The national consultation skills for pharmacy practice program in England

Background: Pharmacy professionals are playing an increasing role in caring for patients, yet evidence has shown their consultation skills are lacking. Objective: This article aims to discuss the need to enhance pharmacy professionals' (pharmacists and pharmacy technicians) consultation skills in England and describe the development of a national consultation skills training program to meet these needs. Methods: The Centre for Pharmacy Postgraduate Education led on a project to create a consultation skills training program for all pharmacy professionals across England. The program embedded a set of consultation skills practice standards developed by a large task and finish group consisting of pharmacy professionals of varying roles from the National Health Service, private pharmacy organizations and academia. Key findings: A Consultation Skills for Pharmacy Practice (CSfPP) training program, consisting of a distance learning workbook and website, was produced and disseminated to all registered pharmacy professionals in England, in March 2014. Conclusions: The first consultation skills training program of its kind was created that aimed to address the growing need to improve the consultations skills of pharmacy professionals in England. Future work will examine the reception of the CSfPP among pharmacy professionals and the impact it has on their practice

Metabolic rate, territoriality and life-history strategies of juvenile Atlantic salmon (Salmo salar L.)

The relationships between relative standard metabolic rate, aggression, territoriality, growth and subsequent life-history strategies were studied in juvenile Atlantic salmon. In order to do this a method of calculating mass-independent relative standard metabolic rates is presented. This procedure involved using individual deviations from allometric predictions of standard metabolic rate based on body size (termed residual standard metabolic rate). As in a previous study, it was found that salmon with higher relative standard metabolic rates were more likely to acquire dominance, in both pairs and groups. However, fish with higher standard metabolic rates appeared to have smaller metabolic scopes within which they had to carry out dominance-acquiring costly activities such as aggression, although fish with higher standard metabolic rates did indeed acquire dominance through greater aggression. Fish with higher standard metabolic rates, although having a higher cost of maintenance, were found to have a lower feeding motivation, possibly because they had a smaller metabolic scope and movements associated with foraging are themselves energetically costly. Therefore it appears that juvenile salmon with high standard metabolic rates and a limited metabolic scope opt to be more aggressive and thus acquire dominance and a feeding territory at the expense of higher foraging rates, since both behavioural strategies are energetically costly. It was also found that in an environment with little food, fish with high standard metabolic rates grew less well than predicted given their position in an artificial stream than conspecifics with lower costs of maintenance. This indicates a potential cost of a high standard metabolic rate. There is a temporal component to acquisition of territories since juvenile salmon emerge from gravel redds over several days. Through this 'prior residence' effect, fish introduced into a new environment first were more likely to acquire territories than later-arriving conspecifics. First-arriving fish, as a consequence of acquiring a feeding territory, grew faster and were more likely to smolt a year earlier than late-arriving juveniles. However, they did not appear to choose the most profitable territories, implying a time constraint to searching for the best sites. If a salmon takes too long to choose a territory, it risks the territories filling up with later-arriving fish and not acquiring one at all. Prior residence appears to be a powerful asymmetry when tested in both pairs and groups, intruders having to be relatively much larger to overcome it and acquire dominance. Relative standard metabolic rate did not predict dominance when prior residence was included as a competitive asymmetry. However, fish with higher standard metabolic rates were more likely to emerge first since they absorbed their yolk-sacs faster and so needed exogenous food sooner. Therefore, a high standard metabolic rate conferred an indirect benefit since it increased the likelihood of a fish being a prior resident. Differences in aggression arising from differences in relative standard metabolic rate were also apparent in a hatchery situation. A group consisting entirely of salmon with high standard metabolic rates showed more aggression than a group of salmon with low standard metabolic rates. However, mean growth did not improve as a consequence of lower aggression rates, although the distribution of individual growth rates was more even in the group of fish with low standard metabolic rates. This may be a consequence of fewer fish in that group behaving despotically and monopolizing available food. As reported in earlier studies, differences in standard metabolic rate between the Upper and Lower Modal Groups of juvenile salmon became apparent during their first winter and spring. However, Upper Modal Group fish had higher weight-specific standard metabolic rates in December, earlier than previously documented, and higher mass-independent metabolic rates in May, prior to smoltification. This is suggested to be a pre-adaptation to the high metabolic demands the smolts will face when they migrate to sea. Individual residual standard metabolic rates varied more in the Upper Modal Group than the Lower Modal Group over winter and spring, possibly because respiratory enzymes in the Upper Modal Group were more seasonally adapted to the changing water temperatures of the period. They may have therefore worked inefficiently at the temperature at which metabolic rate was measured (since it remained constant while the ambient water temperature changed over time), being most inefficient when the difference between sampling and ambient water temperatures was greatest. However, individual residual standard metabolic rates remained broadly invariant throughout the period, demonstrating that individual standard metabolic rate is a relatively stable minimum to aerobic metabolic activity

