Pharmacists detecting atrial fibrillation in general practice: a qualitative focus group study

Background: Atrial fibrillation (AF) affects up to 10% of people aged ≥65 years, yet a third of all cases remain undetected. Practice-based pharmacists are in an ideal position to facilitate opportunistic AF screening, while increasing general practice capacity at a time of workforce crisis. Aim: To explore the perspectives of three stakeholder groups involved in the ‘Pharmacists Detecting Atrial Fibrillation’ (PDAF) study to elucidate the facilitators and barriers to pharmacist-led AF screening in general practice. Design & setting: A qualitative study took place, comprising homogeneous focus groups with stakeholders in Kent, UK. Method: The stakeholder groups — patients, general practice staff (GPS), and clinical pharmacists (CPs) — were recruited using convenience sampling. Audio-recordings were transcribed verbatim and analysed using a deductive Theoretical Domains Framework (TDF) approach. Results: Twenty-five patients, four pharmacists, and nine practice staff participated in six focus groups. Three main themes were identified: knowledge and awareness; prioritisation of resources; and environmental considerations. The public’s lack of awareness of AF-related risks and pharmacist-led screening services was highlighted. Practice-based pharmacists were perceived as an underutilised educational resource which, together with novel electrocardiogram devices, enabled convenient access to screening while reducing GPs’ workload. Participants agreed that AF screening should be incorporated into personalised health checks and at-risk groups should be prioritised, such as care home residents. Patients favoured the general practice environment over the community pharmacy where concerns of privacy, staffing, and commercialisation were raised. Conclusion: The findings of this study support the introduction of pharmacist-led AF screening programmes in general practice surgeries. Commissioners should consider the added value of utilising CPs and focus on the delivery of AF screening within an integrated service

Microclimatic interactions in agroforestry systems

The interaction of the components of an agroforestry system with elements of microclimate is presented in terms of the interception by foliage of radiant energy and of rainfall; and of the temperature, humidity and windspeed of air surrounding the foliage. Most of the measurements reported are from a trial in which pearl millet was grown at ICRISAT, Hyderabad, between hedges of Leucaena leucocephala Lam. In terms of microclimate, the main advantage of the alley system was to intercept more light throughout the year and therefore to produce more biomass. Temperatureand humidity within the alleys differed little from values in the open but windspeed was substantially less. The main disadvantage of the system in terms of pearl millet production was therefore competition below ground rather than abov

Above- and below-ground interactions in a leucaena/millet alley cropping system. I. Experimental design, instrumentation and diurnal trends

Leucaena (Leucaena leucocephala (Lam.) de Wit) and pearl millet (Pennisetum glaucum (L.) R.Br.) were grown together in an alley cropping system in a semi-arid area of India. The five treatments included sole millet (SM), sole leucaena (SL) planted in double rows to form hedges with an alley width of 2.8 m, and alley cropping treatments LM5, LM6 and LM6P with alley widths of 2.8, 3.3 and 3.3 m, respectively. Millet rows within the alleys were spaced at 47 cm, giving five rows in LM5 and six rows in both LM6 and LM6P. LM6P differed from LM6 in that a vertical polythene barrier separated the root systems of leucaena and millet to a depth of 50cm. Light interception, wind speed, saturation deficit and air, soil and leaf temperatures were monitored during the 1986 and 1987 rainy seasons in treatments SM, SL and LM5. This paper describes the experimental design and instrumentation and presents representative diurnal time courses illustrating the nature of the microclimatic changes associated with alley cropping. These indicate that alley cropping altered the microclimate experienced by millet to an extent which depended on its proximity to the hedge, hedge shape and the relative size of the two components. The larger leucaena canopy in 1987 than in 1986 resulted in more substantial reductions in wind speed and incident light in the alleys of LM5 as compared with SM. Leaf and soil temperatures within the alleys tended to be warmer during the night and cooler during the day than in SM and temperature differences between rows within LM5 were related to the degree of shading by leucaena. Analysis of integrated data predicted little effect of the observed changes in saturation deficit on the productivity of millet, while thermal time analysis for 1987 suggested a 2—3 day delay in flowering for millet adjacent to the hedge as compared with sole millet

Above- and below-ground interactions in a leucaena/millet alley cropping system. II. Light interception and dry matter production

