A country-level national needs assessment of the Indonesian pharmacy workforce

Background: Conducting a systematic country-level workforce needs-assessment is a way to develop coherent strategic and justifiable workforce planning. / Objective(s): This article describes a country-level needs-assessment process using a systematic approach (via the FIP Development Goals (FIP DGs) workforce element) as an analytical framework. The needs-assessment aimed to prioritise gaps toward transforming the pharmacy workforce as a prelude to practice and pharmaceutical services reform in Indonesia. / Methods: The needs assessment consisted of three stages: needs identification, needs analysis, and needs prioritisation. The needs (workforce development gaps) were defined as the discrepancies between the perceived workforce challenges and the existing national workforce development projects. Interviews or group discussions were conducted to gather the workforce challenges of individual pharmacists. A structured workshop was conducted to identify workforce challenges and existing organisations' projects, with main stakeholders contributing to pharmacists' development in Indonesia. Perceived challenges findings and identified national workforce projects were mapped to the FIP DGs workforce element. The needs prioritisation was conducted by comparing the proportional mapping to the FIP DGs workforce element. / Results: There were forty-three individual pharmacists and 7 principal stakeholder categories that provided information related to perceived workforce challenges; thirty national projects were identified from stakeholders. While this study identified perceived challenges with workforce “competency development” and “pharmacy workforce intelligence,” there were no active ongoing national projects mapped to those goals. The framework mapping analysis showed there are workforce development gaps centred on “competency development” initiatives, “advanced and specialist development” initiatives, and strategic pharmacy workforce intelligence data gathering. Additionally, there were policy gaps with initiatives for strengthening “working with others” and a lack of clarity on infrastructure for early-career training strategies and workforce impact. / Conclusions: This study prioritises the gaps in developing pharmacists in Indonesia. This process could be used in conducting needs assessment of pharmacy workforce development in other Low and Middle-Income Countries (LMICs)

Rescue medication use as a patient-reported outcome in COPD: a systematic review and regression analysis.

BACKGROUND: Reducing rescue medication use is a guideline-defined goal of asthma treatment, however, little is known about the validity of rescue medicine use as a marker of symptoms in chronic obstructive pulmonary disease (COPD). To improve patient outcomes, greater insight is needed into the relationship between rescue medication use and alternative COPD outcomes. METHODS: A systematic search of electronic databases (Embase®, MEDLINE® and Cochrane CENTRAL) was conducted from database start to 26 May, 2015. Studies of bronchodilator therapy with a duration of ≥24 weeks were included if they reported either mean change from baseline (CFB) in rescue medication use in puffs/day or % rescue-free days (%RFD), and at least one other COPD endpoint. Correlation and meta-regression analyses were undertaken to test the association between rescue medication use and other COPD outcomes using weighted means (weights proportional to the sample size of the treatment group) and unweighted means (equal weight for each treatment group). Each association was assessed at 6 months and study end. RESULTS: Forty-six studies involving 46,531 patients provided mean data from 145 treatment groups for evaluation. Changes in both measures of rescue medication use were correlated with changes in trough forced expiratory volume in one second ([FEV1]; Pearson correlation coefficients |r| ≥ 0.63; p < 0.0001) and with St George's Respiratory Questionnaire (SGRQ) score (|r| ≥ 0.70; p < 0.0001) at study end. Change in rescue medication use in puffs/day during the study correlated with annualized rates of moderate/severe exacerbations at 6 months and study end (both r = 0.66; p ≤ 0.0028). CFB in puffs/day was not well correlated with Transition Dyspnoea Index (TDI), but %RFD did correlate with TDI score at 6 months and study end (both r = 0.69; p < 0.0001). The values for CFB in puffs/day corresponding to the proposed minimal clinically important differences for trough FEV1 and SGRQ score were -1.3 and -0.6 puffs/day, respectively. A -1.0 puffs/day CFB in rescue use corresponded to a change of 0.26 events/patient-year in moderate/severe exacerbations. CONCLUSION: This analysis provides clear evidence of associations at a patient group level between rescue medication use and other clinically important COPD outcomes

Computational micromechanics of the transverse and shear behavior of unidirectional fiber reinforced polymers including environmental effects

Qualification of Fiber Reinforced Polymer materials (FRP’s) for manufacturing of structural components in the aerospace industry is usually associated with extensive and costly experimental campaigns. The burden of testing is immense and materials should be characterized under different loading states (tension, compression, shear) and environmental conditions (temperature, humidity) to probe their structural integrity during service life. Recent developments in multiscale simulation, together with increased computational power and improvements in modeling tools, can be used to alleviate this scenario. In this work, high-fidelity simulations of the material behavior at the micro level are used to predict ply properties and ascertain the effect of ply constituents and microstructure on the homogenized ply behavior. This approach relies on the numerical analysis of representative volume elements equipped with physical models of the ply constituents. Its main feature is the ability to provide fast predictions of ply stiffness and strength properties for different environmental conditions of temperature and humidity, in agreement with the experimental results, showing the potential to reduce the time and costs required for material screening and characterization.The authors would like to acknowledge the support provided by AIRBUS SAS through the project SIMSCREEN (Simulation for Screening Composite Materials Properties). Additionally, C.S. Lopes acknowledges the support of the Spanish Ministry of Economy and Competitiveness through the Ramón y Cajal program. The help of Dr. Miguel Monclús and Dr. Jon Molina in the experimental work is also gratefully acknowledged

