Pharmacy needs global professional standards for education and workforce development.

Catherine Duggan, director of professional development at the Royal Pharmaceutical Society (RPS) and Ian Bates, education adviser to the RPS English Pharmacy Board, discuss the importance of developing a global standard of education and training for pharmacists

Feasibility study ASCS remote sensing/compliance determination system

A short-term technical study was performed by the MSC Earth Observations Division to determine the feasibility of the proposed Agricultural Stabilization and Conservation Service Automatic Remote Sensing/Compliance Determination System. For the study, the term automatic was interpreted as applying to an automated remote-sensing system that includes data acquisition, processing, and management

Validation of a survey tool for use in cross-cultural studies

There is a need for tools to measure the information patients need in order for healthcare professionals in general, and particularly pharmacists, to communicate effectively and play an active part in the way patients manage their medicines. Previous research has developed and validated constructs to measure patients’ desires for information and their perceptions of how useful their medicines are. It is important to develop these tools for use in different settings and countries so that best practice is shared and is based on the best available evidence. Objectives: this project sought to validate of a survey tool measuring the “Extent of Information Desired” (EID), the “Perceived Utility of Medicines” (PUM), and the “Anxiety about Illness” (AI) that had been previously translated for use with Portuguese patients. Methods: The scales were validated in a patient sample of 596: construct validity was explored in Factor analysis (PCA) and internal consistency analysed using Cronbach’s alpha. Criterion validity was explored correlating scores to the AI scale and patients’ perceived health status. Discriminatory power was assessed using ANOVA. Temporal stability was explored in a sub-sample of patients who responded at two time points, using a T-test to compare their mean scores. Results: Construct validity results indicated the need to remove 1 item from the Perceived Harm of Medicines (PHM) and Perceived Benefit of Medicines (PBM) for use in a Portuguese sample and the abandon of the tolerance scale. The internal consistency was high for the EID, PBM and AI scales (alpha>0.600) and acceptable for the PHM scale (alpha=0.536). All scales, except the EID, were consistent over time (p>0.05; p<0.01). All the scales tested showed good discriminatory power. The comparison of the AI scale with the SF-36 indicated good criterion validity (p<0.05). Conclusion: The translated tool was valid and reliable in Portuguese patients- excluding the Tolerance scale. Some of the scales may benefit from further refinement, such as the PHM subscale

The Broad Absorption Line Tidal Disruption Event iPTF15af: Optical and Ultraviolet Evolution

We present multi-wavelength observations of the tidal disruption event (TDE) iPTF15af, discovered by the intermediate Palomar Transient Factory (iPTF) survey at redshift $z=0.07897$. The optical and ultraviolet (UV) light curves of the transient show a slow decay over five months, in agreement with previous optically discovered TDEs. It also has a comparable black-body peak luminosity of $L_{\rm{peak}} \approx 1.5 \times 10^{44}$ erg/s. The inferred temperature from the optical and UV data shows a value of (3$-$5) $\times 10^4$ K. The transient is not detected in X-rays up to $L_X < 3 \times 10^{42}$erg/s within the first five months after discovery. The optical spectra exhibit two distinct broad emission lines in the He II region, and at later times also H$\alpha$ emission. Additionally, emission from [N III] and [O III] is detected, likely produced by the Bowen fluorescence effect. UV spectra reveal broad emission and absorption lines associated with high-ionization states of N V, C IV, Si IV, and possibly P V. These features, analogous to those of broad absorption line quasars (BAL QSOs), require an absorber with column densities $N_{\rm{H}} > 10^{23}$ cm$^{-2}$. This optically thick gas would also explain the non-detection in soft X-rays. The profile of the absorption lines with the highest column density material at the largest velocity is opposite that of BAL QSOs. We suggest that radiation pressure generated by the TDE flare at early times could have provided the initial acceleration mechanism for this gas. Spectral UV line monitoring of future TDEs could test this proposal.Comment: 20 pages, 12 figures, published in Ap

