The potential role for a pharmacist in a multidisciplinary general practitioner super clinic

© 2015, AMJ. All rights reserved. Background The Australian government’s General Practitioner (GP) super clinics programme aims to provide well-integrated, multidisciplinary, patient-centred care for people with chronic disease. However, there is no research into the current role of pharmacists in this setting. Aims To explore the perspectives of GP super clinic staff on current and potential (future) pharmacist-led services provided in this setting. Methods Individual interviews (facilitated using a semi-structured interview guide and thematically analysed) were conducted with purposively sampled staff of a GP super clinic in a semirural location in the state of New South Wales, until theme saturation. Participating staff included (n=9): three GPs, one pharmacist, one nurse, one business manager, and three reception staff. Results Three themes emerged conveying perspectives on: working relationships between staff; a pharmacist’s current role; and potential future roles for a pharmacist. All clinic staff actively engaged the pharmacist in their “team approach”. Currently established roles for home medicines reviews (HMRs) and drug information were well supported, but needed to be expanded, for example, with formalised case conferences between GPs, pharmacists, and other staff. New roles needed be explored in auditing medication use, optimising medication records, specialised drug information, dispensing, and prescribing. Although GPs had differing views about opportunities for pharmacists’ prescribing in this setting, they saw several benefits to this service, such as reducing the time pressure on GPs to enable more effective consultations. Conclusion Results suggest a pharmacist’s services can potentially be better used within the multidisciplinary super clinic model of care to address current gaps within the semi-rural practice setting. Any future role for the pharmacist could be addressed as part of a formalised, strategic approach to creating an integrated healthcare team, with attention to funding and government legislation

A novel parallel nanomixer for high-throughput single-molecule fluorescence detection

This paper introduces a novel fluidic device based on syringe-driven flow of fluorescent species through a parallel array of nanochannels, in which the geometrical confinement enables long observation times of non-immobilized\ud molecules. Extremely low flow rates are achieved by operating the array of nanochannels in parallel with a larger microchannel. The addition of a second microfluidic inlet allows for mixing different species in a well-defined volume,\ud enabling the study of irreversible reactions such as DNA synthesis in real-time using single-molecule fluorescence resonance energy transfer. Devices are fabricated in glass with the purpose of high-throughput single-molecule\ud fluorescence detection

Using scenarios to test the appropriateness of pharmacist prescribing in asthma management

Objective: To explore the potential for community pharmacist prescribing in terms of usefulness, pharmacists' confidence, and appropriateness, in the context of asthma management. Methods: Twenty community pharmacists were recruited using convenience sampling from a group of trained practitioners who had already delivered asthma services. These pharmacists were asked to complete a scenariobased questionnaire (9 scenarios) modelled on information from real patients. Pharmacist interventions were independently reviewed and rated on their appropriateness according to the Respiratory Therapeutic Guidelines (TG) by three expert researchers. Results: In seven of nine scenarios (78%), the most common prescribing intervention made by pharmacists agreed with TG recommendations. Although the prescribing intervention was appropriate in the majority of cases, the execution of such interventions was not in line with guidelines (i.e. dosage or frequency) in the majority of scenarios. Due to this, only 47% (76/162) of the interventions overall were considered appropriate. However, pharmacists were deemed to be often following common clinical practice for asthma prescribing. Therefore 81% (132/162) of prescribing interventions were consistent with clinical practice, which is often not guideline driven, indicating a need for specific training in prescribing according to guidelines. Pharmacists reported that they were confident in making prescribing interventions and that this would be very useful in their management of the patients in the scenarios. Conclusion: Community pharmacists may be able to prescribe asthma medications appropriately to help achieve good outcomes for their patients. However, further training in the guidelines for prescribing are required if pharmacists are to support asthma management in this way

Direct observation of charge inversion by multivalent ions as a universal electrostatic phenomenon

We have directly observed reversal of the polarity of charged surfaces in water upon the addition of tri- and quadrivalent ions using atomic force microscopy. The bulk concentration of multivalent ions at which charge inversion reversibly occurs depends only very weakly on the chemical composition, surface structure, size and lipophilicity of the ions, but is dominated by their valence. These results support the theoretical proposal that spatial correlations between ions are the driving mechanism behind charge inversion.Comment: submitted to PRL, 26-04-2004 Changed the presentation of the theory at the end of the paper. Changed small error in estimate of prefactor ("w" in first version) of equation

Automation of Command and Data Entry in a Glovebox Work Volume: An Evaluation of Data Entry Devices

