Can a mock medication-taking learning activity enable pharmacy students to experience the range of barriers and facilitators to medication adherence? An analysis informed by the Theoretical Domains Framework and COM-B model

Background: Pharmacy professionals are well-placed to provide medication adherence support to patients. The Capability, Opportunity, Motivation-Behaviour (COMsingle bondB) and Theoretical Domains Framework (TDF) are two complementary models previously applied to medication-taking behaviour. Understanding the patient-specific barriers and facilitators to adherence using psychological frameworks from the early stages of pharmacy education enables the design and delivery of effective interventions. Objectives: To examine whether a novel ‘mock medicine’ learning activity enabled students to experience the range of barriers and facilitators to medication adherence using the COM-B and TDF. Methods: A mock medicine activity was conducted with students at pharmacy schools in three universities in the UK, Norway, and Australia over one week. Percentage adherence was calculated for five dosing regimens; theoretical framework analysis was applied to map reflective statements from student logs to COM-B and TDF. Results: A total of 349 students (52.6%) returned completed logs, with high overall mean adherence (83.5%, range 0–100%). Analysis of the 277 (79.4%) students who provided reflective statements included barriers and facilitators that mapped onto one (9%), two (29%) or all three (62%) of the COM-B components and all fourteen TDF domains (overall mean = 4.04; Uni 1 = 3.72; Uni 2 = 4.50; Uni 3 = 4.38; range 1–8). Most frequently mapped domains were ‘Environmental context and resources’ (n = 199; 72%), ‘Skills’ (n = 186; 67%), ‘Memory, attention and decision-making’ (184; 66%) and ‘Beliefs about capabilities’ (n = 175; 63%). Conclusions: This is the first study to utilise both COM-B and TDF to analyse a proxy measure of medication adherence in pharmacy education. Data mapping demonstrated that students experienced similar issues to patients when prescribed a short course of medication. Importantly, all the factors influencing medication-taking reported by students were captured by these two psychological frameworks. Future educational strategies will involve students in the mapping exercise to gain hands-on experience of using these psychological constructs in practice

Redundant roles of photoreceptors and cytokinins in regulating photosynthetic acclimation to canopy density

The regulation of photosynthetic acclimation to canopy density was investigated in tobacco canopies and in tobacco and Arabidopsis plants with part of their foliage experimentally shaded. Both species acclimated to canopy light gradients and partial shading by allocating photosynthetic capacity to leaves in high light and adjusting chloroplast organization to the local light conditions. An investigation was carried out to determine whether signalling mediated by photoreceptors, sugars, cytokinin, and nitrate is involved in and necessary for proper photosynthetic acclimation. No evidence was found for a role for sugars, or for nitrate. The distribution of cytokinins in tobacco stands of contrasting density could be explained in part by irradiance-dependent delivery of cytokinins through the transpiration stream. Functional studies using a comprehensive selection of Arabidopsis mutants and transgenics showed that normal wild-type responses to partial shading were retained when signalling mediated by photoreceptors or cytokinins was disrupted. This indicates that these pathways probably operate in a redundant manner. However, the reduction of the chlorophyll a/b ratio in response to local shade was completely absent in the Arabidopsis Ws-2 accession mutated in PHYTOCHROME D and in the triple phyAphyCphyD mutant. Moreover, cytokinin receptor mutants also showed a reduced response, suggesting a previously unrecognized function of phyD and cytokinins

The development of endomycorrhizal root systems VIII. Effects of soil phosphorus and fungal colonization on the concentration of soluble carbohydrates in roots

Concentrations of phosphorus in shoot and soluble carbohydrates (fructose, glucose, sucrose and fructans) in root were measured in non-mycorrhizal and vesicular-arbuscular (VA) mycorrhizal (Glomus mosseae) leek plants (Allium porrum) raised at six concentrations of soil phosphate. In conditions when an increased concentration of soil phosphate reduced VA mycorrhizal infection, the concentrations of soluble carbohydrates in the root were at a maximum. Therefore the hypothesis that greater concentrations of soluble carbohydrates in roots favour VA mycorrhizal infection is discounted. There was a specific effect of VA mycorrhizas, in that infected roots contained a larger concentration of sucrose than did uninfected roots, in plants with similar phosphorus concentrations in dry matter of shoots. We conclude, first, that increased phosphorus supply from either phosphate addition to soil or VA mycorrhizal infection increases concentration of soluble carbohydrates in leek roots and, secondly, that the VA mycorrhizal root behaves as a particularly strong physiological sink when there is an excess concentration of sucrose in the host

Seasonal Dynamics of Mobile Carbon Supply in Quercus aquifolioides at the Upper Elevational Limit

Many studies have tried to explain the physiological mechanisms of the alpine treeline phenomenon, but the debate on the alpine treeline formation remains controversial due to opposite results from different studies. The present study explored the carbon-physiology of an alpine shrub species (Quercus aquifolioides) grown at its upper elevational limit compared to lower elevations, to test whether the elevational limit of alpine shrubs (<3 m in height) are determined by carbon limitation or growth limitation. We studied the seasonal variations in non-structural carbohydrate (NSC) and its pool size in Q. aquifolioides grown at 3000 m, 3500 m, and at its elevational limit of 3950 m above sea level (a.s.l.) on Zheduo Mt., SW China. The tissue NSC concentrations along the elevational gradient varied significantly with season, reflecting the season-dependent carbon balance. The NSC levels in tissues were lowest at the beginning of the growing season, indicating that plants used the winter reserve storage for re-growth in the early spring. During the growing season, plants grown at the elevational limit did not show lower NSC concentrations compared to plants at lower elevations, but during the winter season, storage tissues, especially roots, had significantly lower NSC concentrations in plants at the elevational limit compared to lower elevations. The present results suggest the significance of winter reserve in storage tissues, which may determine the winter survival and early-spring re-growth of Q. aquifolioides shrubs at high elevation, leading to the formation of the uppermost distribution limit. This result is consistent with a recent hypothesis for the alpine treeline formation

Relative nutritional quality of C 3 and C 4 grasses for a graminivorous lepidopteran, Paratrytone melane (Hesperiidae)

We tested the hypothesis that C 4 grasses are inferior to C 3 grasses as host plants for herbivorous insects by measuring the relative performance of larvae of a graminivorous lepidopteran, Paratrytone melane (Hesperiidae), fed C 3 and C 4 grasses. Relative growth rates and final weights were higher in larvae fed a C 3 grass in Experiment I. However, in two additional experiments, relative growth rates and final weights were not significantly different in larvae fed C 3 and C 4 grasses. We examined two factors which are believed to cause C 4 grasses to be of lower nutritional value than C 3 grasses: foliar nutrient levels and nutrient digestibility. In general, foliar nutrient levels were higher in C 3 grasses. In Experiment I, protein and soluble carbohydrates were digested from a C 3 and a C 4 grass with equivalent efficiencies. Therefore, differences in larval performance are best explained by higher nutrient levels in the C 3 grass in this experiment. In Experiment II, soluble carbohydrates were digested with similar efficiencies from C 3 and C 4 grasses but protein was digested with greater efficiency from the C 3 grasses. We conclude (1) that the bundle sheath anatomy of C 4 grasses is not a barrier to soluble carbohydrate digestion and does not have a nutritionally significant effect on protein digestion and (2) that P. melane may consume C 4 grasses at compensatory rates.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47798/1/442_2004_Article_BF00317268.pd