The development of a marker system for Pharmacists' Behavioural Skills

Objectives: Pharmacists increasingly require complex behavioural skills to fulfil enhanced roles within healthcare teams. Behavioural marker systems are used to assess behavioural (or non-technical) skills during immersive simulation. This study aimed to develop a marker system for pharmacists' behavioural skills in patient-focussed care scenarios, and to investigate its content validity. Methods: Literature describing existing marker systems and the requisite behavioural skills of pharmacists were presented to two expert panels, alongside video examples of pharmacists in patient-focussed care simulations. The expert panels used this information to develop a new behavioural marker system. A third expert panel assessed the content validity, and the item- and scale-content validity indices were calculated. Key findings: The resulting tool contains four categories, each with three or four skill elements: situation awareness (gathering information; recognising and understanding information; anticipating, preparing and planning), decision-making and prioritisation (identifying options; prioritising; dealing with uncertainty; implementing or reviewing decisions), collaborative working (involving the patient; information sharing; leadership or followership), self-awareness (role awareness; speaking up; escalating care; coping with stress). The scale-content validity index was 0.95 (ideal) and the only item below the acceptable cut-off was 'leadership or followership' (0.7). Conclusions: This tool is the first marker system designed to assess the behavioural skills of pharmacists in patient-focussed care scenarios. There is evidence of good content validity. It is hoped that once validated, the Pharmacists' Behavioural Skills marker system will enable pharmacy educators to provide individualised and meaningful feedback on simulation participants' behavioural skills.</p

За индустриальные кадры. 1953. № 3(1110)

Cet article met en perspective les différentes expressions du manquement à l’obligation scolaire à travers le prisme d’un dispositif de rappel à la loi instauré au sein d’une inspection académique. Quel est le milieu social des élèves signalés absentéistes ? Quels arguments les jeunes et leurs parents avancent-ils face aux représentants de l’institution scolaire ? À partir de l’observation de 60 entretiens de rappels à la loi et de l’étude de 250 dossiers d’élèves signalés, les auteurs exposent les motifs d’absentéisme en six grandes tendances tout en dévoilant certains aspects méconnus qui ressortent de la variété des situations. Considérés dans leur ensemble, ces manquements à l’obligation scolaire sont révélateurs de la fragilisation d’une fraction des classes moyennes, des difficultés croissantes des classes populaires et notamment de la relégation des familles les plus défavorisées ; ils traduisent également l’affaiblissement de l’offre éducative auprès de jeunes qui, pour la plupart, finissent par se détacher du système scolaire et renoncer à la réalisation d’eux-mêmes par cette voie.This article seeks to describe the different ways in which students can fall short of their mandatory schooling obligations. To that end, it focuses on cases which result in legal reprimand. Is absenteeism more common in certain social settings?  What arguments do pupils and parents present to school authorities to explain absenteeism? Drawing upon observations during 60 interviews and after the study of 250 files involving reported absent pupils, the authors rank the motives identifying six main streams of absenteeism. Nevertheless the wide variety of motives reveals a number of unanticipated social situations. On the whole, instances of absenteeism seem to reveal the weakening of a fraction of the middle class, as well as increased difficulties for the lower classes and notably the banishment of the lowest classes from the school system.  These phenomena go hand-in-hand with the weakening of the educational offer to teenagers who, for the greater part, eventually turn away from the school system and to give up the accomplishment of themselves in this way.Este artículo analiza las diferentes expresiones del incumplimiento de la obligación escolar a través del prisma de un dispositivo de llamada al cumplimiento de la ley instaurado en el seno de una inspección académica. ¿ Cuál es el entorno social de los alumnos calificados como absentistas? ¿ Qué argumentos alegan los jóvenes y sus padres ante los representantes de la institución escolar? A partir de la observación de 60 conversaciones de llamadas al cumplimiento de la ley y del estudio de 250 expedientes de estos alumnos, los autores exponen los motivos de absentismo en seis grandes tendencias y al mismo tiempo, revelan algunos aspectos desconocidos que se desprenden de las diferentes situaciones. Considerados en conjunto, estos incumplimientos de la obligación escolar son reveladores de la debilitación de una parte de las clases medias y de la relegación de las familias más desfavorecidas; asimismo, dejan de manifiesto el debilitamiento de la oferta educativa y, por consiguiente, el deterioro de la democracia social

Draining and salting as responsible key steps in the generation of the acid-forming potential of cheese: Application to a soft blue-veined cheese

