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Objective: From 1995, the European Association of Hospital Pharmacists (EAHP) has regularly investigated the progress of the hospital pharmacy profession in Europe, and identified key barriers and drivers of this. The most recent 'Investigation of the Hospital Pharmacy Profession in Europe' was conducted from November 2022 to March 2023., Methods: The online questionnaire was sent to all hospital pharmacies in EAHP member countries. The investigation was drafted using the same questions as the 2015 baseline survey. Where possible and relevant, responses were compared with the data from previous surveys that monitored the implementation of the EAHP statements. Keele University, Centre for Medicines Optimisation, School of Pharmacy and Bioengineering, UK analysed the data., Results: The overall number of responses was 653, with a better response rate of 19% compared with 14% in 2018 statements survey. The findings indicated that participating hospital pharmacies have similar characteristics to previous surveys. Section 1 (Introductory statements and governance), section 2 (Selection, procurement and distribution), section 3 (Production and compounding), section 5 (Patient safety and quality assurance) questions were generally answered positively, with results ranging from 52% to 90%. However, results for section 4 (Clinical pharmacy services) returned lower levels of positivity, with responses from 8 of the 15 questions being less than 60%. When asked what is preventing hospital pharmacists from achieving implementation of these activities, most answers were limited capacity, not considered to be a priority by managers, or other healthcare professionals do this. The last section focused on self-assessment and action planning, with fewer than 50% of positive responses; COVID-19 preparedness and vaccines with mixed positive and negative responses. Furthermore, implementation of the falsified medicines directive impacted the medication handling processes in 50% or more of the answers. Regarding sustainability, the majority (59%) of respondents felt a greater focus should be on sustainability from an organisational or management perspective., Conclusion: Results offer valuable insights into the hospital pharmacy profession throughout Europe. While there have been improvements in certain areas, challenges remain, particularly in implementing clinical pharmacy services. The findings provide a foundation for further dialogue, advocacy, and strategic planning to advance the role of hospital pharmacists and enhance patient care in Europe's healthcare systems., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Originator pharmaceutical companies prolonging the patent of a medicine prevents rivals' entry to the market and competition. As the entry of generic alternatives usually results in price reduction, any delay in their entry potentially deprives the National Health Service (NHS) of much-needed savings. This study estimates the potential cost savings lost to the NHS as a result of delayed entry of generic low-dose buprenorphine (LDTB) patches in England., Design: Two case scenarios were modelled to determine the savings from the entry of generic LDTB Butec only between February and August 2016 and the potential savings which could have been achieved if all generic LDTB patches had entered the market at the same time., Setting: The volume of utilisation of branded and generic LDTB in UK primary care was derived from the NHS business services authority website for prescriptions dispensed between February 2015 and January 2018., Main Outcome Measures: Cost savings associated with the entry of generic LDTB., Results: The cumulative cost savings from the introduction of Butec alone was £0.7 ($0.92) million. The model predicted that if all generic buprenorphine entered the market at the same time with Butec, they could have been achieved a £1.2 ($1.57) million saving. This means that approximately £0.5 ($0.65) million savings was lost to the NHS over the 6-month time period., Conclusions: The entry of Butec was associated with cost savings. We estimated that more cost savings could have been achieved if other generic LDTB patches had entered the market at the same time to drive competition between rivals. Patent protection strategies which delayed the entry of multiple generics were responsible for the reduced cost savings to the NHS in England., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To investigate knowledge and attitudes of different healthcare professionals in UK towards infliximab and insulin glargine biosimilars METHODS: UK medical consultants/registrars, nurses and pharmacists participated in anonymised, self-administered web-based survey distributed by professional associations., Key Findings: There were 234 respondents: medical consultants/registrars (150), nurses (58) and pharmacists (26). 76% of medical consultants/registrars, 84% of pharmacists and 53% of nurses understood what biosimilars were. Medical consultants/registrars and pharmacists had safety and efficacy concerns when switching patients compared to initiation. Nurses had similar levels of safety and efficacy concerns about initiation., Conclusion: Healthcare professionals were more comfortable with the initiation of biosimilars than switching current patients. Medical consultants/registrars and pharmacists were more informed than nurses., (© 2018 Royal Pharmaceutical Society.)

