Understanding stakeholder requirements on an NHS hospital project: application of semiotics-rooted theories.

Hospitals represent complex and difficult contexts for AEC (architecture, engineering and construction) professionals to engage with due to their functional complexity and diversity of stakeholder interests (i.e. patient, visitor, medical specialist). Hospital designers need to take note of changing NHS policy contexts (e.g. the possible empowerment of general practitioners to shape services), technological advances in medical equipment design and the potential health needs of future generations. It is imperative for hospital designers and architects to align their processes and methodologies (e.g. briefing and requirements capture) to the needs and desires of their clients so that a medical facility design is produced which is truly aligned to the requirements of the hospital stakeholders. Semiotics, the “study” or “discipline” of signs aims to investigate the nature of signs (their inception, representation and meaning), whilst semiotics-rooted theories are concerned with investigating how meaning and understanding is mobilized between persons and between organisations. This paper details a semiotics-rooted research approach for investigating the interactions between hospital designers and stakeholders on a forthcoming NHS hospital project in the UK. A semiotics grounded study will potentially provide a deeper understanding of how meaning and understanding is established between hospital project stakeholders and construction professionals.

Climate on the Southern Black Sea coast during the Holocene: implications from the Sofular Cave record

We present the updated Holocene section of the Sofular Cave record from the southernBlackSeacoast (northern Turkey); an area with considerably different present-day climate compared to that of the neighboring Eastern Mediterranean region. Stalagmite δ13C, growth rates and initial (234U/238U) ratios provide information about hydrological changes above the cave; and prove to be more useful than δ18O for deciphering Holocene climatic variations. Between ∼9.6 and 5.4 ka BP (despite a pause from ∼8.4 to 7.8 ka BP), the Sofular record indicates a remarkable increase in rainfall amount and intensity, in line with other paleoclimate studies in the Eastern Mediterranean. During that period, enhanced summertime insolation either produced much stronger storms in the following fall and winter through high sea surface temperatures, or it invoked a regional summer monsoon circulation and rainfall. We suggest that one or both of these climatic mechanisms led to a coupling of the BlackSea and the Mediterranean rainfall regimes at that time, which can explain the observed proxy signals. However, there are discrepancies among the Eastern Mediterranean records in terms of the timing of this wet period; implying that changes were probably not always occurring through the same mechanism. Nevertheless, the Sofular Cave record does provide hints and bring about new questions about the connection between regional and large scale climates, highlighting the need for a more extensive network of high quality paleoclimate records to better understand Holoceneclimate.

Molecular requirements for L-type Ca2+ channel blockade by testosterone

Despite being generally perceived as detrimental to the cardiovascular system, testosterone has marked beneficial vascular effects; most notably it acutely and directly causes vasodilatation. Indeed, men with hypotestosteronaemia can present with myocardial ischemia and angina which can be rapidly alleviated by infusion of testosterone. To date, however, in vitro studies have failed to provide a convincing mechanism to account for this clinically important effect. Here, using whole-cell patch-clamp recordings to measure current flow through recombinant human L-type Ca2+ channel alpha(1C) subunits (Ca(v)1.2), we demonstrate that testosterone inhibits such currents in a concentration-dependent manner. Importantly, this occurs over the physiological range of testosterone concentrations (IC50 34 nM), and is not mimicked by the metabolite 5alpha-androstan-17beta-ol-3-one (DHT), nor by progesterone or estradiol, even at high (10 microM) concentration. L-type Ca2+ channels in the vasculature are also important clinical targets for vasodilatory dihydropyridines. A single point mutation (T1007Y) almost completely abolishes nifedipine sensitivity in our recombinant expression system. Crucially, the same mutation renders the channels insensitive to testosterone. Our data strongly suggest, for the first time, the molecular requirements for testosterone binding to L-type Ca2+ channels, thereby supporting its beneficial role as an endogenous Ca2+ channel antagonist in the treatment of cardiovascular disease.

The speliothem record of climate variability in Southern Arabia.

