Integration of a clinical pharmacist workforce into newly forming primary care networks: a qualitatively driven, complex systems analysis

Objective The introduction of a new clinical pharmacist workforce via Primary Care Networks (PCNs) is a recent national policy development in the National Health Service in England. This study elicits the perspectives of people with responsibility for local implementation of this national policy package. Attention to local delivery is necessary to understand the contextual factors shaping the integration of the new clinical pharmacy workforce, and thus can be expected to influence future role development. Design A qualitative, interview study Setting and participants PCN Clinical Directors and senior pharmacists across 17 PCNs in England (n=28) Analysis Interviews were transcribed, coded and organised using the framework method. Thematic analysis and complex systems modelling were then undertaken iteratively to develop the themes. Results Findings were organised into two overarching themes: (1) local organisational innovations of a national policy under conditions of uncertainty; and (2) local multiprofessional decision-making on clinical pharmacy workforce integration and initial task assignment. Although a phased implementation of the PCN package was planned, the findings suggest that processes of PCN formation and clinical pharmacist workforce integration were closely intertwined, with underpinning decisions taking place under conditions of considerable uncertainty and workforce pressures. Conclusions National policy decisions that required General Practitioners to form PCNs at the same time as they integrated a new workforce risked undermining the potential of both PCNs and the new workforce. PCNs require time and support to fully form and integrate clinical pharmacists if successful role development is to occur. Efforts to incentivise delivery of PCN pharmacy services in future must be responsive to local capacity

Inflationary models with a flat potential enforced by non-abelian discrete gauge symmetries

Non-abelian discrete gauge symmetries can provide the inflaton with a flat potential even when one takes into account gravitational strength effects. The discreteness of the symmetries also provide special field values where inflation can end via a hybrid type mechanism. An interesting feature of this method is that it can naturally lead to extremely flat potentials and so, in principle, to inflation at unusually low energy scales. Two examples of effective field theories with this mechanism are given, one with a hybrid exit and one with a mutated hybrid exit. They include an explicit example in which the single field consistency condition is violated.Comment: 24 pages, uses revtex.sty, submitted to PRD (Nov. 1999) Final version to appear in PRD. Background information on supergravity expande

Field induced magnetic order in the frustrated magnet Gadolinium Gallium Garnet

Gd3Ga5O12, (GGG), has an extraordinary magnetic phase diagram, where no long range order is found down to 25 mK despite \Theta_CW \approx 2 K. However, long range order is induced by an applied field of around 1 T. Motivated by recent theoretical developments and the experimental results for a closely related hyperkagome system, we have performed neutron diffraction measurements on a single crystal sample of GGG in an applied magnetic field. The measurements reveal that the H-T phase diagram of GGG is much more complicated than previously assumed. The application of an external field at low T results in an intensity change for most of the magnetic peaks which can be divided into three distinct sets: ferromagnetic, commensurate antiferromagnetic, and incommensurate antiferromagnetic. The ferromagnetic peaks (e.g. (112), (440) and (220)) have intensities that increase with the field and saturate at high field. The antiferromagnetic reflections have intensities that grow in low fields, reach a maximum at an intermediate field (apart from the (002) peak which shows two local maxima) and then decrease and disappear above 2 T. These AFM peaks appear, disappear and reach maxima in different fields. We conclude that the competition between magnetic interactions and alternative ground states prevents GGG from ordering in zero field. It is, however, on the verge of ordering and an applied magnetic field can be used to crystallise ordered components. The range of ferromagnetic and antiferromagnetic propagation vectors found reflects the complex frustration in GGG.Comment: 6 pages, 7 figures, HFM 2008 conference pape

Higher Order Methods for Simulations on Quantum Computers

To efficiently implement many-qubit gates for use in quantum simulations on quantum computers we develop and present methods reexpressing exp[-i (H_1 + H_2 + ...) \Delta t] as a product of factors exp[-i H_1 \Delta t], exp[-i H_2 \Delta t], ... which is accurate to 3rd or 4th order in \Delta t. The methods we derive are an extended form of symplectic method and can also be used for the integration of classical Hamiltonians on classical computers. We derive both integral and irrational methods, and find the most efficient methods in both cases.Comment: 21 pages, Latex, one figur

Rotation symmetry axes and the quality index in a 3D octahedral parallel robot manipulator system

The geometry of a 3D octahedral parallel robot manipulator system is specified in terms of two rigid octahedral structures (the fixed and moving platforms) and six actuation legs. The symmetry of the system is exploited to determine the behaviour of (a new version of) the quality index for various motions. The main results are presented graphically

Using qualitative process evaluation in the development of a complex intervention to advance person-centred practice by pharmacists: The Medicines and Alcohol Consultation (MAC)

In order to effectively evaluate complex interventions, there have been calls for the further integration of qualitative methods. Qualitative process studies of brief alcohol interventions and medicines reviews are notably lacking. This article provides a grounded example through the presentation of findings from an embedded qualitative process evaluation of a multi-site, pilot cluster RCT of a new intervention: the Medicines and Alcohol Consultation (MAC). MAC is designed to increase the capacity of community pharmacists (CPs) to conduct person-centred medicines reviews in which the subject of alcohol consumption is raised in connection with medications and associated health conditions. Participant-focused qualitative studies (interviews, observations, recorded consultations) sought to understand how CPs engaged with and implemented MAC in context. This article documents effects of the intervention on developing person-centred consultation practice and highlights how qualitative process studies can be used formatively to develop middle range programme theory and to optimise intervention design for testing in a definitive RCT

Ab-initio investigation of phonon dispersion and anomalies in palladium

In recent years, palladium has proven to be a crucial component for devices ranging from nanotube field effect transistors to advanced hydrogen storage devices. In this work, I examine the phonon dispersion of fcc Pd using first principle calculations based on density functional perturbation theory. While several groups in the past have studied the acoustic properties of palladium, this is the first study to reproduce the phonon dispersion and associated anomaly with high accuracy and no adjustable parameters. In particular, I focus on the Kohn anomaly in the [110] direction.Comment: 19 pages, preprint format, 7 figures, added new figures and discussio

Renormalization schemes and the range of two-nucleon effective field theory

The OS and PDS renormalization schemes for the effective field theory with nucleons and pions are investigated. We explain in detail how the renormalization is implemented using local counterterms. Fits to the NN scattering data are performed in the 1S0 and 3S1 channels for different values of mu_R. An error analysis indicates that the range of the theory with perturbative pions is consistent with 500 MeV.Comment: 40 pages, typos corrected, journal version. Discussion of the range in section VII clarified, conclusions unchange