Evidence for the outcomes and impact of clinical pharmacy: context of UK hospital pharmacy practice

Objectives: The role of clinical pharmacists in hospitals has evolved and continues to expand. In the UK, outside of a few national policy drivers, there are no agreed priorities, measures or defined outcomes for hospital clinical pharmacy (CP). This paper aims to (1) highlight the need to identify and prioritise specific CP roles, responsibilities and practices that will bring the greatest benefit to patients and health systems and (2) describe systematic weaknesses in current research methodologies for evaluating CP services and propose a different approach. Method: Published reviews of CP services are discussed using the Economic, Clinical and Humanistic Outcomes framework. Recurring themes regarding study methodologies, measurements and outcomes are used to highlight current weaknesses in studies evaluating CP. Results: Published studies aiming to demonstrate the economic, clinical or humanistic outcomes of CP often suffer from poor research design and inconsistencies in interventions, measurements and outcomes. This has caused difficulties in drawing meaningful conclusions regarding CP’s definitive contribution to patient outcomes. Conclusion: There is a need for more research work in National Health Service (NHS) hospitals, employing a different paradigm to address some of the weaknesses of existing research on CP practice. We propose a mixed-methods approach, including qualitative research designs, and with emphasis on cost-consequence analyses for economic evaluations. This approach will provide more meaningful data to inform policy and demonstrate the contribution of hospital CP activities to patient care and the NHS

Evaluation of the effectiveness of Eladi Keram for the treatment of acne vulgaris: a randomised controlled pilot study

Introduction: Acne is a multifactorial and common skin disease which can significantly affect the quality of life of sufferers. In this study, a topical herbal preparation traditionally used in Ayurvedic medicine was evaluated as a treatment for individuals with acne on their shoulders and backs. Methods: Study participants were randomly assigned either to treatment (Eladi Keram) or vehicle control (coconut oil) groups under double blind conditions and instructed on its daily home application. Standardised lesion counting and acne grading were conducted in accordance with US Food and Drug Administration guidelines and with reference to the Leeds Acne Grading Technique. Participants were assessed for severity of the condition at commencement and on day 28 of treatment. Results: The treatment group showed improvements of 42% (p < 0.005) on the Investigators Global Assessment scale, a 60% (p < 0.05) reduction in inflammatory lesions, a 59% (p < 0.05) reduction in non-inflammatory lesions, and a 59% (p < 0.005) reduction in combined lesion count. The control group showed no statistically significant changes for these criteria. Conclusion: This study is the first reported clinical evaluation of Eladi Keram as a treatment for acne and findings suggest that it could be effective in reducing inflammatory and non-inflammatory lesions, warranting further investigation by means of a larger scale clinical trial

Supporting independent living for older adults; employing a visual based fall detection through analysing the motion and shape of the human body

Falls are one of the greatest risks for older adults living alone at home. This paper presents a novel visual-based fall detection approach to support independent living for older adults through analysing the motion and shape of the human body. The proposed approach employs a new set of features to detect a fall. Motion information of a segmented silhouette when extracted can provide a useful cue for classifying different behaviours, while variation in shape and the projection histogram can be used to describe human body postures and subsequent fall events. The proposed approach presented here extracts motion information using best-fit approximated ellipse and bounding box around the human body, produces projection histograms and determines the head position over time, to generate 10 features to identify falls. These features are fed into a multilayer perceptron neural network for fall classification. Experimental results show the reliability of the proposed approach with a high fall detection rate of 99.60% and a low false alarm rate of 2.62% when tested with the UR Fall Detection dataset. Comparisons with state of the art fall detection techniques show the robustness of the proposed approach

Herb-drug interaction: Effect of aqueous extract of Bridelia ferruginea leaves on the pharmacokinetics of metformin

