This is a repository copy of Deep-water channel-lobe transition zone dynamics: Processes and depositional architecture, an example from the Karoo Basin, South Africa.

The facilitators and barriers to SO disclosure by LGBT individuals are widespread but most were modifiable and could therefore be targeted to improve healthcare professionals' awareness of their patients' SO. Healthcare professionals should be aware of the broad range of factors that influence SO disclosure and the potential disadvantageous effects of non-disclosure on care. The environment in which patients are seen should be welcoming of different SOs as well as ensuring that healthcare professionals' communication skills, both verbal and non-verbal, are accepting and inclusive.

BackgroundSelf-administration of medicines is believed to increase patients' understanding about their medication and to promote their independence and autonomy in the hospital setting. The effect of inpatient self-administration of medication (SAM) schemes on patients, staff and institutions is currently unclear.ObjectiveTo systematically review the literature relating to the effect of SAM schemes on the following outcomes: patient knowledge, patient compliance/medication errors, success in self-administration, patient satisfaction, staff satisfaction, staff workload, and costs.DesignKeyword and text word searches of online databases were performed between January and March 2013. Included articles described and evaluated inpatient SAM schemes. Case studies and anecdotal studies were excluded.Results43 papers were included for final analysis. Due to the heterogeneity of results and unclear findings it was not possible to perform a quantitative synthesis of results. Participation in SAM schemes often led to increased knowledge about drugs and drug regimens, but not side effects. However, the effect of SAM schemes on patient compliance/medication errors was inconclusive. Patients and staff were highly satisfied with their involvement in SAM schemes.ConclusionsSAM schemes appear to provide some benefits (e.g. increased patient knowledge), but their effect on other outcomes (e.g. compliance) is unclear. Few studies of high methodological quality using validated outcome measures exist. Inconsistencies in both measuring and reporting outcomes across studies make it challenging to compare results and draw substantive conclusions about the effectiveness of SAM schemes.

The effects of abrupt changes in slope angle and orientation on turbidity current behavior have been investigated in numerous physical and numerical experiments and examined in outcrop, subsurface, and modern systems. However, the long-term impact of subtle and evolving seabed topography on the stratigraphic architecture of deep-water systems requires fine-scale observations and extensive 3-D constraints. This study focuses on the Permian Laingsburg and Fort Brown formations, where multiple large sand-rich systems (Units A-F) have been mapped from entrenched slope valleys, through channel-levee systems, to basin-floor lobe complexes over a 2500 km 2 area. Here, we investigate three thinner (typically <5 m in thickness) and less extensive sand-rich packages, Units A/B, B/C, and D/E, between the large-scale systems. Typically, these sand-rich units are sharp-based and topped, and contain scours and mudstone clast conglomerates that indicate deposition from high-energy turbidity currents. The mapped thickness and facies distribution suggest a lobate form. These distinctive units were deposited in similar spatial positions within the basin-fill and suggest similar accommodation patterns on the slope and basin floor prior to the larger systems (B, C, and E). Stratigraphically, these thin units represent the first sand deposition following major periods of shut-down in sediment supply, and are interpreted as marking a partial re-establishment of sand delivery pathways creating "disconnected lobes" that are fed mainly by flows sourced from failures on the shelf and upper slope rather than major feeder channel-levee systems.Thickness and facies patterns throughout the deep-water stratigraphy suggest seabed topography was present early in the basin formation and maintained persistently in a similar area to ultimately form a stepped slope profile. The stepped slope profile evolved through three key stages of development: Phase 1, where sediment supply exceeds deformation rate (likely caused by differential subsidence); Phase 2, where sediment supply is on average equal to deformation rate; and Phase 3, where deformation rate outpaces sediment supply. This study demonstrates that smaller systems are a sensitive record of evolving seabed topography and they can consequently be used to recreate more accurate paleotopographic profiles.

ObjectiveTo investigate the changes in overdue doses rates over a 4-year period in an National Health Service (NHS) teaching hospital, following the implementation of interventions associated with an electronic prescribing system used within the hospital.DesignRetrospective time-series analysis of weekly dose administration data.SettingUniversity teaching hospital using a locally developed electronic prescribing and administration system (Prescribing, Information and Communication System or PICS) with an audit database containing details on every drug prescription and dose administration.ParticipantsPrescription data extracted from the PICS database.Intervention(s)Four interventions were implemented in the Trust: (i) the ability for doctors to pause medication doses; (ii) clinical dashboards; (iii) visual indicators for overdue doses and (iv) overdue doses Root Cause Analysis (RCA) meetings and a National Patient Safety Agency (NPSA) Rapid Response Alert.Main outcome measure(s)The percentage of missed medication doses.ResultsRates of both missed antibiotic and non-antibiotic doses decreased significantly upon the introduction of clinical dashboards (reductions of 0.60 and 0.41 percentage points, respectively), as well as following the instigation of executive-led overdue doses RCA meetings (reductions of 0.83 and 0.97 percentage points, respectively) and the publication of an associated NPSA Rapid Response Alert. Implementing a visual indicator for overdue doses was not associated with significant decreases in the rates of missed antibiotic or non-antibiotic doses.ConclusionsElectronic prescribing systems can facilitate data collection relating to missed medication doses. Interventions providing hospital staff with information about overdue doses at a ward level can help promote reductions in overdue doses rates.