Genetic algorithms: a pragmatic, non-parametric approach to exploratory analysis of questionnaires in educational research

Data from a survey to determine student attitudes to their courses are used as an example to show how genetic algorithms can be used in the analysis of questionnaire data. Genetic algorithms provide a means of generating logical rules which predict one variable in a data set by relating it to others. This paper explains the principle underlying genetic algorithms and gives a non-mathematical description of the means by which rules are generated. A commercially available computer program is used to apply genetic algorithms to the survey data. The results are discussed

Evaluation of a Phosphate Management Protocol to Achieve Optimum Serum Phosphate Levels in Hemodialysis Patients

Original article can be found at: http://www.sciencedirect.com/science/journal/10512276 Copyright National Kidney Foundation, Inc. DOI: 10.1053/j.jrn.2008.05.003To evaluate the effectiveness of a protocol designed to optimize serum phosphate levels in patients undergoing regular hemodialysis (HD).Peer reviewe

Approximate roots of a valuation and the Pierce-Birkhoff Conjecture

This paper is a step in our program for proving the Piece-Birkhoff Conjecture for regular rings of any dimension (this would contain, in particular, the classical Pierce-Birkhoff conjecture which deals with polynomial rings over a real closed field). We first recall the Connectedness and the Definable Connectedness conjectures, both of which imply the Pierce - Birkhoff conjecture. Then we introduce the notion of a system of approximate roots of a valuation v on a ring A (that is, a collection Q of elements of A such that every v-ideal is generated by products of elements of Q). We use approximate roots to give explicit formulae for sets in the real spectrum of A which we strongly believe to satisfy the conclusion of the Definable Connectedness conjecture. We prove this claim in the special case of dimension 2. This proves the Pierce-Birkhoff conjecture for arbitrary regular 2-dimensional rings

Consultation skills development in general practice: findings from a qualitative study of newly recruited and more experienced clinical pharmacists during the COVID-19 pandemic.

The new structured medication review (SMR) service was introduced into the National Health Service in England during the COVID-19 pandemic, following a major expansion of clinical pharmacists within new formations known as primary care networks (PCNs). The aim of the SMR is to tackle problematic polypharmacy through comprehensive, personalised medication reviews involving shared decision-making. Investigation of clinical pharmacists' perceptions of training needs and skills acquisition issues for person-centred consultation practice will help better understand their readiness for these new roles. A longitudinal interview and observational study in general practice. A longitudinal study of 10 newly recruited clinical pharmacists interviewed three times, plus a single interview with 10 pharmacists recruited earlier and already established in general practice, across 20 newly forming PCNs in England. Observation of a compulsory 2-day history taking and consultation skills workshop. A modified framework method supported a constructionist thematic analysis. Remote working during the pandemic limited opportunities for patient-facing contact. Pharmacists new to their role in general practice were predominantly concerned with improving clinical knowledge and competence. Most said they already practiced person-centred care, using this terminology to describe transactional medicines-focused practice. Pharmacists rarely received direct feedback on consultation practice to calibrate perceptions of their own competence in person-centred communication, including shared decision-making skills. Training thus provided knowledge delivery with limited opportunities for actual skills acquisition. Pharmacists had difficulty translating abstract consultation principles into specific consultation practices. SMRs were introduced when the dedicated workforce was largely new and being trained. Addressing problematic polypharmacy requires structural and organisational interventions to enhance the communication skills of clinical pharmacists (and other health professionals), and their use in practice. The development of person-centred consultation skills requires much more substantial support than has so far been provided for clinical pharmacists. [Abstract copyright: © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Alcohol, the overlooked drug: clinical pharmacist perspectives on addressing alcohol in primary care.

Attempts to routinely embed brief interventions in health systems have long been challenging, with healthcare professionals concerned about role adequacy, legitimacy, and support. This is the first study to explore clinical pharmacists' experiences of discussing alcohol with patients in their new role in UK primary care, in developing a novel approach to brief intervention. It investigates their confidence with the subject of alcohol in routine practice and explores views on a new approach, integrating alcohol into the medication review as another drug directly linked to the patient's health conditions and medicines, rather than a separated 'healthy living' issue. The study forms part of wider efforts to repurpose and reimagine the potential application of brief interventions and to rework their contents. Longitudinal qualitative study of 10 recruits to the new clinical pharmacist role in English primary care, involving three semi-structured interviews over approximately 16 months, supplemented by 10 one-off interviews with pharmacists already established in general practice. When raised at all, enquiring about alcohol in medication reviews was described in terms of calculating dose and level of consumption, leading to crude advice to reduce drinking. The idea was that those who appeared dependent should be referred to specialist services, though few such referrals were recalled. Pharmacists acknowledged that they were not currently considering alcohol as a drug in their practice and were interested in learning more about this concept and the approach it entailed, particularly in relation to polypharmacy. Some recognised a linked need to enhance consultation skills. Alcohol complicates routine clinical care and adversely impacts patient outcomes, even for those drinking at seemingly unremarkable levels. Changing clinical practice on alcohol requires engaging with, and supportively challenging, routine practices and entrenched ideas of different kinds. Framing alcohol as a drug may help shift the focus from patients with alcohol problems to problems caused for patients by alcohol. This is less stigmatising and provides role legitimacy for pharmacists to address alcohol clinically in medication reviews, thus providing one element in the formation of a new prevention paradigm. This approach invites further innovations tailored to other healthcare professional roles. [Abstract copyright: © 2023. The Author(s).