Background: The approval of new biosimilars of infliximab, etanercept and adalimumab by the European Medicines Agency is expected to produce further cost savings to the healthcare system budget., Objectives: This study aimed to estimate the budget impact of the introduction of new biosimilars Flixabi ® , Erelzi ® , Solymbic ® , Amgevita ® and Imraldi ® in rheumatology and gastroenterology specialities in the UK., Methods: A published budget impact model was adapted to estimate the expected cost savings following the entry of new biosimilars Flixabi ® , Erelzi ® , Solymbic ® , Amgevita ® and Imraldi ® in the UK over three-year time horizon. This model was based on retrospective market shares of biologics used in rheumatology and gastroenterology which were derived from DEFINE Software and healthcare professional perspectives., Results: The model predicted that infliximab and etanercept biosimilars would replace their corresponding reference agents by 2020. Adalimumab biosimilars were predicted to achieve 19% of the rheumatology and gastroenterology market by 2020. Without the introduction of further biosimilars, the model predicted a reduction in expenditure of £44 million on biologics over the next three years. With the entry of Flixabi ® , Erelzi ® , Solymbic ® , Amgevita ® and Imraldi ® the model estimates cumulative savings of £285 million by 2020., Conclusions: The introduction of new infliximab, etanercept and adalimumab biosimilars will be associated with considerable cost savings and have a substantial favourable impact on the UK NHS budget. The number of biosimilars and time of entry of is critical to create competition which will result in maximum cost savings., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Aims and Objectives: The aim of the 2018 EAHP Survey on Medicines Shortages was to provide a clearer picture on the issue of medicines shortages, including the impact on hospital pharmacists' time, budgets and the effect on patient care., Methods: A survey was conducted by the EAHP, collecting information from European hospital pharmacists on the shortage situation in their respective countries. The survey ran from 19 March 2018 to 11 June 2018. Keele University, UK analysed and compared the results to those of the 2014 survey., Results: There were 1666 responses to the 2018 survey, which represented a threefold increase from the 2014 survey which received 607 responses. Ninety per cent of respondents answered 'Yes' when asked if shortages of medicines are a current problem in delivering the best care to patients, while only 7% of respondents answered 'No', and 3% 'Unsure'.Problems with shortages of antimicrobials were most commonly reported (77% of respondents reporting this as an issue in 2018 vs 57% in 2014), followed by preventative medicines (43% in 2018 vs 20% in 2014) and anaesthetics (39% in 2018 vs 27% in 2014). Fifty-nine per cent of respondents have seen care delayed as a consequence of medication shortages, with cancellations of care (31% of respondents), medication errors (25% of respondents) and suboptimal treatment for patients (25% of respondents) also being frequently reported.Sixty-three per cent of respondents reported having had to pay a higher price to procure from alternate sources most of the time or always when there was a shortage of a medicine., Conclusions: Medicines shortages is an increasing problem across Europe and is having an adverse impact on patient care. Medicines shortages are adding to hospital pharmacists' time pressures and have an adverse budgetary impact. More timely information about impending shortages and how long they will last is seen as necessary to help manage the problem., Competing Interests: Competing interests: None declared.

Good management of sulfide minerals and sulfuric acid in Acid Sulfate Soils (ASS) requires cost-effective rapid analytical data for their characterisation. However, the determination of properties in ASS samples using traditional laboratory techniques is expensive and time consuming. Excessive delays in analysis risks sample changes from oxidation. Mid-infrared (MIR) spectroscopy with multivariate regression offers a quicker and cheaper surrogate. This manuscript reports the prediction of some of the following key soil parameters in ASS characterisation using benchtop (Perkin Elmer) and handheld (ExoScan) diffuse reflectance MIR Fourier transform (DRIFT) spectrometers: Total Organic Carbon (TOC), Titratable Actual Acidity (TAA), Extractable Sulfate Sulfur (ESS), Reduced Inorganic Sulfur (RIS), Retained Acidity (RA), Acid Neutralising Capacity (ANC), and Lime Calculation (LC). Three sets of representative ASS soil profiles, comprising 132 samples from hyposulfidic, hypersulfidic and sulfuric materials, and covering a wide range of environments in South Australia were scanned under laboratory conditions. These were combined with reference laboratory data in partial least squares regression (PLSR) calibration models. The calibrations were validated by leave-one-out cross validation, with a further test set available for validation. Predictions with coefficient of determination (R 2 ) > 0.75, were obtained for TOC (0.95), TAA (0.88), RIS (0.86), LC (0.76) and ANC (0.76), but models for ESS (0.66) and RA (0.41) were less satisfactory. The handheld spectrometer performed similarly to the benchtop spectrometer in terms of PLSR prediction accuracies with the potential for in-field sampling. Results thus confirmed the possibility of using MIR spectroscopy for the rapid and cost-effective characterisation of ASS., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: To investigate UK healthcare professionals' perceptions and perspectives towards biosimilar infliximab, etanercept and insulin glargine and the potential barriers and facilitators to their prescribing., Design: A cross-sectional qualitative study design was used., Setting: Five hospitals within the West Midlands area in UK., Interventions: 30 min face-to-face, semistructured interviews of healthcare professionals., Participants: 22 healthcare professionals (consultants, nurses and pharmacists) participated in the semistructured interviews., Outcomes: Participants' opinion and attitudes about biosimilars and the barriers and facilitators to the prescribing of infliximab, etanercept and insulin glargine biosimilars in gastroenterology, rheumatology and diabetology specialties., Results: This study showed that UK healthcare professionals had good knowledge of biosimilars and were content to initiate them. Healthcare professionals disagreed with biosimilar auto-substitution at pharmacy level and multiple switching. Subtle differences among healthcare professionals were identified in the acceptance of switching stable patients, indication extrapolation and cost savings sharing., Conclusion: Safety and efficacy concerns, patients' opinion and how cost savings were shared were the identified barriers to considering prescribing biosimilars. Real-life data and financial incentives were the suggested facilitators to increase biosimilar utilisation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

