Independent effects of volume and energy density manipulation on energy intake and appetite in healthy adults: A randomized, controlled, crossover study.

Consuming enough energy to meet high energy demands can be challenging for military personnel wherein logistical constraints limit food availability. Increasing dietary energy density (ED) and/or volume density (VD) of rations may be countermeasures, but whether positive linear associations between ED and energy intake (EI) hold at moderate-to-high ED and VD is unclear. This study examined the effects of covertly increasing the ED and VD of moderate ED (≥1.6 kcal/g) foods on appetite and energy intake. Twenty healthy men completed four 2-day treatments in random order by consuming a standardized diet containing three experimental food items (EXP) engineered using leavening, physical compression and fat manipulation to be isovolumetric but lower (L) or higher (H) in ED and VD creating four treatments: LED/LVD, LED/HVD, HED/LVD, HED/HVD. Consumption of EXP was compulsory during two meals and a snack, but remaining intake was self-selected (SSF). Results failed to show any ED-by-VD interactions. During LVD, EI was lower for EXP (-417 kcal [95%CI: 432, -402], p < 0.01) and TOTAL (SSF + EXP) (-276 kcal [95%CI: 470, -83], p = 0.01) compared to HVD, while SSF EI did not differ (140 kcal [-51, 332], p = 0.15). During LED, EI for EXP (-291 kcal [95%CI: 306, -276], p < 0.01) was lower than HED, while SSF EI was higher than HED (203 kcal 95%CI: [12, 394], p = 0.04) and TOTAL EI did not differ (-88 kcal [-282, 105], p = 0.36). Thus, when a small isovolumetric portion of the diet was manipulated, increasing the VD of moderate ED foods failed to elicit compensatory reductions in ad libitum EI while increasing the ED of moderate ED foods did. Findings may support VD manipulation of moderate ED foods as a strategy to promote increased short-term EI in environments wherein logistical burden may limit food volume.

Comparing the multivariate relationships of conceptual adversity models and structural brain development in adolescent girls: A registered report.

Adverse experiences throughout development confer risk for a multitude of negative long-term outcomes, but the processes via which these experiences are neurobiologically embedded are still unclear. Adolescence provides an opportunity to understand how these experiences impact the brain's rapidly changing structure. Two models are central to current adversity conceptualizations: a cumulative risk model, where all types of experiences are combined to represent accumulating stress, and a dimensional model, where certain features of experience (e.g., threat or deprivation) exert unique neurophysiological influence. In this registered report, we extended upon previous research by using a form of representational similarity analysis to examine whether the dimensional and cumulative risk models of adversity predict cortical thinning in frontoparietal and frontotemporal networks and volumetric changes in subcortical regions throughout adolescence. Drawing from a longitudinal sample of 179 adolescent girls (ages 10-13 years at the first wave) from Lane County, Oregon, United States, and up to four waves of follow-up data, we found that operationalizing adversity by similarity in threat and deprivation provided better prediction of brain development than similarity in overall adversity. However, these dimensions do not exhibit unique associations with developmental changes in the hypothesized brain changes. These results underscore the significance of carefully defining adversity and considering its impact on the entire brain. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Revisioning aging: Indigenous, crip and queer renderings.

In this article, we re-vision Anishinaabe, crip and queer futures of aging against and beyond dominant successful aging narratives by drawing on our archive of digital/multimedia videos (short documentaries) produced in conjunction with older/e/Elder persons and the Re•Vision: Centre for Art and Social Justice. These documentaries are directed and come from the lives of those older and e/Elder persons whose aging embodiments intra-sect with their Indigenous, disabled and queer selves. Disrupting hegemonic successful aging narratives, and specifically heteronormative and ableist trajectories of aging, these alternative renderings of aging futures offer rich, affective relationalities and cyclical timescapes of older experience that draw on the past even as they reach into divergent futurities. Anishinaabe, crip and queer aging emerge. While we discern resonances in relationalities and temporalities among and between the Anishinaabe and non-Indigenous stories, we also identify significant differences across accounts, indicating that they cannot be collapsed together. Instead, we argue for holding different life-ways and futures alongside one another, following the 1613 Two Row Wampum Treaty between the Dutch and the Haudenosaunee, in which each party promised to respect the other's ways, and committed to non-interference, as well as to the development and maintenance of relationship.

