bluuebunny/crossref_metadata_2025 huggingface dataset:
Safer pharmacy practice: a preliminary study of significant event analysis and peer feedback
Authors: Bradley Nicholas A , Power Ailsa , Hesselgreaves Hannah , McMillan Fiona , Bowie Paul
Published: October 2010

Objectives

The aim was to investigate the effectiveness of significant event analyses (SEAs) undertaken by pharmacists as judged by a new system of independent peer feedback.

Method

The setting was a convenience sample of 37 pharmacists working in community pharmacy, secondary care and academic settings in NHS Scotland. Preliminary study involved the content analysis of pharmacists' SEAs and written feedback reports, which were generated by pharmacists trained in using a validated instrument to facilitate peer feedback. The content of reports and feedback letters were systematically coded and categorised by identifying and quantifying key words and phrases. Data collected included the range and severity of significant events identified; the reported reasons for the events occurring; types of learning needs identified; action(s) taken; and learning issues raised by peer feedback.

Key findings

A total of 37 pharmacists submitted 43 SEA reports during the study period. All events submitted were classified as having a negative impact on the quality and safety of patient care. Most events related to prescribing, dispensing, administration, communication and patient-/relative-centred issues. Patients reportedly came to harm in 13% of cases. Sixty-three per cent of reported learning needs related to personal awareness/ responsibilities when undertaking work tasks, and 58% of implemented change involved amending existing protocols or introducing new procedures. Seventy per cent of SEAs were judged to be ‘satisfactory’ by the peer reviewers. The effectiveness of change implementation and providing a clear description of an event were highlighted as key issues which required improvement in those event analyses judged to be ‘unsatisfactory’.

Conclusions

The findings demonstrate that most pharmacists in this study were able to apply SEA in a satisfactory manner by demonstrating reflective learning, undertaking insightful analyses and implementing necessary change. SEA and peer feedback may have a potential role to play in enhancing the quality and safety of pharmacy practices.
Audit of parenteral nutrition use in Guernsey
Authors: Harbottle Lynn , Brache Elmarie , Clarke Janine
Published: October 2010

Objectives

This audit was precipitated by a huge increase in the local prescribing of parenteral nutrition (PN) in Guernsey and concomitant burden on pharmacy/sterile services unit staff. It aimed to establish whether PN was being used appropriately and the extent to which feeding prescriptions followed UK National Institute for Health and Clinical Excellence and local Guernsey guidelines with regard to the initiation, monitoring and cessation of feeding.

Method

All PN patients at the Princess Elizabeth Hospital in Guernsey during a 1 year period (November 2006-December 2007) were subject to audit. A data-collection form was designed to ascertain exclusion of other feeding options, risk of re-feeding complications, suitability of PN regime, compliance with monitoring guidelines and patient outcomes. Copies of the form were completed by pharmacists/dietitians.

Key findings

Eighteen men and 12 women were included (average age 67 years). PN was initiated appropriately, with the most common indication being gastrointestinal surgery. Assessment of re-feeding risk and use of low-calorie starter regimes with full micronutrient and electrolyte additions was routinely carried out, except in the case of two patients admitted at weekends. Five patients were not given appropriate supplementary intravenous Pabrinex. The duration of PN ranged from 2 to 62 days (average 14 days). The majority of patients were fed continuously but three longer-term PN patients were fed cyclically (12–16 h). Only 13 patients had accurate daily fluid-balance charts kept. Seventeen had a planned cessation of PN, of whom only 11 were weaned off appropriately. Two patients were re-admitted for feeding problems within 28 days of discharge.

Conclusions

The audit findings demonstrated that PN at the Princess Elizabeth Hospital was generally being initiated, monitored and stopped with a high level of consideration to local guidelines. The main problem identified was with PN started at or immediately prior to the weekend when appropriate assessment and initiation could not be guaranteed.
The extent and characteristics of United Kingdom hospital pharmacists keeping, or not keeping, a professional development portfolio
Authors: Kostrzewski Andrzej J , Dhillon Soraya , Goodsman Danë , Taylor Kevin M G , Weinman John A
Published: October 2010

Objectives

The aim of this study was to examine the use of continuing professional development (CPD) portfolios by hospital pharmacists. The objectives were to assess the extent to which pharmacists use portfolios in CPD and to examine the attitudes/beliefs which differentiate those who do and do not keep a portfolio.

Method

Participants completed two questionnaires: (1) personality traits were examined using the Big-Five questionnaire and (2) a new Pharmacist Portfolio-Engaging Behaviour Questionnaire (PPEBQ) examined the attitudes and beliefs. What constitutes a portfolio was left to the interpretation of the participants, but it was specified that the survey was about participants' views of producing written records of their professional practice for CPD. The setting was hospital pharmacists based in the London area in December 2004.

Key findings

Overall, 134 pharmacists (78%) returned both questionnaires, and 80 stated that they kept a portfolio and 52 stated that they did not (two questionnaires were returned spoilt). There was no significant difference in the age or number of years qualified between those with and without a portfolio. Three personality traits were linked to keeping a portfolio (conscientiousness, agreeableness and emotional stability). Pharmacists with a portfolio scored highly on the perceived behavioural control and behavioural intention scales of the PPEBQ.