The current and potential role of community pharmacy in asset-based approaches to health and wellbeing: a qualitative study

From Springer Nature via Jisc Publications RouterHistory: received 2020-10-15, registration 2021-01-29, accepted 2021-01-29, pub-electronic 2021-02-26, online 2021-02-26, pub-print 2021-10Publication status: PublishedFunder: Helath Education EnglandAbstract: Background Asset-based approaches seek to positively mobilise the strengths, capabilities, and resources of individuals and communities. To date, limited consideration has been given to the potential value of this approach in relation to community pharmacy practice, yet this is important and timely given community pharmacy’s expanding role and contribution to public health initiatives. Objectives This qualitative study aimed to explore the current and potential role of community pharmacy in asset-based approaches. Methods Fifteen semi-structured telephone interviews were undertaken with community pharmacists and project leads, and public health policy and strategic leads in the UK. Transcripts were analysed using simultaneous inductive open and deductive coding using an applied Theory of Change as an illustrative lens. Results The shift towards patient-facing roles in community pharmacy was felt to offer expanded relational opportunities to engage and collaborate with individuals, communities, and other stakeholders. However, only a small number of respondents described examples of systemic asset-based working within the pharmacy sector. The adoption of asset-based approaches was challenged or enabled by several factors including the availability of protected time/resources, workplace and organisational culture/values, strategic leadership, commissioning, and funding arrangements. Conclusions The study provides valuable insights into the potential for community pharmacy, a previously unconsidered sector, to further adopt and contribute to asset-based approaches and play a more central role in the improvement of public health and reduction of health inequalities

Building an international network for a primary care research program: reflections on challenges and solutions in the set-up and delivery of a prospective observational study of acute cough in 13 European countries

BACKGROUND: Implementing a primary care clinical research study in several countries can make it possible to recruit sufficient patients in a short period of time that allows important clinical questions to be answered. Large multi-country studies in primary care are unusual and are typically associated with challenges requiring innovative solutions. We conducted a multi-country study and through this paper, we share reflections on the challenges we faced and some of the solutions we developed with a special focus on the study set up, structure and development of Primary Care Networks (PCNs).METHOD: GRACE-01 was a multi-European country, investigator-driven prospective observational study implemented by 14 Primary Care Networks (PCNs) within 13 European Countries. General Practitioners (GPs) recruited consecutive patients with an acute cough. GPs completed a case report form (CRF) and the patient completed a daily symptom diary. After study completion, the coordinating team discussed the phases of the study and identified challenges and solutions that they considered might be interesting and helpful to researchers setting up a comparable study.RESULTS: The main challenges fell within three domains as follows:i) selecting, setting up and maintaining PCNs;ii) designing local context-appropriate data collection tools and efficient data management systems; andiii) gaining commitment and trust from all involved and maintaining enthusiasm.The main solutions for each domain were:i) appointing key individuals (National Network Facilitator and Coordinator) with clearly defined tasks, involving PCNs early in the development of study materials and procedures.ii) rigorous back translations of all study materials and the use of information systems to closely monitor each PCNs progress;iii) providing strong central leadership with high level commitment to the value of the study, frequent multi-method communication, establishing a coherent ethos, celebrating achievements, incorporating social events and prizes within meetings, and providing a framework for exploitation of local data.CONCLUSIONS: Many challenges associated with multi-country primary care research can be overcome by engendering strong, effective communication, commitment and involvement of all local researchers. The practical solutions identified and the lessons learned in implementing the GRACE-01 study may assist in establishing other international primary care clinical research platforms

Compressed representation of a partially defined integer function over multiple arguments

In OLAP (OnLine Analitical Processing) data are analysed in an n-dimensional cube. The cube may be represented as a partially defined function over n arguments. Considering that often the function is not defined everywhere, we ask: is there a known way of representing the function or the points in which it is defined, in a more compact manner than the trivial one

Enabling and Enhancing Science Exploration Across the Solar System: Aerocapture Technology for SmallSat to Flagship Missions

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Combined Forward-Backward Asymmetry Measurements in Top-Antitop Quark Production at the Tevatron

The CDF and D0 experiments at the Fermilab Tevatron have measured the asymmetry between yields of forward- and backward-produced top and antitop quarks based on their rapidity difference and the asymmetry between their decay leptons. These measurements use the full data sets collected in proton-antiproton collisions at a center-of-mass energy of $\sqrt s =1.96$ TeV. We report the results of combinations of the inclusive asymmetries and their differential dependencies on relevant kinematic quantities. The combined inclusive asymmetry is $A_{\mathrm{FB}}^{t\bar{t}} = 0.128 \pm 0.025$. The combined inclusive and differential asymmetries are consistent with recent standard model predictions