The Nature of the Low-Metallicity ISM in the Dwarf Galaxy NGC 1569

We are modeling the spectra of dwarf galaxies from infrared to submillimeter wavelengths to understand the nature of the various dust components in low-metallicity environments, which may be comparable to the ISM of galaxies in their early evolutionary state. The overall nature of the dust in these environments appears to differ from those of higher metallicity starbursting systems. Here, we present a study of one of our sample of dwarf galaxies, NGC 1569, which is a nearby, well-studied starbursting dwarf. Using ISOCAM, IRAS, ISOPHOT and SCUBA data with the Desert et al. (1990) model, we find consistency with little contribution from PAHs and Very Small Grains and a relative abundance of bigger colder grains, which dominate the FIR and submillimeter wavelengths. We are compelled to use 4 dust components, adding a very cold dust component, to reproduce the submillimetre excess of our observations.Comment: 4 pages, 4 postscript figures. Proceedings of "Infrared and Submillimeter Astronomy. An International Colloquium to Honor the Memory of Guy Serra" (2002

Private Sector Credit, Policy and Enforcement: 1978-1982. Quarterly Economic Commentary Special Article, May 1983

This paper is concerned with exammmg certain aspects of the Central Bank's quantitative credit guidelines over the period 1978 to 1982. The sectoral or personal lending guidelines are not considered in this paper. The approach is to consider first the policy aspects to the guidelines and in particular the relationship between the guideline and the external reserve objective. Secondly, the issue of neutralization of interest rates is discussed and some evidence is presented on this matter. Finally, the paper examines how Central Bank enforcement may act as an indicator of the existence and timing of credit rationing and concludes by demonstrating how policy and enforcement combined to cause a reduction in the Associated Banks' relative lending share

Dielectric response of a polar fluid trapped in a spherical nanocavity

We present extensive Molecular Dynamics simulation results for the structure, static and dynamical response of a droplet of 1000 soft spheres carrying extended dipoles and confined to spherical cavities of radii $R=2.5$, 3, and 4 nm embedded in a dielectric continuum of permittivity $\epsilon' \geq 1$. The polarisation of the external medium by the charge distribution inside the cavity is accounted for by appropriate image charges. We focus on the influence of the external permittivity $\epsilon'$ on the static and dynamic properties of the confined fluid. The density profile and local orientational order parameter of the dipoles turn out to be remarkably insensitive to $\epsilon'$. Permittivity profiles $\epsilon(r)$ inside the spherical cavity are calculated from a generalised Kirkwood formula. These profiles oscillate in phase with the density profiles and go to a ``bulk'' value $\epsilon_b$ away from the confining surface; $\epsilon_b$ is only weakly dependent on $\epsilon'$, except for $\epsilon' = 1$ (vacuum), and is strongly reduced compared to the permittivity of a uniform (bulk) fluid under comparable thermodynamic conditions. The dynamic relaxation of the total dipole moment of the sample is found to be strongly dependent on $\epsilon'$, and to exhibit oscillatory behaviour when $\epsilon'=1$; the relaxation is an order of magnitude faster than in the bulk. The complex frequency-dependent permittivity $\epsilon(\omega)$ is sensitive to $\epsilon'$ at low frequencies, and the zero frequency limit $\epsilon(\omega=0)$ is systematically lower than the ``bulk'' value $\epsilon_b$ of the static primitivity.Comment: 12 pages including 17 figure

Integration of a clinical pharmacist workforce into newly forming primary care networks: a qualitatively driven, complex systems analysis

Objective The introduction of a new clinical pharmacist workforce via Primary Care Networks (PCNs) is a recent national policy development in the National Health Service in England. This study elicits the perspectives of people with responsibility for local implementation of this national policy package. Attention to local delivery is necessary to understand the contextual factors shaping the integration of the new clinical pharmacy workforce, and thus can be expected to influence future role development. Design A qualitative, interview study Setting and participants PCN Clinical Directors and senior pharmacists across 17 PCNs in England (n=28) Analysis Interviews were transcribed, coded and organised using the framework method. Thematic analysis and complex systems modelling were then undertaken iteratively to develop the themes. Results Findings were organised into two overarching themes: (1) local organisational innovations of a national policy under conditions of uncertainty; and (2) local multiprofessional decision-making on clinical pharmacy workforce integration and initial task assignment. Although a phased implementation of the PCN package was planned, the findings suggest that processes of PCN formation and clinical pharmacist workforce integration were closely intertwined, with underpinning decisions taking place under conditions of considerable uncertainty and workforce pressures. Conclusions National policy decisions that required General Practitioners to form PCNs at the same time as they integrated a new workforce risked undermining the potential of both PCNs and the new workforce. PCNs require time and support to fully form and integrate clinical pharmacists if successful role development is to occur. Efforts to incentivise delivery of PCN pharmacy services in future must be responsive to local capacity

Water exchange at a hydrated platinum electrode is rare and collective

We use molecular dynamics simulations to study the exchange kinetics of water molecules at a model metal electrode surface -- exchange between water molecules in the bulk liquid and water molecules bound to the metal. This process is a rare event, with a mean residence time of a bound water of about 40 ns for the model we consider. With analysis borrowed from the techniques of rare-event sampling, we show how this exchange or desorption is controlled by (1) reorganization of the hydrogen bond network within the adlayer of bound water molecules, and by (2) interfacial density fluctuations of the bulk liquid adjacent to the adlayer. We define collective coordinates that describe the desorption mechanism. Spatial and temporal correlations associated with a single event extend over nanometers and tens of picoseconds.Comment: 10 pages, 9 figure