation of internment, in comparison with the law of international armed conflict. On the other hand, the relevant rules under international human rights law (IHRL) appear derogable in such situations. This article demonstrates that the approach taken to this issue in the Copenhagen Principles is one which essentially draws on the procedural rules applicable to civilian internment in the international armed conflicts. These rules adopt standards that are lower than those under IHRL. Reference is then made to other recent practice, which illustrates that the Copenhagen Principles do not apply in a legal vacuum. In particular, two recent judicial developments highlight the continued relevance of human rights law and domestic law, respectively, in regulating detention operations in the context of international military operations. Compliance with the Copenhagen Principles may not, therefore, be sufficient for detention to be lawful.

Large inert carbon pool in the terrestrial biosphere at the Last Glacial Maximum

During each of the late Pleistocene glacial–interglacial transitions, atmospheric carbon dioxide concentrations rose by almost 100 ppm. The sources of this carbon are unclear, and efforts to identify them are hampered by uncertainties in the magnitude of carbon reservoirs and fluxes under glacial conditions. Here we use oxygen isotope measurements from air trapped in ice cores and ocean carbon-cycle modelling to estimate terrestrial and oceanic gross primary productivity during the Last Glacial Maximum. We find that the rate of gross terrestrial primary production during the Last Glacial Maximum was about 40±10 Pg C yr−1, half that of the pre-industrial Holocene. Despite the low levels of photosynthesis, we estimate that the late glacial terrestrial biosphere contained only 330 Pg less carbon than pre-industrial levels. We infer that the area covered by carbon-rich but unproductive biomes such as tundra and cold steppes was significantly larger during the Last Glacial Maximum, consistent with palaeoecological data. Our data also indicate the presence of an inert carbon pool of 2,300 Pg C, about 700 Pg larger than the inert carbon locked in permafrost today. We suggest that the disappearance of this carbon pool at the end of the Last Glacial Maximum may have contributed to the deglacial rise in atmospheric carbon dioxide concentrations.

Reconstruction and prediction of variations in the open solar magnetic flux and interplanetary conditions

Historic geomagnetic activity observations have been used to reveal centennial variations in the open solar flux and the near-Earth heliospheric conditions (the interplanetary magnetic field and the solar wind speed). The various methods are in very good agreement for the past 135 years when there were sufficient reliable magnetic observatories in operation to eliminate problems due to site-specific errors and calibration drifts. This review underlines the physical principles that allow these reconstructions to be made, as well as the details of the various algorithms employed and the results obtained. Discussion is included of: the importance of the averaging timescale; the key differences between “range” and “interdiurnal variability” geomagnetic data; the need to distinguish source field sector structure from heliospherically-imposed field structure; the importance of ensuring that regressions used are statistically robust; and uncertainty analysis. The reconstructions are exceedingly useful as they provide calibration between the in-situ spacecraft measurements from the past five decades and the millennial records of heliospheric behaviour deduced from measured abundances of cosmogenic radionuclides found in terrestrial reservoirs. Continuity of open solar flux, using sunspot number to quantify the emergence rate, is the basis of a number of models that have been very successful in reproducing the variation derived from geomagnetic activity. These models allow us to extend the reconstructions back to before the development of the magnetometer and to cover the Maunder minimum. Allied to the radionuclide data, the models are revealing much about how the Sun and heliosphere behaved outside of grand solar maxima and are providing a means of predicting how solar activity is likely to evolve now that the recent grand maximum (that had prevailed throughout the space age) has come to an end.

Quantifying the roles of ocean circulation and biogeochemistry in governing ocean carbon-13 and atmospheric carbon dioxide at the last glacial maximum

We use a state-of-the-art ocean general circulation and biogeochemistry model to examine the impact of changes in ocean circulation and biogeochemistry in governing the change in ocean carbon-13 and atmospheric CO2 at the last glacial maximum (LGM). We examine 5 different realisations of the ocean's overturning circulation produced by a fully coupled atmosphere-ocean model under LGM forcing and suggested changes in the atmospheric deposition of iron and phytoplankton physiology at the LGM. Measured changes in carbon-13 and carbon-14, as well as a qualitative reconstruction of the change in ocean carbon export are used to evaluate the results. Overall, we find that while a reduction in ocean ventilation at the LGM is necessary to reproduce carbon-13 and carbon-14 observations, this circulation results in a low net sink for atmospheric CO2. In contrast, while biogeochemical processes contribute little to carbon isotopes, we propose that most of the change in atmospheric CO2 was due to such factors. However, the lesser role for circulation means that when all plausible factors are accounted for, most of the necessary CO2 change remains to be explained. This presents a serious challenge to our understanding of the mechanisms behind changes in the global carbon cycle during the geologic past.

