A pilot study of the S-MAP (Solutions for Medications Adherence Problems) intervention for older adults prescribed polypharmacy in primary care: Study protocol

Background: Adhering to multiple medications as prescribed is challenging for older patients (aged ≥ 65 years) and a difficult behaviour to improve. Previous interventions designed to address this have been largely complex in nature but have shown limited effectiveness and have rarely used theory in their design. It has been recognised that theory ('a systematic way of understanding events or situations') can guide intervention development and help researchers better understand how complex adherence interventions work. This pilot study aims to test a novel community pharmacy-based intervention that has been systematically developed using the Theoretical Domains Framework (12-domain version) of behaviour change. Methods: As part of a non-randomised pilot study, pharmacists in 12 community pharmacies across Northern Ireland (n = 6) and London, England (n = 6), will be trained to deliver the intervention to older patients who are prescribed ≥ 4 regular medicines and are non-adherent (self-reported). Ten patients will be recruited per pharmacy (n = 120) and offered up to four tailored one-to-one sessions, in the pharmacy or via telephone depending on their adherence, over a 3-4-month period. Guided by an electronic application (app) on iPads, the intervention content will be tailored to each patient's underlying reasons for non-adherence and mapped to the most appropriate solutions using established behaviour change techniques. This study will assess the feasibility of collecting data on the primary outcome of medication adherence (self-report and dispensing data) and secondary outcomes (health-related quality of life and unplanned hospitalisations). An embedded process evaluation will assess training fidelity for pharmacy staff, intervention fidelity, acceptability to patients and pharmacists and the intervention's mechanism of action. Process evaluation data will include audio-recordings of training workshops, intervention sessions, feedback interviews and patient surveys. Analysis will be largely descriptive. Discussion: Using pre-defined progression criteria, the findings from this pilot study will guide the decision whether to proceed to a cluster randomised controlled trial to test the effectiveness of the S-MAP intervention in comparison to usual care in community pharmacies. The study will also explore how the intervention components may work to bring about change in older patients' adherence behaviour and guide further refinement of the intervention and study procedures. Trial registration: This study is registered at ISRCTN: https://doi.org/10.1186/ISRCTN7383153

Appropriate Polypharmacy and Medicine Safety: When Many is not Too Many

The use of multiple medicines (polypharmacy) is increasingly common in middle-aged and older populations. Ensuring the correct balance between the prescribing of ‘many’ drugs and ‘too many’ drugs is a significant challenge. Clinicians are tasked with ensuring that patients receive the most appropriate combinations of medications based on the best available evidence, and that medication use is optimised according to patients’ clinical needs (appropriate polypharmacy). Historically, polypharmacy has been viewed negatively because of the associated medication safety risks, such as drug interactions and adverse drug events. More recently, polypharmacy has been identified as a risk factor for under-prescribing, such that patients do not receive necessary medications and this can also pose risks to patients’ safety and well-being. The negative connotations that have long been associated with the term polypharmacy could potentially be acting as a driving factor for under-prescribing, whereby clinicians are reluctant to prescribe necessary medicines for patients who are already receiving ‘many’ medicines. It is now recognised that the prescribing of ‘many’ medicines can be entirely appropriate in patients with several chronic conditions and that the risks of adverse drug events that have been associated with polypharmacy may be greatly reduced when patients’ clinical context is taken into consideration. In this article, we outline the current perspectives on polypharmacy and make the case for adopting the term ‘appropriate polypharmacy’ in differentiating between the prescribing of ‘many’ drugs and ‘too many’ drugs. We also outline the inherent challenges in doing so and provide recommendations for future clinical practice and research

Magnetic properties of a novel Pr Fe Ti phase

In a systematic study of the (Pr1−xTix)Fe5 alloy series, the (Pr0.65Ti0.35)Fe5 alloy has been found to have a dominant phase with either the rhombohedral Th2Zn17 structure or the newly discovered Nd2(Fe,Ti)19 (S. J. Collocott, R. K. Day, J. B. Dunlop, and R. L. Davis, in Proceedings of the Seventh International Symposium on Magnetic Anisotropy and Coercivity in R‐T Alloys, Canberra, July 1992, p. 437) structure, depending on the annealing procedure. Powder‐x‐ray‐diffraction patterns and scanning electron microscopy show that the sample annealed at a temperature of 850 °C followed by 1000 °C has the 2:17 structure whereas annealing at 1000 °C directly leads to the new 2:19 structure. Energy‐dispersive x‐ray analysis yields Pr:Fe:Ti ratios of 10.7:86.2:3.1 for the Pr2(Fe,Ti)17 phase and 9.2:85.9:4.9 for the Pr2(Fe,Ti)19 phase. 57 Fe Mössbauer spectroscopy (at 295 K) gives values for the average 57 Fe hyperfine field of 15.7 T for the 2:17 phase and 17.5 T for the 2:19 phase, respectively

An evaluation of nonprofit brand image: towards a better conceptualization and measurement