Multimethod assessment of pubertal timing and associations with internalizing psychopathology in early adolescent girls.

Early pubertal timing has consistently been associated with internalizing psychopathology in adolescent girls. Here, we aimed to examine whether the association between timing and mental health outcomes varies by measurement of pubertal timing and internalizing psychopathology, differs between adrenarcheal and gonadarcheal processes, and is stronger concurrently or prospectively. We assessed 174 female adolescents (age 10.0-13.0 at Time 1) twice, with an 18-month interval. Participants provided self-reported assessments of depression/anxiety symptoms and pubertal development, subjective pubertal timing, and date of menarche. Their parents/guardians also reported on the adolescent's pubertal development and subjective pubertal timing. We assessed salivary dehydroepiandrosterone (DHEA), testosterone, and estradiol levels and conducted clinical interviews to determine the presence of case level internalizing disorders. From these data, we computed 11 measures of pubertal timing at both time points, as well as seven measures of internalizing psychopathology, and entered these in a Specification Curve Analysis. Overall, earlier pubertal timing was associated with increased internalizing psychopathology. Associations were stronger prospectively than concurrently, suggesting that timing of early pubertal processes might be especially important for later risk of mental illness. Associations were strongest when pubertal timing was based on the Tanner Stage Line Drawings and when the outcome was case-level Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) depression or Hierarchical Taxonomy of Psychopathology (HiTOP) distress disorders. Timing based on hormone levels was not associated with internalizing psychopathology, suggesting that psychosocial mechanisms, captured by timing measures of visible physical characteristics might be more meaningful determinants of internalizing psychopathology than biological ones in adolescent girls. Future research should precisely examine these psychosocial mechanisms. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Value of Mechanistic Experiments to Target the Shared Neural Circuitry of Parenting and Addiction: The Potential for Video Feedback Interventions.

Certain neural processes that underlie addiction are also central to parenting, notably stress and reward. Parenting interventions that incorporate the unique context of caregivers with addiction have demonstrated some success: However, real-world implementation of evidence-based interventions can be difficult with this population. Video feedback interventions are an especially promising approach to reach parents who experience barriers to participation, particularly caregivers with addiction. A translational neuroscientific approach to elucidating the mechanisms of change in these interventions will aid the delivery and success of this method and advance theory surrounding parenting in the context of addiction. Along these lines, we provide an example of one video feedback intervention, Filming Interactions to Nurture Development, that will serve as such a mechanistic experiment.

Ultrasonic agglomeration of model flour systems: Process parameter-product physico-thermal property relationships.

Ultrasonic compression was applied to wheat flour to create an agglomerated and compacted model food system. This novel process combines physical compression with ultrasonic vibration to permanently weld particles together, thereby producing a robust compact. Fundamental relationships among operating parameters, energy imparted to the specimens, and physical properties of the agglomerated products were developed. Integrated agglomeration energy was determined to be a linear function of percent maximum horn amplitude and ultrasonication time, and integrated energy in turn influenced product physical properties, such as density and fracture strength, in highly significant linear relationships. Microscopic, computer tomographic, and differential scanning calorimetric analyses confirmed progressive compaction of and thermal stability changes in the flour matrix with increased processing energy. Specimens agglomerated at higher energy levels were furthermore demonstrated to have higher fracture strength than conventionally (pressure-only) compressed specimens despite similar densities, due to the robust interparticle bridging produced by agglomeration. PRACTICAL APPLICATION: Ultrasonic agglomeration represents a potential improvement over standard compression in the manufacturing of meal-supplementing energy bars. Ultrasonic agglomeration effectively adheres particles together without incorporation of low-nutrient- density syrups and binders. Agglomerated and compacted products also have superior mechanical stability, which can improve texture and physical stability during product handling.

Glycaemic regulation, appetite and ex vivo oxidative stress in young adults following consumption of high-carbohydrate cereal bars fortified with polyphenol-rich berries.