pH is a "master variable" controlling many biogeochemical processes in soils. Acid sulfate soils undergo rapid and large pH changes from circumneutral pH under anaerobic soil conditions to sulfuric soils with ultra (pH < 3.5) and extremely (pH 3.5-4.4) acidic properties following oxidation. Measuring soil pH using a glass electrode has several potential drawbacks including liquid junction errors, drift, suspension effects and clogging. Spectrophotometric pH measurement, involving addition of an indicator dye to the sample, is widely used in seawater and has recently been developed for soil extracts at circumneutral pH ranges. The aim of this study was to extend the spectrophotometric method for application in ultra and extremely acidic soils. The acid dissociation constant (pK a = 5.02) and molar absorptivities of the indicator dye bromocresol green were determined and shown to enable spectrophotometric pH measurement between pH 3 - 5.3. To demonstrate the performance and application of the method, pH and metal availability (Fe, Al, Zn) were measured during the incubation of two acid sulfate soils, which both classified as hypersulfidic soils (pH > 4) and transformed to sulfuric soils (pH < 4) after incubation for 12 weeks. The method compared well (r 2 > 0.99) to glass electrode measurements under acidic conditions with high metal availability. The method has potential to improve understanding of biogeochemical processes in ultra and extremely acidic soils., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: Biological disease-modifying antirheumatic drugs (bDMARDs) are effective but expensive options for treating rheumatoid arthritis. The introduction of infliximab and etanercept biosimilars presents a significant potential cost saving in a financially constrained health system such as the National Health Service (NHS) in the UK. This study examines the impact of the introduction of infliximab and etanercept biosimilars on the utilisation of bDMARDs and subsequent budget impact., Methods: We conducted an interrupted time series analysis of secondary care utilisation data in rheumatology specialities from the DEFINE database, between March 2014 and February 2017., Results: The cumulative cost savings from the introduction of infliximab and etanercept biosimilars was £38.8 million over 2 years. There was a statistically significant increase in average monthly utilisation of bDMARDs for adalimumab (0.48%), certolizumab pegol (1.90%), golimumab (3.06%), abatacept (2.97%) and tocilizumab (2.24%), but not for etanercept. In contrast, the overall utilisation of infliximab decreased slightly by an average of 0.03% per month. The introduction of infliximab biosimilars negatively affected the monthly utilisation of branded infliximab significantly. Similarly, the introduction of an etanercept biosimilar negatively affected the monthly utilisation of branded etanercept significantly., Conclusions: The introduction of bDMARDs biosimilars has resulted in considerable cost savings to the NHS, with the branded products reducing their prices in response to the availability of less expensive biosimilars and competition between the biosimilars themselves. Our results also suggest that when a biosimilar is available for a directly comparable branded molecule, price is the key influencing factor in the prescribing of a specific product.

Archival research into episodes of frontier violence in the Kimberley region of Western Australia indicate that the bodies of Aboriginal victims of massacres were frequently incinerated following the event. This paper presents the results of a scientific investigation of a reported massacre at Sturt Creek where burnt bone fragments were identified in two adjacent sites and documents the archaeological signatures associated with the sites. The methodology used to undertake the project brought together three systems of knowledge: the oral testimonies of the descent group originating from a sole adult survivor of the massacre; archival, historical and scientific research. An archaeological survey defined the two distinct sites containing hundreds of fragile bone fragments; a third site was found to be highly disturbed. Scientific investigations included macroscopic and microscopic examination of selected bone fragments by an anatomical pathologist and a zooarchaeologist and X-ray diffraction analysis of sixteen bone fragments. The anatomical pathologist and zooarchaeologist undertook macroscopic and microscopic examinations of selected bone samples to identify morphological evidence for human origin. It was concluded that three bone fragments examined may have been human, and two of the fragments may have been from the vault of a skull. It was concluded that the likelihood of them being human would be strengthened if it was found that the three samples had been subjected to high temperatures. X-ray diffraction analysis of 16 bone fragments provided this evidence. All fragments showed sharp hydroxylapatite peaks (crystallite sizes 9882nm and 597nm respectively) and all had been subjected to extreme temperatures of either 600°C for more than 80h, 650°C for more than 20h, 700°C for more than 4h or 800°C for more than 1h. XRD analyses were also done on bone samples collected from three cooking hearths at three different archaeological sites. It was found that two of the three samples had been exposed to substantially lower temperatures for a short time period. It was concluded that there was strong pathological and archaeological evidence that the bone fragments were human in origin, but that the evidence was not conclusive. This research also identified archaeological signatures for the identification of massacre sites in similar Australian environments and circumstances., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Infliximab and etanercept biosimilars present significant potential cost savings to the NHS. Patients need to be involved in the decision to use these medicines but there is limited published literature on their knowledge and attitudes about these biosimilars., Objectives: The aim of this study was to investigate ankylosing spondylitis and rheumatoid arthritis patients' knowledge and attitudes towards infliximab and etanercept biosimilars in the UK., Methods: A self-administered web survey was conducted among the members of the National Rheumatoid Arthritis Society and the National Ankylosing Spondylitis Society in the UK between 2 March 2017 and 2 June 2017., Results: A total of 182 patients participated in this survey. The majority of participants (73%) were on etanercept, and 66 and 80% of patients on originator biologic and biosimilars, respectively, understood what biosimilars were. Patients who were currently on biosimilars had greater confidence in their effectiveness and the doctor's decision to initiate than those who were originally on originator biologics that doctors proposed to switch to biosimilars. The majority (82%) of participants on biosimilars thought that biosimilars help to save money for the NHS, while just over half (54%) of participants on the originator biologics thought the cost of treatment should not be considered when prescribing biosimilars., Conclusions: Survey participants had a good knowledge and understanding of biosimilars. Participants on biosimilars were confident and positive about biosimilars' safety, efficacy and switching, whereas participants on the originator biologics were more reluctant to switch to biosimilars. Those patients who expressed concerns felt that more clinical trials on switching biosimilars, better communication and reassurance by healthcare professional teams and further involvement in decision making would increase their acceptance of biosimilars.

