Defining pharmacy and its practice: a conceptual model for an international audience

Background: There is much fragmentation and little consensus in the use of descriptors for the different disciplines that make up the pharmacy sector. Globalization, reprofessionalization and the influx of other disciplines means there is a requirement for a greater degree of standardization. This has not been well addressed in the pharmacy practice research and education literature. Objectives: To identify and define the various subdisciplines of the pharmacy sector and integrate them into an internationally relevant conceptual model based on narrative synthesis of the literature. Methods: A literature review was undertaken to understand the fragmentation in dialogue surrounding definitions relating to concepts and practices in the context of the pharmacy sector. From a synthesis of this literature, the need for this model was justified. Key assumptions of the model were identified, and an organic process of development took place with the three authors engaging in a process of sense-making to theorize the model. Results: The model is “fit for purpose” across multiple countries and includes two components making up the umbrella term “pharmaceutical practice”. The first component is the four conceptual dimensions, which outline the disciplines including social and administrative sciences, community pharmacy, clinical pharmacy and pharmaceutical sciences. The second component of the model describes the “acts of practice”: teaching, research and professional advocacy; service and academic enterprise. Conclusions: This model aims to expose issues relating to defining pharmacy and its practice and to create dialogue. No model is perfect, but there are implications for what is posited in the areas of policy, education and practice and future research. The main point is the need for increased clarity, or at least beginning the discussion to increase the clarity of definition and consistency of meaning in-and-across the pharmacy sector locally, nationally and internationall

Validation of the Algorithms Developed for Preliminary Prediction of Daylight Distribution in a Toplighted Atrium

Empirically based preliminary prediction algorithms were recently developed for different atrium types under various diffuse sky conditions. In the case of toplighted atriums, these algorithms were developed to predict light levels on the horizontal floor and on the vertical wall surfaces of the atrium. However, the actual building atriums measured to assess these algorithms in a full-scale setting were four stories high or lower. This study presents an investigation of the validity of the developed algorithms using full-scale measurements in two four-sided toplighted atriums 11 and 14 stories high respectively. The measurements were made over several days in the two large atriums of the Anatole Hotel in Dallas, Texas. These data are compared with the algorithm predictions, and the usefulness of the prediction models is discussed

Combining Ability and Heterosis for Yield and Yield Components in Maize

Abstract: The study was conducted at two sites , University of Khartoum the experimental farm, faculty of Agriculture, Shambat and at west of Khartoum state, Elrawkeeb Dry Land Research Station, Sudan, during the summer and winter seasons of 2009 and 2010 respectively. Five inbred lines (2, 3, 6, 277, and 405) were used as lines and two inbred lines namely (66Y and 160) were used as (testers). These lines were crossed together according to line x tester technique to generate 10 F 1 -hybrids, every genotype was planted in rows with 4 m along, 70cm between rows and 25cm between plants. A line × tester method for estimation the general combining ability (GCA) of parent and specific combining ability (SCA) of their F 1 -hybrids was used. Genetic components resulting from additive and nonadditive type of gene action were also estimated. Heterosis was measured as a deviation from the midparents and better-parent. The analysis of variance for combining ability revealed that both GCA and SCA variances were highly significant for most of the studied characters indicating importance of additive as well as non-additive types of gene action in controlling these traits. GCA mean squares for inbred lines were significant (P < 0.01) for all the traits except cob length and number of kernels/row while GCA due to testers was only significant (P<0.05) for 100-kernels weight. Moreover, variances due to SCA were higher in magnitude than GCA for the yield and yield components except cob diameter, number of rows/cob, number of kernels/row and harvest index. GCA to SCA ratios were less than one for most of the traits except cob diameter, number of kernels row/cob, number of kernels/row and harvest index indicating a preponderance of additive over no additive gene action. High positive heterosis for grain yield and its components was found for more than half of the hybrids studied. Crosses involving 160×3 and 66Y×2 produced the highest heterosis. It can be concluded that these parental lines can be desirable parents for hybrids as well as for inclusion in breeding program, since they may contribute favorable alleles in the synthesis of new varietie

Dose volume histogram analysis of normal structures associated with accelerated partial breast irradiation delivered by high dose rate brachytherapy and comparison with whole breast external beam radiotherapy fields

<p>Abstract</p> <p>Purpose</p> <p>To assess the radiation dose delivered to the heart and ipsilateral lung during accelerated partial breast brachytherapy using a MammoSite™ applicator and compare to those produced by whole breast external beam radiotherapy (WBRT).</p> <p>Materials and methods</p> <p>Dosimetric analysis was conducted on patients receiving MammoSite breast brachytherapy following conservative surgery for invasive ductal carcinoma. Cardiac dose was evaluated for patients with left breast tumors with a CT scan encompassing the entire heart. Lung dose was evaluated for patients in whom the entire lung was scanned. The prescription dose of 3400 cGy was 1 cm from the balloon surface. MammoSite dosimetry was compared to simulated WBRT fields with and without radiobiological correction for the effects of dose and fractionation. Dose parameters such as the volume of the structure receiving 10 Gy or more (V10) and the dose received by 20 cc of the structure (D20), were calculated as well as the maximum and mean doses received.</p> <p>Results</p> <p>Fifteen patients were studied, five had complete lung data and six had left-sided tumors with complete cardiac data. Ipsilateral lung volumes ranged from 925–1380 cc. Cardiac volumes ranged from 337–551 cc. MammoSite resulted in a significantly lower percentage lung V30 and lung and cardiac V20 than the WBRT fields, with and without radiobiological correction.</p> <p>Conclusion</p> <p>This study gives low values for incidental radiation received by the heart and ipsilateral lung using the MammoSite applicator. The volume of heart and lung irradiated to clinically significant levels was significantly lower with the MammoSite applicator than using simulated WBRT fields of the same CT data sets.</p> <p>Trial registration</p> <p>Dana Farber Trial Registry number 03-179</p