Consumption of certain berries appears to slow postprandial glucose absorption, attributable to polyphenols, which may benefit exercise and cognition, reduce appetite and/or oxidative stress. This randomised, crossover, placebo-controlled study determined whether polyphenol-rich fruits added to carbohydrate-based foods produce a dose-dependent moderation of postprandial glycaemic, glucoregulatory hormone, appetite and ex vivo oxidative stress responses. Twenty participants (eighteen males/two females; 24 (sd 5) years; BMI: 27 (sd 3) kg/m2) consumed one of five cereal bars (approximately 88 % carbohydrate) containing no fruit ingredients (reference), freeze-dried black raspberries (10 or 20 % total weight; LOW-Rasp and HIGH-Rasp, respectively) and cranberry extract (0·5 or 1 % total weight; LOW-Cran and HIGH-Cran), on trials separated by ≥5 d. Postprandial peak/nadir from baseline (Δmax) and incremental postprandial AUC over 60 and 180 min for glucose and other biochemistries were measured to examine the dose-dependent effects. Glucose AUC0-180 min trended towards being higher (43 %) after HIGH-Rasp v. LOW-Rasp (P=0·06), with no glucose differences between the raspberry and reference bars. Relative to reference, HIGH-Rasp resulted in a 17 % lower Δmax insulin, 3 % lower C-peptide (AUC0-60 min and 3 % lower glucose-dependent insulinotropic polypeptide (AUC0-180 min) P<0·05. No treatment effects were observed for the cranberry bars regarding glucose and glucoregulatory hormones, nor were there any treatment effects for either berry type regarding ex vivo oxidation, appetite-mediating hormones or appetite. Fortification with freeze-dried black raspberries (approximately 25 g, containing 1·2 g of polyphenols) seems to slightly improve the glucoregulatory hormone and glycaemic responses to a high-carbohydrate food item in young adults but did not affect appetite or oxidative stress responses at doses or with methods studied herein.

Long-Term Vitamin Stabilization in Low Moisture Products for NASA: Techniques and Three-Year Vitamin Retention, Sensory, and Texture Results.

Multiyear spaceflight will require innovative strategies to preserve vitamins in foods, in order to retain astronaut health and functionality long-term. Furthermore, space foods must be low weight/volume to comply with cargo restrictions, and must retain sensory quality to ensure consumption. Low water activity products were developed, fortified with vitamins A, B1, B9, C, and E at twice their spaceflight requirements, stored for three years at 21 °C and one year at 38 °C, and analyzed annually for retained vitamin content and organoleptic quality. The vitamins were encapsulated in carbohydrate or lipid coatings and tested in relatively low and high fat versions of compressed bars and powdered drink mix formulations. Susceptibility to degradation at 21 °C followed the sequence B9 > A > B1 > C > E; degradation rates were fitted to first-order kinetics. Vitamins A and C were more sensitive at the higher storage temperature. Vitamin retention was slightly higher in compressed bars verses powders. Effects of matrix lipid level on stability were vitamin dependent. Sensory characteristics for products stored three years at 21 °C remained mostly above 6.0 on a 9-point hedonic scale, whereas those stored for one year at 38 °C remained mostly above 5.0. Compressed bars firmed significantly during storage. All vitamin levels after three years at 21 °C remained above the space flight requirements, demonstrating the suitability of the selected fortification schemes and food matrices for long-term preservation. PRACTICAL APPLICATION: Vitamins A, B1, B9, C, and E were retained at 70% to 95% levels for three years at 21 °C in carefully formulated, fortified low water activity products. Product compression and vacuum packaging slightly helped to further preserve vitamins. The sensory quality of these products was retained throughout storage.

Mapping the literature of hospital pharmacy.

OBJECTIVES: This study describes the literature of hospital pharmacy and identifies the journals most commonly cited by authors in the field, the publication types most frequently cited, the age of citations, and the indexing access to core journals. The study also looks at differing citation practices between journals with a wide audience compared to a national journal with a focus on regional issues and trends in the field. METHOD: Cited references from five discipline-specific source journals were collected and analyzed for publication type and age. Two sets were created for comparison. Bradford's Law of Scattering was applied to both sets to determine the most frequently cited journals. RESULTS: Three-quarters of all cited items were published within the last 10 years (71%), and journal articles were the most heavily cited publication type (n=65,760, 87%). Citation analysis revealed 26 journal titles in Zone 1, 177 journal titles in Zone 2, and the remaining were scattered across 3,886 titles. Analysis of a national journal revealed Zone 1 comprised 9 titles. Comparison of the 2 sets revealed that Zone 1 titles overlapped, with the exception of 2 titles that were geographically focused in the national title. CONCLUSION: Hospital pharmacy literature draws heavily from its own discipline-specific sources but equally from core general and specialty medical journals. Indexing of cited journals is complete in PubMed and EMBASE but lacking in International Pharmaceutical Abstracts. Gray literature is a significant information source in the field.