The present study was designed to examine the human-computer interface for data entry while performing experimental procedures within a glovebox work volume in order to make a recommendation to the Space Station Biological Research Project for a data entry system to be used within the Life Sciences Glovebox. Test subjects entered data using either a manual keypad, similar to a standard computer numerical keypad located within the glovebox work volume, or a voice input system using a speech recognition program with a microphone headset. Numerical input and commands were programmed in an identical manner between the two systems. With both electronic systems, a small trackball was available within the work volume for cursor control. Data, such as sample vial identification numbers, sample tissue weights, and health check parameters of the specimen, were entered directly into procedures that were electronically displayed on a video monitor within the glovebox. A pen and paper system with a 'flip-chart' format for procedure display, similar to that currently in use on the Space Shuttle, was used as a baseline data entry condition. Procedures were performed by a single operator; eight test subjects were used in the study. The electronic systems were tested under both a 'nominal' or 'anomalous' condition. The anomalous condition was introduced into the experimental procedure to increase the probability of finding limitations or problems with human interactions with the electronic systems. Each subject performed five test runs during a test day: two procedures each with voice and keypad, one with and one without anomalies, and one pen and paper procedure. The data collected were both quantitative (times, errors) and qualitative (subjective ratings of the subjects)

Biofuels Production from Biomass by Thermochemical Conversion Technologies

Agricultural biomass as an energy resource has several environmental and economical advantages and has potential to substantially contribute to present days’ fuel demands. Currently, thermochemical processes for agricultural biomass to energy transformation seem promising and feasible. The relative advantage of thermochemical conversion over others is due to higher productivity and compatibility with existing infrastructure facilities. However, the majority of these processes are still under development phase and trying to secure a market share due to various challenges, right from suitable infrastructure, raw material, technical limitations, government policies, and social acceptance. The knowledge at hand suggests that biomass can become a sustainable and major contributor to the current energy demands, if research and development are encouraged in the field of thermochemical conversion for various agricultural biomass types. This paper intends to explore the physical and chemical characteristics of biofuel substitutes of fossil fuels, potential biomass sources, and process parameters for thermochemical conversion

Determining Distribution and Size of Larval Pacific Geoduck Clams (Panopea Generosa Gould 1850) in Quartermaster Harbor (Washington, USA) Using a Novel Sampling Approach

Realistic species-specific information about larval life history is necessary for effective management of shellfish and parameterization of larval connectivity models. The patchiness of dispersing larvae, and the resources needed for sorting and identifying them, has limited many studies of larval distribution in the field, especially for species that are less common. In particular, little is known about in situ larval distribution of Pacific geoduck clams (Panopea generosa Gould 1850), a commercially important species found in Puget Sound, WA. A novel approach-time-integrating larval tube traps paired with molecular identification and sorting (FISH-CS)-was used to determine the distribution of geoduck larvae over 4 moat 3 stations in Quartermaster Harbor. Larvae were found consistently at the surface and thermocline rather than at the bottom. More and larger larvae were captured in the inside and middle of the harbor than the outer harbor, indicating at least some larval retention. Two pulses of larvae were captured, in March and late May to early June. Size frequency distributions of larvae indicate that these were 2 separate cohorts of larvae, with the possibility of a pulse of larvae from elsewhere toward the end of the season. The only physical parameter associated with relative larval abundance was degree of stratification, although the association was weak. These data represent the first reported study of geoduck larval distribution in the field and the first use of the FISH-CS technique for field collections. In the future, this approach can be used to answer many relevant management questions locally and more broadly, including quantifying larval export from shellfish farms, placement of restoration sites and marine protected areas, and spread of invasive species

Role of osmotic and hydrostatic pressures in bacteriophage genome ejection

A critical step in the bacteriophage life cycle is genome ejection into host bacteria. The ejection process for double-stranded DNA phages has been studied thoroughly \textit{in vitro}, where after triggering with the cellular receptor the genome ejects into a buffer. The experimental data have been interpreted in terms of the decrease in free energy of the densely packed DNA associated with genome ejection. Here we detail a simple model of genome ejection in terms of the hydrostatic and osmotic pressures inside the phage, a bacterium, and a buffer solution/culture medium. We argue that the hydrodynamic flow associated with the water movement from the buffer solution into the phage capsid and further drainage into the bacterial cytoplasm, driven by the osmotic gradient between the bacterial cytoplasm and culture medium, provides an alternative mechanism for phage genome ejection \textit{in vivo}; the mechanism is perfectly consistent with phage genome ejection \textit{in vitro}.Comment: 5 pages, 2 figures, references update

Crossover from 2-dimensional to 1-dimensional collective pinning in NbSe3

We have fabricated NbSe$_3$ structures with widths comparable to the Fukuyama-Lee-Rice phase-coherence length. For samples already in the 2-dimensional pinning limit, we observe a crossover from 2-dimensional to 1-dimensional collective pinning when the crystal width is less than 1.6 $\mu$m, corresponding to the phase-coherence length in this direction. Our results show that surface pinning is negligible in our samples, and provide a means to probe the dynamics of single domains giving access to a new regime in charge-density wave physics.Comment: 4 pages, 2 figures, and 1 table. Accepted for publication in Physical Review