Background: The use of statins has increased substantially over the last 2 decades in England and represents a significant cost burden to the National Health Service. Therefore, it is important to understand what influences prescribers' choice., Objectives: This study examines the changes in use pattern of all statins in England (1998-2015). The study focuses on the use of simvastatin and atorvastatin before and after their patent expiry and rosuvastatin, to investigate the impact of the reduced acquisition costs on prescribing., Methods: Interrupted time series analysis of primary care use data from the health and social care information centre database from 1998 to 2015., Results: Primary care expenditure on statins increased by 125% during the period 1998 to 2004 driven by branded simvastatin and atorvastatin. Before 2003, the rate of use of more potent branded atorvastatin exceeds branded simvastatin. Between 2004 and 2011, the less potent but less expensive agent generic simvastatin has the higher utilisation rate (66%). Since 2012, the more potent agent but less expensive generic atorvastatin has the higher utilisation rate (50%). The more potent branded rosuvastatin failed to make a significant impact on the English statins market., Conclusions: The availability of generic statins has reduced overall expenditure significantly. When there is a significant price difference, acquisition cost appears to be the main influencing factor in prescribing statins, but, when costs are similar, potency is a key factor. This suggests that English prescribers are cost sensitive and appear to be prepared to trade marginal benefit for savings., (Copyright © 2017 John Wiley & Sons, Ltd.)