The Inhibition of Maillard Browning by Different Concentrations of Rosmarinic Acid and Epigallocatechin-3-Gallate in Model, Bakery, and Fruit Systems.

UNLABELLED: Rosmarinic acid and Epigallocatechin gallate concentrations were studied as natural inhibitors of Maillard browning in glucose/glycine model systems, and in bakery rolls and applesauce. The concentrations of the inhibitors were varied to determine the highest level of inhibition without a pro-oxidant/browning effect. UV absorbance and gas chromatography/mass spec (GC/MS) with solid phase microextraction (SPME) sampling was used to study browning in the model systems. Hunter L*, a*, b* was used to analyze the color change results of the inhibitors on applesauce and bakery rolls. It was determined that a 1.0% solution of either antioxidant in the glucose/glycine system produced the greatest inhibition and a synergistic effect was not apparent when the two were combined. Inhibition of browning and a lack of synergy between the antioxidants were also determined in food systems consisting of applesauce and bakery rolls. GC/MS analysis of the model system revealed a high level of pyrazine formation in no-inhibitor control samples and the absence of pyrazines in inhibitor-containing samples. PRACTICAL APPLICATION: Natural browning inhibitors, that is Rosmarinic acid and Epigallocatechin gallate, can be added to food items to inhibit browning over a prolonged period of storage in order to increase product shelf stability. The concentrations of the inhibitors require optimization since a pro-oxidant effect and increased browning will occur at high levels.

Absorption of omega-3 fats from carbohydrate and proteinaceous food matrices before and after storage.

Development of n-3 fortified, shelf-stable foods is facilitated by encapsulated docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), since natural n-3 food sources cannot withstand high temperature and prolonged shelf life. Organoleptic stability of n-3 fortified, shelf-stable foods has been demonstrated, but chemical changes in the food matrix throughout storage could conceivably impact digestibility of the protein-based encapsulant thereby compromising n-3 bioavailability. We assessed the effect of prolonged high-temperature storage and variations in food matrix (proteinaceous or carbohydrate) on the time course and magnitude of blood fatty acids changes associated with ingestion of n-3 fortified foods. Low-protein (i.e., cake) and high-protein (i.e., meat sticks) items were supplemented with 600 mg encapsulated DHA+EPA, and frozen either immediately after production (FRESH) or after 6 months storage at 100°F (STORED). Fourteen volunteers consumed one item per week (randomized) for 4 weeks. Blood samples obtained at baseline, 2, 4, and 6 h post-consumption were analyzed for circulating long-chain omega 3 fatty acids (LCn3). There was no difference in LCn3 area under the curve between items. LCn3 in response to cakes peaked at 2-h (FRESH: 54.0 ± 16.8 µg/mL, +18%; STORED: 53.0 ± 13.2 µg/mL, +20%), while meats peaked at 4-h (FRESH: 51.9 ± 12.5 µg/mL, +22%; STORED: 53.2 ± 16.9 µg/mL, +18%). There were no appreciable differences in time course or magnitude of n-3 appearance in response to storage conditions for either food types. Thus, bioavailability of encapsulated DHA/EPA, within low- and high-protein food items, was not affected by high-temperature shelf-storage. A shelf-stable, low- or high-protein food item with encapsulated DHA/EPA is suitable for use in shelf-stable foods.

Correction: evaluating predictive pharmacogenetic signatures of adverse events in colorectal cancer patients treated with fluoropyrimidines.

[This corrects the article DOI: 10.1371/journal.pone.0078053.].

Evaluating predictive pharmacogenetic signatures of adverse events in colorectal cancer patients treated with fluoropyrimidines.

