Prospective clinical audit of chloral hydrate administration practices in a neonatal unit

Aim: Chloral hydrate is generally considered a safe and effective single dosing procedural sedative for neonates in the clinical setting. However, its safety profile as a repetitive dosing maintenance sedative is largely unknown. This study aimed to document current administration practices of chloral hydrate in the Neonatal Unit, Royal Children's Hospital, Melbourne, Australia, over a 6-month period.

Methods: Patients who had been prescribed chloral hydrate during the specified audit period were recruited into the study and prospectively followed for a period of 28 days, or until they were discharged from the unit. Demographic data were collected on recruitment, and daily documentation of chloral hydrate administration was recorded.

Results: A total of 238 doses of chloral hydrate were administered to a cohort of 32 patients during the study period. The majority of the audited doses (84%) were ordered as repeating doses. Doses were more likely to be given at night than during the day, and the median dosage for repetitive dosing was found to be above the study site's recommended dosing range. Pre-dose and/or post-dose assessment of distress/agitation accompanied dosage approximately half of the time. The audit did not reveal any recognisable pattern of sedation maintenance or weaning process for patients who received multiple doses.

Conclusions: Health-care professionals caring for hospitalised infants should be made aware of the potential risks of chloral hydrate as a repetitive dosing sedative, and of the importance of systematically evaluating the appropriateness and effectiveness of utilising such pharmacological intervention for managing and treating distress.

Recessionary Bundles: HR Practices in the Irish Economic Crisis

The HR practices adopted by firms in response to the current deep and prolonged recession have received little attention in the literature. There are reasons for supposing that firms will adopt HR practices in bundles in responding to the recession in order to benefit from technical and behavioural complementarities. Drawing on a nationally representative survey, the article investigates the bundles of HR practices adopted by firms during the Irish recession and examines influences on the bundles that are evident. The article contributes to HRM theory by testing different views on HR bundles likely to be adopted in recessionary conditions and by moving beyond the prevailing focus in HRM on HR bundles adopted by firms in steady-state business conditions.

Principal Component Analysis of Wide Area Phasor Measurements for Islanding Detection – A Geometric View

This paper presents a new technique for the detectionof islanding conditions in electrical power systems. This problem isespecially prevalent in systems with significant penetrations of distributedrenewable generation. The proposed technique is based onthe application of principal component analysis (PCA) to data setsof wide-area frequency measurements, recorded by phasor measurementunits. The PCA approach was able to detect islandingaccurately and quickly when compared with conventional RoCoFtechniques, as well as with the frequency difference and change-ofangledifference methods recently proposed in the literature. Thereliability and accuracy of the proposed PCA approach is demonstratedby using a number of test cases, which consider islandingand nonislanding events. The test cases are based on real data,recorded from several phasor measurement units located in theU.K. power system.

Medication use review in Qatar: Are community pharmacists prepared for the extended professional role?

Background
The incidence of chronic illnesses is increasing globally. Non-adherence to medications and other medication-related problems are common among patients receiving long-term medications. Medication use review (MUR) is a service provision with an accredited pharmacist undertaking structured, adherence-centered reviews with patients receiving multiple medications. MUR services are not yet available in community pharmacies in Qatar.

Objective
The current study aims to evaluate community pharmacists' knowledge, attitudes, and perception towards establishing MUR as an extended role in patient care.

Setting
Private community pharmacies in Qatar including chains and independent pharmacies.

Methodology
A cross-sectional survey using a self-administered questionnaire was conducted among licensed community pharmacists from December 2012 to January 2013. Data analysis was conducted using descriptive and inferential statistics.

Main outcome measures
Knowledge, attitudes, and practices related to MUR concept and services.

Results A total of 123 participants responded to the survey (response rate 56 %). The mean total knowledge score was 71.4 ± 14.7 %. An overwhelming proportion of the participants (97 %) were able to identify the scope of MUR in relation to chronic illnesses and at enhancing the quality of pharmaceutical care. Furthermore, 80 % of the respondents were able to identify patients of priority for inclusion in an MUR program. However, only 43 % of the participants knew that acute medical conditions were not the principal focus of an MUR service, while at least 97 % acknowledged that the provision of MUR services is a great opportunity for an extended role of community pharmacists and that MUR makes excellent use of the pharmacist's professional skills in the community. The participants generally reported concerns about time, dedicated consultation area, and support staff as significant barriers towards MUR implementation.

Conclusion
This study suggests that community pharmacists in Qatar had sufficient knowledge about the concept of MUR and its scope, but there were still important deficiencies that warrant further education. The findings have important implications on policy and practice pertaining to the implementation of MUR as an extended role of pharmacists and as part of Qatar's National Health Strategy to move primary health care forward.

Introduction: Beyond the Divided City: Policies and Practices of Shared Space

Introduction to special feature on 'post-conflict' Belfast

Distributed Sounding Art – Practices in Distributing Sound (eds. Barry Truax, Marcel Cobussen and Vincent Meelberg)

This chapter examines distributed sounding art by focusing on three key aspects that we consider essentially tied to the notion of distribution: assignment, transport and sharing. These aspects aid us in navigating through a number of nodes in a history of sounding art practices where sound becomes assigned, transported and shared between places and people. Sound or data become distributed, and in the process of distribution, meanings become assigned and altered through differing socio-cultural contexts of places and people. We have selected several works, commencing in the 1960’s as we consider this period as having produced some of the seminal works that address distribution.
We draw on works by composers, performers and sound artists and thus present a history of sounding art, which is amongst the many histories of sounding art in the 20th and 21st century.