Errors associated with the preparation of aseptic products in UK hospital pharmacies: lessons from the national aseptic error reporting scheme

Background Pharmacy aseptic units prepare and supply injectables to minimise risks. The UK National Aseptic Error Reporting Scheme has been collecting data on pharmacy compounding errors, including near-misses, since 2003. Objectives The cumulative reports from January 2004 to December 2007, inclusive, were analysed. Methods The different variables of product types, error types, staff making and detecting errors, stage errors detected, perceived contributory factors, and potential or actual outcomes were presented by cross-tabulation of data. Results A total of 4691 reports were submitted against an estimated 958 532 items made, returning 0.49% as the overall error rate. Most of the errors were detected before reaching patients, with only 24 detected during or after administration. The highest number of reports related to adult cytotoxic preparations (40%) and the most frequently recorded error was a labelling error (34.2%). Errors were mostly detected at first check in assembly area (46.6%). Individual staff error contributed most (78.1%) to overall errors, while errors with paediatric parenteral nutrition appeared to be blamed on low staff levels more than other products were. The majority of errors (68.6%) had no potential patient outcomes attached, while it appeared that paediatric cytotoxic products and paediatric parenteral nutrition were associated with greater levels of perceived patient harm. Conclusions The majority of reports were related to near-misses, and this study highlights scope for examining current arrangements for checking and releasing products, certainly for paediatric cytotoxic and paediatric parenteral nutrition preparations within aseptic units, but in the context of resource and capacity constraints.

An empirical study of process-related attributes in segmented software cost-estimation relationships

Parametric software effort estimation models consisting on a single mathematical relationship suffer from poor adjustment and predictive characteristics in cases in which the historical database considered contains data coming from projects of a heterogeneous nature. The segmentation of the input domain according to clusters obtained from the database of historical projects serves as a tool for more realistic models that use several local estimation relationships. Nonetheless, it may be hypothesized that using clustering algorithms without previous consideration of the influence of well-known project attributes misses the opportunity to obtain more realistic segments. In this paper, we describe the results of an empirical study using the ISBSG-8 database and the EM clustering algorithm that studies the influence of the consideration of two process-related attributes as drivers of the clustering process: the use of engineering methodologies and the use of CASE tools. The results provide evidence that such consideration conditions significantly the final model obtained, even though the resulting predictive quality is of a similar magnitude.

Environmental oestrogens and breast cancer: long-term low-dose effects of mixtures of various chemical combinations

The incidence of breast cancer has risen worldwide to unprecedented levels in recent decades, making it now the major cancer of women in many parts of the world.1 Although diet, alcohol, radiation and inherited loss of BRCA1/2 genes have all been associated with increased incidence, the main identified risk factors are life exposure to hormones including physiological variations associated with puberty/pregnancy/menopause,1 personal choice of use of hormonal contraceptives2 and/or hormone replacement therapy.3–6 On this basis, exposure of the human breast to the many environmental pollutant chemicals capable of mimicking or interfering with oestrogen action7 should also be of concern.8 Hundreds of such environmental chemicals have now been measured in human breast tissue from a range of dietary and domestic exposure sources7 ,9 including persistent organochlorine pollutants (POPs),10 polybrominated diphenylethers and polybromobiphenyls,11 polychlorinated biphenyls,12 dioxins,13 alkyl phenols,14 bisphenol-A and chlorinated derivatives,15 as well as other less lipophilic compounds such as parabens (alkyl esters of p-hydroxybenzoic acid),16 but studies investigating any association between raised levels of such compounds and the development of breast cancer remain inconclusive.7–16 However, the functionality of these chemicals has continued to be assessed on the basis of individual chemicals rather than the environmental reality of long-term low-dose exposure to complex mixtures. This misses the potential for individuals to have high concentrations of different compounds but with a common mechanism of action. It also misses the complex interactions between chemicals and physiological hormones which together may act to alter the internal homeostasis of the oestrogenic environment of mammary tissue.