Climatic impacts of fresh water hosing under Last Glacial Maximum conditions: a multi-model study

Fresh water hosing simulations, in which a fresh water flux is imposed in the North Atlantic to force fluctuations of the Atlantic Meridional Overturning Circulation, have been routinely performed, first to study the climatic signature of different states of this circulation, then, under present or future conditions, to investigate the potential impact of a partial melting of the Greenland ice sheet. The most compelling examples of climatic changes potentially related to AMOC abrupt variations, however, are found in high resolution palaeo-records from around the globe for the last glacial period. To study those more specifically, more and more fresh water hosing experiments have been performed under glacial conditions in the recent years. Here we compare an ensemble constituted by 11 such simulations run with 6 different climate models. All simulations follow a slightly different design, but are sufficiently close in their design to be compared. They all study the impact of a fresh water hosing imposed in the extra-tropical North Atlantic. Common features in the model responses to hosing are the cooling over the North Atlantic, extending along the sub-tropical gyre in the tropical North Atlantic, the southward shift of the Atlantic ITCZ and the weakening of the African and Indian monsoons. On the other hand, the expression of the bipolar see-saw, i.e., warming in the Southern Hemisphere, differs from model to model, with some restricting it to the South Atlantic and specific regions of the southern ocean while others simulate a widespread southern ocean warming. The relationships between the features common to most models, i.e., climate changes over the north and tropical Atlantic, African and Asian monsoon regions, are further quantified. These suggest a tight correlation between the temperature and precipitation changes over the extra-tropical North Atlantic, but different pathways for the teleconnections between the AMOC/North Atlantic region and the African and Indian monsoon regions.

Housing or property? The dynamics of housing policy and property principles in the right to buy

This paper examines the interplay and tension between housing law and policy and property law, in the specific context of the right to buy (RTB). It focuses on funding arrangements between the RTB tenant and another party. It first examines how courts determine the parties' respective entitlements in the home, highlighting the difficulty of categorising, under traditional property law principles, a contribution in the form of the statutory discount conferred on the RTB tenant. Secondly, it considers possible exploitation of the RTB scheme, both at the macro level of exploitation of the policy underpinning the legislation and, at the micro level, of exploitation of the tenant. The measures contained in the Housing Act 2004 intended to curb exploitation of the RTB are analysed to determine what can be considered to be legitimate and illegitimate uses of the scheme. It is argued that, despite the government's implicit approval, certain funding arrangements by non-resident relatives fail to give effect to the spirit of the scheme.

Reducing inconsistencies in point observations of maximum flood inundation level

Flood simulation models and hazard maps are only as good as the underlying data against which they are calibrated and tested. However, extreme flood events are by definition rare, so the observational data of flood inundation extent are limited in both quality and quantity. The relative importance of these observational uncertainties has increased now that computing power and accurate lidar scans make it possible to run high-resolution 2D models to simulate floods in urban areas. However, the value of these simulations is limited by the uncertainty in the true extent of the flood. This paper addresses that challenge by analyzing a point dataset of maximum water extent from a flood event on the River Eden at Carlisle, United Kingdom, in January 2005. The observation dataset is based on a collection of wrack and water marks from two postevent surveys. A smoothing algorithm for identifying, quantifying, and reducing localized inconsistencies in the dataset is proposed and evaluated showing positive results. The proposed smoothing algorithm can be applied in order to improve flood inundation modeling assessment and the determination of risk zones on the floodplain.

Pollen, plant macrofossil and charcoal records for palaeovegetation reconstruction in the Mediterranean-Black Sea Corridor since the Last Glacial Maximum

New reconstructions of changing vegetation patterns in the Mediterranean-Black Sea Corridor since the Last Glacial Maximum are being produced by an improved biomisation scheme that uses both pollen and plant macrofossil data, in conjunction. Changes in fire regimes over the same interval will also be reconstructed using both microscopic and macroscopic charcoal remains. These reconstructions will allow a diagnosis of the interactions between climate, fire and vegetation on millennial timescales, and will also help to clarify the role of coastline and other geomorphic changes, salinity and impacts of human activities in this region. These new data sets are being produced as a result of collaboration between the Palynology Working Group (WG-2) within the IGCP-521 project and the international Palaeovegetation Mapping Project (BIOME 6000). The main objective of this paper is to present the goals of this cooperation, methodology, including limitations and planned improvements, and to show the initial results of some applications.

Results of PMIP2 coupled simulations of the mid-Holocene and Last Glacial Maximum, Part 2: feedbacks with emphasis on the location of the ITCZ and mid- and high latitudes heat budget

A set of coupled ocean-atmosphere(-vegetation) simulations using state of the art climate models is now available for the Last Glacial Maximum (LGM) and the Mid-Holocene (MH) through the second phase of the Paleoclimate Modeling Intercomparison Project (PMIP2). Here we quantify the latitudinal shift of the location of the Intertropical Convergence Zone (ITCZ) in the tropical regions during boreal summer and the change in precipitation in the northern part of the ITCZ. For both periods the shift is more pronounced over the continents and East Asia. The maritime continent is the region where the largest spread is found between models. We also clearly establish that the larger the increase in the meridional temperature gradient in the tropical Atlantic during summer at the MH, the larger the change in precipitation over West Africa. The vegetation feedback is however not as large as found in previous studies, probably due to model differences in the control simulation. Finally, we show that the feedback from snow and sea-ice at mid and high latitudes contributes for half of the cooling in the Northern Hemisphere for the LGM, with the remaining being achieved by the reduced CO2 and water vapour in the atmosphere. For the MH the snow and albedo feedbacks strengthen the spring cooling and enhance the boreal summer warming, whereas water vapour reinforces the late summer warming. These feedbacks are modest in the Southern Hemisphere. For the LGM most of the surface cooling is due to CO2 and water vapour.