Conclusions

The Big-Five personality questionnaire is a useful tool to investigate pharmacists' use of a portfolio. Results of the PPEBQ suggested that hospital pharmacists who had a portfolio were concerned with having control over its production. However, the PPEBQ requires further development to improve its reliability. These findings have implications for the educational support of CPD.
Supply of over-the-counter weight-loss products from community pharmacies
Authors: Andronicou Anna-Maria , Krska Janet , Hackett Allan , Richards Jacqueline
Published: October 2010

Objectives

The aim was to ascertain the availability of over-the-counter (OTC) weight-loss products from community pharmacies and other retail outlets in a large conurbation, and to determine the knowledge and practices of pharmacy staff in the supply of OTC weight-loss products.

Method

The setting was one primary care trust in England. We used a cross-sectional survey of 123 community pharmacies, 12 health stores and 64 supermarkets, plus telephone interview of the pharmacists.

Key findings

Over two-thirds of community pharmacies (69%) and health stores (67%) but few supermarkets (8%) stocked one or more OTC weight-loss products. In total, 73 different products were available from pharmacies, most of which (50) were claimed by manufacturers to be appetite suppressants. Seventy-eight pharmacists were interviewed, of whom 57 stocked OTC weight-loss products. Of these 57, only two claimed to undertake any measurements before supplying the products and 33 had no supporting materials/information about the products, although 38 claimed to provide advice. None of the 57 pharmacists had undertaken any specific training in relation to weight loss. Only 44% of all those interviewed considered OTC weight-loss products to be useful, with even fewer (35%) considering them to be safe.

Conclusions

Community pharmacies are a major distributor of OTC weight-loss products, despite the lack of evidence of their efficacy and concerns about their safety. Many pharmacists had limited knowledge of the products, placed few restrictions on their supply and viewed training in weight loss as unnecessary. Pharmacists should consider the appropriateness of supplying these products and utilize the opportunities presented to support weight reduction by more effective means.
Pharmaceutical brand substitution in Australia: Identifying factors associated with having multiple brand substitutions
Authors: Kalisch Lisa M , Roughead Elizabeth E , Gilbert Andrew L
Published: October 2010

Objective

The aim was to determine the frequency with which people have multiple brand changes for more than one medicine and to identify factors associated with having multiple brand substitutions.

Method

The setting was the Repatriation Pharmaceutical Benefits Scheme, a national subsidised scheme for medicines supply in Australia. We used a retrospective cohort design using prescription claims data for subsidised medicine dispensings from 1 June 2005 to 31 August 2006. Analysis was limited to patients with the opportunity for brand substitution of two or more medicines. ‘Switches’ were identified for each medicine if different brand or generic products were supplied at consecutive dispensings. Multivariate analysis was conducted to identify factors associated with patients who had multiple switches during follow-up.

Key findings

A total of 84 040 people were included. On average, they received 11 prescription medicines. Forty-nine per cent of people received the same product throughout follow-up for each medicine and 34% had a single brand substitution. Seventeen per cent had multiple switches for one or more medicine; however, only 3% of all patients had multiple switches for more than one medicine. Independent factors associated with having multiple switches were increasing number of hospital admissions, prescription medicines, co-morbidities, prescribers, dispensing pharmacies and living in an aged-care facility or city.

Conclusions

Most patients do not have multiple brand substitutions of their medicine, even when all medicine use is considered. This is the first study to identify factors associated with having multiple brand substitutions. Quality use of medicines interventions targeting individuals with these risk factors could minimise the potential for patient confusion as a result of multiple brand changes.
The impact of the introduction of a ward-based automated medicines vending unit on nursing tasks and time in the Emergency Department
Authors: Ardern-Jones Joanne , Hughes Donald K , Rowe Philip H , Mottram David R , Green Christopher F
Published: October 2010

Objectives

This study assessed the impact of the introduction of medicines vending units (MVUs) into an Emergency Department (ED) on nursing time spent on medicines-use processes. The objectives included identification of changes in nursing activities pre- and post-automation and the impact of automation on the time needed for nurses to access medicines and replenish ward stock.

Methods

This study was carried out in a district general hospital ED which is attended by over 65 000 patients each year. Staff were observed using work sampling techniques to compare activity before and after the introduction of MVUs. To assess possible changes in dose acquisition time, staff were timed withdrawing doses of medicines from traditional storage units and then from MVUs. To obtain baseline data about traditional methods of replenishing stock, nursing staff recorded the time at which traditional stock replenishment was carried out and the time required to do it.

Key findings

Nursing staff spent approximately 11% of their time on work activities related to medicines pre-automation and 12% post-automation (P = 0.234). The median time to acquire a dose of medication decreased from 139.5 s pre-automation to 44 s post-automation (P < 0.0001). Following automation, a total of 7.1 h/day could be saved in nursing time. A mean saving of 46.5 min/week was also identified because nursing staff are no longer involved in stock replenishment.

