6,260 research outputs found

    An Exploration of the Suitability of Pharmacy Education in Saudi Arabia to Prepare Graduates to Meet Healthcare Needs: a Mixed-Methods Study

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    The key role of pharmacists within the health system, particularly in optimising safe, responsible and effective use of medicines, underpins the demand for a highly skilled and competent workforce. Therefore, developing the capacity of pharmacists to attain and maintain essential competencies relevant to the population’s health needs is required to ensure a high standard of patient care, thereby helping to improve patient and population health. In Saudi Arabia, little evidence exists regarding the assessment of national educational programmes’ structure and outcomes. Moreover, no national competency framework exists for pharmacists in any sector or stage of practice. In the absence of such core quality elements to inform pharmacy education assessment and development, the extent to which pharmacy schools in Saudi Arabia prepare competent pharmacists to address societal needs from pharmacy services is unclear. Therefore, this study aimed to explore the extent to which pharmacy education can prepare competent pharmacists to address the healthcare needs for pharmacy practice in Saudi Arabia. An exploratory sequential mixed methods research design was used to address the aim of this study in three phases: individual interviews and focus groups were employed with a purposively selected sample of pharmacy policy makers, pharmacists and the public to explore societal healthcare needs and the roles required of pharmacists to meet those needs; a national online survey of pharmacists and an online nominal group consensus method of pharmacy experts were used to identify competencies considered essential to develop a profession-wide national foundation level competency framework; and a case study in which curriculum mapping of two purposively selected Doctor of Pharmacy (PharmD) curricula was used to assess the extent to which the current pharmacy programme in Saudi Arabia meets the identified competencies of the developed national competency framework. Based on qualitative and quantitative analyses of societal healthcare needs, pharmacists’ roles, core competencies and curricular contents within the local context of Saudi Arabia, findings showed that there is a mismatch between initial education and real practice needs and expectations. While the country’s current needs from pharmacists are to optimise health system capacity and increase access to primary care services and medicines expertise in community pharmacies, the study indicated local education is product-oriented with a focus of curricular content and experiential training opportunities in most schools on preparing future pharmacists for hospital pharmacy practice. The study also identified several gaps between current initial education programmes and the competencies required to practise the expected roles, suggesting that current initial education might not prepare the students sufficiently to provide the full range of quality pharmaceutical services as per the country’s pharmacy practice needs. The study provided a new understanding of graduates’ readiness to practise as per the country’s pharmacy practice needs, the quality of educational programmes and pharmacists' professional development opportunities in Saudi Arabia. Findings maybe used to inform the development of competency-based education and maximise graduates’ capacity to deliver and develop pharmaceutical services effectively to best meet societal healthcare needs in Saudi Arabia

    Biosimilars in Europe

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    This reprint examines regulatory, pricing and reimbursement issues related to the market access and uptake of off-patent biologics, biosimilars, next-generation biologics and competing innovative medicines in European countries

    Understanding the factors associated with mental health practitioners’ engagement in effective suicide prevention activities within an Improving Access to Psychological Therapies (IAPT) service