The potential clinical utility of genetic markers associated with response to fluoropyrimidine treatment in colorectal cancer patients remains controversial despite extensive study. Our aim was to test the clinical validity of both novel and previously identified markers of adverse events in a broad clinical setting. We have conducted an observational pharmacogenetic study of early adverse events in a cohort study of 254 colorectal cancer patients treated with 5-fluorouracil or capecitabine. Sixteen variants of nine key folate (pharmacodynamic) and drug metabolising (pharmacokinetic) enzymes have been analysed as individual markers and/or signatures of markers. We found a significant association between TYMP S471L (rs11479) and early dose modifications and/or severe adverse events (adjusted OR = 2.02 [1.03; 4.00], p = 0.042, adjusted OR = 2.70 [1.23; 5.92], p = 0.01 respectively). There was also a significant association between these phenotypes and a signature of DPYD mutations (Adjusted OR = 3.96 [1.17; 13.33], p = 0.03, adjusted OR = 6.76 [1.99; 22.96], p = 0.002 respectively). We did not identify any significant associations between the individual candidate pharmacodynamic markers and toxicity. If a predictive test for early adverse events analysed the TYMP and DPYD variants as a signature, the sensitivity would be 45.5 %, with a positive predictive value of just 33.9 % and thus poor clinical validity. Most studies to date have been under-powered to consider multiple pharmacokinetic and pharmacodynamic variants simultaneously but this and similar individualised data sets could be pooled in meta-analyses to resolve uncertainties about the potential clinical utility of these markers.

The role of nutritional research in the success of human space flight.

The United States has had human space flight programs for >50 y and has had a continued presence in space since 2000. Providing nutritious and safe food is imperative for astronauts because space travelers are totally dependent on launched food. Space flight research topics have included energy, protein, nutritional aspects of bone and muscle health, and vision issues related to 1-carbon metabolism. Research has shown that energy needs during flight are similar to energy needs on Earth. Low energy intakes affect protein turnover. The type of dietary protein is also important for bone health, plant-based protein being more efficacious than animal protein. Bone loss is greatly ameliorated with adequate intakes of energy and vitamin D, along with routine resistive exercise. Astronauts with lower plasma folate concentrations may be more susceptible to vision changes. Foods for space flight were developed initially by the U.S. Air Force School of Aerospace Medicine in conjunction with the U.S. Army Natick Laboratories and NASA. Hazard Analysis Critical Control Point safety standards were specifically developed for space feeding. Prepackaged foods for the International Space Station were originally high in sodium (5300 mg/d), but NASA has recently reformulated >90 foods to reduce sodium intake to 3000 mg/d. Food development has improved nutritional quality as well as safety and acceptability.

Inhibition of α-amylase and glucoamylase by tannins extracted from cocoa, pomegranates, cranberries, and grapes.

Proanthocyanidins and ellagitannins, referred to as "tannins", exist in many plant sources. These compounds interact with proteins due to their numerous hydroxyl groups, which are suitable for hydrophobic associations. It was hypothesized that tannins could bind to the digestive enzymes α-amylase and glucoamylase, thereby inhibiting starch hydrolysis. Slowed starch digestion can theoretically increase satiety by modulating glucose "spiking" and depletion that occurs after carbohydrate-rich meals. Tannins were isolated from extracts of pomegranate, cranberry, grape, and cocoa and these isolates tested for effectiveness to inhibit the activity of α-amylase and glucoamylase in vitro. The compositions of the isolates were confirmed by NMR and LC/MS analysis, and tannin-protein interactions were investigated using relevant enzyme assays and differential scanning calorimetry (DSC). The results demonstrated inhibition of each enzyme by each tannin, but with variation in magnitude. In general, larger and more complex tannins, such as those in pomegranate and cranberry, more effectively inhibited the enzymes than did less polymerized cocoa tannins. Interaction of the tannins with the enzymes was confirmed through calorimetric measurements of changes in enzyme thermal stability.

Multidisciplinary collaborative gross tumour volume definition for lung cancer radiotherapy: a prospective study.

Variability in gross tumour volume (GTV) definition is a major source of systematic error in conformal radiotherapy. This prospective study assesses the role of multidisciplinary collaboration between oncologists and radiologists in defining lung cancer volumes. Twenty patients with non-small cell lung cancer due to receive three-dimensional conformal radiotherapy formed the study population. GTVs were defined by a radiologist (GTVrad) and an oncologist (GTVonc) using available clinical information and imaging. A collaborative meeting was then held to agree on a final, common GTV (GTVfin) to be used for treatment planning, and differences analysed. The collaboration changed the GTV in 19/20 patients with a total of 50 regions being edited. Changes made were categorized as (a) differentiation of tumour from atelectasis or ground glass shadowing, (b) separation of tumour from vasculature, and (c) defining mediastinal extent of tumour. Oncologists were more confident in the GTVfin than the GTVonc. The radiologist took longer to define the GTV than the oncologist. Real-time collaborative GTV definition by a radiologist and oncologist is practical and feasible. This approach allows specific areas of uncertainty to be categorized and focussed on, reducing systematic error in GTV definition. The physician's approach to risk and decision making for each patient may also play a role.