Entertainment education theory and practice in HIV/AIDS communication: a South Africa / United Kingdom comparison

Within development communication, gaps remain in theory and practice: communication innovations are taking place which either do not incorporate theory or fail to challenge the assumptions of development communication and HIV/AIDS theory. This can lead to the implementation of unsuccessful interventions that lack theoretical frameworks or to uninformed practice, making it difficult to replicate. Further, research has demonstrated that Entertainment Education (EE) interventions have a measurable impact on behaviour in areas such as HIV/AIDS prevention. Given the transitions in EE practice and evidence of its impact, EE theory and practice can contribute insight into these challenges. A pilot study investigated these dilemmas within the context of the monitoring and evaluation of development communication. Framing this discussion is the concept of South-North dialogue, using comparative analysis of EE interventions to distil lessons through contrasting experiences in two diverse settings. It holds as a principle that lessons from the experience of EE in the Southern context can inform lessons for the North. Further, comparison of the case studies can generate insights for the broader development communication field. We present four case studies, informed by key informant interviews, of EE interventions in the UK and South Africa. We address how communication is defined in planning, implementation and evaluation, highlighting how it often misses the importance of 'listening'. The case studies show that HIV/AIDS communication, and development communication more broadly, has not internalised ideas of evaluation and listening in communication. Successes in the case studies can be partially attributed to responsiveness and context-specificity rather than following rigid planning templates, such as those found in some development communication literature. This indicates the importance of flexibility and responsiveness to context for both development communication and HIV/AIDS communication.

Quality control, validation and user feedback of the European Flood Alert System (EFAS)

The quality control, validation and verification of the European Flood Alert System (EFAS) are described. EFAS is designed as a flood early warning system at pan-European scale, to complement national systems and provide flood warnings more than 2 days before a flood. On average 20–30 alerts per year are sent out to the EFAS partner network which consists of 24 National hydrological authorities responsible for transnational river basins. Quality control of the system includes the evaluation of the hits, misses and false alarms, showing that EFAS has more than 50% of the time hits. Furthermore, the skills of both the meteorological as well as the hydrological forecasts are evaluated, and are included here for a 10-year period. Next, end-user needs and feedback are systematically analysed. Suggested improvements, such as real-time river discharge updating, are currently implemented.

Addressing the market research skills gap

This Viewpoint focuses on the debate in market research around the gap between academia and practitioners. It argues that the debate misses the key role that universities play in the provision of market research skills and that it is this skills gap that needs to be addressed in order to ensure the future of research as a profession.

The regulation of cyber warfare under the jus ad bellum

This chapter evaluates the potential for legal regulation of the resort to cyber warfare between states under the ‘jus ad bellum’ (the law on the use of force). Debate in the literature has largely concerned whether cyber warfare falls within the scope of Article 2(4) UNC. The first part of this chapter sets out this debate. It then goes on to argue that the ‘Article 2(4) debate’ often misses the fact that an act of cyber warfare can be considered a breach of a different legal rule: the principle of non-intervention. The chapter further considers some of the issues in applying either the prohibition of the use of force or the principle of non-intervention to cyber warfare, and then concludes by arguing that the debate should be reoriented to focus on another existing international legal obligation: the duty to prevent cyber-attacks.

Toward a scholarly edition of Beckett's critical writings

This essay outlines the case for a new, scholarly edition of Beckett's critical writings, one that would be complete and with critical annotation. For the most part these texts (critical writings, tributes, in memoria and epigraphs) have been published in a range of places. As well as in the magazines, newspapers, books and special-issue publications in which pieces originally appeared, a number were collected in Disjecta (Calder 1983 & Grove 1984). This volume, however, is not exhaustive; it misses out a number of important texts (not least Proust) and contains some textual inaccuracies. Furthermore, Beckett's critical writings are currently not available from the UK publishers Faber and the Grove Press Centenary Edition of Beckett's works, the fourth volume of which contains a section entitled ‘Criticism’, presents only three works of criticism by Beckett (Proust, ‘Dante … Bruno . Vico . . Joyce’ and ‘Three Dialogues’). In this essay, we give a brief (and far from exhaustive) overview of the publication history of Beckett's non-fiction prose texts, before outlining some of the editorial challenges they pose. Although Beckett tended to be dismissive of these works, they form an integral part of his canon.