International audienceA disregarded nutritional feature of cheeses is their high acid-forming potential when ingested, associated with deleterious effects for consumers' health. This work aimed to characterize the generation of the acid-forming potential of a blue-veined cheese during manufacturing to identify the main key steps of the process involved in this phenomenon. Sampling was performed on 3 batches at 10 steps of the cheese-making process: reception of raw milk, pasteurization, maturation of milk, coagulation, stirring, draining of the curds and at 4 ripening stages: 21, 28, 42, and 56 d. Acid-forming potential of each sample was evaluated through (1) the calculation of the potential renal acid load (PRAL) index (considering protein, Cl, P, Na, K, Mg, and Ca contents) and (2) its organic anion content (lactate and citrate), considered as alkalinizing elements. Draining and salting were identified as the main key steps responsible for the generation of the acid-forming potential of cheese. The draining process induced an increase in the PRAL index from 1.2 mEq/100 g in milk to 10.4 mEq/100 g in drained curds due to the increase of the dry matter and the loss of alkaline minerals into the whey. The raise of PRAL value (20.3 mEq/100 g at d 56) following salting resulted from an imbalance between the strong acidogenic elements (Cl, P, and proteins) and the main alkalinizing ones (Na and Ca). Particularly, the Cl element had a major effect on the PRAL value. Regarding organic anions, draining induced a loss of 93% of the citrate content in initial milk. The lactate content increased as fermentation occurred (1,297.9 mg/100 g in drained curds), then decreased during ripening (519.3 mg/100 g at d 56). This lactate level probably contributes to moderate the acidifying potential of end products. Technological strategies aiming to limit the acid-forming potential of cheeses are proposed and would deserve further research to evaluate their nutritional relevance

Draining and salting as responsible key steps in the generation of the acid-forming potential of cheese: Application to a soft blue-veined cheese

International audienc

Calcium lactate as an attractive compound to partly replace salt in blue-veined cheese

International audienceIn addition to their high sodium content, cheeses are thought to induce an acid load to the body, which is associated with deleterious effects on consumers' health. Our objective was to explore the use of alkalinizing salts in partial substitution of NaCl to reduce both the sodium content and the acid-forming potential of cheese, without altering its sensory properties. Blue-veined cheeses were produced under industrial conditions, using brine salting followed by dry salting with a 4:1 (wt/ wt) mixture of calcium lactate: NaCl or calcium citrate: NaCl. Sodium chloride was used in 2 granulometries: coarse (control treatment) and fine, to obtain homogeneous mixtures with the organic salts. Cheeses were then ripened for 56 d. No major appearance defects were observed during ripening. Calcium lactate substitution decreased the Na content of the cheese core by 33%, and calcium citrate substitution increased the citrate content of the cheese core by 410%, respectively, compared with fine NaCl. This study highlighted the substantial role of salt granulometry in sodium content, with the use of the coarse salt reducing the sodium content by 21% compared with fine salt. Sensory profiles showed nonsignificant differences in bitter and salty perceptions of salt-substituted cheeses with calcium lactate and calcium citrate compared with control cheeses. The use of calcium lactate should be considered to reduce the sodium content and improve the nutritional quality of cheeses while maintaining the sensory quality of the products. Alkalinizing organic salts could replace the acidifying salts KCl or CaCl 2 , which are currently used in salt replacement and are not recommended for consumers with renal disease. The method described here should be considered by cheese-making producers to improve the nutritional quality of cheese. Additional nutritional optimization strategies are suggested

Exploratory study of acid-forming potential of commercial cheeses: impact of cheese type

International audienceDue to their composition, cheeses are suspected to induce an acid load to the body. To better understand this nutritional feature, the acid-forming potential of five cheeses from different cheese-making technologies and two milk was evaluated on the basis of their potential renal acid load (PRAL) index (considering protein, P, Cl, Na, K, Mg and Ca contents) and organic anions contents. PRAL index ranged from -0.8 mEq/100g edible portion for fresh cheese to 25.3 mEq/100g for hard cheese Cantal and 28 mEq/100g for blue-veined cheese Fourme d'Ambert. PRAL values were greatly subjected to interbatch fluctuations. This work emphasized a great imbalance between acidifying elements of PRAL calculation (Cl, P and proteins elements) and alkalinizing ones (Na and Ca). Particularly, Cl followed by P elements had a strong impact on the PRAL value. Hard cheeses were rich in lactate, thus, might be less acidifying than suspected by their PRAL values only

Calcium lactate as an attractive compound to partly replace salt in blue-veined cheese

In addition to their high sodium content, cheeses are thought to induce an acid load to the body, which is associated with deleterious effects on consumers' health. Our objective was to explore the use of alkalinizing salts in partial substitution of NaCl to reduce both the sodium content and the acid-forming potential of cheese, without altering its sensory properties. Blue-veined cheeses were produced under industrial conditions, using brine salting followed by dry salting with a 4:1 (wt/wt) mixture of calcium lactate:NaCl or calcium citrate: NaCl. Sodium chloride was used in 2 granulornetries: coarse (control treatment) and fine, to obtain homogeneous mixtures with the organic salts. Cheeses were then ripened for 56 d. No major appearance defects were observed during ripening. Calcium lactate substitution decreased the Na content of the cheese core by 33%, and calcium citrate substitution increased the citrate content of the cheese core by 410%, respectively, compared with fine NaCl. This study highlighted the substantial role of salt granulometry in sodium content, with the use of the coarse salt reducing the sodium content by 21% compared with fine salt. Sensory profiles showed nonsignificant differences in bitter and salty perceptions of salt-substituted cheeses with calcium lactate and calcium citrate compared with control cheeses. The use of calcium lactate should be considered to reduce the sodium content and improve the nutritional quality of cheeses while maintaining the sensory quality of the products. Alkalinizing organic salts could replace the acidifying salts KCl or CaCl2, which are currently used in salt replacement and are not recommended for consumers with renal disease. The method described here should be considered by cheese-making producers to improve the nutritional quality of cheese. Additional nutritional optimization strategies are suggested