Leucaena (Leucaena leucocephala (Lam.) de Wit) and pearl millet (Pennisetum glaucum (L.) R.Br.) were grown together in an alley cropping system in a semi-arid area of India. The five treatments included sole millet (SM), sole leucaena (SL) planted in double rows to form hedges with an alley width of 2.8 m, and alley cropping treatments LM5, LM6, and LM6P with alley widths of 2.8, 3.3 and 3.3 m and five, six and six rows of millet, respectively. LM6P differed from LM6 in that a vertical polythene barrier separated the root systems of leucaena and millet to a depth of 50 cm. Dry matter production and light interception data for millet and leucaena are presented to allow comparison of light capture and utilisation efficiency by the two species under contrasting hedge management in the rainy seasons of 1986 and 1987. Dry matter yields of leucaena did not differ significantly between treatments in either rainy season, but were much higher in 1987 than in 1986 because of the less severe lopping regime. The higher yields in 1987 resulted from a greater mean fractional light interception by leucaena, which increased shading of alley cropped millet when compared with 1986. The dry matter yields of millet in treatments LM5 and LM6 were reduced relative to the sole crop in both years. In 1986, this reduction appeared to result primarily from shading, while in 1987 the mean fractional light interception and the pre-anthesis conversion coefficient were both lower in LM5 than in SM. Above- and below-ground competition interacted in 1986, so that when root competition was reduced (LM6P) the millet was able to grow taller, eventually matching the leucaena in height and partially escaping the shading and yield reduction experienced in LM5 and LM6. In 1987, the hedges were always more than 1 m taller than the millet and the root barrier failed to remove the detrimental competition between leucaena and mille

Opportunistic screening for atrial fibrillation by clinical pharmacists in UK general practice during the influenza vaccination season: a cross-sectional feasibility study

Background: Growing prevalence of atrial fibrillation (AF) in the ageing population, and its associated life-changing health and resource implications, have led to a need to improve its early detection. Primary care is an ideal place to screen for AF, however this is limited by shortages in general practitioner (GP) resources. Recent increases in the number of clinical pharmacists within primary care, makes them ideally placed to conduct AF screening. This study aimed to determine the feasibility of GP practice-based clinical pharmacists to screen the over 65s for AF, using digital technology and pulse palpation during the influenza vaccination season. Methods and Findings: Screening was conducted over two influenza vaccination seasons, 2017-2018 and 2018-2019 in four GP practices in Kent, UK. Pharmacists were trained by a cardiologist to pulse palpate, record and interpret a single-lead ECG (SLECG). Eligible persons aged ≥65 years, attending an influenza vaccination clinic were offered a free heart rhythm check. 604 participants were screened (median age 73 years, 42.7% male). Total prevalence of AF was 4.3%. All participants with AF qualified for anticoagulation and were more likely to be male (57.7%); older; have an increased BMI and have a CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥ 75, Diabetes, previous Stroke, Age 65-74 years, Sex category) score ≥ 3. The sensitivity and specificity of clinical pharmacists diagnosing AF using pulse palpation was 76.9% [95% CI: 56.4-91.0] and 92.2% [89.7-94.3], respectively. This rose to 88.5% (69.9-97.6) and 97.2% [95.5-98.4] with a SLECG. At follow-up, four participants (0.7%) were diagnosed with new AF and 3 (0.5%) were initiated on anticoagulation. Screening with SLECG also helped identify new non-AF cardiovascular diagnoses, such as left ventricular hypertrophy, in 28 participants (4.6%). The screening strategy was cost-effective in 71.8% and 64.3% of the estimates for SLECG or pulse palpation, respectively. Feedback from participants (422/604) was generally positive. Key limitations of the study were that the intervention did not reach individuals who did not attend the practice for an influenza vaccination and there was a limited representation of UK ethnic minority groups in the study cohort. Conclusions: This study demonstrates that AF screening performed by GP practice-based pharmacists was feasible, economically viable and positively endorsed by participants. Furthermore, diagnosis of AF by the clinical pharmacist using a SLECG was more sensitive and more specific than the use of pulse palpation alone. Future research should explore the key barriers preventing the adoption of national screening programmes

Techniques for synchronization of X-Ray pulses to the pump laser in an ultrafast X-Ray facility

Accurate timing of ultrafast x-ray probe pulses emitted from a synchrotron radiation source with respect to the signal initiating a process in the sample under study is critical for the investigation of structural dynamics in the femtosecond regime. We describe schemes for achieving accurate timing of femtosecond x-ray synchrotron radiation pulses relative to a pump laser, where x-rays pulses of <100 fs duration are generated from the proposed LUX source based on a recirculating superconducting linac. We present a description of the timing signal generation and distribution systems to minimize timing jitter of the x-rays relative to the experimental lasers

Screening for atrial fibrillation in care homes using pulse palpation and the AliveCor Kardia Mobile® device: a comparative cross-sectional pilot study.