The concurrent use of herbal medicines and orthodox drugs, especially in the treatment and management of chronic ailments, may result in clinically significant herb-drug interactions. Bridelia ferruginea Benth (Euphorbiaceae) is a common medicinal plant with known anti-diabetic properties and has been reported to be taken alongside the orthodox medicine, metformin. The aim of this study was to investigate the effect of aqueous extract of B. ferruginea leaves on the pharmacokinetics of metformin in female Sprague-Dawley rats. Reconstituted freeze dried extract of B. ferruginea leaves (30 mg/kg), and metformin (7 mg/kg) were administered concurrently as a single dose to female Sprague-Dawley rats. Whole blood samples (1 ml) were aseptically withdrawn by tail bleeding at 1, 2, 4, 8, and 24 h after administration of the single dose for pharmacokinetics analyses. Concurrent administration of metformin and B. ferruginea significantly affected (P &lt; 0.05) all the pharmacokinetics parameters of metformin except for the time to attain the maximum concentration (Tmax), which increased but insignificantly. Whereas the area under the curve, maximum whole blood concentration (Cmax) and half-life (T½) of metformin decreased significantly in the presence of B. ferruginea, the elimination rate constant (Kel), clearance (Cl), absorption rate constant (Ka), and volume of distribution (Vd) of metformin increased significantly in the presence of B. ferruginea. Therefore, in clinical practice, patients should be advised on the implication of concurrent administration of metformin and B. ferrruginea

In vitro microtuberization of Black Zira (Bunium persicum Boiss.)

Bunium persicum or Black Zira is one of the endangered species in the land of Persia. The main purpose of this study was to investigate microtuberization of B persicumin in order to use in germplasm storage and commercial production. Seeds of B. persicum were used as explant. Different culture media (MS, ½MS and B5) along with different concentrations of jasmonic acid (JA) (0, 2 and 5) were used individually as basal media and also in combination with two different temperatures (15 and 20°C) to develop appropriate media for microtuberization. Moreover, propagated microtubers were then vernalized and acclimatized in order to transfer to greenhouse. The results revealed that by increasing in concentration of JA, weight and length of microtubers increased significantly. MS medium seemed to be the most effective basal medium for this plant. In contrary, this study indicated that MS medium and 5 mM JA were the most suitable combination for in vitro culture establishment and short-term maintenance of tested B. persicum. Also, 15°C showed significant effect on increasing the weight of microtubers.Keywords: Microtuberization, Bunium persicum, jasmonic acid, temperature, medium

A Contactless IoT-Based GPS-Tracked Waste Bin to Curb Medical Waste Infections in Ghana

Irregular checking of waste especially in some medical facilities of Ghana leads to overflow of waste. A study by World Health Organisation (WHO) in February 2018 indicates that 15% of the total waste collected from medical facilities may be infectious, toxic, or radioactive and may contribute to unintended release of chemical or biological hazards. Considering the present COVID-19 pandemic and other diseases like ebola and hantavirus, it is critical to properly manage waste collected from medical facilities. In this study, Internet of Things (IoT) is used to design a smart bin to help reduce user contact to waste. Using a flowchart, a schematic model of the system was developed using Proteus 8.11 software. Two HCSR04 ultrasonic sensors were used to measure the waste level in the bin and detect proximity of objects to the bin to trigger an MG996R servo motor for automatic operation of the lid of the waste bin having a monitoring system. A NEO-6M GPS module was used to determine the location of the waste bin and displayed on a 16x2 LCD. A Graphical User Interface (GUI) was created for remote monitoring of waste over the internet. An ESP32 node MCU was programmed using Arduino software and used to interface the system with the GUI. The designed system was constructed and incorporated into a rectangular-shaped plastic bin. During testing, a hand wave at the sensor on the side of the container triggered opening of the bin. Sample waste placed in the bin were detected and real-time information regarding waste levels were sent to a self-designed HTML webpage called ‘Smart Bin’ with dynamic IP address. This system could be used in health facilities to prevent medical waste overflow, limit human contact to waste and avoid spread of infections

Colin Marsh (1996) Handbook for Beginning Teachers. Addison Wesley Longman: Australia. 406 pp

This study examines the relationship between corporate irresponsibility (CI) and social evaluations of the firm. Utilising a large and unique corporate irresponsibility dataset, we explore how, when, and for whom corporate irresponsibility alters stakeholder perceptions of organisational reputation. By combining attribution theory and expectancy violations theory, our study elucidates the conditions under which organisational assessors attribute hypocrisy. Results generally indicate that organisational reputation, derived from the assessments of managers and market analysts, is infrequently influenced by acts of corporate irresponsibility alone. Contrary to previous studies, we find that stakeholder impressions of the firm are largely path dependent. In turn, our findings reveal that firms previously believed to be most socially responsible are perceived as hypocritical and sanctioned when causality for acts of CI can be externally validated. Conversely, our study reveals risks associated with firms believed to be least socially responsible, in that stakeholders may expect firms with reduced social performance to be culpable for corporate irresponsibility when accused of highly egregious behaviour

