England’s Electronic Prescription Service: Infrastructure in an Institutional Setting

We describe the development of the Electronic Prescription Service (EPS), the solution for the electronic transmission of prescriptions adopted by the English NHS for primary care. The chapter is based on both an analysis of data collected as part of a nationally commissioned evaluation of EPS, and on reports of contemporary developments in the service. Drawing on the notion of an installed infrastructural base, we illustrate how EPS has been assembled within a rich institutional and organizational context including causal pasts, contemporary practices and policy visions. This process of assembly is traced using three perspectives; as the realization and negotiation of constraints found in the wider NHS context, as a response to inertia arising from limited resources and weak incentive structures, and as a purposive fidelity to the existing institutional cultures of the NHS. The chapter concludes by reflecting on the significance of this analysis for notions of an installed base

Classification of behaviour in housed dairy cows using an accelerometer-based activity monitoring system

Background Advances in bio-telemetry technology have made it possible to automatically monitor and classify behavioural activities in many animals, including domesticated species such as dairy cows. Automated behavioural classification has the potential to improve health and welfare monitoring processes as part of a Precision Livestock Farming approach. Recent studies have used accelerometers and pedometers to classify behavioural activities in dairy cows, but such approaches often cannot discriminate accurately between biologically important behaviours such as feeding, lying and standing or transition events between lying and standing. In this study we develop a decision-tree algorithm that uses tri-axial accelerometer data from a neck-mounted sensor to both classify biologically important behaviour in dairy cows and to detect transition events between lying and standing. Results Data were collected from six dairy cows that were monitored continuously for 36 h. Direct visual observations of each cow were used to validate the algorithm. Results show that the decision-tree algorithm is able to accurately classify three types of biologically relevant behaviours: lying (77.42 % sensitivity, 98.63 % precision), standing (88.00 % sensitivity, 55.00 % precision), and feeding (98.78 % sensitivity, 93.10 % precision). Transitions between standing and lying were also detected accurately with an average sensitivity of 96.45 % and an average precision of 87.50 %. The sensitivity and precision of the decision-tree algorithm matches the performance of more computationally intensive algorithms such as hidden Markov models and support vector machines. Conclusions Biologically important behavioural activities in housed dairy cows can be classified accurately using a simple decision-tree algorithm applied to data collected from a neck-mounted tri-axial accelerometer. The algorithm could form part of a real-time behavioural monitoring system in order to automatically detect dairy cow health and welfare status

Two years survival rate of class II composite resin restorations prepared by ART with and without a chemomechanical caries removal gel in primary molars

The aim was to test the null hypotheses that there is no difference: (1) in carious lesion development at the restoration margin between class II composite resin restorations in primary molars produced through the atraumatic restorative treatment (ART) with and without a chemomechanical caries removal gel and (2) in the survival rate of class II composite resin restorations between two treatment groups after 2 years. Three hundred twenty-seven children with 568 class II cavitated lesions were included in a parallel mouth study design. Four operators placed resin composite (Filtek Z 250) restorations bonded with a self-etch adhesive (Adper prompt L pop). Two independent examiners evaluated the restorations after 0.5, 1, and 2 years using the modified Ryge criteria. The Kaplan–Meier survival method was applied to estimate survival percentages. A high proportion of restorations were lost during the study period. Therefore, the first hypothesis could not be tested. No statistically significant difference was observed between the cumulative survival percentages of restorations produced by the two treatment approaches over the 2-year period (ART, 54.1 ± 3.4%; ART with Carisolv™, 46.0 ± 3.4%). This hypothesis was accepted. ART with chemomechanical gel might not provide an added benefit increasing the survival percentages of ART class II composite resin restorations in primary teeth

Knowledge, Attitude and Practice of Modern Contraceptives (especially Spacing Methods) in Acceptors and Non-acceptors of Tubectomy

Context: From National Health Policy 1983 to NHP 2017, three demographic goals are constantly persuaded:  to reduce CBR (Crude Birth Rate) to 21, NRR (Net Reproduction Rate) to 1 and raise the CPR (Couple Protection Rate) to at least 60%, which are not yet reached and could be achieved by promoting spacing contraceptive methods. NFHS-4 reveals that, the contribution of all five spacing methods to all modern contraceptives was only 11.5%.  Objectives:  This study was intended to assess and compare the knowledge, attitude and practice of modern contraceptives, especially spacing methods, amongst acceptors and non acceptors of tubectomy. Methodology: An observational, analytical, case-control study design was used. The data on acceptors and non-acceptors of tubectomy, 137 each, were collected by trained staff and analyzed by using ‘epi-info’, and ‘WIN-PEPI’ soft ware. Results: The proportions of acceptors and non-acceptors with adequate knowledge of contraception were 77% and 81% respectively and that with favorable attitude, were 96% and 87% respectively, but only 45% acceptors and 43% non acceptors used some temporary contraception. Conclusions:  Number and sex of children is the significant determinant for use of contraception. Proportions of acceptors and non acceptors of tubectomy with unfavorable attitude towards contraceptives were 4% and 13% respectively and this difference was statistically highly significant

Selection efficiency for growth performance of Menz sheep in a community-based breeding program

The study was undertaken to evaluate the efficiency of selection on growth performance of Menz sheep under a community-based breeding program (CBBP) from the period of 2009 – 2017. A total of 3996 lamb records (ram lambs 2025/ ewe lambs 1971) were used to evaluate the phenotypic and genetic factors affecting the growth traits of Menz sheep. REML in Wombat and General linear model on SAS (version 9.0) were used to evaluate selection efficiency for growth of Menz sheep. The least squares means and standard errors on phenotypic growth weight for birth, weaning age, six month age and yearling age were 2.58±0.004, 8.99±0.02, 13.28±0.02 and 19.94±0.06 kg, respectively. The effect of sex was significant (p0.05) was observed for weaning, six month and yearling weights. All growth traits were not affected by fixed effect of parity and birth type in this particular study. However, birth season and birth year had a great influence (p<0.0001) on all growth traits. The genetic trend on estimated breeding values (EBV) was not consistent across years and varied between sexes. The highest EBV for weaning, six month and yearling were recorded for the year 2013 and the lowest in 2009 (at weaning and six month) and 2015 (at yearling).The female EBV (at weaning, six month and yearling) was higher than male for the current (2017) and base population (2009).The responses to selection as compared to base population (2009) for birth, weaning, six month and yearling weight were – 0.00446Kg, + 0.11Kg, + 0.54Kg and + 0.75Kg respectively. This study indicates that improvement in body weight for Menz sheep through CBBP is possible; however, the response to selection varied across years and its pattern was irregular for the implemented years due to the problem on selection of breeding rams (lower availability of breeding rams) and management effect