Emergent quality issues in the supply of Chinese medicinal plants: A mixed methods investigation of their contemporary occurrence and historical persistence

Quality issues that emerged centuries ago in Chinese medicinal plants (CMP) were investigated to explore why they still persist in an era of advanced analytical testing and extensive legislation so that a solution to improve CMP quality could be proposed. This is important for 85% of the world’s population who rely on medicinal plants (MP) for primary healthcare considering the adverse events, including fatalities that arise from such quality issues. CMP are the most prevalent medicinal plants globally. This investigation used mixed-methods, including 15 interviews with CMP expert key informants (KI), together with thematic analysis that identified the main CMP quality issues, why they persisted, and informed solutions. An unexplained case example, Eleutherococcus nodiflorus (EN), was analysed by collection of 106 samples of EN, its known toxic adulterant Periploca sepium (PS), and a related substitute, Eleutherococcus senticosus (ES), across mainland China, Taiwan and the UK. Authenticity of the samples was determined using High-performance thinlayer chromatography. Misidentification, adulteration, substitution and toxicity were the main CMP quality issues identified. Adulteration was found widespread globally with 57.4% EN found authentic, and 24.6% adulterated with cardiotoxic PS, mostly at markets and traditional pharmacies. The EN study further highlighted that the reason CMP quality issues persisted was due to the laboratory-bound nature of analytical methods and testing currently used that leave gaps in detection throughout much of the supply chain. CMP quality could be more effectively tested with patented analytical technology (PAT) and simpler field-based testing including indicator strip tests. Education highlighting the long-term economic value and communal benefit of delivering better quality CMP to consumers was recommended in favour of the financial motivation for actions that lead to the persistence of well-known and recurrent CMP quality issues

Quasi-monotonic segmentation of state variable behavior for reactive control

Real-world agents must react to changing conditions as they execute planned tasks. Conditions are typically monitored through time series representing state variables. While some predicates on these times series only consider one measure at a time, other predicates, sometimes called episodic predicates, consider sets of measures. We consider a special class of episodic predicates based on segmentation of the the measures into quasi-monotonic intervals where each interval is either quasi-increasing, quasi-decreasing, or quasi-flat. While being scale-based, this approach is also computational efficient and results can be computed exactly without need for approximation algorithms. Our approach is compared to linear spline and regression analysis

Investigating an open methodology for designing domain-specific language collections

With this research and design paper, we are proposing that Open Educational Resources (OERs) and Open Access (OA) publications give increasing access to high quality online educational and research content for the development of powerful domain-specific language collections that can be further enhanced linguistically with the Flexible Language Acquisition System (FLAX, http://flax.nzdl.org). FLAX uses the Greenstone digital library system, which is a widely used open-source software that enables end users to build collections of documents and metadata directly onto the Web (Witten, Bainbridge, & Nichols, 2010). FLAX offers a powerful suite of interactive text-mining tools, using Natural Language Processing and Artificial Intelligence designs, to enable novice collections builders to link selected language content to large pre-processed linguistic databases. An open methodology trialed at Queen Mary University of London in collaboration with the OER Research Hub at the UK Open University demonstrates how applying open corpus-based designs and technologies can enhance open educational practices among language teachers and subject academics for the preparation and delivery of courses in English for Specific Academic Purposes (ESAP)

Becoming critical beings: a thematic study exploring the development, learning and teaching of a group of non traditional adult learners

The current literature on critical thinking, critical reflection and critical action supports the view that higher education cannot be defined as such without the implicit existence of all three elements in the curriculum. There are many who suggest that, given the changing profile of those now engaging in higher education, these features need to be made more explicit. This study attempts to illustrate how these elements can be made more explicit within a unique teaching and learning context and with a specific non traditional group of adult learners. Barnett (1997) goes further and suggests that these features, which he refers to collectively as the practice of critical being, are an essential requirement for those engaging in higher education. He does not give specifics on how this practice can be taught or how it might find expression in the lives or educational understanding and knowledge of participating students, which is one of the issues this research will attempt to address

Virtues and optimal moral education in the values education in Australian schools project

This thesis argues that a sustained treatment of virtue is missing from the project undertaken to introduce values education into Australian schools over the period 1999 – 2010. It maintains that the inclusion of a focus on virtue, both in relation to the cognitive content and the behavioural impact of education in the virtues is an indispensable part of optimal moral education. One of the aims of the Australian values education project was that it should serve as a form of moral or character education. The absence of a serious treatment of virtue has resulted in an impoverished understanding of that part of the project which claims to provide a guide to moral or character education. For values education in Australian schools to provide an optimal moral education, the cognitive appreciation and the crucial behavioural dimensions of virtues must be included

Interventions designed to reduce implicit prejudices and implicit stereotypes in real world contexts: a systematic review

