Care homes’ use of medicines study: prevalence, causes and potential harm of medication errors in care homes for older people

Introduction: Care home residents are at particular risk from medication errors, and our objective was to determine the prevalence and potential harm of prescribing, monitoring, dispensing and administration errors in UK care homes, and to identify their causes. Methods: A prospective study of a random sample of residents within a purposive sample of homes in three areas. Errors were identified by patient interview, note review, observation of practice and examination of dispensed items. Causes were understood by observation and from theoretically framed interviews with home staff, doctors and pharmacists. Potential harm from errors was assessed by expert judgement. Results: The 256 residents recruited in 55 homes were taking a mean of 8.0 medicines. One hundred and seventy-eight (69.5%) of residents had one or more errors. The mean number per resident was 1.9 errors. The mean potential harm from prescribing, monitoring, administration and dispensing errors was 2.6, 3.7, 2.1 and 2.0 (0 = no harm, 10 = death), respectively. Contributing factors from the 89 interviews included doctors who were not accessible, did not know the residents and lacked information in homes when prescribing; home staff’s high workload, lack of medicines training and drug round interruptions; lack of team work among home, practice and pharmacy; inefficient ordering systems; inaccurate medicine records and prevalence of verbal communication; and difficult to fill (and check) medication administration systems. Conclusions: That two thirds of residents were exposed to one or more medication errors is of concern. The will to improve exists, but there is a lack of overall responsibility. Action is required from all concerned.

Superhumps, magnetic fields and the mass ratio in AM Canum Venaticorum

We show that the observed K velocities and periodicities of AM CVn can be reconciled given a mass ratio q~0.22 and a secondary star with a modest magnetic field of surface strength B~1 T. We see that the new mass ratio implies that the secondary is most likely semidegenerate. The effect of the field on the accretion disc structure is examined. The theory of precessing discs and resonant orbits is generalized to encompass higher order resonances than 3:2 and shown to retain consistency with the new mass ratio.

Buyer–seller interaction in experimental spatial markets

We report results from experimental spatial markets with endogenous buyer location on a discrete version of Hotelling's linear city. Buyer locations favor more often the hypothesis of transportation cost minimization than that of strategic location aimed at increasing price competition between sellers. However, the latter of the two hypotheses receives systematic support too. Differentiation by seller-subjects is substantially less than the theory would predict for the specific framework used. Our results suggest that location strategies adopted by subjects can be seen as a rational process favoring conservative product design and spatial agglomeration of economic activities.

How well can we simulate past climates? Evaluating the models using global palaeoenvironmental datasets.

Global syntheses of palaeoenvironmental data are required to test climate models under conditions different from the present. Data sets for this purpose contain data from spatially extensive networks of sites. The data are either directly comparable to model output or readily interpretable in terms of modelled climate variables. Data sets must contain sufficient documentation to distinguish between raw (primary) and interpreted (secondary, tertiary) data, to evaluate the assumptions involved in interpretation of the data, to exercise quality control, and to select data appropriate for specific goals. Four data bases for the Late Quaternary, documenting changes in lake levels since 30 kyr BP (the Global Lake Status Data Base), vegetation distribution at 18 kyr and 6 kyr BP (BIOME 6000), aeolian accumulation rates during the last glacial-interglacial cycle (DIRTMAP), and tropical terrestrial climates at the Last Glacial Maximum (the LGM Tropical Terrestrial Data Synthesis) are summarised. Each has been used to evaluate simulations of Last Glacial Maximum (LGM: 21 calendar kyr BP) and/or mid-Holocene (6 cal. kyr BP) environments. Comparisons have demonstrated that changes in radiative forcing and orography due to orbital and ice-sheet variations explain the first-order, broad-scale (in space and time) features of global climate change since the LGM. However, atmospheric models forced by 6 cal. kyr BP orbital changes with unchanged surface conditions fail to capture quantitative aspects of the observed climate, including the greatly increased magnitude and northward shift of the African monsoon during the early to mid-Holocene. Similarly, comparisons with palaeoenvironmental datasets show that atmospheric models have underestimated the magnitude of cooling and drying of much of the land surface at the LGM. The inclusion of feedbacks due to changes in ocean- and land-surface conditions at both times, and atmospheric dust loading at the LGM, appears to be required in order to produce a better simulation of these past climates. The development of Earth system models incorporating the dynamic interactions among ocean, atmosphere, and vegetation is therefore mandated by Quaternary science results as well as climatological principles. For greatest scientific benefit, this development must be paralleled by continued advances in palaeodata analysis and synthesis, which in turn will help to define questions that call for new focused data collection efforts.

