Financial accountability, pharmacists and doctors: control issues in a professional context

The reforming of the UK National Health Service (NHS), in response to pressure on financial resources, has led to the reshaping of healthcare professionals' roles. Within NHS hospitals, clinicians traditionally have held a dominant position in terms of decision making with regard to the use of resources and clinical autonomy. However, the changing environment now faced by hospital clinicians, in the form of increasing financial, legal and regulatory complexities is having an impact on their power base as managerial and accounting control becomes a key element in the changes advocated by healthcare reformers. Some have argued that these changes challenge the power and autonomy of clinicians and their relationships with other healthcare professionals and society; perhaps best exemplified by the increasing role of clinical pharmacists in prescribing decisions. In the past, pharmacy as a health care function has been termed a marginal or quasi-profession due to its apparent inability to promote and control its existence. Traditional professional and jurisdictional boundaries militated against a closer working relationship between pharmacists and clinicians, contributing to this marginalisation.This thesis investigates the impact that NPM initiatives and increases in financial accountability have had on the pharmacy and the medical professions. It will be shown that, over the last 25 years or so, there have been significant developments in hospital pharmaceutical services which have served to erode the professional boundaries through the emergence of specialist pharmacy services and clinical pharmacists that operate in the clinical setting. The findings demonstrate that, clinical pharmacists, whose specialism is to assist the clinicians in safe, economic and effective use of medicines by optimizing pharmaceutical factors, are increasingly being utilized and regarded as an essential function within the hospital setting. Indeed it has been suggested by both parties that as clinicians increasingly feel the pressure of financial constraints that pharmacy's involvement in clinical decisions and prescribing practice should continue to increase.This research, therefore, illuminates the erosion of professional boundaries within healthcare as a result of NPM initiatives and increased financial accountability. In particular it focuses upon the changing relationship between pharmacy and the medical profession. The baseline for this study is the period between the Conservatives government reign under the leadership of Margaret Thatcher to the end of New Labour's term in office. The empirical findings generate valuable information that helps to explain and aid our understanding of the professional relationships of clinical pharmacists and clinicians in the current drive towards the rationalisation of prescribing and cost containment procedures. It further, shows how changes in financial accountability have served as a catalyst in the erosion of professional boundaries between the two professions

Pharmacists prescribing : A professional restratification or a back to the future scenario?

DATA AVAILABILITY STATEMENT The data that support the findings of this study are available on request from the corresponding author. The data arenot publicly available due to privacy or ethical restrictions.Peer reviewedPostprin

Sustainability on campus : knowledge creation through social and environmental reporting

We are very grateful for the comments received by the reviewers of this paper. We appreciate the support received by members of staff and external organizations (due to research procedures we are unable to disclose their names) that contributed to the project. We also would like to express our appreciation to Dr Bill Jackson and Dr Akira Yonekura for their useful comments and feedback. Thanks also go to the students who participated in the project. Without their engagement and passion to the subject this article would not exist. An early version of this paper was presented the 2013 International Enhancement Themes Conference organized by the Scottish Higher Education Academy. We very much appreciated the comments received during this event. We are also grateful for the comments we received at the BAFA 50th Annual conference. We also would like to give our thanks to the Edinburgh Centre for European Financial Studies (EDIFIS) and the QAA Enhancement Theme, who provided small grants to the University Enhancement Group to support this project.Peer reviewedPostprin

Accounting control, governance and anti-corruption initiatives in public sector organisations

This special issue focuses on the interactions between accounting, public sector organisations and the socio-economic and political environments in which they operate, with a specific focus on the critical analysis of policy and practice in the fight against corruption. The aim of the special issue is to disseminate knowledge to enable a more sustainable, accountable and less corrupt public sector, regardless of where it is located in the world. It presents the work of a global community of scholars engaged in research projects on policies and strategies related to accountability, transparency, auditing, regulatory disclosure, governance, investor protection and anti-corruption initiatives in public sector organisations. The papers presented here address many different angles of corruption and aspects of the way in which it is reported using a broad range of methodologies, theoretical frameworks and research locations. Collectively, these papers demonstrate that more attention needs be given to investigating the human cost associated with illegal activity that leads to human suffering, inequality, and lifetime costs. They further emphasise that we have much to learn about regulatory disclosure and jurisprudential practice in the fight against fraud and corruption

Accounting practice, fiscal decentralization and corruption

In prior studies, accounting and decentralization corruption solutions have so far been analysed in isolation. In this article, we connect these two strands of literature on corruption. Understanding this connection is important because weak financial accounting and reporting systems can inhibit monitoring incentives and thus reduce decentralization benefits in countering corruption. We argue that the effectiveness of decentralization as an anti-corruption barrier is complemented by the quality of the accounting practice in a country. Using multiple sources of data, we find that decentralization has a positive and increasing effect on reducing corruption among countries with a high-quality accounting practice. In contrast, decentralization has a negative and decreasing effect on reducing corruption among countries with weak-quality accounting practices. These findings are robust to alternative measures of accounting, decentralization and corruption and to endogeneity tests. Our findings demonstrate the crucial information role of accounting in enhancing decentralization monitoring mechanisms and in thereby reducing corruption

How easy can the barley brie : drinking culture and accounting failure at the end of the nineteenth century in Britain

