Moral reasoning perspectives of community pharmacists in situations of drug shortages

BACKGROUND: Drug shortages affect health systems worldwide. Research in community pharmacy has focused on the nature, extent and impact of these shortages on patients and pharmacists. However, pharmacists' moral reasoning in situations of drug shortages has not been addressed. OBJECTIVE: To explore the moral reasoning perspectives of Dutch community pharmacists in situations of drug shortages. METHOD: An electronic survey was developed around three drug shortage scenarios with a varying impact on patient outcomes: a Contraceptive, a Parkinson's and an Osteoporosis scenario. Pharmacists rated the likelihood of nine handling options and rated and ranked 13 considerations that may have played a role therein. The considerations represented three moral reasoning perspectives (MRPs): a business orientation (BO), a rules and regulations (RR), and a professional ethics (PE) MRP. Principle component analysis (PCA) was used to investigate construct validity of the MRPs. MRP rating and MRP ranking scores measured the relative importance of the different MRPs of pharmacists in the three shortages. RESULTS: Results from 267 Pharmacists were obtained. They reported mostly similar handling in the three shortages, except for the likelihood to make agreements with prescribers or other pharmacists and regarding the decision to import a product. The PCA analysis confirmed the three MRPs that accounted for 29% of variance in the data. Both the MRP rating and especially the MRP ranking scores indicated that PE-MRP considerations were most influential on pharmacists' intended handling of the shortages. In the Contraceptive and the Osteoporosis scenarios, the relative importance of a BO-MRP was higher than in the Parkinson's scenario. CONCLUSION: Pharmacists predominantly reason with a PE-MRP when handling drug shortages. However, this perspective can be compromised when the drug shortage is perceived to have a lower impact on patient outcomes and when alternative drugs or therapy are expensive

Harmonic analysis of cosmic microwave background data I: ring reductions and point-source catalogue

We present a harmonic model for the data analysis of an all-sky cosmic microwave background survey, such as Planck, where the survey is obtained through ring-scans of the sky. In this model, resampling and pixelisation of the data are avoided. The spherical transforms of the sky at each frequency, in total intensity and polarization, as well as the bright-point-source catalogue, are derived directly from the data reduced onto the rings. Formal errors and the most significant correlation coefficients for the spherical transforms of the frequency maps are preserved. A clean and transparent path from the original samplings in the time domain to the final scientific products is thus obtained. The data analysis is largely based on Fourier analysis of rings; the positional stability of the instrument's spin axis during these scans is a requirement for the data model and is investigated here for the Planck satellite. Brighter point sources are recognised and extracted as part of the ring reductions and, on the basis of accumulated data, used to build a catalogue. The analysis of the rings is performed iteratively, involving a range of geometric and detector response calibrations. The reconstructed spherical transforms of the sky form the input to the subsequent analysis stages. Although the methods in this paper were developed with the data processing for Planck in mind, many aspects should have wider application, such as in the construction of real-space pixelised maps. (Abridged)Comment: 20 pages, 9 figures. To appear in MNRA

Two Dot1 isoforms in Saccharomyces cerevisiae as a result of leaky scanning by the ribosome

Dot1 is a conserved histone methyltransferase that methylates histone H3 on lysine 79. We previously observed that in Saccharomyces cerevisiae, a single DOT1 gene encodes two Dot1 protein species. Here, we show that the relative abundance of the two isoforms changed under nutrient-limiting conditions. A mutagenesis approach showed that the two Dot1 isoforms are produced from two alternative translation start sites as a result of leaky scanning by the ribosome. The leaky scanning was not affected by the 5′- or 3′-untranslated regions of DOT1, indicating that translation initiation is determined by the DOT1 coding sequence. Construction of yeast strains expressing either one of the isoforms showed that both were sufficient for Dot1’s role in global H3K79 methylation and telomeric gene silencing. However, the absence of the long isoform of Dot1 altered the resistance of yeast cells to the chitin-binding drug Calcofluor White, suggesting that the two Dot1 isoforms have a differential function in cell wall biogenesis

The Luminosities and Distance Scales of Type II Cepheid and RR Lyrae variables

Infrared and optical absolute magnitudes are derived for the type II Cepheids kappa Pav and VY Pyx from revised Hipparcos parallaxes and for kappa Pav, V553 Cen and SW Tau from pulsation parallaxes. Phase-corrected JHK mags are given for 142 RR Lyrae variables based on 2MASS data. RR Lyrae itself is overluminous compared with LMC RR Lyraes at the classical Cepheid modulus (18.39) consistent with a prediction of Catalan and Cortes. V553 Cen and SW Tau deviate by only 0.02 mag in the mean from the Matsunaga PL(K) relation for globular cluster type II Cepheids with a zero-point based on the same LMC modulus. Comparing directly these two stars with type II Cepheids in the LMC and in the Galactic Bulge leads to an LMC modulus of 18.37\pm0.09 and a distance to the Galactic Centre of 7.64\pm 0.21kpc. Kappa Pav may be a binary. V553 Cen and SW Tau show that at optical wavelengths PL relations are wider for field stars than for those in globular clusters (abridged).Comment: 29 pages, 13 figures, accepted for MNRA