Free-standing graphene films embedded in epoxy resin with enhanced thermal properties

The poor thermal conductivity of polymer composites has long been a deterrent to their increased use in high-end aerospace or defence applications. This study describes a new approach for the incorporation of graphene in an epoxy resin, through the addition of graphene as free-standing film in the polymeric matrix. The electrical and thermal conductivity of composites embedding two different free-standing graphene films was compared to composites with embedded carbon nanotube buckypapers (CNT-BP). Considerably higher thermal conductivity values than those achieved with conventional dispersing methods of graphene or CNTs in epoxy resins were obtained. The characterisation was complemented with a study of the structure at the microscale by cross-sectional scanning electron microscopy (SEM) images and a thermogravimetric analysis (TGA). The films are preconditioned in order to incorporate them into the composites, and the complete manufacturing process proposed allows the production and processing of these materials in large batches. The high thermal conductivity obtained for the composites opens the way for their use in demanding thermal management applications, such as electronic enclosures or platforms facing critical temperature loads.European Defence Agency tender No 17.ESI.OP.066. Study on the Impact of Graphene on Defence Application

POTENTIAL EFFECTS OF DUKU (LANSIUM DOMESTICUM CORR) AND LANGSAT (LANSIUM DOMESTICUM JACK) EXTRACTS ON THE GROWTH OF BIFIDOBACTERIA SPP.

Objective: Lansium domesticum Corr. is a fruit tree species belongs to the family Meliaceae. There are numerous forms of the species and grouped into two main types: Duku and Langsat. The objective of this study is to screen the ability of adding extracts of freeze-dried duku and langsat to stimulate the growth and stability of selected Bifidobacteria spp in skimmed milk.Methods: Samples were prepared by adding either 5% or 12% of oligosaccharides from duku, langsat, inulin, galacto-oligosaccharides (GOS) and fructo-oligosaccharides (FOS) to 5% and 12% (w/v) reconstituted nonfat dry milk (NDM), respectively. The specific growth rates (µ) for each sample were calculated. All experiments were replicated ten times.Results: The mean doubling time (Td) for Bifidobacterium longum, was lowest in the presence of freeze-dried duku and langsat compared to GOS, FOS and inulin. Retention of the viability of five Bifidobacterium species was greatest in the presence of freeze-dried duku and langsat followed by GOS, FOS and inulin. The highest percentage of acetic and lactic acids were produced by B. longum, B. infantis and B. adolescentis with freeze-dried duku and langsat. The pattern of results was similar to the commercial product, oligosaccharides (inulin, GOS and FOS). Conclusion: Therefore, this study provides promising results on promoting growth and probiotic activity of natural oligosaccharides compound from freeze-dried duku and langsat

Adjuvant chemotherapy with or without bevacizumab in patients with resected non-small-cell lung cancer (E1505): an open-label, multicentre, randomised, phase 3 trial.