Purpose &ndash; This paper seeks to extend the development of the historical accounting research agenda further into the area of popular culture. The work examines the discourses that surrounded the drinking of alcohol in nineteenth century Britain and explores how an accounting failure disrupted the tension between the two established competing discourses, leading to a significant impact on UK drinking culture at the end of the nineteenth century. Design/methodology/approach &ndash; The paper employs both primary and secondary sources. Secondary sources are used to develop the main themes of the discourses deployed by the temperance societies and the whisky companies. Primary sources derived from the contemporary press are employed, as necessary, in support. Findings &ndash; The paper demonstrates that accounting, although it may not be central to a discourse or other social structure, can still have a profound impact upon cultural practices. The potential for research into culture and accounting should not therefore be dismissed if no immediate or concrete relationship between culture and accounting can be determined. Further support is provided for studies that seek to expand the accounting research agenda into new territories. Originality/value &ndash; The study of popular culture is relatively novel in accounting research. This paper seeks to add to this research by exploring an area of cultural activity that has hitherto been neglected by researchers, i.e. by exploring how an accounting incident impacted upon the historical consumption of Scotch whisky in the UK.<br /

Reorganization of Atlantic Waters at sub-polar latitudes linked to deep-water overflow in both glacial and interglacial climate states

While a large cryosphere may be a necessary boundary condition for millennial-scale events to persist, a growing body of evidence from previous interglacial periods suggests that high-magnitude climate events are possible during low-cryosphere climate states. However, the full spectrum of variability, and the antecedent conditions under which such variability can occur, have not been fully described. As a result, the mechanisms generating high-magnitude climate variability during low-cryosphere boundary conditions remain unclear. In this study, high-resolution climate records from Deep Sea Drilling Project (DSDP) site 610 are used to portray the North Atlantic climate's progression through low ice, boundary conditions of Marine Isotope Stage (MIS) 11c into the glacial inception. We show that this period is marked by two climate events displaying rapid shifts in both deep overflow and surface climate. The reorganization between Polar Water and Atlantic Water at subpolar latitudes appears to accompany changes in the flow of deep water emanating from the Nordic Seas, regardless of magnitude or boundary conditions. Further, during both intermediate and low ice boundary conditions, we find that a reduction in deep water precedes surface hydrographic change. The existence of surface and deep-ocean events, with similar magnitudes, abruptness, and surface–deep phasing, advances our mechanistic understanding of, and elucidates antecedent conditions that can lead to, high-magnitude climate instability.publishedVersio

Can biodiversity of preexisting and created salt marshes match across scales? An assessment from microbes to predators

Coastal wetlands are rapidly disappearing worldwide due to a variety of processes, including climate change and flood control. The rate of loss in the Mississippi River Delta is among the highest in the world and billions of dollars have been allocated to build and restore coastal wetlands. A key question guiding assessment is whether created coastal salt marshes have similar biodiversity to preexisting, reference marshes. However, the numerous biodiversity metrics used to make these determinations are typically scale dependent and often conflicting. Here, we applied ecological theory to compare the diversity of different assemblages (surface and below-surface soil microbes, plants, macroinfauna, spiders, and on-marsh and off-marsh nekton) between two created marshes (4–6 years old) and four reference marshes. We also quantified the scale-dependent effects of species abundance distribution, aggregation, and density on richness differences and explored differences in species composition. Total, between-sample, and within-sample diversity (γ, β, and α, respectively) were not consistently lower at created marshes. Richness decomposition varied greatly among assemblages and marshes (e.g., soil microbes showed high equitability and α diversity, but plant diversity was restricted to a few dominant species with high aggregation). However, species abundance distribution, aggregation, and density patterns were not directly associated with differences between created and reference marshes. One exception was considerably lower density for macroinfauna at one of the created marshes, which was drier because of being at a higher elevation and having coarser substrate compared with the other marshes. The community compositions of created marshes were more dissimilar than reference marshes for microbe and macroinfauna assemblages. However, differences were small, particularly for microbes. Together, our results suggest generally similar taxonomic diversity and composition between created and reference marshes. This provides support for the creation of marsh habitat as tools for the maintenance and restoration of coastal biodiversity. However, caution is needed when creating marshes because specific building and restoration plans may lead to different colonization patterns

CSF tau microtubule-binding region identifies pathological changes in primary tauopathies

Despite recent advances in fluid biomarker research in Alzheimer's disease (AD), there are no fluid biomarkers or imaging tracers with utility for diagnosis and/or theragnosis available for other tauopathies. Using immunoprecipitation and mass spectrometry, we show that 4 repeat (4R) isoform-specific tau species from microtubule-binding region (MTBR-tau275 and MTBR-tau282) increase in the brains of corticobasal degeneration (CBD), progressive supranuclear palsy (PSP), frontotemporal lobar degeneration (FTLD)-MAPT and AD but decrease inversely in the cerebrospinal fluid (CSF) of CBD, FTLD-MAPT and AD compared to control and other FTLD-tau (for example, Pick's disease). CSF MTBR-tau measures are reproducible in repeated lumbar punctures and can be used to distinguish CBD from control (receiver operating characteristic area under the curve (AUC) = 0.889) and other FTLD-tau, such as PSP (AUC = 0.886). CSF MTBR-tau275 and MTBR-tau282 may represent the first affirmative biomarkers to aid in the diagnosis of primary tauopathies and facilitate clinical trial designs

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London