Conclusions

A significant release of nursing time was identified from the observed acquisition of doses of medicines from the MVU. Work sampling techniques suggest this does not appear to have translated into significant savings on nursing time dealing with medicines, although the nature of these activities has changed.
Incidence, type and causes of dispensing errors: a review of the literature
Authors: James K Lynette , Barlow Dave , McArtney Rowena , Hiom Sarah , Roberts Dave , Whittlesea Cate
Published: October 2010

Objectives

To identify, review and evaluate the published literature on the incidence, type and causes of dispensing errors in community and hospital pharmacy.

Method

Electronic databases were searched from 1966 to February 2008. This was supplemented by hand-searching the bibliographies of retrieved articles. Analysis of the findings explored the research methods, operational definitions, incidence, type and causes of dispensing errors.

Key findings

Sixty papers were identified investigating dispensing errors in the UK, US, Australia, Spain and Brazil. In general, the incidence of dispensing errors varied depending on the study setting, dispensing system, research method and operational definitions. The most common dispensing errors identified by community and hospital pharmacies were dispensing the wrong drug, strength, form or quantity, or labelling medication with the incorrect directions. Factors subjectively reported as contributing to dispensing errors were look-alike, sound-alike drugs, low staffing and computer software. High workload, interruptions, distractions and inadequate lighting were objectively shown to increase the occurrence of dispensing errors.

Conclusions

Comparison of the reviewed studies was confounded by differences in study setting, research method and operational definitions for dispensing errors, error rate and classification of error types. The World Health Organization is currently developing global patient safety taxonomy. Such a standardized taxonomy for dispensing errors would facilitate consistent data collection and assist the development of error-reduction strategies.
Impact of perceived innovation characteristics on adoption of pharmacy-based in-house immunization services
Authors: Westrick Salisa C , Mount Jeanine K
Published: October 2010

Objectives

An in-house immunization service in which staff pharmacists administer vaccines was conceptualized as an innovation. Prior to making adoption decisions, community pharmacies evaluated characteristics of in-house immunization services. This study examined the impact of three specific characteristics (perceived benefit, perceived compatibility and perceived complexity) of in-house immunization services on community pharmacies' adoption decisions.

Methods

A multi-stage mixed-mode survey design was used to collect data from key informants of community pharmacies in Washington State, USA. Key informants included pharmacy managers or pharmacists-on-duty who were able to answer questions related to immunization activities in their pharmacies. Perceived characteristics of in-house immunization services and pharmacy adoption decisions were measured in 2004 and in 2006–2007, respectively.

Key findings

Each perceived characteristic individually predicted adoption of in-house immunization services. When all three characteristics were included in logistic regression, perceived benefit was the only significant predictor of in-house immunization service adoption.

Conclusions

Appropriate strategies, particularly promoting the benefit of in-house immunization services, should be implemented. The proposed model and findings may be applicable to other pharmacy-based innovative practices or other public health initiatives. We recommend that organizational leaders, researchers and practitioners consider the impact of perceived benefit and incorporate it when they design strategies to foster adoption of innovative practices. Doing this may increase the number of adopters and also increase diffusion rates for innovative services.
Sustaining delivery of the first publicly reimbursed cognitive service in Denmark: a cross-case analysis
Authors: Kaae Susanne , Søndergaard Birthe , Haugbølle Lotte Stig , Traulsen Janine Morgall
Published: October 2010

Objectives

The aim was to identify local organisational factors that affect sustained delivery of the first Danish publicly reimbursed cognitive service, the Inhaler Technique Assessment Service (ITAS). The ITAS is a 10-min interactive counselling session during which pharmacy staff assess the inhalation technique of individual asthma patients at the pharmacy counter, and correct any errors. Knowledge of how the organisation of a local pharmacy influences ITAS provision will be used to develop quality indicators as part of a targeted quality-assurance system to support the sustainability of the service in all Danish community pharmacies.

Methods

Qualitative methods included field observations, semi-structured interviews, group interviews and the collecting of documentary material. Data-source and method triangulation were applied. Seven pharmacies were included in the study. A cross-case analysis compared pharmacies with sustained and reduced numbers of services based on three selected themes: administration of the ITAS, leadership interventions and professional values of pharmacy owner and staff.

Key findings

Pharmacies with sustained delivery had introduced systematic evaluations of the local delivery of the ITAS and made ongoing efforts to improve staff competencies. They dealt with individual barriers such as lack of knowledge of rarely distributed inhalation devices and communication techniques. Pharmacy staff in general rarely assessed patients' clinical needs before offering the service and rarely provided follow-up. Thus, pharmacy staff failed to utilise the full clinical potential of the ITAS.

Conclusions

In order to achieve and support further ITAS sustainability, the knowledge, skills and professional values of pharmacy staff must be developed. Human resource leadership techniques would be useful in achieving this aim, as would focusing on the service by providing systematic evaluations.
Cross-cultural validation of the desire for information about prescribed medicines scale
Authors: Droege Marcus , Leonard Sean T , Duggan Catherine A
Published: October 2010

Objectives

It is the overall aim of this study to validate an existing scale to measure patients' desire for information about their medicines in the geographically and culturally disparate context of the USA. Specific objectives are to determine the psychometric properties of the previously validated Extent of Information Desired (EID) and Perceived Utility of Medicines (PUM) scales and to describe the complexities inherent to cross-cultural validation.