BackgroundAdjuvant chemotherapy for resected early-stage non-small-cell lung cancer (NSCLC) provides a modest survival benefit. Bevacizumab, a monoclonal antibody directed against VEGF, improves outcomes when added to platinum-based chemotherapy in advanced-stage non-squamous NSCLC. We aimed to evaluate the addition of bevacizumab to adjuvant chemotherapy in early-stage resected NSCLC.MethodsWe did an open-label, randomised, phase 3 trial of adult patients (aged ≥18 years) with an Eastern Cooperative Oncology Group performance status of 0 or 1 and who had completely resected stage IB (≥4 cm) to IIIA (defined by the American Joint Committee on Cancer 6th edition) NSCLC. We enrolled patients from across the US National Clinical Trials Network, including patients from the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network (ECOG-ACRIN) affiliates in Europe and from the Canadian Cancer Trials Group, within 6-12 weeks of surgery. The chemotherapy regimen for each patient was selected before randomisation and administered intravenously; it consisted of four 21-day cycles of cisplatin (75 mg/m2 on day 1 in all regimens) in combination with investigator's choice of vinorelbine (30 mg/m2 on days 1 and 8), docetaxel (75 mg/m2 on day 1), gemcitabine (1200 mg/m2 on days 1 and 8), or pemetrexed (500 mg/m2 on day 1). Patients in the bevacizumab group received bevacizumab 15 mg/kg intravenously every 21 days starting with cycle 1 of chemotherapy and continuing for 1 year. We randomly allocated patients (1:1) to group A (chemotherapy alone) or group B (chemotherapy plus bevacizumab), centrally, using permuted blocks sizes and stratified by chemotherapy regimen, stage of disease, histology, and sex. No one was masked to treatment assignment, except the Data Safety and Monitoring Committee. The primary endpoint was overall survival, analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00324805.FindingsBetween June 1, 2007, and Sept 20, 2013, 1501 patients were enrolled and randomly assigned to the two treatment groups: 749 to group A (chemotherapy alone) and 752 to group B (chemotherapy plus bevacizumab). 383 (26%) of 1458 patients (with complete staging information) had stage IB, 636 (44%) had stage II, and 439 (30%) had stage IIIA disease (stage of disease data were missing for 43 patients). Squamous cell histology was reported for 422 (28%) of 1501 patients. All four cisplatin-based chemotherapy regimens were used: 377 (25%) patients received vinorelbine, 343 (23%) received docetaxel, 283 (19%) received gemcitabine, and 497 (33%) received pemetrexed. At a median follow-up of 50·3 months (IQR 32·9-68·0), the estimated median overall survival in group A has not been reached, and in group B was 85·8 months (95% CI 74·9 to not reached); hazard ratio (group B vs group A) 0·99 (95% CI 0·82-1·19; p=0·90). Grade 3-5 toxicities of note (all attributions) that were reported more frequently in group B (the bevacizumab group) than in group A (chemotherapy alone) were overall worst grade (ie, all grade 3-5 toxicities; 496 [67%] of 738 in group A vs 610 [83%] of 735 in group B), hypertension (60 [8%] vs 219 [30%]), and neutropenia (241 [33%] vs 275 [37%]). The number of deaths on treatment did not differ between the groups (15 deaths in group A vs 19 in group B). Of these deaths, three in group A and ten in group B were considered at least possibly related to treatment.InterpretationAddition of bevacizumab to adjuvant chemotherapy did not improve overall survival for patients with surgically resected early-stage NSCLC. Bevacizumab does not have a role in this setting and should not be considered as an adjuvant therapy for patients with resected early-stage NSCLC.FundingNational Cancer Institute of the National Institutes of Health

Assessment of power spectral density of microvascular hemodynamics in skeletal muscles at very low and low-frequency via near-infrared diffuse optical spectroscopies

In this work, we used a hybrid time domain near-infrared spectroscopy (TD-NIRS) and diffuse correlation spectroscopy (DCS) device to retrieve hemoglobin and blood flow oscillations of skeletal muscle microvasculature. We focused on very low (VLF) and low-frequency (LF) oscillations (i.e., frequency lower than 0.145 Hz), that are related to myogenic, neurogenic and endothelial activities. We measured power spectral density (PSD) of blood flow and hemoglobin concentration in four muscles (thenar eminence, plantar fascia, sternocleidomastoid and forearm) of 14 healthy volunteers to highlight possible differences in microvascular hemodynamic oscillations. We observed larger PSDs for blood flow compared to hemoglobin concentration, in particular in case of distal muscles (i.e., thenar eminence and plantar fascia). Finally, we compared the PSDs measured on the thenar eminence of healthy subjects with the ones measured on a septic patient in the intensive care unit: lower power in the endothelial-dependent frequency band, and larger power in the myogenic ones were observed in the septic patient, in accordance with previous works based on laser doppler flowmetry

Risk factors associated with typhoid fever in children aged 2-16 years in Karachi, Pakistan

We analysed the data from the control group in a typhoid vaccine trial in Karachi to assess the differences in individual-, household-and cluster-level characteristics for developing typhoid fever. The annual incidence of typhoid in children aged 2-16 years in the control arm of the vaccine trial was 151/100 000 population. After adjustment, the risk of typhoid was lower with increasing age [risk ratio (RR) 0.89, 95% confidence interval (CI) 0.83-0.95], was higher with an increase in population density (RR 1.13, 95% CI 1.05-1.21) and was lower in the households using a safe drinking-water source (RR 0.63, 95% CI 0.41-0.99). Typhoid fever affects younger children living in areas of high population density and lack of access to safe water in Pakistan. A combination of environmental and biological interventions is required to prevent the continued epidemiological and economic impact of typhoid fever in high-risk areas of Pakistan

Mortgage design in an equilibrium model of the housing market

How can mortgages be redesigned to reduce macrovolatility and default? We address this question using a quantitative equilibrium life‐cycle model. Designs with countercyclical payments outperform fixed payments. Among those, designs that front‐load payment reductions in recessions outperform those that spread relief over the full term. Front‐loading alleviates liquidity constraints when they bind most, reducing default and stimulating housing demand. To illustrate, a fixed‐rate mortgage (FRM) with an option to convert to adjustable‐rate mortgage, which front‐loads payment reductions relative to an FRM with an option to refinance underwater, reduces price and consumption declines six times as much and default three times as much.Funding Provided by NSF under grant "Mortgage Design in an Equilibrium Model of the Housing Market" (1623801 - National Science Foundation)Accepted manuscrip