Special-purpose elements to impose Periodic Boundary Conditions for multiscale computational homogenization of composite materials with the explicit Finite Element Method

A novel methodology is presented to introduce Periodic Boundary Conditions (PBC) on periodic Representative Volume Elements (RVE) in Finite Element (FE) solvers based on dynamic explicit time integration. This implementation aims at overcoming the difficulties of the explicit FE method in dealing with standard PBC. The proposed approach is based on the implementation of a user-defined element, named a Periodic Boundary Condition Element (PBCE), that enforces the periodicity between periodic nodes through a spring-mass-dashpot system. The methodology is demonstrated in the multiscale simulation of composite materials. Two showcases are presented: one at the scale of computational micromechanics, and another one at the level of computational mesomechanics. The first case demonstrates that the proposed PBCE allows the homogenization of composite ply properties through the explicit FE method with increased efficiency and similar reliability with respect to the equivalent implicit simulations with traditional PBC. The second case demonstrates that the PBCE coupled with Periodic Laminate Elements (PLE) can effectively be applied to the computational homogenization of elastic and strength properties of entire laminates taking into account highly nonlinear effects. Both cases motivate the application of the methodology in multiscale virtual testing in support of the building-block certification of composite materials.The research leading to this publication was supported by the European Community FP7 Programme through project MAAXIMUS (grant agreement 213371) and by the Spanish Ministry of Industry, Economy and Competitiveness (MINECO) through project HYDTCOMP (grant MAT2015-69491-C03-02). C.S. Lopes also acknowledges the support of MINECO through the Ramón y Cajal fellowship (grant RYC-2013-14271). The authors are grateful to Prof. Ignacio Romero for his helpful insights on this research

Impact of changes to reimbursement of fixed combinations of inhaled corticosteroids and long-acting β₂ -agonists in obstructive lung diseases: a population-based, observational study.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.In 2010, the Icelandic government introduced a new cost-saving policy that limited reimbursement of fixed inhaled corticosteroid/long-acting β₂ -agonist (ICS/LABA) combinations.This population-based, retrospective, observational study assessed the effects of this policy change by linking specialist/primary care medical records with data from the Icelandic Pharmaceutical Database. The policy change took effect on 1 January 2010 (index date); data for the year preceding and following this date were analysed in 8241 patients with controlled/partly controlled asthma and/or chronic obstructive pulmonary disease (COPD) who had been dispensed an ICS/LABA during 2009. Oral corticosteroid (OCS) and short-acting β₂ -agonist (SABA) use, and healthcare visits, were assessed pre- and post-index.The ICS/LABA reimbursement policy change led to 47.8% fewer fixed ICS/LABA combinations being dispensed during the post-index period among patients whose asthma and/or COPD was controlled/partly controlled during the pre-index period. Fewer ICS monocomponents were also dispensed. A total of 48.6% of patients were no longer receiving any respiratory medications after the policy change. This was associated with reduced disease control, as demonstrated by more healthcare visits (44.0%), and more OCS (76.3%) and SABA (51.2%) dispensations.Overall, these findings demonstrate that changes in healthcare policy and medication reimbursement can directly impact medication use and, consequently, clinical outcomes and should, therefore, be made cautiously.AstraZenec

Epipelagic mesozooplankton distribution and abundance over the Mascarene Plateau and Basin, south-western Indian Ocean

The crescent shaped Mascarene Plateau (southwestern Indian Ocean), some 2200 km in length, forms a partial barrier to the (predominantly westward) flow of the South Equatorial Current. Shallow areas of the Mascarene Plateau effectively form a large shelf sea without an associated coastline. Zooplankton sampling transects were made across the plateau and also the basin to the west, to investigate the role the partial interruption of flow has on zooplankton biomass and community structure over the region. Biomass data from Optical Plankton Counter (OPC) analysis, and variability in community structure from taxonomic analysis, appear to indicate that the obstruction by the plateau causes upwelling, nutrient enrichment and enhanced chlorophyll and secondary production levels downstream. The Mascarene Basin is clearly distinguishable from the ridge itself, and from the waters to the south and north, both in terms of size-distributed zooplankton biomass and community structure. Satellite remote sensing data, particularly remotely-sensed ocean colour imagery and the sea surface height anomaly (SSHA), indicate support for this hypothesis. A correlation was found between OPC biovolume and SSHA and sea surface temperature (SST), which may indicate the physical processes driving mesozooplankton variability in this area. Biomass values away from the influence of the ridge averaged 24 mg m-3, but downstream if the ridge biomass averaged 263 mg m-3. Copepods comprised 60% of the mean total organisms. Calanoid copepods varied considerably between regions, being lowest away from the influence of the plateau, where higher numbers of the cyclopoid copepods Oithona spp., Corycaeus spp. and Oncaea spp., and the harpacticoid Microsetella spp. were found

