Blogging as a viable research methodology for young people with arthritis: a qualitative study.

The development of services that are responsive to the needs of users is a health policy priority. Finding ways of engaging young people in research to gain insights into their particular experiences, perspectives, and needs is vital but challenging. These data are critical to improving services in ways that meet the needs of young people

Conditions that Stabilize Membrane Domains Also Antagonize n-Alcohol Anesthesia

Diverse molecules induce general anesthesia with potency strongly correlated with both their hydrophobicity and their effects on certain ion channels. We recently observed that several n -alcohol anesthetics inhibit heterogeneity in plasma-membrane-derived vesicles by lowering the critical temperature (Tc) for phase separation. Here, we exploit conditions that stabilize membrane heterogeneity to further test the correlation between the anesthetic potency of n -alcohols and effects on Tc. First, we show that hexadecanol acts oppositely to n -alcohol anesthetics on membrane mixing and antagonizes ethanol-induced anesthesia in a tadpole behavioral assay. Second, we show that two previously described “intoxication reversers” raise Tc and counter ethanol’s effects in vesicles, mimicking the findings of previous electrophysiological and behavioral measurements. Third, we find that elevated hydrostatic pressure, long known to reverse anesthesia, also raises Tc in vesicles with a magnitude that counters the effect of butanol at relevant concentrations and pressures. Taken together, these results demonstrate that ΔTc predicts anesthetic potency for n-alcohols better than hydrophobicity in a range of contexts, supporting a mechanistic role for membrane heterogeneity in general anesthesia

A cross-sectional study using freedom of information requests to evaluate variation in local authority commissioning of community pharmacy public health services in England.

OBJECTIVES: This study aims to provide a national picture of the extent and nature of public health services commissioned by local authorities (LAs) from community pharmacies across England in financial year 2014/15. DESIGN: Cross-sectional survey of public health services commissioned in community pharmacies by LAs, gathered via freedom of information requests and documentary analysis. SETTING AND PARTICIPANTS: All 152 LAs in England. RESULTS: A total of 833 commissioned services were reported across England (range 3-10 per LA). Four services were commissioned by over 90% of LAs: emergency hormonal contraception (EHC), smoking cessation support, supervised consumption of methadone or other opiates and needle and syringe programmes (NSPs). The proportion of pharmacies commissioned to deliver these services varied considerably between LAs from <10% to 100%. This variation was not related to differences in relevant proxy measures of need. NHS Health Checks and alcohol screening and brief advice were commissioned by fewer LAs (32% and 15%, respectively), again with no relationship to relevant measures of need. A range of other services were commissioned less frequently, by fewer than 10% of LAs.Supervised consumption and NSPs were the most frequently used services, with over 4.4 million individual supervisions and over 1.4 million needle packs supplied. Pharmacies provided over 200 000 consultations for supply of EHC, over 30 000 supplies of free condoms and almost 16 000 chlamydia screening kits. More than 55 000 people registered to stop smoking in a community pharmacy, almost 30 000 were screened for alcohol use and over 26 000 NHS Health Checks were delivered. CONCLUSIONS: There is significant variation in commissioning and delivery of public health services in community pharmacies across England, which correlate poorly with potential benefit to local populations. Research to ascertain reasons for this variation is needed to ensure that future commissioning and delivery of these services matches local need

Applying the 'You're Welcome' youth-friendly service criteria to community pharmacy in the UK

OBJECTIVES: The Department of Health in England developed the 'You're Welcome' framework, comprising criteria for all health services seeing 11- to 19-year olds, to improve their quality and coverage and reduce access inequities. To date, however, the 'You're Welcome' criteria have not been considered within community pharmacy service development policy. The aim of this article was to assess the relevance of the 'You're Welcome' criteria to community pharmacy, and examine ways in which they are currently met, or not met, to guide future service development. METHODS: The project employed three methods. Checklist-guided observations and face-to-face semistructured interviews with staff members were undertaken in eight community pharmacies across England and Scotland, purposively selected because of their known focus on provision of young people's services. This was complemented by a cross-sectional online survey for completion by pharmacy staff across a wider range of pharmacies recruited through targeted Local Pharmaceutical Committees (LPC). Study instruments were designed to gather information relevant to each of the 'You're Welcome' criteria. KEY FINDINGS: Eight pharmacies took part in observations and interviews. Six LPCs posted the online survey link on their website, which was returned by 56 respondents. The results demonstrate applicability of the 'You're Welcome' criteria to community pharmacy services, highlighting particular strengths of community pharmacy services for young people (e.g. accessibility) as well as opportunities and priorities for service development to meet their specific needs (e.g. staff training, engagement and integration with local service provision). CONCLUSIONS: The 'You're Welcome' criteria can be applied to community pharmacy services without adaptation providing an appropriate framework to guide service development to promote young people friendly pharmacy services. JPHS

