Dermal absorption of high molecular weight parent and alkylated polycyclic aromatic hydrocarbons from manufactured gas plant soils using in vitro assessment.

An enhanced in vitro human dermal bioavailability method was developed to measure the release of twenty parent and seven alkylated high molecular weight (HMW) polycyclic aromatic hydrocarbons (PAHs) from contaminated soils collected from five former manufactured Gas Plants (MGP) in England. GC-MS/MS was used to quantify HMW PAHs in soil, Strat-M artificial membrane representing skin, and synthetic receptor solution (RS) representing systemic circulation at 1-h, 10-h, and 24-h timesteps. Fluoranthene and pyrene exhibited the highest fluxes from soils to membrane (ranging from 9.5 - 281 ng/cm2/h) and soil to RS (

Exploring the Role of Guidelines in Contributing to Medication Errors: A Descriptive Analysis of National Patient Safety Incident Data.

INTRODUCTION: Clinical guidelines can contribute to medication errors but there is no overall understanding of how and where these occur. OBJECTIVES: We aimed to identify guideline-related medication errors reported via a national incident reporting system, and describe types of error, stages of medication use, guidelines, drugs, specialties and clinical locations most commonly associated with such errors. METHODS: Retrospective analysis of reports to the National Reporting and Learning System for England and Wales. A hierarchical task analysis (HTA) was developed, describing expected practice when using guidelines. A free-text search was conducted of medication incident reports (2016-2021) using search terms related to common guidelines. All identified reports linked to moderate-severe harm or death, and a random sample of 5100 no/low-harm reports were coded to describe deviations from the HTA. A random sample of 500 cases were independently double-coded. RESULTS: In total, 28,217 reports were identified, with 608 relating to moderate-severe harm or death. Fleiss' kappa for interrater reliability was 0.46. Of the 5708 reports coded, 642 described an HTA step discrepancy (including four linked to a death), suggesting over 3200 discrepancies in the entire dataset of 28,217 reports. Discrepancies related to finding guidelines (n = 300 reports), finding information within guidelines (n = 166) and using information (n = 176). Discrepancies were most frequently identified for guidelines produced by a local organisation (n = 405), and most occurred during prescribing (n = 277) or medication administration (n = 241). CONCLUSION: Difficulties finding and using information from clinical guidelines contribute to thousands of prescribing and medication administration incidents, some of which are associated with substantial patient harm.

Costs and Cost-Effectiveness of User-Testing of Health Professionals' Guidelines to Reduce the Frequency of Intravenous Medicines Administration Errors by Nurses in the United Kingdom: A Probabilistic Model Based on Voriconazole Administration.

AIM: In the UK, injectable medicines are often prepared and administered by nurses following the Injectable Medicines Guide (IMG). Our earlier study confirmed a higher frequency of correct administration with user-tested versus standard IMG guidelines. This current study aimed to model the cost-effectiveness of user-testing. METHODS: The costs and cost-effectiveness of user-testing were explored by modifying an existing probabilistic decision-analytic model. The adapted model considered administration of intravenous voriconazole to hospital inpatients by nurses. It included 11 error types, their probability of detection and level of harm. Model inputs (including costs) were derived from our previous study and other published data. Monte Carlo simulation using 20,000 samples (sufficient for convergence) was performed with a 5-year time horizon from the perspective of the 121 NHS trusts and health boards that use the IMG. Sensitivity analyses were undertaken for the risk of a medication error and other sources of uncertainty. RESULTS: The net monetary benefit at £20,000/quality-adjusted life year was £3,190,064 (95% credible interval (CrI): -346,709 to 8,480,665), favouring user-testing with a 96% chance of cost-effectiveness. Incremental cost-savings were £240,943 (95% CrI 43,527-491,576), also favouring user-tested guidelines with a 99% chance of cost-saving. The total user testing cost was £6317 (95% CrI 6012-6627). These findings were robust to assumptions about a range of input parameters, but greater uncertainty was seen with a lower medication error risk. CONCLUSIONS: User-testing of injectable medicines guidelines is a low-cost intervention that is highly likely to be cost-effective, especially for high-risk medicines.

The Chemical Recycling of Polyesters for a Circular Plastics Economy: Challenges and Emerging Opportunities.

Whilst plastics have played an instrumental role in human development, growing environmental concerns have led to increasing public scrutiny and demands for outright bans. This has stimulated considerable research into renewable alternatives, and more recently, the development of alternative waste management strategies. Herein, the aim was to highlight recent developments in the catalytic chemical recycling of two commercial polyesters, namely poly(lactic acid) (PLA) and poly(ethylene terephthalate) (PET). The concept of chemical recycling is first introduced, and associated opportunities/challenges are discussed within the context of the governing depolymerisation thermodynamics. Chemical recycling methods for PLA and PET are then discussed, with a particular focus on upcycling and the use of metal-based catalysts. Finally, the attention shifts to the emergence of new materials with the potential to modernise the plastics economy. Emerging opportunities and challenges are discussed within the context of industrial feasibility.

Zinc Complexes for PLA Formation and Chemical Recycling: Towards a Circular Economy.

A series of ZnII complexes, based on propylenediamine Schiff bases, have been prepared and fully characterized. X-ray crystallography and NMR spectroscopy identified significant differences in the solid and solution state for the ZnII species. All complexes have been applied to the ring-opening polymerization of l-lactide with emphasis on industrial conditions. High conversion and good molecular weight control were generally achievable for Zn(A-D)2 , and high-molecular-weight poly(lactic acid) (PLA) was prepared in 1 min at a 10 000:1:33 [lactide]/[Zn]/[BnOH] loading. The more active ZnII catalysts were also applied to PLA degradation to alkyl lactate under mild conditions. Zn(A-B)2 demonstrated high activity and selectivity in this process with PLA being consumed within 1 h at 50 °C. Zn(C-D)2 were shown to be less active, and these observations can be related to the catalysts' structure and the degradation mechanism. Initial results for the degradation of poly(ethylene terephthalate) and mixed feeds are also presented, highlighting the broader applicability of the systems presented.