Methods

The setting was a culturally diverse tri-county (Palm Beach, Broward and Miami Dade counties) area of South Florida. The research design was cross-sectional and descriptive; data were gathered from respondents using a facilitator-administered survey instrument.

Key findings

The overall reliability of the survey was 0.669 using Cronbach's α. When EID and PUM survey statements were analysed alone, internal consistency was 0.692 and 0.545 respectively. The association between scores and select demographic variables were analysed and no correlation was found. The previously validated scale (UK) was not reliable in the complex cultural population of Florida.

Conclusions

Instruments demonstrating reliability in one country are not immediately replicable in other countries, even if the same language is spoken. Caution needs to be taken when interpreting the findings from studies using instruments designed in cultural contexts dissimilar from those in which the have been developed originally.
Direct-to-consumer advertising: Australian pharmacists' experiences with non-prescription medicines
Authors: Chaar Betty , Kwong Kenelm
Published: October 2010

Objective

Direct-to-consumer advertising (DTCA) of over-the-counter or prescribed medicines is a highly controversial issue relating to public health care. Advocates highlight the advantages of DTCA in terms of patient awareness and autonomy. Opponents voice concerns about safety and patients' best interests. The views of physicians and consumers about DTCA have been widely investigated. There has been little research, however, in relation to pharmacists' experiences with DTCA and the impact of DTCA on pharmacy practice. The aim of this study was therefore to explore pharmacists' perceptions of DTCA in Australia and its impact on pharmacy practice.

Methods

A semi-structured in-depth interview was conducted with a purposive convenience sample of retail pharmacists in Sydney, Australia. Interviews were recorded, transcribed ad verbatim and continued until data saturation. Emerging themes were extracted and analysed according to the grounded theory approach.

Key findings

Pharmacists participating in this study reported concern about potential harm to patient health and well-being as a result of the influence of DTCA. DTCA was seen to impede pharmacists in the discharge of their fundamental ethical responsibilities, leading to a strong sense of disempowerment. Pharmacists' gate-keeping role was challenged by DTCA encouraging consumers to self-medicate and inducing a range of drug-seeking behaviours. Although pharmacists acknowledged that DTCA may have a role in promoting patient autonomy, in practice DTCA compromised their role in safeguarding consumers from inappropriate use of medicines.

Conclusions

This study highlighted that the impact of DTCA is not restricted to prescription medicines, but extended also to over-the-counter, pharmacist-only and other pharmacy-related products. Pharmacists perceived that DTCA disempowered them, compromising their role in safeguarding the community from inappropriate medicine use.
English Reformations
Authors: Aers David , Smith Nigel
Published: October 2010

This special issue is devoted to the English Reformations and current historiography. The title intentionally pluralizes the traditionally singular noun Reformation to signify a scope that includes both the early Reformation (through to 1547) and continuing senses of reformation through to the later seventeenth century. But the plural also encourages investigation of what has seemed a mistaken homogenization of the religious and political processes involved at all stages of “the Reformation.” The articles in this issue look at the grand narratives into which the minute particulars of historical processes are perceived, interpreted, and occluded. They also carefully attend to the place of theology and its diverse traditions in these processes together with its relations to the political imaginary and practices driving what Eamon Duffy memorably calls “the stripping of the altars.”
Synthesis and Characterization of Artificial Antigens for Nickel
Authors: Guo Ming , Che Xiaoqing , Yang Ping , Shen Jinyu , Yao Jiayun
Published: October 2010

A novel artificial antigen (AA) for Ni2+ was prepared by designed route, which coupled diethylenetriamine-N,N,N′,N′′,N′′-pentaacetic dianhydride (DTPAA) with bovine serum albumin (BSA) and human serum albumin (HSA), and then chelated the DTPAA–BSA/HSA with Ni2+. The AA was characterized by bicinchoninic acid (BCA) protein assay, atomic absorption spectroscopy (AAS), ultraviolet (UV) spectrum, fluorescence spectrum, sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), and 2,4,6-trinitrobenzenesulfonic acid assay (TNBS). The consistent results showed that the synthetic route different from the traditional method was effective, and the AA was synthesized successfully.
Preparation of Reduction-sensitive Nanogels with a Large Swelling Capacity by a Surfactant-free Precipitation Method
Authors: Nishiguchi Akihiro , Yoshida Hiroaki , Matsusaki Michiya , Akashi Mitsuru
Published: October 2010