JASMINE: Near-infrared astrometry and time-series photometry science

The Japan Astrometry Satellite Mission for INfrared Exploration (JASMINE) is a planned M-class science space mission by the Institute of Space and Astronautical Science, the Japan Aerospace Exploration Agency. JASMINE has two main science goals. One is Galactic archaeology with a Galactic Center survey, which aims to reveal the Milky Way’s central core structure and formation history from Gaia-level (∼25 ${\mu}$as) astrometry in the near-infrared (NIR) Hw band (1.0–1.6 ${\mu}$m). The other is an exoplanet survey, which aims to discover transiting Earth-like exoplanets in the habitable zone from NIR time-series photometry of M dwarfs when the Galactic Center is not accessible. We introduce the mission, review many science objectives, and present the instrument concept. JASMINE will be the first dedicated NIR astrometry space mission and provide precise astrometric information on the stars in the Galactic Center, taking advantage of the significantly lower extinction in the NIR. The precise astrometry is obtained by taking many short-exposure images. Hence, the JASMINE Galactic Center survey data will be valuable for studies of exoplanet transits, asteroseismology, variable stars, and microlensing studies, including discovery of (intermediate-mass) black holes. We highlight a swath of such potential science, and also describe synergies with other missions

A Modified Epigenetics Toolbox to Study Histone Modifications on the Nucleosome Core

In the eukaryotic cell nucleus, the DNA is packaged in a structure called chromatin. The fundamental building block of chromatin is the nucleosome, which is composed of DNA wrapped around an octamer of four distinct histone proteins. Post-translational modifications (PTMs) of histone proteins can affect chromatin structure and function and thereby play critical roles in regulating gene expression. Most histone PTMs are found in unstructured histone tails that protrude from the nucleosome core. As a consequence, (synthetic) peptide truncations of these tails provide convenient substrates for the analysis of histone binding proteins and modifying enzymes. Modifications located on residues that reside in the nucleosome core are more difficult to study because short peptides do not recapitulate this defined structured state well. Methylation of histone H3 on Lys79 (H3K79), mediated by the Dot1 enzyme, is an example of such a core PTM. This modification, which is highly conserved, is linked to human leukemia, and pharmacological modulation of Dot1 activity could be a strategy to treat leukemia. Here we review the available and emerging genetic, biochemical, and chemical methods that together are starting to reveal the function and regulation of this and other histone modifications on the nucleosome core. © 2011 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim

Moral reasoning among Dutch community pharmacists : testing the applicability of the Australian Professional Ethics in Pharmacy test

Background Moral reasoning competency is essential in healthcare practice, especially in situations of moral dilemmas when a professional has to choose a morally justifiable action among several suboptimal action options. The Australian Professional Ethics in Pharmacy test (PEP test) measures moral reasoning among pharmacists. In Australia three levels of moral reasoning (schemas) were measured (1) business orientation (2) rules and regulations, and (3) patient rights (i.e. most advanced schema). Objective To test the applicability of the PEP test to pharmacists working in the Netherlands. Setting Dutch community pharmacy. Methods The PEP test consists of 36 statements (items) accompanying 3 moral dilemma scenarios. It was translated into Dutch and completed by 390 pharmacists. Principle component analysis (PCA) was used to investigate construct validity and Cronbach’s Alpha was used to indicate internal consistency of the Dutch version of the PEP test. The eligible grouped statements and perceived possible moral reasoning schemas were compared to the Australian findings. Main outcome measure Moral reasoning schemas. Results The PCA analysis resulted in 3 components (i.e. possible moral reasoning schemas) that together accounted 27% variance in the data. The statements that represented the moral reasoning schemas ‘business orientation’ and ‘rules and regulations’ were somewhat similar when comparing these with the statements that represented these schemas in the PEP test study. The most advanced moral reasoning schema identified in Dutch pharmacists contained different statements compared to the statements that represented that schema among Australian pharmacists. This schema was labelled ‘professional ethics’. Conclusion The PEP test needs further adaptation to the Dutch pharmacy practice context: especially the statements that should reflect the most advanced moral reasoning schema, need more accurate representations of professional pharmacy ethics that guide pharmacists in the Netherlands. Moral reasoning tests for a specific professional setting or country should be developed and adapted by experts who share the same professional values and practice as the respondents

Moral reasoning among Dutch community pharmacists: testing the applicability of the Australian Professional Ethics in Pharmacy test

Contains fulltext : 209476.pdf (publisher's version ) (Open Access

Moral dilemmas of community pharmacists: a narrative study

Contains fulltext : 190035.pdf (publisher's version ) (Open Access