Non-medical prescribers and benzodiazepines: A qualitative study.

Benzodiazepines continue to be widely prescribed in primary care for longer than guidelines advise and can cause adverse consequences for those who have long-term prescriptions. The aim of this study was to explore the experience of nonmedical prescribers (NMPs) in relation to their role in improving benzodiazepine prescribing management in primary care. A qualitative study using a thematic analysis framework, in which face-to-face interviews with eight NMPs from the disciplines of nursing and pharmacy were conducted in their areas of practice in 2011 in rural localities in southern Scotland. The NMPs view their qualification as rigorous in its capacity to promote more focused and confident practice, and provide detailed knowledge about medications and the ability to question the appropriateness of medicines. As medication review is an integral part of the role of the NMP they are suited to contribute positively to benzodiazepine prescribing management. Although several obstacles to the successful integration and full utilization of non-medical prescribing currently exist, more training in the recognition of mild-to-moderate mental health problems, psychopharmacology and alternative interventions would allow this role to be assumed with confidence. NMPs may have a useful role to play in benzodiazepine prescribing. NMPs have regular contact with patients in the older age group and those with chronic illnesses, and are in a prime position to utilize opportunistic medication review to improve concordance in this area of prescribing.

Changes in innovation styles - comprehensive study of the changes in innovation styles to identify the causes and effects of different influencing factors and capabilities to create a general innovation pattern.

An investigation in innovation management and entrepreneurial management is conducted in this thesis. The aim of the research is to explore changes of innovation styles in the transformation process from a start-up company to a more mature phase of business, to predict in a second step future sustainability and the probability of success. As businesses grow in revenue, corporate size and functional complexity, various triggers, supporters and drivers affect innovation and company's success. In a comprehensive study more than 200 innovative and technology driven companies have been examined and compared to identify patterns in different performance levels. All of them have been founded under the same formal requirements of the Munich Business Plan Competition -a research approach which allowed a unique snapshot that only long-term studies would be able to provide. The general objective was to identify the correlation between different factors, as well as different dimensions, to incremental and radical innovations realised. The 12 hypothesis were formed to prove have been derived from a comprehensive literature review. The relevant academic and practitioner literature on entrepreneurial, innovation, and knowledge management as well as social network theory revealed that the concept of innovation has evolved significantly over the last decade. A review of over 15 innovation models/frameworks contributed to understand what innovation in context means and what the dimensions are. It appears that the complex theories of innovation can be described by the increasing extent of social ingredients in the explanation of innovativeness. Originally based on tangible forms of capital, and on the necessity of pull and technology push, innovation management is today integrated in a larger system. Therefore, two research instruments have been developed to explore the changes in innovations styles. The Innovation Management Audits (IMA Start-up and IMA Mature) provided statements related to product/service development, innovativeness in various typologies, resources for innovations, innovation capabilities in conjunction to knowledge and management, social networks as well as the measurement of outcomes to generate high-quality data for further exploration. In obtaining results the mature companies have been clustered in the performance level low, average and high, while the start-up companies have been kept as one cluster. Firstly, the analysis exposed that knowledge, the process of acquiring knowledge, interorganisational networks and resources for innovations are the most important driving factors for innovation and success. Secondly, the actual change of the innovation style provides new insights about the importance of focusing on sustaining success and innovation ii 16 key areas. Thirdly, a detailed overview of triggers, supporters and drivers for innovation and success for each dimension support decision makers in putting their company in the right direction. Fourthly, a critical review of contemporary strategic management in conjunction to the findings provides recommendation of how to apply well-known management tools. Last but not least, the Munich cluster is analysed providing an estimation of the success probability of the different performance cluster and start-up companies. For the analysis of the probability of success of the newly developed as well as statistically and qualitative validated ICP Model (Innovativeness, Capabilities & Potential) has been developed and applied. While the model was primarily developed to evaluate the probability of success of companies; it has equal application in the situation to measure innovativeness to identify the impact of various strategic initiatives within small or large enterprises. The main findings of the model are that competitor, and customer orientation and acquiring knowledge important for incremental and radical innovation. Formal and interorganisation networks are important to foster innovation but informal networks appear to be detrimental to innovation. The testing of the ICP model h the long term is recommended as one subject of further research. Another is to investigate some of the more intangible aspects of innovation management such as attitude and motivation of mangers. IV

The lack of associations between alleles at the hypoxia-Inducible factor 1A C1772T loci and responses to acute hypoxia.

Objective The aim of this study was to investigate the associations between alleles of the hypoxia-inducible factor 1A (HIF1A) C1772T polymorphism and several physiological responses to hypoxia, including the hypoxic ventilatory response (HVR), and serum erythropoietin (EPO), arterial oxygen saturation (Sao2), and acute mountain sickness (AMS) responses during 8 hours of exposure to normobaric hypoxia. Methods A total of 76 males participated in the study; 52 participants completed an 8-hour exposure to 12.7% oxygen, during which time Sao2, EPO concentrations, and AMS scores were measured, while 62 individuals took part in an HVR trial (in total 38 individuals completed both protocols). DNA was obtained from leukocytes, and a 346-bp fragment of the HIF1A gene containing the C1772T polymorphism was amplified using polymerase chain reaction. Fragments were sequenced to reveal individual genotypes, and the associations between HIF1A genotype and EPO, Sao2, AMS responses to hypoxia and HVR were examined. Results The magnitude of the hypoxic responses was highly variable between individuals. The increase in participants' EPO responses ranged from 89% to 388% of baseline values following hypoxia, while Sao2 values during the exposure ranged from 71% to 89%. The HVR ranged from −0.04 to +2.18 L · min−1 · Sao2%−1 among participants. No significant differences in EPO, Sao2, AMS, or HVR results were observed between the HIF1A CC genotype and the combined CT/TT genotype group. Conclusion In this study, the HIF1A C1772T polymorphism does not appear to influence EPO, Sao2, or AMS responses during acute hypoxic exposure, or the magnitude of the HVR.