Reduction-sensitive nanogels with a large swelling capacity were successfully prepared by the crosslinking reaction of biodegradable polymers in water, followed by the insolubilization of the polymers with the gradual addition of ethanol. The obtained nanogels were ca. 200–300 nm in diameter, and had a high water content, over 99%. Moreover, these nanogels were easily decomposed by the cleavage of the disulfide crosslinkages to their thiol groups using a reductant. These biocompatible and biodegradable nanogels prepared without toxic surfactants will be useful as novel carriers for drug delivery systems.
Guest-induced Single-crystal-to-single-crystal Transformation in Copper Complexes of 1,3,5-Benzenetricarboxylic Acid and 4,4′-Bipyridine
Authors: Chen Jinxi , Kitagawa Susumu
Published: October 2010

A 2-dimensional (2D) noninterpenetrated flexible porous coordination polymer, [Cu(HBTC)(4,4′-bpy)]·C6H11OH·H2O (1), has been synthesized and characterized using single-crystal X-ray diffraction. The cyclohexanol guest molecules in 1 can be removed upon soaking 1 in ethanol. Complex 1 undergoes a single-crystal transformation to form an ethanol solvate, [Cu(HBTC)(4,4′-bpy)(H2O)]·C2H5OH·2H2O (2), and during the process, the octahedral coordination of the copper cation in 1 converts to square-pyramidal coordination in 2.
Nitrogen-15 NMR Spectroscopy of Sugar Sensor with B–N Interaction as a Key Regulator of Colorimetric Signals
Authors: Egawa Yuya , Tanaka Yoshiyuki , Gotoh Ryota , Niina Satoshi , Kojima Yu , Shimomura Naoki , Nakagawa Hiroko , Seki Toshinobu , Anzai Jun-ichi
Published: October 2010

Nitrogen-15 NMR spectroscopy showed strongly upfield values of the chemical shift for one of the azo nitrogen atoms of a boronic-acid-appended azo dye: this indicated the formation of a boron–nitrogen (B–N) dative bond. The B–N dative bond was cleaved by sugar addition.
Poly(N-isopropylacrylamide)-grafted Thermosensitive Anodized Aluminum Oxide Membrane
Authors: Jang Joo Hee , In Insik
Published: October 2010

Thermosensitive membrane is prepared by surface-initiated atom-transfer radical polymerization of N-isopropylacrylamide (NIPAM) from initiator-attached anodized aluminum oxide (AAO) membrane to formulate smart membrane which can control mass transport through membrane by temperature control. PNIPAM-grafted AAO membrane with partially open pores shows accelerated water transport on heating above lower critical solution temperature (LCST). Pore widening effect might suppress increased hydrophobicity of PNIPAM brush on the pores of AAO membrane above LCST.
A Facile Reprecipitation Method for the Preparation of Polyimide Hollow Spheres with Controllable Morphologies and Permeable Shell
Authors: Liu Junzhi , Yan Yuzhi , Chen Zhihua , Gu Yi , Liu Xikui
Published: October 2010

We present our preliminary work on the fabrication of polyimide hollow sphere by reprecipitation. Through fine-tuning the PAA concentration, many intriguing shapes, including deflated capsules, bowl-shaped and dimple-like hollow spheres can be obtained. Adding salt to the PAA solution helps the formation of PI hollow spheres with complete shells. The morphologies can be fixed through imidization, thus obtaining a controllable and reproducible method to prepare high-performance polyimide hollow spheres with various morphologies.
Ethnic disparities in knowledge of cancer screening programmes in the UK
Authors: Robb Kathryn , Wardle Jane , Stubbings Sarah , Ramirez Amanda , Austoker Joan , Macleod Una , Hiom Sara , Waller Jo
Published: October 2010

Objective

The aim of the study was to examine awareness of the three National Cancer Screening Programmes (breast, cervical, bowel) among white and ethnic minority groups in the UK. Setting Data were from two surveys in which the screening questions were added: (i) the Office of National Statistics (ONS) Opinions Survey, carried out in September and October 2008; and (ii) the EthnibusTM survey of the main ethnic minority groups in England, conducted in October and November 2008.

Methods

The ONS sample consisted of 2216 adults selected using stratified probability sampling to obtain a population-representative sample. The EthnibusTM sample was obtained by quota sampling and included 1500 adults from the six largest ethnic minority groups in England (Indian, Pakistani, Bangladeshi, Caribbean, African and Chinese). Participants completed questions on awareness of cancer screening programmes as part of the wider Cancer Awareness Measure (CAM) in home-based, face-to-face interviews.

Results

Awareness of breast and cervical cancer screening was high in the white ONS participants (89% breast and 84% cervical), lower in the ONS ethnic minority sample (74% for both breast and cervical) and lowest in the EthnibusTM sample (69% breast and 66% cervical). Ethnic disparities persisted after controlling for age, gender and occupational group. In both groups, knowledge of breast and cervical screening was lower among men and more socioeconomically deprived groups. Awareness of the new bowel cancer screening programme was less than 30% in both white and ethnic minority groups.

Conclusions

Ethnic disparities in knowledge of breast and cervical cancer screening should be addressed. Strategies to engage ethnic minority and socioeconomically deprived groups in bowel cancer screening should be instigated to avoid the emergence of disparities.
Improvements to the newborn bloodspot screening service are required to meet national standards
Authors: Bello S , Ferguson C , Wallis R
Published: October 2010

Objective

The UK Newborn Screening Programme has standards to facilitate the early identification and treatment of five specific diseases to prevent lifelong impairment or death. This audit aimed to assess the newborn bloodspot screening programme in an inner London borough and to make recommendations for service improvement.