Background Implicit biases are present in the general population and among professionals in various domains, where they can lead to discrimination. Many interventions are used to reduce implicit bias. However, uncertainties remain as to their effectiveness. Methods We conducted a systematic review by searching ERIC, PUBMED and PSYCHINFO for peer-reviewed studies conducted on adults between May 2005 and April 2015, testing interventions designed to reduce implicit bias, with results measured using the Implicit Association Test (IAT) or sufficiently similar methods. Results 30 articles were identified as eligible. Some techniques, such as engaging with others’ perspective, appear unfruitful, at least in short term implicit bias reduction, while other techniques, such as exposure to counterstereotypical exemplars, are more promising. Robust data is lacking for many of these interventions. Conclusions Caution is thus advised when it comes to programs aiming at reducing biases. This does not weaken the case for implementing widespread structural and institutional changes that are multiply justified

The medium-term sustainability of organisational innovations in the national health service

Background: There is a growing recognition of the importance of introducing new ways of working into the UK's National Health Service (NHS) and other health systems, in order to ensure that patient care is provided as effectively and efficiently as possible. Researchers have examined the challenges of introducing new ways of working-'organisational innovations'-into complex organisations such as the NHS, and this has given rise to a much better understanding of how this takes place-and why seemingly good ideas do not always result in changes in practice. However, there has been less research on the medium-and longer-term outcomes for organisational innovations and on the question of how new ways of working, introduced by frontline clinicians and managers, are sustained and become established in day-to-day practice. Clearly, this question of sustainability is crucial if the gains in patient care that derive from organisational innovations are to be maintained, rather than lost to what the NHS Institute has called the 'improvement-evaporation effect'. Methods: The study will involve research in four case-study sites around England, each of which was successful in sustaining its new model of service provision beyond an initial period of pilot funding for new genetics services provided by the Department of Health. Building on findings relating to the introduction and sustainability of these services already gained from an earlier study, the research will use qualitative methods-in-depth interviews, observation of key meetings, and analysis of relevant documents-to understand the longer-term challenges involved in each case and how these were surmounted. The research will provide lessons for those seeking to sustain their own organisational innovations in wide-ranging clinical areas and for those designing the systems and organisations that make up the NHS, to make them more receptive contexts for the sustainment of innovation. Discussion: Through comparison and contrast across four sites, each involving different organisational innovations, different forms of leadership, and different organisational contexts to contend with, the findings of the study will have wide relevance. The research will produce outputs that are useful for managers and clinicians responsible for organisational innovation, policy makers and senior managers, and academics

A service improvement project to review prescribing information provided by general practitioners for new referrals to a UK National Health Service hospital pain clinic: potential implications of CYP2D6 enzyme inhibition.

INTRODUCTION: Chronic pain is often managed using co-prescription of analgesics and adjuvants, with concomitant medication prescribed for comorbidities. Patients may have suboptimal response to some analgesics or be at risk of drug interactions or adverse drug reactions (ADRs) due to polypharmacy affecting CYP2D6 enzyme activity. The aim of the service improvement project was to determine the proportion of patients referred to a specialist pain service in the UK National Health Service (NHS) by general practitioners (GPs) who may be at risk of suboptimal analgesic response or ADRs due to CYP2D6 inhibition through polypharmacy. This was achieved by reviewing clinical prescribing information provided by GPs at time of referral. It was hoped that the findings could be used to aid clinical and prescribing decisions without conducting CYP2D6 genotyping or phenotyping. METHODS: A review of letters from 250 patients referred to an NHS hospital pain service from GPs over a 3-month period was undertaken. Information about current and concomitant medications was analysed to identify the potential for CYP2D6 inhibition and adverse events. RESULTS: Letters failed to provide information about current pain medication for 20 (8%) patients or non-pain concomitant medication for 54 (21.6%) patients. Of 176 patients, 52 (29.5%) patients with information about non-pain concomitant medication had been prescribed at least one known CYP2D6 inhibitor. A total of 35 (19.9%) patients were identified as being at risk of an adverse drug reaction and 33 (18.75%) patients at risk of suboptimal analgesic response due to co-administration of CYP2D6 inhibitors. CONCLUSION: The review revealed the need for improved detail in GP referral letters used to transfer care to UK NHS hospital pain clinics. There is a need to consider an individual's CYP2D6 phenotype when prescribing analgesic prodrugs to manage persistent pain. Caution is needed when patients are co-prescribed codeine or tramadol with selective serotonin reuptake inhibitors (SSRIs)

Role emerging placements in undergraduate occupational therapy training: a case study

YesPurpose: Role emerging placements in occupational therapy training are contributing to professional and workforce development because of their strong occupational focus and placement of students in emerging practice. This manuscript explores how one role emerging placement challenged and developed student theoretical and clinical skills, presented new ways of working at the recipient site and enhanced service delivery. Methods: The background to role emerging placements in occupational therapy is explored through the use of a case study which reflects on and analyses how the assessment and treatment of occupation enhanced service delivery at a local, no-traditional site is presented. Eight students in England developed and ran a psycho-education group to support the occupational needs of female service users who have experienced domestic abuse. Results: There was an overall increase in self-esteem scores and an expressed increase in knowledge and understanding by participants. Students reported developing a deeper understanding of occupation and the hosts identified the student’s clinical skills as unique contributors to service delivery. Conclusion: By focusing on occupation, role emerging placements draw on the roots of the profession and anchor its future to the theoretical foundations of its past. However, in order to employ occupational therapists, these organisations need to understand what the occupational therapy profession can offer them