A series of soil transference experiments (STEs) were undertaken to determine whether patterns identified in laboratory experiments could also be recognised at a simulated crime scene in the field. A clothed 55kg human rescue dummy dressed in a padded bra was either dragged or merely placed on a soil surface at sites with natural and anthropogenic soil types under both wet and dry soil conditions. Transfer patterns produced by dragging compared favourably with those of laboratory experiments. Twelve patterns were identified when a clothed human rescue dummy was dragged across the two soil types in the field. This expanded the original set of eight soil transfer patterns identified from dragging weighted fabric across soil samples in the laboratory. Soil transferred by placing the human rescue dummy resulted in a set of six transfer patterns that were different to those produced by dragging. By comparing trace soil patterns transferred to bras using each transfer method, it was revealed that certain transfer patterns on bras could indicate how the fabric had made contact with a soil surface. A photographic method was developed for crime scene examiners to capture this often subtle soil evidence before a body is transported or the clothing removed. This improved understanding of the dynamics of soil transference to bras and related clothing fabric may assist forensic investigators reconstruct the circumstances of a variety of forensic events., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: To investigate healthcare professionals' knowledge and attitudes towards infliximab and insulin glargine biosimilars and the factors influencing their prescribing. Then, to compare healthcare professionals' attitudes with the utilisation of these biosimilars in UK hospitals., Design: Self-administered, one-time web-based survey and drug utilisation analysis., Setting and Data Sources: Professional associations and societies in the field of dermatology, diabetology, gastroenterology and rheumatology in the UK, between 8 August 2016 and 8 January 2017. The volume of utilisation of branded and biosimilar infliximab and insulin glargine in UK hospitals was derived from the DEFINE database, between 2015 and 2016., Outcomes: Participants' knowledge and awareness of biosimilars and factors influencing their use and corresponding usage of infliximab and insulin glargine biosimilars., Results: Responses were obtained from 234 healthcare professionals across dermatology, diabetology, gastroenterology and rheumatology specialties. 75% of respondents were aware that biosimilars were available on their local formulary. 77% of respondents considered biosimilars extremely or very important to save costs for the NHS. Gastroenterologists had the highest utilisation of infliximab biosimilars (14%) in 2015 rising to (62%) in 2016. Healthcare professionals had greater concerns about safety and efficacy when switching patients to biosimilars than when starting biosimilars in biological naïve patients. Guidance from National Institute for Health and Care Excellence and robust pharmacovigilance studies on biosimilars were both considered important factors in increasing biosimilars use., Conclusion: British healthcare professionals are well informed about biosimilars with high level of awareness. Safety and efficacy concerns were higher in switching than in initiating biosimilars among some prescribers. It is probable that personal experience of biologics as well as discipline-specific guidance influenced prescribers' responses., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objective: The patent expiry of a number of biological medicines and the advent of biosimilars raised the expectations of healthcare commissioners that biosimilars would reduce the high cost of these medicines and produce potential savings to the NHS. We aimed to examine the prescribing pattern of different growth hormone preparations (ready to use and reconstitution requiring) in primary and secondary care in England to determine relative rates of decrease or increase and identify the possible factors influencing prescribing following the introduction of biosimilar growth hormone in 2008., Design: Longitudinal observational study., Setting and Data Sources: Primary care prescribing cost and volume data was derived from the NHS business services authority website, and for secondary care from the DEFINE database, between April 2011 and December 2015., Outcomes: Quarterly prescribing analysis to examine trends and measure the relationship between usage and price., Results: Expenditure and usage of growth hormone in primary care decreased by 17.91% and 7.29%, respectively, whereas expenditure and usage in secondary care increased by 68.41% and 100%, respectively, between April 2011 and December 2015. The usage of reconstitution requiring products significantly declined in primary care (R²=0.9292) and slightly increased in use in secondary care (R²=0.139). In contrast, the usage of ready-to-use products significantly increased in use in primary (R²=0.7526) and secondary care (R²=0.9633), respectively. Weak or no correlation existed between the usage and price of growth hormone preparations in primary and secondary care., Conclusions: The price of growth hormone products was not the key factor influencing the prescribing of the biological medicines. The main driver for specific product selection was the ease of use and the number of steps in dose preparation. Prescribers appear to be taking into account patient preferences rather than cost in their prescribing decisions., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Objective: To undertake an analysis of hospital pharmacy staffing levels in England comparing national and regional averages for 2007/2008 and 2012/2013., Methods: Individual hospital pharmacy staffing establishment data were extracted from the National Health Service (NHS) Pharmacy Education and Development Committee's National NHS Pharmacy Staffing Establishment and Vacancy Survey for 2007/2008 and 2012/2013. Hospital activity data for the 2 years were extracted from the NHS Health and Social Care Information Centre website. For each hospital, the number of whole time equivalent (WTE) pharmacy staff was divided by the number of admissions and a percentage WTE/admission calculated. Acute hospitals were analysed separately from mental health hospitals., Results: The mean % WTE pharmacy staff/admission in acute hospitals in England 2012/2013 was 0.114 compared with 0.112 in 2007/2008 (p>0.05). The means for individual staff groups have either remained unchanged or have reduced slightly. There were also changes by region with some increasing and others decreasing. The changes in mental health and social care trusts were more marked with the median % WTE pharmacy staff/admission almost doubling in 2012/2013 compared with 2007/2008. This increase in establishment was seen in all pharmacy staff groups., Conclusions: The number of pharmacy staff per admission in acute hospitals in England between 2007/2008 and 2012/2013 has not changed significantly. This indicates that pharmacy services have kept pace with increasing activity. In contrast, pharmacy staffing levels in mental health trusts have almost doubled in the intervening 5 years as a result of a national initiative to develop the workforce in mental health services., Competing Interests: Competing interests: None declared.

In a recent Australian homicide, trace soil on the victim's clothing suggested she was initially attacked in her front yard and not the park where her body was buried. However the important issue that emerged during the trial was how soil was transferred to her clothing. This became the catalyst for designing a range of soil transference experiments (STEs) to study, recognise and classify soil patterns transferred onto fabric when a body is dragged across a soil surface. Soil deposits of interest in this murder were on the victim's bra and this paper reports the results of anthropogenic soil transfer to bra-cups and straps caused by dragging. Transfer patterns were recorded by digital photography and photomicroscopy. Eight soil transfer patterns on fabric, specific to dragging as the transfer method, appeared consistently throughout the STEs. The distinctive soil patterns were largely dependent on a wide range of soil features that were measured and identified for each soil tested using X-ray Diffraction and Non-Dispersive Infra-Red analysis. Digital photographs of soil transfer patterns on fabric were analysed using image processing software to provide a soil object-oriented classification of all soil objects with a diameter of 2 pixels and above transferred. Although soil transfer patterns were easily identifiable by naked-eye alone, image processing software provided objective numerical data to support this traditional (but subjective) interpretation. Image software soil colour analysis assigned a range of Munsell colours to identify and compare trace soil on fabric to other trace soil evidence from the same location; without requiring a spectrophotometer. Trace soil from the same location was identified by linking soils with similar dominant and sub-dominant Munsell colour peaks. Image processing numerical data on the quantity of soil transferred to fabric, enabled a relationship to be discovered between soil type, clay mineralogy (smectite), particle size and soil moisture content that would not have been possible otherwise. Soil type (e.g. Anthropogenic, gravelly sandy loam soil or Natural, organic-rich soil), clay mineralogy (smectite) and soil moisture content were the greatest influencing factors in all the dragging soil transference tests (both naked eye and measured properties) to explain the eight categories of soil transference patterns recorded. This study was intended to develop a method for dragging soil transference laboratory experiments and create a baseline of preliminary soil type/property knowledge. Results confirm the need to better understand soil behaviour and properties of clothing fabrics by further testing of a wider range of soil types and clay mineral properties., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Following the break of a severe drought in the Murray-Darling Basin, rising water levels restored subaqueous conditions to dried inland acid sulfate soils with sulfuric horizons (pH <3.5). Equilibrium dialysis membrane samplers were used to investigate in situ changes to soil acidity and abundance of metals and metalloids following the first 24 mo of restored subaqueous conditions. The rewetted sulfuric horizons remained severely acidified (pH ∼4) or had retained acidity with jarosite visibly present after 5 mo of continuous subaqueous conditions. A further 19 mo of subaqueous conditions resulted in only small additional increases in pH (∼0.5-1 pH units), with the largest increases occurring within the uppermost 10 cm of the soil profile. Substantial decreases in concentrations of some metal(loid)s were observed with time most likely owing to lower solubility and sorption as a consequence of the increase in pH. In deeper parts of the profiles, porewater remained strongly buffered at low pH values (pH <4.5) and experienced little progression toward anoxic circumneutral pH conditions over the 24 mo of subaqueous conditions. It is proposed that low pH conditions inhibited the activity of SO-reducing bacteria and, in turn, the in situ generation of alkalinity through pyrite production. The limited supply of alkalinity in freshwater systems and the initial highly buffered low pH conditions were also thought to be slowing recovery. The timescales involved for a sulfuric horizon rewetted by a freshwater body to recover from acidic conditions could therefore be in the order of several years., (Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.)