Methods

Data on babies registered with a general practitioner in the borough between April 2008 and March 2009 were obtained from the borough's health database and the laboratory result systems and compared with national screening standards. Interviews were conducted with the leads of each service providing components of newborn screening.

Results

A total of 292 (8%) out of 3636 babies registered within the audit period had no result on the database (average 1 in 13). Regional reports revealed that over the previous three years the borough, like many others, had consistently failed to achieve the core standards for newborn bloodspot screening. Major areas of concern identified by this audit pertained to the quality of the bloodspot sample, response to requests for repeat samples, timely identification of untested babies and communication of results to parents.

Conclusion

The audit revealed that for the majority of children registered in the borough, screening was successfully carried out. However, gaps in the service meant that with current practice one affected child could be missed every seven years. Recommendations include staff training, frequent data reviews, and providing a coordinating officer to oversee the programme and follow up missing results.
Effect of temperature changes on the occurrence of congenital hypothyroidism
Authors: Aminzadeh M , Chomeili B , Riahi K , Dehdashtian M , Cheraghian B , Valavi E
Published: October 2010

Objective

To investigate an association between seasonal changes in temperature and the prevalence of congenital hypothyroidism (CH) in the Southwest of Iran.

Methods

A prospective two-year study conducted from March 2007 to March 2009 during the nationwide screening programme for CH in Ahvaz, the biggest city in southwest Iran. Blood samples were taken from almost all newborns by heel-stick and used in a thyroid-stimulating hormone (TSH)-enzyme-linked immunosorbent assay (ELISA). Serum thyroxine (T4) and TSH were measured if the ELISA-TSH was >5 mlU/L (suspicious cases). Infants were considered to have CH with T4 <6.0μg/dL and TSH > 10 mlU/L, or with normal T4 values and persistent high TSH values for >2 months (subclinical hypothyroidism). Date of birth and sex were recorded. Detailed temperature data were obtained from the meteorological organization. The relationship between the monthly incidence of CH and the average monthly temperature was investigated.

Results

From 47,075 (50.92% male) newborns, 1131 were referred (recall rate = 2.4%) and 142 infants (51.4% male) were confirmed to have CH. The seasonal distribution of CH cases was 32.4% in the warm period and 67.6% in the cold period of the year (19%, 13.4%, 32.4% and 35.2% in spring, summer, fall and winter, respectively; P = 0.001). A statistical difference was seen between mid-summer (2.8%, warmest time) and early winter (15.5%, coldest time). The above-mentioned difference was the same for suspicious individuals ( P < 0.001). The odds of being affected were increased by 4% for each fall of 1°C.

Conclusion

The prealence of CH has a significant negative correlation with the temperature in the tropical area of Iran.
A Study of New Referrals to a Menopause Clinic and Their Initial Outcomes: How Can We Improve the Service We Provide?
Authors: Liddiard Andrea , Bain Christine
Published: October 2010

This retrospective case-note study was performed to examine the ways in which an already established menopause clinic could improve service to its patients. The management of 151 patients was examined. Most were referred by their general practitioner and the most common reason for referral was to seek an alternative to hormone replacement therapy (HRT). The consultant saw 17% of the patients, and with the trainee was most likely to discharge the patient. Better information on alternatives to HRT, more consultant input and better use of telephone consultation for follow-up would enhance the service provided by the menopause clinic.
Obesity is Related to Increased Menopausal Symptoms among Spanish Women
Authors: Fernández-Alonso Ana M , Cuadros José l , Chedraui Peter , Mendoza Marcela , Cuadros Ángela M , Pérez-López Faustino R
Published: October 2010

Objective.

To assess the metabolic syndrome (METS) and its components in postmenopausal women using updated diagnostic criteria and explore their relation to menopausal symptom severity.

Method.

Medical records of the first visit of 574 postmenopausal Caucasian Spanish women attending a menopause clinic were retrospectively reviewed. Recorded information included general demographic data, type of menopause, menopausal symptom intensity (Kupperman index) and baseline hormonal and metabolic parameters. METS was established if three or more of the following criteria were met: body mass index (BMI) >28.8 kg/m2, fasting glycaemia >100 mg/dL, high-density lipoprotein cholesterol (HDL-C) <50 mg/dL, triglycerides ≥150 mg/dL and blood pressure ≥130/85 mmHg.

Results

Mean ± SD age of the whole cohort was 49.9 ± 6.1 years, 66% had natural menopause and 38.9% were obese. In all, 23.1% met diagnostic criteria for METS who were significantly older and displayed higher rates of being married, obesity and abnormal glucose, triglyceride, HDL-C, low-density lipoprotein cholesterol and blood pressure values, when compared with those without the syndrome. The mean Kupperman index score for the whole sample was 26.4 ± 10.6, with 73.8% displaying moderate to severe scores (20 or more). Logistic regression analysis determined that obesity and marriage status were independent risk factors related to more severe menopausal symptoms (Kupperman index scores of 20 or more).