'They would never receive you without a husband' : Paradoxical barriers to antenatal care scale-up in Rwanda

OBJECTIVE: to explore perspectives and experiences of antenatal care and partner involvement among women who nearly died during pregnancy ('near-miss'). DESIGN: a study guided by naturalistic inquiry was conducted, and included extended in-community participant observation, semi-structured interviews, and focus group discussions. Qualitative data were collected between March 2013 and April 2014 in Kigali, Rwanda. FINDINGS: all informants were aware of the recommendations of male involvement for HIV-testing at the first antenatal care visit. However, this recommendation was seen as a clear link in the chain of delays and led to severe consequences, especially for women without engaged partners. The overall quality of antenatal services was experienced as suboptimal, potentially missing the opportunity to provide preventive measures and essential health education intended for both parents. This seemed to contribute to women's disincentive to complete all four recommended visits and men's interest in attending to ensure their partners' reception of care. However, the participants experienced a restriction of men's access during subsequent antenatal visits, which made men feel denied to their increased involvement during pregnancy. CONCLUSIONS: 'near-miss' women and their partners face paradoxical barriers to actualise the recommended antenatal care visits. The well-intended initiative of male partner involvement counterproductively causes delays or excludes women whereas supportive men are turned away from further health consultations. Currently, the suboptimal quality of antenatal care misses the opportunity to provide health education for the expectant couple or to identify and address early signs of complications IMPLICATIONS FOR PRACTICE: these findings suggest a need for increased flexibility in the antenatal care recommendations to encourage women to attend care with or without their partner, and to create open health communication about women's and men's real needs within the context of their social situations. Supportive partners should not be denied involvement at any stage of pregnancy, but should be received only upon consent of the expectant mother.

Da legalidade da guerra perante a ordem jurídica internacional

"O mundo nasceu de duas forças:o Amor e a Guerra(Erros e Polemós)", assim assem asseverava, EMPÉDOCLES.A guerra e a paz, a moralidade e imoralidade dos atos humanos são questões que nos remetem a tempos imemoriais.."Batalhas míticas entre o Bem e o Mal" presentes nas teogonias e culturas, bem como, nas mais variadas expressões religiosas.Afinal, segundo a teologia da maioria delas, a"Primeira Grande Guerra" foi à havida no Céu!A validação moral e consequentemente jurídicas da guerra é questão controvertida e ocupa posto permanente nos pensamentos e reflexões de eminentes homens, desde filósofos, juristas, clérigos e pontífices; e até mesmo aos homens medianos.Há uma justificação para a guerra?É valida como instrumento de justiça?OU, segundo, nos incita a meditação, o saudoso poeta GIBRAN KALIL GIBRAN, em célebre poema,"As Almas Rebeldes":"oporemos ao mal um mal maior, e diremos:é a lei?E combateremos o vício com pior, e diremos:é a moral?E lutaremos contra o crime com crimes mais cruéis, e diremos:é a justiça?".Em demanda de respostas a estas indagações, fizemos uso, quanto ás pesquisas e análises, para a elaboração desde trabalho, de abordagem eclética, sincrética e harmonista, por tratar-se de matéria e assunto, complexos e de difícil delimitação.A guerra é inegavelmente, um fenômeno de grande relevância perante o Direito e como tal, caracteriza-se como um fato jurídico, devendo , portanto, ser observada e regulada, por meios eficazes e instrumentais,emanados e definidos com clareza, por órgãos competentes e legítimos, admitidos pelos interessados.A guerra legal ou justa é aquela que visa o restabelecimento da "ordem" como expressão da "beleza" ou harmonia";diante de uma injusta agressão de uma injusta agressão a um direito lesado.Guerra legal ou Justa;é única e exclusivamente, a admitida pelo Direito Internacional de Guerra, qual seja; a decorrente de legítima defesa.Porém, esta-nos vigiar sempre sobre o tal questão, haja vista,existirem provas históricas e atuais, da utilização deste princípio-quando o pervertem-visando a "justificação" da agressão, ou melhor;em "nome da paz", realizam a guerra , na melhor expressão do antigo adágio latino:"... se queres a paz,prepara-te para a guerra...".

Inovação e hibridismos na obra Visagens nordestinas

Dissertação apresentada ao Programa de Pós-graduação em Comunicação- Mestrado da Universidade Municipal de São Caetano do Sul

O composto de marketing e a teologia da prosperidade: um estudo sobre dízimos e ofertas em uma igreja neopentecostal

Este trabalho se propôs aprofundar os estudos relativos à aplicação de Marketing de Serviços nas atividades religiosas, bem como, identificar quais os motivos que levam os fiéis a adotar as práticas de troca estabelecidas pelas igrejas, em relação à devolução dos dízimos e das ofertas pelos fiéis. Usando pesquisa exploratória, de natureza qualitativa, por meio de estudo de caso, o foco central da pesquisa buscou formular hipóteses que contribuam para estudar os motivos que levam os fiéis a adotar essas práticas. Nesse sentido, buscou-se a identificação de situações relevantes nesse campo do conhecimento, bem como de possibilidades práticas de utilização do Marketing de Serviços nas Igrejas Neopentecostais. Os resultados da pesquisa apontam que as pessoas devolvem o dízimo e dão suas ofertas, na maioria das vezes, apenas em decorrência da fundamentação retórica que legitima esse procedimento nas Escrituras Sagradas na aspiração de obter a paz na vida eterna.