Acid sulfate soils with sulfuric material (pH<4) can have significant impacts on surface water quality and aquatic ecosystems due to low pH and high soluble metal concentrations in runoff and drainage discharges. There has been limited research on the complex geochemical transformations that occur along flow pathways from the soil acidity source to receiving waters. We studied the integrated geochemistry of metals in acid sulfate soils with sulfuric material, groundwater, drain and river water in the Lower Murray River (South Australia) over a 2 year period. The oxidation of an estimated 3500 ha of acid sulfate soils with sulfidic material (pH>4) underlying this former floodplain occurred due to falling river and groundwater levels during the 2006-2010 extreme "millennium" drought. A low pH (<4.5) soil layer was found approximately 1-2.5m below ground level with substantial amounts (up to 0.2 mol H(+)/kg dry weight) of available/soluble acidity and retained acidity in the form of the Fe oxyhydroxy sulfate mineral jarosite. The jarosite appears to be dissolving over time and buffering the sub-surface soil layers at pH≈4. Metal (Fe, Al, Mn) and metalloid (As) lability was greatly increased in the acidic soil layer. Highly acidic and metal rich groundwater (median pH 4.3, Fe, Al, Mn of 0.04-0.52 mmol/L) was observed at the same depths as the acidic soil layers. Nearly all of the dissolved Fe in the groundwater was present as Fe(2+). In the drains, increases in pH and redox potential promoted formation of the Fe oxyhydroxysulfate mineral schwertmannite. This mineral precipitation transferred a portion of the dissolved acidity to the drain sediments. Upon discharge to, and dilution of, the acid drainage in the river, pH neutralisation and rapid oxidation, hydrolysis, and precipitation of solid Al and Fe phases occurred in a localised area. Acidity is persisting (>3 years) following a return to pre-drought water levels., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Iron-monosulfide oxidation and associated S transformations in a natural sediment were examined by combining selective extractions, electron microscopy and S K-edge X-ray absorption near-edge structure (XANES) spectroscopy, The sediment examined in this study was collected from a waterway receiving acid-sulfate soil drainage. It contained a high acid-volatile sulfide content (1031 micromol g(-1)), reflecting an abundance of iron-monosulfide. The iron-monosulfide speciation in the initial sediment sample was dominated by nanocrystalline mackinawite (tetragonal FeS). At near-neutral pH and an 02 partial pressure of approximately 0.2 atm, the mackinawite was found to oxidize rapidly, with a half-time of 29 +/- 2 min. This oxidation rate did not differ significantly (P < 0.05) between abiotic versus biotic conditions, demonstrating that oxidation of nanocrystalline mackinawite was not microbially mediated. The extraction results suggested that elemental S (S8(0)) was a key intermediate S oxidation product Transmission electron microscopy showed the S8(0) to be amorphous nanoglobules, 100-200 nm in diameter. The quantitative importance of S8(0) was confirmed by linear combination XANES spectroscopy, after accounting for the inherent effect of the nanoscale S8(0) particle-size on the corresponding XANES spectrum. Both the selective extraction and XANES data showed that oxidation of S8(0) to SO4(2-) was mediated by microbial activity. In addition to directly revealing important S transformations, the XANES results support the accuracy of the selective extraction scheme employed here.