Conclusion.

Although METS was observed in a lower frequency than previous reports, obesity was associated with more severe menopausal symptoms among postmenopausal Spanish women.
Lowering the Age at Menarche and Risk of Early Menarche in a Population of Spanish Postmenopausal Women During the Past Two Decades
Authors: Mendoza Nicolás , Galliano Daniela , Salamanca Alberto , Castro Juan Eloy Ruiz , Mozas Juan , Sánchez-Borrego Rafael , Quereda Francisco , Vázquez Francisco , Martínez-Astorquiza Txantón
Published: October 2010

Aim.

The purpose of this study is to confirm in our population the decreasing secular trend in the age of menarche (AAM) observed in other European countries. Another aim is to investigate the association between early menarche and breast cancer, metabolic disorders risk or early menopause.

Materials and Methods

We conducted a nationwide population-based study of 1980 Caucasoid Spanish postmenopausal women from 2003 to 2006 to investigate the AAM, the duration of the fertile period and the relation of early menarche with breast cancer and some metabolic disorders.

Results

Regression analysis of AAM demonstrates a trend towards the younger AAM in our population during the past decades ( P > 0.001). Parallel to this decrease we observe a significant increase in the fertility period and the height of our population ( P < 0.001). In the women with AAM less than 11 years, there is an increased risk of hypercholesterolaemia, being overweight and obesity. However, early menarche does not raise the risk of adult onset diabetes, hypertension or breast cancer.

Conclusions

These data indicate a decreasing secular trend of AAM in a Spanish population in the last decades. Furthermore, hypercholesterolaemia and obesity, but not breast cancer, appears to be influenced by younger AAM. Only women who have their menarche at the age of nine years or less are more likely to have an earlier menopause.
Project Management Contracts with Delayed Payments
Authors: Kwon H. Dharma , Lippman Steven A. , McCardle Kevin F. , Tang Christopher S.
Published: October 2010

When managing projects with considerable uncertainty, such as those arising in construction, defense, and new product development, it is customary for a manufacturer (project manager) to offer contracts under which each supplier (contractor) receives a prespecified payment when she completes her task. However, there are recent cases in which the manufacturer imposes “delayed payment” contracts under which each supplier is paid only when all suppliers have completed their tasks. By considering a model of one manufacturer and n ≥ 2 identical and independent suppliers with exponential completion times, we analyze the impact of both a delayed payment regime and a no-delayed-payment regime on each supplier's effort level and on the manufacturer's net profit in equilibrium. When the suppliers' work rates are unadjustable, we conjecture that the manufacturer is actually worse off under the delayed payment regime. However, when the suppliers' work rates are adjustable, we obtain a different result: the delayed payment regime is more profitable for the manufacturer either when the project revenue is sufficiently small or when the number of suppliers is sufficiently large.
On the origins of physicians: Darwinian or Lamarckian evolution?
Authors: Diamandis Phedias
Published: October 2010

Achieving acceptance to a North American and some European medical schools is one of the most difficult academic tasks faced by undergraduate students. The limited number of spots allows for only a fraction of the most highly promising applicants to be accepted each year. Perhaps one of the difficulties that many students face when applying to medical school is that due to the current restriction on enrollment, the application process poses selective pressures, independent of the applicants' suitability for the medical profession. Here I discuss, based on personal experiences, how I believe the process could become more just to all applicants. Allowing public needs and student interest to better dictate the number of graduating physicians could help relieve some of the current admission pressures, including the rather arbitrary selection of a small fraction of applicants from a large group of sufficiently proficient students. I believe that this proposal, if implemented, will likely not only remove some biases of our admission system, but also sufficiently change the landscape of those accepted, to include students with a genuine professional interest in the underserviced field of family practice.

Clin Chem Lab Med 2010;48:1389–92.
Changes caused by heat treatment in chemical composition and some physical properties of acacia hybrid sapwood
Authors: Tuong Vu Manh , Li Jian
Published: October 2010

Acacia hybrid (Acacia mangium×auriculiformis) sapwood was heat-treated in nitrogen under laboratory conditions for 2–6 h at 210°C–230°C. Chemical composition and physical properties including water absorption and swelling were examined. The results showed that these properties were reduced significantly by heat treatment, and there is an interactive effect of temperature and time on them. Chemical changes of the wood surface were determined by X-ray photo-electron spectroscopy analysis. Results indicate that the O/C ratio decreases as a function of treatment intensity due to the migration of extractives and degradation products to the surface during heat treatment. The C1speaks showed an elevated content of lignin and extractives, whereas the hydroxyl group content was diminished with elevated treatment temperature. The O1speaks revealed an increase in the O1peak and confirmed the course of C1speaks. These results coincide with the decrease in water absorption and swelling of wood after heat treatment.
Fungi associated with bamboo and their decay capabilities
Authors: Kim Jae-Jin , Lee Sung-Suk , Ra Jong-Bum , Lee Hwanhwi , Huh Nayoon , Kim Gyu-Hyeok
Published: October 2010