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    Background This thesis comprises of a systematic review and three empirical studies. It developed from efforts to encourage a culture within a primary care mental health service which maintained a focus on suicide prevention, despite the relative rarity of suicide deaths in any individual clinical setting. The service aimed to improve the knowledge and confidence of practitioners in this vital area and recognised the importance of supporting practitioners in the event of them losing a patient to suicide. Methods Three areas for study were selected which may be associated with practitioners’ engagement in suicide prevention efforts. A systematic review of the impact on mental health practitioners of losing a patient to suicide was followed by a qualitative study exploring the impact of such deaths on practitioners within an Improving Access to Psychological Therapies service. A survey of all staff in an NHS Mental Health Trust was conducted using the Attitudes to Suicide Prevention Scale (ASPS) and these data were used to perform a replication of the validation of the scale. A new scale was developed to measure practitioners’ confidence in assessing, formulating and managing the risk of suicide. This was administered to mental health practitioners to assess the psychometric properties of the scale. Results The systematic review included qualitative and quantitative studies (n=54) and found that the most common personal reactions included guilt, shock, sadness, anger and fear of blame. Impact on professional practice included self-doubt and being more cautious and defensive in the management of suicide risk. As quantitative study methodologies were heterogeneous, it was difficult to make direct comparisons across studies. However, across 13 studies (total n = 717 practitioners) that utilised the Impact of Event Scale, between 12% and 53% of practitioners recorded clinically significant trauma scores. The need for training focused on the impact of suicides and the value placed upon informal support were often cited in these studies. The experience of losing a patient through suicide can have a significant impact on mental health professionals, both in terms of their personal reactions and subsequent changes to professional practice. The negative impact, however, may be moderated by cultural and organisational factors and by the nature of support available. In Study one, survey data from all Trust staff were used to explore the psychometric properties of the Attitudes to Suicide Prevention Scale. Two items from the scale displayed poor item-scale correlation, therefore they were excluded from the factor analysis and a further item was also excluded as it used different anchor points. However, analyses of the remaining 11 items were not satisfactory, with no adequate factor structure emerging. Nonetheless, there were statistically significant differences in attitudes between specific staff groups (i.e., those with/with suicide awareness or prevention training, gender and by level of patient contact), but not between groups defined by age range. Generally, however, the scale indicated that there were positive attitudes across all Trust staff. Study two, the development of a scale to measure practitioners’ confidence in assessing, formulating and managing risk of suicide, the analysis indicated a singlefactor structure, good test–retest reliability and statistically significant increases in confidence between pre- and post-training and between pre-training and six-month follow-up. Cohen’s effect size values suggest a moderate to large effect. In Study three, a qualitative study with IAPT practitioners (n=7), analysis of the transcripts identified a number of themes related to the impact on staff. Specifically, the analyses yielded four superordinate themes which were represented in the majority of cases: 1) feeling shocked and upset about the death of a patient; 2) attempting to understand the causes of the suicide; 3) learning from the tragic event; and 4) reflections on what helped in coping with the tragic event. IAPT practitioners reported initial emotional responses of shock, upset, guilt and fear of blame following the death through suicide of a patient. This is consistent with the findings of the systematic review and previous research with mental health practitioners more broadly. Conclusion The studies included in this thesis, improved our understanding of the impact on practitioners of the loss of a patient by suicide. This supported changes within our service to help better prepare and support practitioners for such an eventuality. All practitioners are made aware of the potential for the loss of a patient by suicide, of the likely impact of this and of the support available to them. In order to keep a focus on the prevention of suicide and to improve practitioners’ confidence in this, training has been developed in risk assessment, formulation and management and further training into the psychological moderators of suicidal behaviour and into safety planning has been delivered. Understanding staff attitudes could help identify potential barriers to effective engagement of practitioners in suicide prevention. The selection of the Attitudes to Suicide Prevention Scale for research purposes should be treated with caution and given the findings of Study one there is a sufficient rationale to develop a new measure. Effective engagement is also likely to be affected by practitioners’ confidence in their ability to assess, formulate and manage suicide risk. A newly developed scale (Study two) displays promise as a measure for this purpose. The findings from Study three support the following recommendations from the systematic review. Services and training providers should ensure that practitioners are prepared for the eventuality of a patient suicide and are adequately supported if they experience such a tragic event. The provision of regular suicide prevention training can help create a culture that supports engagement in this vital activity. Training should also; address any negative attitudes to suicide prevention, increase practitioners’ confidence in the assessment, formulation and management of suicide risk, prepare staff for the potential experience of losing a patient through suicide and inform them of what to expect in such an event including the available support

    A Decision Support System for Economic Viability and Environmental Impact Assessment of Vertical Farms

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    Vertical farming (VF) is the practice of growing crops or animals using the vertical dimension via multi-tier racks or vertically inclined surfaces. In this thesis, I focus on the emerging industry of plant-specific VF. Vertical plant farming (VPF) is a promising and relatively novel practice that can be conducted in buildings with environmental control and artificial lighting. However, the nascent sector has experienced challenges in economic viability, standardisation, and environmental sustainability. Practitioners and academics call for a comprehensive financial analysis of VPF, but efforts are stifled by a lack of valid and available data. A review of economic estimation and horticultural software identifies a need for a decision support system (DSS) that facilitates risk-empowered business planning for vertical farmers. This thesis proposes an open-source DSS framework to evaluate business sustainability through financial risk and environmental impact assessments. Data from the literature, alongside lessons learned from industry practitioners, would be centralised in the proposed DSS using imprecise data techniques. These techniques have been applied in engineering but are seldom used in financial forecasting. This could benefit complex sectors which only have scarce data to predict business viability. To begin the execution of the DSS framework, VPF practitioners were interviewed using a mixed-methods approach. Learnings from over 19 shuttered and operational VPF projects provide insights into the barriers inhibiting scalability and identifying risks to form a risk taxonomy. Labour was the most commonly reported top challenge. Therefore, research was conducted to explore lean principles to improve productivity. A probabilistic model representing a spectrum of variables and their associated uncertainty was built according to the DSS framework to evaluate the financial risk for VF projects. This enabled flexible computation without precise production or financial data to improve economic estimation accuracy. The model assessed two VPF cases (one in the UK and another in Japan), demonstrating the first risk and uncertainty quantification of VPF business models in the literature. The results highlighted measures to improve economic viability and the viability of the UK and Japan case. The environmental impact assessment model was developed, allowing VPF operators to evaluate their carbon footprint compared to traditional agriculture using life-cycle assessment. I explore strategies for net-zero carbon production through sensitivity analysis. Renewable energies, especially solar, geothermal, and tidal power, show promise for reducing the carbon emissions of indoor VPF. Results show that renewably-powered VPF can reduce carbon emissions compared to field-based agriculture when considering the land-use change. The drivers for DSS adoption have been researched, showing a pathway of compliance and design thinking to overcome the ‘problem of implementation’ and enable commercialisation. Further work is suggested to standardise VF equipment, collect benchmarking data, and characterise risks. This work will reduce risk and uncertainty and accelerate the sector’s emergence