Atrial fibrillation (AF) is a major cause of stroke in older people. Exacerbated by age and co-morbidities, residents of care homes are more likely to develop AF and less likely to receive oral anticoagulants. To determine the prevalence of AF using the design and methodology of the Pharmacists Detecting Atrial Fibrillation (PDAF) study in a care home setting. A cross-sectional AF screening pilot study within four UK care homes, three residential and one residential/nursing. Screening followed the original PDAF protocol: a manual pulse check, followed by a single-Lead ECG ( ECG, AliveCor Kardia Mobile (KMD)) delivered by a pharmacist. All recorded ECG were reviewed by a cardiologist and any residents requiring follow-up investigations were referred to their general practitioner. Fifty-three of 112 care home residents participated. From 52 ECGs recorded, the cardiologist interpreted 13.5% (7/52) as having possible AF of which 9.6% (5/52) were previously unknown. One resident with previously unknown AF received anticoagulation. This study has shown a need for AF screening in care homes and that elements of the PDAF screening protocol are transferable in this setting. Early diagnosis and treatment of AF are essential to reduce the risk of stroke in this population. [Abstract copyright: © 2023. The Author(s).

Conditions for parents' participation in the care of their child in neonatal intensive care – a field study

<p>Abstract</p> <p>Background</p> <p>To promote participation by parents in the care of their child in neonatal intensive care units (NICU), health professionals need better understanding of what facilitates and what obstructs participation. The aim was to elucidate conditions for parents' participation in the care of their child in NICUs.</p> <p>Methods</p> <p>A field study with a hermeneutic lifeworld approach was used and data were collected at two NICUs through participative observations and interviews with representatives of management, staff and parents.</p> <p>Results</p> <p>The results point to a number of contradictions in the way parents were offered the opportunity to participate in neonatal intensive care. Management and staff both had good ambitions to develop ideal care that promoted parent participation. However, the care including the conditions for parental participation was driven by the terms of the staff, routines focusing on the medical-technical care and environment, and budgetary constraints.</p> <p>Conclusion</p> <p>The result shows that tangible strategies need to be developed in NICUs aimed at optimising conditions for parents to be present and involved in the care of their child.</p

Conserving the World’s Megafauna and Biodiversity: The Fierce Urgency of Now

First paragraph: In our recent perspective article, we noted that most (approximately 60 percent) terrestrial large carnivore and large herbivore species are now threatened with extinction, and we offered a 13-point declaration designed to promote and guide actions to save these iconic mammalian megafauna (Ripple et al. 2016). Some may worry that a focus on saving megafauna might undermine efforts to conserve biodiversity more broadly. We believe that all dimensions of biodiversity are important and that efforts to conserve megafauna are not in themselves sufficient to halt the dispiriting trends of species and population losses in recent decades. From 1970 to 2012, a recent global analysis showed a 58 percent overall decline in vertebrate population abundance (WWF 2016). Bold and varied approaches are necessary to conserve what remains of Earth’s biodiversity, and our declaration in no way disputes the value of specific conservation initiatives targeting other taxa. Indeed, the evidence is clear that without massively scaling up conservation efforts for all species, we will fail to achieve internationally agreed-upon targets for biodiversity (Tittensor et al. 2014).Additional co-authors: Holly T Dublin, James A Estes, Kristoffer T Everatt, Mauro Galetti, Varun R Goswami, Matt W Hayward, Simon Hedges, Michael Hoffmann, Luke TB Hunter, Graham IH Kerley, Mike Letnic, Taal Levi, John C Morrison, Michael Paul Nelson, Thomas M Newsome, Luke Painter, Robert M Pringle, Christopher J Sandom, John Terborgh, Adrian Treves, Blaire Van Valkenburgh, John A Vucetich, Aaron J Wirsing, Arian D Wallach, Christopher Wolf, Rosie Woodroffe, Hillary Young, And Li Zhan