Biological deterioration is the most important issue facing the use of bamboo as a bioresource. To identify the fungi responsible for bamboo degradation, isolates were obtained from three decaying bamboo species and evaluated. A total of 16 genera and 18 species of fungi were isolated and identified. The major fungi causing serious damage are Trametes versicolor and Arthrinium arundinis, which caused the largest weight losses in tests, of approximately 21.6% and 17.9%, respectively. This investigation confirms that the natural durability of bamboo in outdoor utilization is low.
Undrained Response of Clay in Hollow Cylinder Expansion Tests
Authors: Silvestri Vincenzo , Diab Riad , Abou Samra Ghassan , Bravo-Jonard Christian
Published: October 2010

This paper presents the results of undrained plane strain expansion tests of hollow cylindrical specimens of normally consolidated clay. The stress-strain curves and the total stress paths are first deduced from the experimental radial pressure-expansion relationships by using Nadai’s total stress approach. The stress-strain curves are then compared with theoretical relations based on the modified Cam clay theory. The effective stress paths, which are obtained by subtracting measured pore water pressure from the total stress paths, are also compared with those derived from the modified Cam clay. Finally, the undrained shear strengths, calculated from both Nadai’s approach and the modified Cam clay, are compared with values determined by using an expression based upon an elastic perfectly plastic model.
Genetics as a Modernization Program: Biological Research at the Kaiser Wilhelm Institutes and the Political Economy of the Nazi State
Authors: Gausemeier Bernd
Published: October 2010

During the Third Reich, the biological institutes of the Kaiser Wilhelm Society (KWG, Kaiser-Wilhelm-Gesellschaft) underwent a substantial reorganization and modernization. This paper discusses the development of projects in the fields of biochemical genetics, virus research, radiation genetics, and plant genetics that were initiated in those years. These cases exemplify, on the one hand, the political conditions for biological research in the Nazi state. They highlight how leading scientists advanced their projects by building close ties with politicians and science-funding organizations and companies. On the other hand, the study examines how the contents of research were shaped by, and how they contributed to, the aims and needs of the political economy of the Nazi system. This paper therefore aims not only to highlight basic aspects of scientific development under Nazism, but also to provide general insights into the structure of the Third Reich and the dynamics of its war economy.
Purifying Landscapes: The Vichy Regime and The Genetic Modernization of France
Authors: Bonneui Christophe , Thomas Frederic
Published: October 2010

This article argues that "genetic modernism" in seeds was simultaneously a technoscientific and a political project that materialized under wartime Vichy's proto-fascist regime and that contributed to shaping and legitimizing Vichy as a "planner state." The constitution of the genetically homogeneous cultivar as a scientific object, a market commodity, and a state policy object went hand in hand during the Vichy regime. A new biopolitical connection between state and seeds emerged, in which seeds were considered a priority target for state intervention because they were seen as the easiest path toward transforming agricultural practices so as to meet pressing needs for a sufficient and autonomous food supply (autarky). The state acquired the power of life and death over plant genomes in the nation's landscapes and enacted a phytoeugenics that was both positive (aiming to encourage the diffusion of varieties deemed healthy or higher yielding) and negative (aiming to suppress varieties deemed obsolete). The ontology of "genetic modernism" considered living beings as having an intrinsic genetic identity, sealed off from the vagaries of the environment, and favored serial and stable forms of life, which were achieved materially through the production of plant populations composed of isogenotypic individuals (clones, pure lines, F1 hybrids). Such pure line ontology, planned seed-economy practices, and metrological arrangements articulated a biopolitics geared towards superseding a nexus of biocultural crop evolutionary processes under farmers' management with centralized planning of genetic progress. This turned Vichy France into a huge biopolitical laboratory. It also left major legacies in the post–World War II decades.
Human and Divine Love in a Pastoral Setting: The Histories of Copacabana on Lake Titicaca
Authors: MacCormack Sabine
Published: October 2010

In 1583 an image of the Virgin, the work of an indigenous sculptor, was set up in Copacabana on Lake Titicaca, near an ancient cult site of the Inca Sun. It soon attracted Indian and Creole pilgrims and also became known in Europe. United by their devotion to the Virgin, the pilgrims and others who sought her help did so for diverging reasons. In Creole and European terms the cult of the Virgin of Copacabana is explicable in the context of other cults of Christian miracle-working images. Viewed in its Andean context, however, it highlights deep-rooted continuities with pre-Christian observance and the autonomy and resilience of Indian religious and cultural forms.
Fictions of Natural Democracy: Pearl Buck, The Good Earth, and the Asian American Subject
Authors: Jean So Richard
Published: October 2010

This essay offers a new reading of the American author Pearl Buck, focusing on her cultural concept of "natural democracy." It does so by critically reconstructing and examining this concept through three linked contexts: 1930s China, the novel The Good Earth, and the 1943 Chinese Exclusion Acts Repeal hearings. The essay argues that natural democracy enabled the emergence of a U.S.–China, trans-Pacific cultural sphere that helped to facilitate the rise of the postwar Asian American subject.