Lessons learned from a lateral violence and team-building intervention.

BACKGROUND: Lateral violence is likely to exist in settings characterized by poor leadership and lack of clearly articulated roles, expectations, and processes that guide behavior. OBJECTIVES: The purposes of this process improvement project were to (1) identify and improve baseline levels of nurse satisfaction and group cohesion through planned unit-based interventions, (2) determine the effect of a team-building intervention on factors that impact cohesive team functioning, and (3) determine the effect of lateral violence training and communication style differences in improving team cohesion. METHODS: The sample consisted of registered nurses (RNs) from 4 diverse patient care areas, chosen on the basis of low scores on the National Database of Nursing Quality Indicators (NDNQI) RN-RN interaction subscale. A quasi-experimental pre-post intervention design without a control group was employed. The intervention focused on lateral violence and team building. A qualitative component focused on the impact of the intervention on overall group dynamics and processes. RESULTS: RN scores on the Group Cohesion Scale (P = .037) and the RN-RN interaction scores improved postintervention. Group sessions focused on building trust, identifying and clarifying roles, engaging staff in decision making, role-modeling positive interactions, and holding each other accountable. CONCLUSIONS: Key to a cohesive environment is an effective nurse manager able to drive and sustain change.

How medical students demonstrate their professionalism when reflecting on experience.

OBJECTIVES: This paper aims to examine the discourses used by students in a formal assessment of their ability to demonstrate professional values when reflecting on their experiences. METHODS: We carried out a discourse analysis of 50 randomly selected essays from a summative assessment undertaken by all five year groups of students in one UK medical school. RESULTS: Students were able to identify a wealth of relevant examples and to articulate key principles of professional practice. They were also able to critique behaviours and draw appropriate conclusions for their own intended professional development. Detailed textual analysis provided linguistic clues to the depth of apparent reflection: recurrent use of rhetorical language with minimal use of first-person reflections, lack of analysis of underlying factors, and simplistic views of solutions may all indicate students whose ability to learn by reflection on experience needs further development. There were also areas in which cohorts as a whole appeared to have a limited grasp of the important professional issues being addressed. CONCLUSIONS: Assessing written reflections is a useful way of making students link their experiences with professional development. The detailed analysis of language usage may help to refine marking criteria, and to detect students and course components where reflective learning competencies are not being achieved.

Unusual presentation of Lynch Syndrome.

Lynch Syndrome/HNPCC is a syndrome of cancer predisposition linked to inherited mutations of genes participating in post-replicative DNA mismatch repair (MMR). The spectrum of cancer associated with Lynch Syndrome includes tumours of the colorectum, endometrium, ovary, upper gastrointestinal tract and the urothelium although other cancers are rarely described. We describe a family of Lynch Syndrome with an hMLH1 mutation, that harbours an unusual tumour spectrum and its diagnostic and management challenges.

The impact of computerized prescribing on error rate in a department of Oncology/Hematology.

AIMS: A comparison of prescribing errors detected for computerized and spreadsheet prescriptions in the Department of Hematology and Oncology of the Norfolk and Norwich University hospital. METHODS: A prospective audit of 1941 prescriptions for chemotherapy was made from January to September 2005. Each new cycle of chemotherapy ordered was monitored for prescribing errors, which were analyzed by method of prescription (computerized or spreadsheet), prescriber, type, and severity. RESULTS: Computerized prescribing reduced errors by 42% (RR 0.58; 95% CI 0.47-0.72). Errors occurred in 20% of spreadsheet prescriptions compared with 12% of the computerized prescriptions. There was a significant difference in error rates of three different prescribers whichever prescribing system was used. The proportion of errors that were minor was reduced and serious was increased with little change in the proportion of significant or life-threatening errors. CONCLUSIONS: The impact of computerized prescribing on adverse drug events requires further evaluation. Prescriber training may be important in further reducing errors. The implementation of all the existing functions of the electronic system should lead to further reduction in errors.