Objective: To investigate whether Defined Daily Dose/Finished Consultant Episode (DDD/FCE) ratio is sensitive to changes in prescribing patterns and could be used as a prescribing indicator in hospitals., Method: The study comprised two phases. In phase 1 the weekly DDD/FCE ratios for two antibiotics were calculated and monitored in one acute NHS hospital before and after the implementation of prescribing guidelines, which impacted on the use of the antibiotics. In phase 2 data on the use of four antibiotics over one year was collected from fifty-eight medium to large acute hospitals in England, together with corresponding FCE data. DDD/FCE ratios for each antibiotic in each hospital were compared., Main Outcome Measure: Whether the DDD/FCE ratio for two antibiotics changed in one hospital following the introduction of prescribing guidelines for these antibiotics. The variability in DDD/FCE ratio for two broad spectrum antibiotics compared to two narrow spectrum antibiotics across a number of acute hospitals in England., Results: In phase 1 the DDD/FCE ratios for the two antibiotics were lower post implementation of the guidelines indicating that the ratio was sensitive to changes in prescribing. In phase 2 the median DDD/FCE ratios of the two broad spectrum antibiotics from all fifty eight hospitals were much higher (0.126, and 0.265) than for the two narrow spectrum antibiotics (0.048, and 0.021), indicating higher use of the broad spectrum antibiotics. Furthermore, the variation in prescribing between the hospitals, as indicated by the inter-quartile range about the median, was greater for the two broad spectrum agents (0.201 and 0.193), than for the narrow spectrum agents (0.06, and 0.042), as was expected., Conclusion: The DDD/FCE ratio is sensitive to changes in prescribing and can reflect differences in the use of antibiotics between hospitals, after accounting for differences in activity. DDD/FCE ratio has the potential to be used to also account for differences in case mix between hospitals although further work is needed in this area.

Objective: To investigate the provision of clinical pharmacy services in hospitals in one NHS region in UK, and to measure the delivery of these services against published standards., Method: The study comprised two phases. Phase 1 was a postal questionnaire to hospital chief pharmacists seeking information on the provision of clinical pharmacy in their hospital. Phase 2 involved a semi-structured interview with hospital chief pharmacists to obtain a detailed understanding of clinical pharmacy services in their hospital and factors influencing the provision of these services., Results: Ninety-four percent of all hospitals surveyed were providing a clinical pharmacy service. However, only two thirds provided a service to all wards, and the main reason given for not doing so, was lack of resources. There was a divergence of opinion amongst chief pharmacists whether it was better to provide a limited service to all wards or a good service to some wards. Thirty-seven percent of hospitals did not meet the minimum standard of frequency for visiting acute wards, whereas, 58 were meeting the optimal standard of frequency of visits for non-acute short stay wards and 67 for long stay wards, primarily because the latter required less frequent visiting. The study showed that hospital pharmacies were influencing prescribing decisions in a variety of ways other than ward visiting., Conclusion: Although hospital chief pharmacists see clinical pharmacy as a core service, published standards for these services are not being met. As a result of staff shortages, managers are using a variety of approaches to maintain clinical pharmacy services. There is scope for further devolvement of duties to pharmacy technicians in order to release valuable pharmacist time.

Morphine + midazolam and alfentanil + propofol are regimens offering well tolerated and effective sedation for critically ill patients. However, morphine + midazolam is associated with accumulation in these patients, resulting in prolonged recovery characteristics. Alfentanil+propofol, although more expensive, has a shorter elimination half-life, is not associated with accumulation problems and results in a rapid recovery. This study compared sedation quality, patient recovery characteristics and the cost of alfentanil + propofol and morphine + midazolam for sedating critically ill patients in the intensive care setting. 26 patients were randomly allocated to receive sedation with alfentanil + propofol (n = 17) or morphine + midazolam (n = 9). Outcome measures were the times until extubation, intensive care unit (ICU) transfer and final hospital discharge. Cost analysis assessed both drug-related costs, including drug acquisition and administration, and non-drug-related costs, including bed occupancy. Age, gender, diagnosis, Acute Physiological and Chronic Health Evaluation (APACHE) II scores and sedation quality did not differ significantly between groups. The times to extubation and until patients were fit for transfer from ICU were significantly shorter for patients sedated with alfentanil + propofol than for those sedated with morphine + midazolam. The total costs (at the time of the study Pounds 1 was equivalent to $US1.59) for ICU hospital stay per patient for alfentanil + propofol and morphine + midazolam were 3063 Pounds and 9511 Pounds, respectively, because the shorter recovery characteristics of alfentanil + propofol led to a reduction in ICU stay. Corresponding costss for total hospital stay were 6063 Pounds and 13735 Pounds, respectively. In conclusion, alfentanil + propofol has a better pharmacoeconomic profile than morphine + midazolam for sedating critically ill patients in the ICU setting.

The photochemistry of 4-aminobenzoic acid has been investigated using two validated reversed-phase HPLC methods. Up to nine photoproducts have been detected, with chromatographic evidence for the formation of 4,4'-azobenzenedicarboxylic acid and 4,4'-hydrazobenzenedicarboxylic acid. The synthesis and analytical characterization of 4,4'-hydrazobenzenedicarboxylic acid is reported.