    Beyond invisibility: The position and role of the literary translator in the digital paratextual space

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    This thesis presents a new theoretical framework through which to analyse the visibility of literary translators in the digital materials that present translations to readers, referred to throughout as paratextual spaces. Central to this model is the argument that paratextual ‘visibility’ must be understood as including both the way translators and their labour are presented to readers, defined here as their position, and also their role in the establishment of that position. Going beyond Lawrence Venuti’s concept of invisibility as an inevitably negative position to be fought against, this thesis instead establishes paratextual visibility as a complex negotiation between the agency of individual translators, the needs of a publishing house and the interests of readers. The value of this approach is demonstrated through a case study examining the visibility of translator Jamie Bulloch in the digital spaces surrounding his English-language translations of two novels by German author Timur Vermes: Look Who’s Back and The Hungry and the Fat. This analysis finds that even though Bulloch played an early role in creating the publisher’s paratextual materials, publisher MacLehose Press prioritised making the novels’ German origins and the foreignness of the texts visible over Bulloch’s status as the translator, or his translatorship. Bulloch’s limited visibility in the publisher-created materials was then reproduced in digital paratexts created by readers and third parties such as retailer Amazon, despite his attempts to interact with readers and perform his translatorship in digital spaces such as Twitter. Rather than challenging Bulloch’s limited visibility, then, digital spaces served to amplify it. This thesis therefore finds that the translator’s active participation in the promotion of their work does not always equate to increased visibility, thus demonstrating the need to go beyond Venuti’s invisibility and towards understanding the multifaceted roles played by translators in presenting literary texts to new audiences

    Thermal-Hydraulics in Nuclear Fusion Technology: R&D and Applications

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    In nuclear fusion technology, thermal-hydraulics is a key discipline employed in the design phase of the systems and components to demonstrate performance, and to ensure the reliability and their efficient and economical operation. ITER is in charge of investigating the transients of the engineering systems; this included safety analysis. The thermal-hydraulics is required for the design and analysis of the cooling and ancillary systems such as the blanket, the divertor, the cryogenic, and the balance of plant systems, as well as the tritium carrier, extraction and recovery systems. This Special Issue collects and documents the recent scientific advancements which include, but are not limited to: thermal-hydraulic analyses of systems and components, including magneto-hydrodynamics; safety investigations of systems and components; numerical models and code development and application; codes coupling methodology; code assessment and validation, including benchmarks; experimental infrastructures design and operation; experimental campaigns and investigations; scaling issue in experiments

    A systemic approach to the prevention and management of the causes of Hotel Environmental Sustainability Strategy Execution Failure (HESSEF)