Understanding and optimising an identification/brief advice (IBA) service about alcohol in the community pharmacy setting

This is the final report of an evaluation into the identification/brief advice (IBA) service about alcohol in community pharmacy settings in the North West of England. Since 2007, almost 100 pharmacies in the North West have - at some point - been commissioned to provide an identification and brief advice (IBA) service for alcohol. This evaluation sought to understand how the service had been adapted for and implemented in the community pharmacy setting, and how its potential might be maximised. Its aims were: 1. To characterise, consolidate and optimise both the constant and variable elements of the pharmacy alcohol identification/brief advice (IBA) service in NHS Northwest, and 2. To inform planning for current and future pharmacy based services promoting safe consumption of alcohol. The evaluation was split into three main workstreams, supported by a preliminary scoping phase, and combined quantitative and qualitative methods: • Descriptive and comparative statistical analysis of pharmacy alcohol IBA data; • In-pharmacy work, including observation of staff engagement with customers, recording consultations between staff and customers, follow-up telephone interviews with customers, and group feedback interviews with pharmacy staff; • Stakeholder engagement through self-completion surveys, semi-structured interviews and a workshop. This report gives the background to the project, and details the methods, results and implications

The role of pharmacists in caring for young people with chronic illness

PURPOSE: To explore the perceived and potential roles of pharmacists in the care of young people aged 10–24 years with chronic illness, through the exemplar of juvenile arthritis, from the perspectives of UK community and hospital pharmacists, health service commissioners, rheumatology health professionals, and lay advocates. METHODS: A sequential mixed methods study design comprises the following: focus groups with community and hospital pharmacists; telephone interviews with pharmacy and rheumatology stakeholders and commissioners; and multidisciplinary group discussions to prioritize roles generated by the first two qualitative phases. RESULTS: The high priority roles for pharmacists, identified by pharmacists and rheumatology staff, were developing generic health care skills among young people; transferring information effectively across care interfaces; building trusting relationships with young people; helping young people to find credible online health information; and the need to develop specialist expertise. Participants identified associated challenges for pharmacists in supporting young people with chronic illness. These challenges included parents collecting prescription refills alone, thus reducing opportunities to engage, and pharmacist isolation from the wider health care team. CONCLUSIONS: This study has led to the identification of specific enhancements to pharmacy services for young people, which have received the endorsement of a wide range of stakeholders. These suggestions could inform the next steps in developing the contribution of community and hospital pharmacy to support young people with chronic illness in the optimal use of their medication

The use of community pharmacies in Northwest England: an observational study

Background: There are few studies of community pharmacy footfall and activity in the existing literature, especially by direct observation. Pharmacies in England have the ability to provide a range of services and products since the change to their contractual framework in 2005. Objective: To describe the frequency and characteristics of interactions at the counter between pharmacy staff and customers to inform future policy development around pharmacy services. Method: A market researcher used a checklist to directly observe all interactions between pharmacy staff and customers taking place at the counter at specified days and times across the weekly opening hours of five pharmacies across the Northwest of England. Pharmacies were diverse in terms of ownership and location, across an area of significant deprivation. Key findings: Around three-quarters (76%) of all counter interactions observed were associated with prescriptions. Among adults aged <45 years, female: male customer visits were 2:1, changing to almost 1:1 for those aged 45 plus. Pain relief medication (74/307; 24%) and cold and flu remedies (53/307; 17%) were the most commonly purchased types of over-the-counter (OTC) medicines. Approximately two-thirds (62.6%; n=2,078) of the interactions observed at the counter were between a customer and a Medicines Counter Assistant (MCA). Conclusions: Dispensing was the primary activity across the diverse range of pharmacies, but access to other pharmacy services and self-care activities were significant - especially at the weekend. Skill mix observation suggested that different pharmacies were deploying their pharmacists and other staff in different ways across similar patterns of activity