Projected impacts of sowing date and cultivar choice on the timing of heat and drought stress in spring barley grown along a European transect

Publisher Copyright: © 2022Barley is one of the most important cereals for animal and human consumption. Barley heading and grain filling are especially vulnerable to heat and drought stress, which are projected to increase in the future. Therefore, site-specific adaptation options, like cultivar choice or shifting sowing dates, will be necessary. Using a global climate model ensemble and a phenology model we projected spring barley heading and maturity dates for 2031–50 for climatically contrasting sites: Helsinki (Finland), Dundee (Scotland) and Zaragoza (Spain). We compared the projected future heading and maturity dates with the baseline period (1981–2010) and described corresponding heat and drought stress conditions and how they were affected by adaptation options, i.e. shifting the sowing date by + /- 10–20 days, choosing early or late heading cultivars or combining both adaptation options, with agroclimatic indicators. At all sites and sowing dates, heading and maturity in 2031–50 occurred earlier (up to three weeks with earliest sowing) than in the baseline period. Along the European transect, the projected heading and grain filling periods were hotter than under baseline conditions but advancing heading alleviated heat stress notably. Different indicators signaled more severe drought conditions for 2031–50. At Helsinki, delayed heading periods were exposed to less drought stress, likely because the typical early summer droughts were avoided. At Zaragoza, fewer, yet more intense, rainfall events occurred during grain filling of the early cultivars. Only under scenario RCP4.5, heading and grain filling periods at Dundee were slightly wetter for the early cultivars. Our study provides a unique overview of agroclimatic conditions for heading and grain filling periods projected for 2031–50 along a climatic transect and quantifies the effects of different adaptations for spring barley. The approach can be extended by coupling the agroclimatic indicators with crop modelling.Peer reviewe

Vacuum Pyrolysis of Waste Vehicle Tyres into Oil Fuel Using A Locally, Fabricated Reactor

Abstract Some countries still face daunting challenges of managing ever-increasing waste generated, especially plastic and waste vehicle tyres.&nbsp; Whilst some developed countries have adopted innovative ways such as catalytic or pyrolytic decomposition processes for energy or fuel generation from these wastes, developing countries like Ghana still dispose off indiscriminately around communities or un-engineered dumpsites. Hence, this study sought to transform waste vehicle tyres into fuel which invariably minimises or eliminates its environmental impact. Particularly, waste vehicle tyres (sourced from dumpsites in Tarkwa, Ghana) were washed, shredded and decomposed via pyrolysis at high temperature range (~ 450 - 650 oC) using locally designed and fabricated reactor. The physicochemical properties (such as water content, flashpoint, density, sulphur content, solids and viscosity) of the pyrolysis oil produced were also examined using the American Society for Testing and Materials (ASTM) standards and procedures. The results showed that the viscosity, flashpoint and the density of the pyrolysis oil produced were 0.904 cSt, 34.5 oC, and 850.6 kg/m3 (at 15 oC), respectively. The sulphur, water and solids/particulates contents were 4340.0 ppm, 0.8 vol.%, and 483,495.5 ppm, respectively. It was also observed that the pyrolysis oil obtained appeared as thick, single-phase liquid with dark colour and strong odour at room temperature. Relatively, the properties of pyrolysis oil produced without further treatment did not meet the International specification for diesel fuel, hence its usage would require further treatments such as desulphurisation, decanting, centrifugation and filtration. Overall, the study has demonstrated that the pyrolysis of waste vehicle tyres into fuel provides an alternative method for managing end-of-life vehicle tyres and adding value to waste in general. &nbsp; Keywords: Pyrolysis, Waste Vehicle Tyres, Reactor, Pyrolysis Oil, Biofue

A Method for Detecting Abnormal Program Behavior on Embedded Devices

A potential threat to embedded systems is the execution of unknown or malicious software capable of triggering harmful system behavior, aimed at theft of sensitive data or causing damage to the system. Commercial off-the-shelf embedded devices, such as embedded medical equipment, are more vulnerable as these type of products cannot be amended conventionally or have limited resources to implement protection mechanisms. In this paper, we present a self-organizing map (SOM)-based approach to enhance embedded system security by detecting abnormal program behavior. The proposed method extracts features derived from processor's program counter and cycles per instruction, and then utilises the features to identify abnormal behavior using the SOM. Results achieved in our experiment show that the proposed method can identify unknown program behaviors not included in the training set with over 98.4% accuracy