Nonprofit brand image plays an important role in shaping consumers’ charitable donations and therefore nonprofit organizations must be aware of how consumers perceive them. This research examines nonprofit brand image and reports findings from three empirical studies, which aim to offer a better conceptualization and measurement of the concept. Study 1 investigates the psychometric properties of the Michel and Rieunier’s (2012) nonprofit brand image scales with a sample from the UK, and reports key methodological limitations. Specifically, discriminant and convergent validity tests highlight the need for further research into the dimensionality of the nonprofit brand image measures. Subsequently, studies 2 and 3 offer an improved conceptualization and measurement of nonprofit brand image and validate the scales via the use of 2 separate data sets. The new measures consists of 6 dimensions namely, usefulness, efficiency, affect, dynamism, reliability and ethicality which are significantly related to intentions to donate money and time

Novel potentiometric sensors based on calixarenes

This thesis represents a study of the performance of potentiometnc ion sensors incorporating modified calixarene compounds as the lonophores. Three different groups of modified calixarenes were studied, namely tetramenc, hexamenc and oxa calixarenes and formed the basis of Na+, Cs+ and K+ sensors respectively. Tetramenc calix[4]arenes containing ketone functionalities methyl ketone (If), tbutyl ketone (Ig) and adamantyl ketone (Ih) and ester functionalities methyl ester (Ic), ethyl ester (Id) and «-butyl ester (Ie) were incorporated into mini electrode and macro electrode sensors with a conventional liquid filling solution. A further two denvatives containing the monoacid tnmethylester (Ij) and the monoacid tnethylester (Ik) were also assessed for their lonophonc potential and compared to their tetra methylester and tetra ethylester counterparts. All of the ester compounds and the methyl ketone denvative were found to exhibit excellent selectivities for sodium ions over the alkali and alkaline earth metals. An effort was made throughout the research to identify the functionalities in these new class of complexing ligands which are most likely to induce and enhance selective lonbinding. The caesium selective electrodes were based on hexamenc calix[6]arenes ligands (Ila) and (lib). Both ligands contained an ethylester moiety in the substituted lower nm position with an unsubstituted (Ha) and p-t-butyl substituted (lib) para position. The potassium selective electrodes are based on some monooxa and dioxa calix[4]arenes and on the ethylester p-f-butyl calix[5]arene. The oxa calixarenes contain an additional methoxy spacer unit in the macrocyclic nng and hence have cavity sizes intermediate between that of the tetramenc and hexamenc structures. The electrodes based on these ligands showed varying degrees of selectivity and stability but are unlikely to provide viable individual ion sensors for potassium. The final section of the thesis is devoted to solid state sensors. Electrodes were constructed by contacting the PVC liquid membrane either directly onto a platinum substrate or indirectly where the contact between the PVC and the platinum was provided by a layer of conducting polymer polypyrrole (PPy). The calix[4]arene involved was the tetramenc ethylester denvative (Id). Good functioning electrodes were produced and the PPy layer was found to enhance the stability of the contact

57-Fe Mossbauer study of magnetic ordering in superconducting K_0.85Fe_1.83Se_2.09 single crystals

The magnetic ordering of superconducting single crystals of K_0.85Fe_1.83Se_2.09 has been studied between 10K and 550K using 57-Fe Mossbauer spectroscopy. Despite being superconducting below T_sc ~30K, the iron sublattice in K_0.85Fe_1.83Se_2.09 clearly exhibits magnetic order from well below T_sc to its N\'eel temperature of T_N = 532 +/- 2K. The iron moments are ordered perpendicular to the single crystal plates, i.e. parallel to the crystal c-axis. The order collapses rapidly above 500K and the accompanying growth of a paramagnetic component suggests that the magnetic transition may be first order, which may explain the unusual temperature dependence reported in recent neutron diffraction studies.Comment: 6 pages, 4 figures Submitted to Phys.Rev.

Magnetic properties of Gd(Fe1−xCox)9Ti2 alloys

Four samples of Gd(Fe1−xCox)9Ti2 with x=0.0, 0.1, 0.2, and 0.3 were prepared by conventional arc melting followed by annealing at 1000 °C for 3 days. Powder‐x‐ray‐diffraction patterns of these samples show that all of the samples have a dominant phase with the tetragonal CeMn6Ni5 structure. Traces of TiFe2 are also present. 57 Fe Mössbauer spectra have been collected at 80 and 295 K. X‐ray‐diffraction patterns and Mössbauer spectra on magnetically aligned samples indicate that the easy axis of magnetization is the crystallographic c axis. The Curie temperature increases monotonically with increasing cobalt concentration. The average hyperfine field at 80 K reaches a maximum of 26.8(5) T for x≊0.2

Neutron powder diffraction determination of the magnetic structure of Nd2Al

We have determined the magnetic structure of Nd 2 Al by neutron powder diffraction. This orthorhombic intermetallic compound orders ferromagnetically below 36 K with the Nd moments aligned along the b-axis. Even at 1.7 K, the larger of the two Nd moments is only 2.3(2) μ B , about 70% of the 'free-ion' value of 3.27 μ B . This reduction is a consequence of the substantial crystal-field effects at the Nd 3+ sites.(c) 2011 IOP Publishing LT