Experimental and numerical study of strength mismatch in cross-weld tensile testing

The mechanical properties of welded boiler tubes used in power plants can be significantly altered as a result of the fabrication history, such as pre-straining and heat treatment. The primary aim of the study was to determine the effect of fabrication history on local tensile properties across the welds. This was achieved by testing cross-weld specimens machined from welded thin-walled tubes (with unstrained or pre-strained base metal) before and after heat treatment. Digital image correlation, which is a full-field strain measurement technique, was implemented in order to obtain the local stress–strain curves and to extract the corresponding local tensile properties such as offset proof stress. Evidence of strain hardening due to the constraint and thermo-mechanical cycles during the welding process was found in the heat-affected zone and evidence of softening was observed in the pre-strained base metal. It was found that the heat treatment process removed the effect of pre-straining and welding on the proof stress and the strength along the specimen was nearly homogenized. However, mapping the local stress–strain curves in the as-welded cross-weld specimens with pre-strained base metal has revealed abnormal strain relaxation with increase in load in the weld-affected region. For a better understanding of this behaviour, a tensile test of a cross-weld specimen with a large strength mismatch between the weld metal and the base metal was simulated using the finite element method. It was found that the strength mismatch in the specimen causes the development of biaxial stresses in the heat-affected zone once local yielding begins, and the use of global axial stress to construct the local stress–strain curve results in an apparent ‘reduced-strain’ anomaly. Nevertheless, for the strength mismatch ratios studied, this anomalous behaviour did not seem to significantly affect the determination of the local proof stress in the specimens

Rationale and design of the ADDITION-Leicester study, a systematic screening programme and randomised controlled trial of multi-factorial cardiovascular risk intervention in people with type 2 diabetes mellitus detected by screening.

BACKGROUND: Earlier diagnosis followed by multi-factorial cardiovascular risk intervention may improve outcomes in type 2 diabetes mellitus (T2DM). Latent phase identification through screening requires structured, appropriately targeted population-based approaches. Providers responsible for implementing screening policy await evidence of clinical and cost effectiveness from randomised intervention trials in screen-detected T2DM cases. UK South Asians are at particularly high risk of abnormal glucose tolerance and T2DM. To be effective national screening programmes must achieve good coverage across the population by identifying barriers to the detection of disease and adapting to the delivery of earlier care. Here we describe the rationale and methods of a systematic community screening programme and randomised controlled trial of cardiovascular risk management within a UK multiethnic setting (ADDITION-Leicester). DESIGN: A single-blind cluster randomised, parallel group trial among people with screen-detected T2DM comparing a protocol driven intensive multi-factorial treatment with conventional care. METHODS: ADDITION-Leicester consists of community-based screening and intervention phases within 20 general practices coordinated from a single academic research centre. Screening adopts a universal diagnostic approach via repeated 75g-oral glucose tolerance tests within an eligible non-diabetic population of 66,320 individuals aged 40-75 years (25-75 years South Asian). Volunteers also provide detailed medical and family histories; complete health questionnaires, undergo anthropometric measures, lipid profiling and a proteinuria assessment. Primary outcome is reduction in modelled Coronary Heart Disease (UKPDS CHD) risk at five years. Seven thousand (30% of South Asian ethnic origin) volunteers over three years will be recruited to identify a screen-detected T2DM cohort (n = 285) powered to detected a 6% relative difference (80% power, alpha 0.05) between treatment groups at one year. Randomisation will occur at practice-level with newly diagnosed T2DM cases receiving either conventional (according to current national guidelines) or intensive (algorithmic target-driven multi-factorial cardiovascular risk intervention) treatments. DISCUSSION: ADDITION-Leicester is the largest multiethnic (targeting >30% South Asian recruitment) community T2DM and vascular risk screening programme in the UK. By assessing feasibility and efficacy of T2DM screening, it will inform national disease prevention policy and contribute significantly to our understanding of the health care needs of UK South Asians. TRIAL REGISTRATION: Clinicaltrial.gov (NCT00318032).RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Will all scientists working on snails and the diseases they transmit please stand up?

Copyright © 2012 Adema et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.No abstract available