Using honey to heal diabetic foot ulcers

Diabetic ulcers seem to be arrested in the inflammatory/proliferative stage of the healing process, allowing infection and inflammation to preclude healing. Antibiotic-resistant bacteria have become a major cause of infections, including diabetic foot infections. It is proposed here that the modern developments of an ancient and traditional treatment for wounds, dressing them with honey, provide the solution to the problem of getting diabetic ulcers to move on from the arrested state of healing. Honeys selected to have a high level of antibacterial activity have been shown to be very effective against antibiotic-resistant strains of bacteria in laboratory and clinical studies. The potent anti-inflammatory action of honey is also likely to play an important part in overcoming the impediment to healing that inflammation causes in diabetic ulcers, as is the antioxidant activity of honey. The action of honey in promotion of tissue regeneration through stimulation of angiogenesis and the growth of fibroblasts and epithelial cells, and its insulin-mimetic effect, would also be of benefit in stimulating the healing of diabetic ulcers. The availability of honey-impregnated dressings which conveniently hold honey in place on ulcers has provided a means of rapidly debriding ulcers and removing the bacterial burden so that good healing rates can be achieved with neuropathic ulcers. With ischemic ulcers, where healing cannot occur because of lack of tissue viability, these honey dressings keep the ulcers clean and prevent infection occurring

Quality of medication use in primary care - mapping the problem, working to a solution: a systematic review of the literature

Background: The UK, USA and the World Health Organization have identified improved patient safety in healthcare as a priority. Medication error has been identified as one of the most frequent forms of medical error and is associated with significant medical harm. Errors are the result of the systems that produce them. In industrial settings, a range of systematic techniques have been designed to reduce error and waste. The first stage of these processes is to map out the whole system and its reliability at each stage. However, to date, studies of medication error and solutions have concentrated on individual parts of the whole system. In this paper we wished to conduct a systematic review of the literature, in order to map out the medication system with its associated errors and failures in quality, to assess the strength of the evidence and to use approaches from quality management to identify ways in which the system could be made safer. Methods: We mapped out the medicines management system in primary care in the UK. We conducted a systematic literature review in order to refine our map of the system and to establish the quality of the research and reliability of the system. Results: The map demonstrated that the proportion of errors in the management system for medicines in primary care is very high. Several stages of the process had error rates of 50% or more: repeat prescribing reviews, interface prescribing and communication and patient adherence. When including the efficacy of the medicine in the system, the available evidence suggested that only between 4% and 21% of patients achieved the optimum benefit from their medication. Whilst there were some limitations in the evidence base, including the error rate measurement and the sampling strategies employed, there was sufficient information to indicate the ways in which the system could be improved, using management approaches. The first step to improving the overall quality would be routine monitoring of adherence, clinical effectiveness and hospital admissions. Conclusion: By adopting the whole system approach from a management perspective we have found where failures in quality occur in medication use in primary care in the UK, and where weaknesses occur in the associated evidence base. Quality management approaches have allowed us to develop a coherent change and research agenda in order to tackle these, so far, fairly intractable problems

Antidepressant drugs and generic counselling for treatment of major depression in primary care:randomised trial with patient preference arms

Objectives: To compare the efficacy of antidepressant drugs and generic counselling for treating mild to moderate depression in general practice. To determine whether the outcomes were similar for patients with randomly allocated treatment and those expressing a treatment preference.Design: Randomised controlled trial, with patient preference arms. Follow up at 8 weeks and 12 months and abstraction of GP case notes.Setting: 31 general practices in Trent region.Participants: Patients aged 18–70 who met research diagnostic criteria for major depression; 103 patients were randomised and 220 patients were recruited to the preference arms.Main outcome measures: Difference in mean Beck depression inventory score; time to remission; global outcome assessed by a psychiatrist using all data sources; and research diagnostic criteria.Results: At 12 months there was no difference between the mean Beck scores in the randomised arms. Combining the randomised and patient preference groups, the difference in Beck scores was 0.4 (95% confidence interval −2.7 to 3.5). Patients choosing counselling did better than those randomised to it (mean difference in Beck score 4.6, 0.0 to 9.2). There was no difference in the psychiatrist's overall assessment of outcome between any of the groups. 221/265 (83%) of participants with a known outcome had a remission. Median time to remission was shorter in the group randomised to antidepressants than the other three groups (2 months v 3 months). 33/221 (15%) patients had a relapse.Conclusions: Generic counselling seems to be as effective as antidepressant treatment for mild to moderate depressive illness, although patients receiving antidepressants may recover more quickly. General practitioners should allow patients to have their preferred treatment

