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

Economic benefits of Mt. Cook National Park

Market and non-market valued decisions are associated with New Zealand's system of national parks. The use benefits of Mount Cook National Park are not priced by the market mechanism, whereas many of the inputs necessary to operate and maintain the Park are priced. Estimates of the economic benefits are relevant information when deciding upon the allocation of resources to, and within, a system of national parks. In 1984, the consumers' surplus for adult New Zealand visitors was about $2.2 million. An estimate of the net national benefits is given by the consumers' surplus obtained by New Zealand visitors, plus the net benefits associated with foreign visitors, less the cost of Park management and land rental. The net benefit of Mount Cook National Park, as it was in 1984, is likely to be positive, indicating that the benefits associated with the current use pattern of resources exceeds their opportunity cost to the nation. However, this result cannot be used to establish the optimality of current expenditure and management. Approximately 170,000 adults visited Mount Cook National Park over 1984; 29$58. These expenditures give rise to secondary economic benefits and create opportunities for regional development. Visitor expenditures in the Mackenzie Basin area are associated with $13.4 million of additional regional output,$6.8 million of additional regional income, and 196 jobs. These effects derive their significance from regional objectives; they are not indicators of the national benefits associated with Mount Cook National Park

Contemplations on Dirac's equation in quaternionic coordinates

A formulation of Dirac's equation using complex-quaternionic coordinates appears to yield an enormous gain in formal elegance, as there is no longer any need to invoke Dirac matrices. This formulation, however, entails several peculiarities, which we investigate and attempt to interpret

High dose Nitrate ingestion does not improve 40 km cycling time trial performance in trained cyclists

This study evaluated the chronic effects of nitrate (NO3−) ingestion over three days, on 40 km TT performance in 11trained cyclists (VO2max: 60.8 ± 7.4 ml.kg−1.min−1; age: 36 ± 9 years; height: 1.80 ± 0.06 m; body mass: 87.2 ± 12.0 kg). Utilising a double-blind randomised cross-over design, participants completed three 40 km TT on a Velotron® ergometer following the ingestion of either a 140 ml of “BEET It sport®” NO3− shot containing 12.8 mmol or 800 mg of NO3−, a placebo drink or nothing (control). Performance, oxygen consumption (VO2), blood bicarbonate (HCO3-), pH and lactate (BLa) and ratings of perceived exertion (RPE) were measured every 10 km throughout the TT. The present findings show that NO3− ingestion had no effect on TT performance (NO3−: 4098.0 ± 209.8 vs. Placebo: 4161.9 ± 263.3 s, p = 0.296, ES = 0.11), or VO2 (p = 0.253, ES = 0.13). Similarly, blood lactate and RPE were also unaffected by the experimental conditions (p = 0.522, ES = 0.06; p = 0.085, ES = 0.30) respectively. Therefore, these results suggest that a high dose of NO3− over three days has limited efficacy as an ergogenic aid for 40 km TT cycling performance in trained cyclists

Social Values Related to the Development of Health and Care Guidance: Literature review for NICE by its Research Support Unit. Report of the Research Support Unit for the National Institute for Health and Care Excellence

The National Institute for Health and Care Excellence develops guidance for the allocation of resources for services in clinical and public health and social care. It has a policy of social values underpinning this work that was last updated in 2008. This report is of a review of the literature on social values to help inform the further updating of this policy. The review involved a semi iterative search for literature that was then screened for ideas relevant to health and care guidance. These ideas and the main issues they raise are reported under eight major social value categories. Twenty one themes arising from the review are also provided. The literature raises many issues about the nature of social values that can be applied to guidance development. It needs to be emphasized that not all of these issues should necessarily be applied to guidance development. They are simply issues that have been raised in the literature and this review provides an opportunity for them to be considered. Many of the ideas that have been proposed are in tension with each other and could not all be achieved. It should also be emphasized that many of the issues raise considerable practical challenges in terms of methods, data and financial and timeliness. The review does not assume that any of these issues or ideas could or should necessarily be part of NICE’s policy on social values in guidance production. The review simply provides a list of ideas, issues and themes from the literature for consideration

Errors in quantum optimal control and strategy for the search of easily implementable control pulses

We introduce a new approach to assess the error of control problems we aim to optimize. The method offers a strategy to define new control pulses that are not necessarily optimal but still able to yield an error not larger than some fixed a priori threshold, and therefore provide control pulses that might be more amenable for an experimental implementation. The formalism is applied to an exactly solvable model and to the Landau-Zener model, whose optimal control problem is solvable only numerically. The presented method is of importance for applications where a high degree of controllability of the dynamics of quantum systems is required.Comment: 13 pages, 3 figure

Posthumanist Education

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Experiencing male infertility: A review of the qualitative research literature

This article examines the qualitative research literature that exists in relation to men’s experiences of male infertility. Since men have often been marginalized in the realm of reproduction, including academic research on infertility, it is important to focus on any qualitative research that gives voices to male perspectives and concerns. Given the distress documented by studies of infertile women, we focus in particular on the emotive responses and lived experiences of men in relation to infertility. In this article then, we present an analysis of the core themes across 19 qualitative articles, which include “infertility as crisis”; “emoting infertility- men as “being strong”’ “infertility as a source of stigma”; and the “desire for fatherhood.” In light of these insights, we identify key areas for future research and development including men’s emotional responses to infertility, how men seek support for infertility, the intersection between masculinity and infertility, the relationship between the desire to father and infertility, and the outcomes of infertility for men in terms of other aspects of their lives. We suggest that such research would facilitate making the experiences of men more central within our understandings of infertility within a field that has primarily been female focused