A limiting-factor, environmental model for radiata pine (Pinus radiata (D. Don)) has been developed using landform and soil morphological features that influence site productivity. The model focuses on soil and landscape constraints to productivity and predicts the native productivity of land and tree species. It permits the integration of land-use objectives for a catchment through forest management and use of silvicultural practices which increase productivity. The soil site evaluation index (SSEI) is an index of forest productivity found when silviculture extends only to the minimum amount of site disturbance needed to establish a plantation of radiata pine. The impacts of intensive silvicultural practices were deducted from the 'Site Quality' productivity survey rating to calculate the unimproved yield class (uYC). We calculated SSEI by range standardising uYC values from 0 to 1. SSEI was correlated with the environmental factors in a regression tree model using readily available analytical software. The model accurately predicts unimproved forest productivity from observed soil horizon and land surface properties. The environmental constraints in low lying areas relate to waterlogging, soil sodicity and gravel content. In elevated areas, plant available water storage, rock weathering, landform, ironstone gravel and aspect are recognised factors for pine growth.

A single dose, single point method of predicting patients' oral maintenance theophylline dosage has been compared with a noninvasive method. Twenty patients with obstructive lung disease received an oral dose (6 mg kg-1) of micro-crystalline theophylline. The plasma theophylline concentration after 8-10 h was then used to calculate the optimum maintenance dose of sustained release aminophylline required to achieve steady state concentrations between 55 and 110 mumols l-1. The mean steady state plasma theophylline concentration for this dosage schedule was also predicted by a method using population average pharmacokinetic parameters (assumed clearance method). These predictions were then compared with observed concentration-time profiles at steady state. The mean difference between the observed values and those predicted from a morning test dose was -0.11 mumol l-1 (95% CI -7.0 to +7.2). A larger difference (-7.4 mumol l-1 95% CI -18.2 to +3.4) was found for the assumed clearance method. Since the confidence intervals contain zero, these differences are not significantly different from zero at the 5% level, although the morning test dose method allowed prediction of the whole concentration-time profile and was more precise. An evening test dose was also used in the study, but the mean difference between the observed values and those predicted from this method was larger at -24.8 mumol l-1 (95% CI -32.89 to -17.21) and was significantly different from zero. This study indicates that a morning test dose followed by a single blood sample can be used to establish maintenance theophylline therapy quickly and safely in selected patients.

Amoxycillin 3 g twice daily is effective in treating patients with bronchiectasis who have daily purulent sputum. However, it is a relatively expensive treatment if used for prolonged periods. This pilot study in six patients with bronchiectasis showed that the concurrent administration of probenecid with a smaller dose of amoxycillin produced similar clinical responses and pharmacokinetic profiles to those found with high dose amoxycillin alone. The amount of amoxycillin used was reduced by two thirds, producing a potential saving of approximately pound 1000 per patient per annum in those taking long term treatment.

The phosphate esters of racemic (+/-) alpha-chlorohydrin and its S(+)-optical isomer have been prepared as cyclohexylamine salts. In vitro both inhibited glyceraldehyde-3-phosphate dehydrogenase by a competitive mechanism, whereas (+/-) alpha-chlorohydrin did not. The S(+)-isomer was approximately four times as potent as the racemate. These results correlate with data concerning the relative contraceptive activity in rats of racemic and S(+) alpha-chlorohydrin. They support the view that the antifertility mechanism involves in vivo formation of S(+) alpha-chlorohydrin-1-phosphate, with resulting inhibition of glycolysis in sperm.

A pharmacokinetic method for individualizing theophylline dosage is described. The method was shown to be reliable and accurate, and maintained significantly more patients within the optimum therapeutic range when compared with conventional regimens. The study also showed that when conventional dosage regimens are used, a large proportion of patients exhibit theophylline levels well below the optimum therapeutic range. Population pharmacokinetic data for theophylline and the effect of congestive heart failure on its clearance are also presented.

The in vivo concentration-time profiles of chlorhexidine and noxythiolin bladder irrigations were determined by utilizing high-performance liquid chromatography techniques following a once daily irrigation. A total of 14 chlorhexidine irrigations established a mean concentration of 0.006% w/v, 2-3 h post irrigation. A total of 12 noxythiolin irrigations established a mean concentration of 0.266% w/v, 2-3 h post irrigation, which correlated to a mean formaldehyde concentration of 0.0119% w/v at 2-3 h, as estimated from N-methylthiourea. For both solutions the minimum inhibitory concentration was exceeded for up to 5 h post irrigation, which is sufficient contact time to establish a total kill, thus indicating the possibility that a once daily irrigation may be appropriate in asymptomatic bacteriuria which utilizes either chlorhexidine or noxythiolin.

Enalapril was shown to have no effect on the serum potassium of patients (n = 16) already taking Frusemide and Amiloride. Furthermore, there was no difference in serum potassium levels of the group taking a combination of Enalapril, Frusemide and Amiloride when compared to a similar group of patients taking Frusemide and Amiloride alone (n = 19). No patients in either group were deemed to have seriously impaired renal function. The results indicate that the theoretical hyperkalaemic effect of concurrent administration of Enalapril and Amiloride is not manifest in clinical practice in patients with normal renal function.