Computational micromechanics of fiber kinking in unidirectional FRP under different environmental conditions

The determination of ply properties of Fiber Reinforced Polymers (FRP) for particular operational environmental conditions in aeronautical applications is mandatory in order to fulfill current industry stringent certification requirements. However, the traditional experimental approach requires massive investments of resources and time. From the behaviour obtained experimentally, constitutive equations including failure criteria are then devised to be used in the design of FRP structures. The ply longitudinal behaviour under compression is generally the most difficult to measure and characterize. In this work, an alternative coupled experimental-computational micromechanics approach is proposed to determine the longitudinal compression properties of unidirectional FRP plies under different environmental conditions. This methodology includes experimental characterization of matrix and fiber/matrix interface, combined with numerical simulations of realistic microstructures. The interface decohesion is simulated using cohesive-frictional interactions. A pressure dependent, elasto-plastic model that includes tensile damage is employed to capture the matrix nonlinear behaviour. The numerical predictions match the experimentally-obtained ply properties available in the literature in a remarkable way and suggest that virtual ply property characterization is a mature and reliable approach to conduct screening of materials.The authors would like to acknowledge the support provided by AIRBUS SAS through the project SIMSCREEN (Simulation for Screening Composite Materials Properties). Additionally, C.S. Lopes acknowledges the support of the Spanish Ministry of Economy and Competitiveness (RYC-2013-14271) through the Ramón y Cajal program. The collaboration with NASA Langley Research Center in some aspects of this work is also acknowledged

Toxicological evaluation of Thymelaea hirsuta and protective effect against CCl4-induced hepatic injury in rats

The aerial part of Thymelaea hirsuta (TH) is used as decoction in the treatment of different pathologies in folk medicine in Morocco. The present investigation was carried out to evaluate the potential of toxicity of an aqueous extract of TH and its hepatoprotective activity against CCl4-induced hepatic injury in rats. In the acute study, there were no signs of toxicity observed after oral administration of single dose of the extract (5g/kg body weight). In the sub-chronic dose study, (given by gavages (4 ml/kg) to Wistar rats daily at: 0.0 g/kg, 0.5g/kg, 1 g/kg or 2 g/kg body weight for 4 weeks) no variation on biochemical parameters; serum glucose, creatinine and urea levels was observed compared to the control group. However, the serum levels of alanine aminotransferase (ALAT) and aspartate aminotransferase (ASAT) were markedly decreased (P &lt; 0.05 and P&lt;0.001 respectively) as compared to the controls. There were no significant differences in red blood cells count (p&lt;0.05), in Hemoglobin and Hematocrit serum levels but a significant increase in white blood cells count (p&lt;0.001) and in platelets (p&lt; 0.05) for all doses tested. Histopathological examination of the liver, spleen and kidneys tissues at the end of the study showed normal architecture. The elevated serum enzymatic activities of ALAT and ASAT, due to carbon tetrachloride treatment (1 ml/kg CCl4 every 72 h during 15 days) were restored towards normalization by the plant extracts. The biochemical observations were supplemented with histopathological examination of liver sections. The results indicate that this plant possesses no toxicity effects but hepatoprotective properties.Keywords: Thymelaea hirsuta, Wistar rats, Toxicity, Histopathology, hepatoprotective action, Folk medicin

Interface characterization in fiber-reinforced polymer-matrix composites

A novel methodology is presented and applied to measure the shear interface strength of fiber-reinforced polymers. The strategy is based in fiber push-in tests carried out on the central fiber of highly-packed fiber clusters with hexagonal symmetry, and it is supported by a detailed finite element analysis of the push-in test to account for the influence of hygrothermal residual stresses, fiber constraint and fiber anisotropy on the interface strength. Examples of application are presented to determine the shear interface strength in carbon and glass fiber composites reinforced with either thermoset or thermoplastic matrices. In addition, the influence of the environment (either dry or wet conditions) on the interface strength in C/epoxy composites is demonstrated.This investigation was supported by the Ministerio de Ciencia e Innovación of Spain through the Grant MAT2012-37552, by the Comunidad de Madrid through the program DIMMAT (P2013/MIT2775), and by the European Community's Seventh Framework Programme FP7/2007-2013 under Grant Agreement 213371 (MAAXIMUS, www.maaximus.eu). In addition, the support of Airbus through the project SIMSCREEN ("Simulation for Screening Properties of Materials") is gratefully acknowledged