An Evolving Understanding of Sense of Place in Social-Ecological Systems Research and the Barriers and Enablers to its Measurement

Social-ecological systems (SES) are changing more in the Anthropocene than ever before. With this also comes a change in Sense of Place (SoP), that is, the emotional bond that a person (or group of people) has with a place. This impacts how individuals and groups interact with a place (i.e., their behaviours) and respond to disturbance or change (i.e., their adaptive capacity). To understand how SoP is changing across space and time and to be able to compare this across social-ecological contexts, we must first take stock of how SoP is conceptualised so as to understand how to capture and measure the phenomena in a meaningful way (e.g., to inform policy). Based on in-depth qualitative interviews with leading SoP researchers (n = 17 from 8 countries) this paper aims to identify: (1) the current breadth of theoretical conceptualisations for SoP; (2) the methodologies that have been used to measure SoP in different contexts and settings; and (3) the barriers and (4) enablers to the use of different methodologies. Results show that there has been a change in how SoP has been conceptualised over time, whereby it was traditionally considered as something singular and limited, towards something much more dynamic. Results also show that diverse methods (both quantitative and qualitative) have been used to measure SoP, but the choice of method is often a result of resource constraints that limit research design. These findings suggest that broader collaboration among stakeholders and increased interdisciplinarity would undoubtedly lead to improved outcomes in our understanding of SoP, specifically how it is changing in response to anthropogenic pressures, and how the results can be integrated into policy and practice to support environment conservation and management. It is hoped these findings can help establish a community of practice around how we conceptualise SoP, and hence understand it, to create space for methodological integration and shared learnings as a field

Escrevendo em aulas de Ciências

Neste artigo, apresentamos uma análise dos registros escritos dos alunos do 3° ano do Ensino Fundamental nas aulas de Ciências, em que a professora utilizou as atividades de conhecimento físico, criadas pelo Laboratório de Pesquisa e Ensino de Física da Faculdade de Educação da Universidade de São Paulo. Os registros analisados foram coletados na Escola de Aplicação da Feusp, no ano de 2001, durante o acompanhamento de três aulas de Ciências: o problema do submarino, o problema do barquinho e o problema da pressão. O artigo procura mostrar um panorama de como aparecem os registros realizados pelos alunos, após uma aula de Ciências em que eles são levados a resolver situações problemáticas por meio da experimentação, argumentar e escrever sobre os fenômenos físicos. Durante a análise, levou-se em consideração os tipos de textos que os alunos escrevem, o uso da primeira pessoa, o uso de verbos de ação, o respeito à ordem cronológica dos eventos e quais os tipos de explicações os alunos atribuem aos fenômenos trabalhados

Search for the standard model Higgs boson in the H to ZZ to 2l 2nu channel in pp collisions at sqrt(s) = 7 TeV

A search for the standard model Higgs boson in the H to ZZ to 2l 2nu decay channel, where l = e or mu, in pp collisions at a center-of-mass energy of 7 TeV is presented. The data were collected at the LHC, with the CMS detector, and correspond to an integrated luminosity of 4.6 inverse femtobarns. No significant excess is observed above the background expectation, and upper limits are set on the Higgs boson production cross section. The presence of the standard model Higgs boson with a mass in the 270-440 GeV range is excluded at 95% confidence level.Comment: Submitted to JHE