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    Thesis (MEng)--Stellenbosch University, 2022.ENGLISH ABSTRACT: Our world is at risk due to unprecedented anthropogenic global warming leading to climate change. From pre-industrial period (1850-1900) to 2006-2015, global mean surface (land and ocean) temperature (GMST) and mean land surface air temperature (MSAT) respectively increased by 0.87°C and 1.53°C, leading to increasing occurrence of severe natural disasters. Hotels (184 thousand with 17 million hotel rooms in 2018) enable significant economic growth and social progress within international tourism, the third largest industry in the world. In 2018, this industry was worth USD 1.7 trillion, contributed 10.4 per cent to world’s Gross Domestic Product (GDP), cared for 1.4 billion tourists, and employed 319 million persons (one in ten jobs). Unfortunately, hotels also have negative environmental impacts and account for one to two per cent of the five per cent global carbon dioxide emitted by the tourism industry. Hotels hence contribute to the global warming and climate change. There is a need to curb hotels’ carbon dioxide emissions with appropriate strategies. However, properly formulated strategies do not guarantee effective execution. Strategy Execution (SE) is difficult to achieve and execution failure is possible. The execution of Hotel Environmental Sustainability Strategies (HESS) is not an exception. A Hotel Environmental Sustainability Strategy Execution (HESSE) paradigm shift and behaviour change, with subsequent habits of effectiveness are hence required. The aim of this study is to address the following research problem: “There is no model that can assist hotel practitioners (HP) and academics with a systemic approach to the prevention and management of the causes of Hotel Environmental Sustainability Strategy Execution Failure (HESSEF).” The primary objective of the study is the development of the Seven Habits of Effective HESSE (7HoE HESSE) model to address this problem. In support to the primary objective, a number of secondary objectives are pursued. First, the world sustainability challenges and initiatives are described. Second, the challenges of environmental sustainability within the context of hotel management are understood and opportunities for improvement are identified. Third, the challenges of HESSE are understood. Fourth, the escalation of HESSEF is analyzed and possible HESSE paradigm shift and behaviour change for systemic HESSE enhancement are studied. Fifth, the 7HoE HESSE model for HESSE systemic enhancement is conceptualized and operationalized. Sixth, the model is verified. Seventh, the model is validated through face to-face structured interview of HP and feedback used for the model improvement. The 7HoE HESSE model is described by HP as the way forward for sustainability as it provides a good approach towards sustainability. HP highly appreciated the model describing it as a great tool, highly suitable to the hospitality industry, interesting model, straight-forward, easy to understand and well structured with appropriate monitoring HESSE processes. HP expressed high willingness to experience the 7HoE HESSE model which properly summarizes and contextualizes their reality. They are willing to experience the model as they believe it will be very useful for favouring collaboration and commitment of all hotel stakeholders. They expressed the views that the model could ensure successful execution of sustainability projects in the hotel industry.AFRIKAANSE OPSOMMING: Die planeet word bedreig deur ongekende vlakke van aardverwarming wat lei tot klimaatsverandering. Die gemiddelde Land en Oseaan temperature of the wel (GMST), sowel as gemiddelde Land en Atmosfeer temperatuur of te wel (MSAT) het onderskeidlik met 0.87 grade celcuis en 1.53 grade celcuis toegeneem sedert die pre-industrieĂ«le periode (1850- 1900). Klimaatsverandering gee aanleiding tot natuur rampe. Die hotel industrie het ‘n positiewe impak op ekonomies groei en sosiale ontwikkeling. Daar is tans nie minder as 184 duisend hotelle and 17 miljoen hotel kamers. Toerisme was pre-Covid die derde grootste industrie ter wĂȘreld en was in 2018 USD 1.7 triljoen werd. Die industrie was verantwoordelik vir 10.4 persent van die wĂȘreld se Bruto Nasionale Produk, en het werk verskaf aan 319 miljoen mense (een uit elke 10 werk geleenthede op aarde). Hotelle het ongelukkig ook ‘n baie negatiewe impak op die omgewing en is verantwoordelik vir tot 40 present van alle CO2 wat deur die toerisme bedryf geproduseer word. Dit is dus baie belangrik vir hotelle om strategieĂ«. te onwikkel wat hierdie potensiele nagatiewe impak kan verlaag. Strategie Uitvoering (SU) in die algemeen is moeilik en mislukking is baie moontlik. Die uitvoer van ‘n Hotel Omgewings Volhoubaarheid Strategie (HOVS) is nie ‘n uitsondering nie. ‘n Paradigma skuif en gedragsverandering is dus noodsaaklik om effeftiewe HOVS Uitvoering (HOVSU) te verseker. Dit is dus verdermeer nodig om effektiewiteits gewoontes te kweek. Die oogmerk van hierdie studie is om die volgende navorsingsprobleem aan te spreek: “Daar bestaan tans geen model wat Hotel Operateurs (HO) en akademici kan bystaan om deur middel van ‘n systematiese benadering die oorsake van Hotel Omgewings Volhoubaarheid Strategie Uitvoerings Mislukking (HOVSUM) te verminder en te bestuur nie.” Die primĂȘre doelwit van die studie is die ontwikkeling van ‘n gedragsveranderingsmodel wat sal aanleiding gee tot die kweek van Sewe HOVSU gewoontes (7HoE HESSE). In ondersteuning tot die primĂȘre doelwit is ‘n aantal sekondĂȘre doelwitte geformuleer. Eerstens is die aard en omvang van die planeet se volhoubaarheidsuitdagins en inisiatiewe beskyf. Tweendens is die omgewingsvolhoubaarheiduitdagings wat hotelle in die gesig staar beskryf. Derderds is die problematiek aangaande HOVSU ondersoek en beskryf. Vierdens is die verloop van HOVSUM en moontlikhede aangaande gedragsverandering en gewoonte vorming beskryf. Die vyde sekondĂȘre doelwit was die formulering en operasionalisering van die 7HoE HESSE model. In die sesde plek is die model geverifieer en in die sewende plek is die model gevalideer tydens indiepte onderhoude met Hotel Operateurs en bestuurders sowel as industrie kundiges. Die terugvoer van beide operateurs en kundiges is besonder positief en die model word beskryf as ‘n eenvoudige en prakties implementeerbare instrument om die problematiek wat verband hou met die uitvoer van omgewingsvolhoubaarheid strategieĂ« binne hotelle die hoof te bied.Master
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