Ajustamento intercultural de executivos japoneses expatriados no Brasil: um estudo empírico

O ajustamento intercultural tem sido considerado fator determinante do sucesso em missões internacionais e o conceito-chave do modelo de ajustamento internacional de Black, Mendenhall e Oddou (1991a). O objetivo deste artigo é analisar o ajustamento intercultural de executivos japoneses expatriados. Realizou-se uma pesquisa qualitativa com 37 executivos japoneses expatriados, em 21 empresas de diversos setores no Brasil. Apesar de a literatura considerar os expatriados japoneses exemplos de sucesso,

Estudo de diferentes métodos de extração por Ultra-Som de pesticidas em latossolo utilizando técnicas cromatográficas

Amostras de solo (latossolo vermelho destroférrico) coletadas em três pontos distintos, no município de Caibaté (Região das Missões, RS), na profundidade de aproximadamente 10 cm (da superfície do solo), em diferentes estações do ano e com diferentes tipos de manejo de solo (plantio convencional; plantio direto e cultivo mínimo), foram analisadas com o intuito de verificar a presença e a persistência de pesticidas no solo. Adicionalmente foi avaliada a relação entre a concentração dos produtos e tipo de manejo de solo aplicado. Este estudo é justificado por ser esta região de caráter tipicamente agrícola, com uso sistemático de pesticidas, tais como: monocrotofós, tiabendazole, triadimenol, lufenuron e imazetapir. Primeiramente foram estudadas as melhores condições de extração, considerando as técnicas mais comumente utilizadas, como o soxhlet, o banho e a sonda de ultra-som. As análises foram realizadas por Cromatografia Líquida de Alta Eficiência com Detector UV-visível (lufenuron e imazetapir) e Cromatografia Gasosa com Detector Seletivo de Massas (monocrotofós, tiabendazole e triadimenol), dependendo das características do analito em estudo. Os resultados mostram a presença de todos os pesticidas estudados, permitindo inferir que os mesmos persistem no solo. Além disto, os resultados indicam que não há uma uniformidade da extração dos analitos nas amostras dos solos, que foram extraídas com as técnicas de soxhlet, banho e sonda de ultra-som. Tais diferenças podem ser devido à heterogeneidade das amostras ou uma extração seletiva dos analitos. Quanto as influências do tipo de manejo das lavouras, não foi possível constatar a contribuição destas formas de plantio para a persistência de resíduos de pesticidas no solo.

Relações entre estratégia e estrutura organizacional : um estudo de caso na URI

A presente pesquisa, realizada sob a forma de estudo de caso, objetiva caracterizar as relações existentes entre a estrutura e as estratégias no âmbito da Universidade Regional Integrada do Alto Uruguai e das Missões - URI. A URI caracteriza-se como uma universidade comunitária, multicampi, de característica eminentemente regional e integrada, originada da associação de Escolas Isoladas de Ensino Superior, localizada no Interior do Rio Grande do Sul, com Campi em Erechim, Santo Ângelo, Frederico Westphalen e Santiago, além de extensões em São Luiz Gonzaga e Cerro Largo. As estruturas foram estudadas utilizando-se as variáveis configuração estrutural, níveis de tomada de decisão e complexidade. Já as estratégias foram estudadas no sentido de identificar os tipos predominantes na organização e como estas são formadas. Caracterizada por uma gestão acadêmica única, embora com descentralização administrativa, o estudo conclui que a estratégia inicial de criação da universidade determinou a forma de organização estrutural, e que esta organização, que alocou substantiva autonomia para os Campi, configura-se como uma estrutura organizacional do tipo divisionalizada, com características de burocracia profissional do tipo racionalburocrática. As estratégias podem ser denominadas como do tipo guarda-chuva, em que as linhas gerais são deliberadas, e os detalhes passam a emergir no decorrer do percurso. O estudo propõe uma reconfiguração estrutural e estratégica que respeite as características de individualidade da organização, mas que consiga inseri-la numa perspectiva moderna de organização, buscando criar condições de inserção num novo momento, em que as organizações precisam ser menos hierarquizadas e mais inovativas.