Species concepts in Cercospora: spotting the weeds among the roses

The genus Cercospora contains numerous important plant pathogenic fungi from a diverse range of hosts. Most species of Cercospora are known only from their morphological characters in vivo. Although the genus contains more than 5 000 names, very few cultures and associated DNA sequence data are available. In this study, 360 Cercospora isolates, obtained from 161 host species, 49 host families and 39 countries, were used to compile a molecular phylogeny. Partial sequences were derived from the internal transcribed spacer regions and intervening 5.8S nrRNA, actin, calmodulin, histone H3 and translation elongation factor 1-alpha genes. The resulting phylogenetic clades were evaluated for application of existing species names and five novel species are introduced. Eleven species are epi-, lecto- or neotypified in this study. Although existing species names were available for several clades, it was not always possible to apply North American or European names to African or Asian strains and vice versa. Some species were found to be limited to a specific host genus, whereas others were isolated from a wide host range. No single locus was found to be the ideal DNA barcode gene for the genus, and species identification needs to be based on a combination of gene loci and morphological characters. Additional primers were developed to supplement those previously published for amplification of the loci used in this study. TAXONOMIC NOVELTIES: New species - Cercospora coniogrammes Crous & R.G. Shivas, Cercospora delaireae C. Nakash., Crous, U. Braun & H.D. Shin, Cercospora euphorbiae-sieboldianae C. Nakash., Crous, U. Braun & H.D. Shin, Cercospora pileicola C. Nakash., Crous, U. Braun & H.D. Shin, Cercospora vignigena C. Nakash., Crous, U. Braun & H.D. Shin. Typifications: epitypifications - Cercospora alchemillicola U. Braun & C.F. Hill, Cercospora althaeina Sacc., Cercospora armoraciae Sacc., Cercospora corchori Sawada, Cercospora mercurialis Pass., Cercospora olivascens Sacc., Cercospora violae Sacc.; neotypifications - Cercospora fagopyri N. Nakata & S. Takim., Cercospora sojina Hara.

The CURE scale: a multidimensional measure of service recovery strategy

Purpose – This paper aims to address the gaps in service recovery strategy assessment. An effective service recovery strategy that prevents customer defection after a service failure is a powerful managerial instrument. The literature to date does not present a comprehensive assessment of service recovery strategy. It also lacks a clear picture of the service recovery actions at managers’ disposal in case of failure and the effectiveness of individual strategies on customer outcomes. Design/methodology/approach – Based on service recovery theory, this paper proposes a formative index of service recovery strategy and empirically validates this measure using partial least-squares path modelling with survey data from 437 complainants in the telecommunications industry in Egypt. Findings – The CURE scale (CUstomer REcovery scale) presents evidence of reliability as well as convergent, discriminant and nomological validity. Findings also reveal that problem-solving, speed of response, effort, facilitation and apology are the actions that have an impact on the customer’s satisfaction with service recovery. Practical implications – This new formative index is of potential value in investigating links between strategy and customer evaluations of service by helping managers identify which actions contribute most to changes in the overall service recovery strategy as well as satisfaction with service recovery. Ultimately, the CURE scale facilitates the long-term planning of effective complaint management. Originality/value – This is the first study in the service marketing literature to propose a comprehensive assessment of service recovery strategy and clearly identify the service recovery actions that contribute most to changes in the overall service recovery strategy.

Growth of entrepreneurial software firms in cities

Despite the prediction of the demise of cities with the advance of new information and communication technologies in the New Economy, the software industry has emerged from cities in the USA, Europe and Asia in the past two decades. This article explores the reasons why cities are centers of software clusters, with reference to Boston, London and Dublin. It is suggested that cities' roles as centres of knowledge flows and creativity are the key determinants of their competitiveness in the knowledge-intensive software industry.