Uranium-series dated stalagmites from Oman indicate that pluvial conditions prevailed from 6.3 to 10.5, 78 to 82, 120 to 130, 180 to 200 and 300 to 330 kyr B.P.; all of these periods coincide with peak interglacials. Oxygen (δ18O) and hydrogen (δD) isotope ratios of speleothem calcite and fluid inclusions reveal the source of moisture and provide information on the amount of precipitation, respectively. δ18O and δD values of stalagmites deposited during peak interglacials vary between −8 and −4 ‰ (VPDB) and −53 and −20‰ (Vienna Standard Mean Ocean Water [VSMOW]) respectively, whereas modern stalagmites range from −2.6 to −1.1‰ in δ18O (VPDB) and −7.6 and −3.3‰ in δD (VSMOW), respectively. The growth and isotopic records indicate that during peak interglacial periods, the limit of the monsoon rainfall was shifted far north of its present location and each pluvial period was coinciding with an interglacial stage of the marine oxygen isotope record.

A framework for assessing continuing professional development activities for satisfying pharmacy revalidation requirements

The United Kingdom’s pharmacy regulator contemplated using continuing professional development (CPD) in pharmacy revalidation in 2009, simultaneously asking pharmacy professionals to demonstrate the value of their CPD by showing its relevance and impact. The idea of linking new CPD requirements with revalidation was yet to be explored. Our aim was to develop and validate a framework to guide pharmacy professionals to select CPD activities that are relevant to their work and to produce a score sheet that would make it possible to quantify the impact and relevance of CPD. METHODS: We adapted an existing risk matrix, producing a CPD framework consisting of relevance and impact matrices. Concepts underpinning the framework were refined through feedback from five pharmacist teacher-practitioners. We then asked seven pharmacists to rate the relevance of the framework’s individual elements on a 4-point scale to determine content validity. We explored views about the framework through focus groups with six and interviews with 17 participants who had used it formally in a study. RESULTS: The framework’s content validity index was 0.91. Feedback about the framework related to three themes of penetrability of the framework, usefulness to completion of CPD, and advancement of CPD records for the purpose of revalidation. DISCUSSION: The framework can help professionals better select CPD activities prospectively, and makes assessment of CPD more objective by allowing quantification, which could be helpful for revalidation. We believe the framework could potentially help other health professionals with better management of their CPD irrespective of their field of practice.

A high resolution late Holocene palaeo environmental record from the central Adriatic Sea

A multi-proxy study of a Holocene sediment core (RF 93-30) from the western flank of the central Adriatic, in 77 m of water, reveals a sequence of changes in terrestrial vegetation, terrigenous sediment input and benthic fauna, as well as evidence for variations in sea surface temperature spanning most of the last 7000 yr. The chronology of sedimentation is based on several lines of evidence, including AMS 14C dates of foraminifera extracted from the core, palaeomagnetic secular variation, pollen indicators and dated tephra. The temporal resolution increases towards the surface and, for some of the properties measured, is sub-decadal for the last few centuries. The main changes recorded in vegetation, sedimentation and benthic foraminiferal assemblages appear to be directly related to human activity in the sediment source area, which includes the Po valley and the eastern flanks of the central and northern Appenines. The most striking episodes of deforestation and expanding human impact begin around 3600 BP (Late Bronze Age) and 700 BP (Medieval) and each leads to an acceleration in mass sedimentation and an increase in the proportion of terrigenous material, reflecting the response of surface processes to widespread forest clearance and cultivation. Although human impact appears to be the proximal cause of these changes, climatic effects may also have been important. During these periods, signs of stress are detectable in the benthic foram morphotype assemblages. Between these two periods of increased terrigeneous sedimentation there is smaller peak in sedimentation rate around 2400BP which is not associated with evidence for deforestation, shifts in the balance between terrigenous and authigenic sedimentation, or changes in benthic foraminifera. The mineral magnetic record provides a sensitive indicator of changing sediment sources: during forested periods of reduced terrigenous input it is dominated by authigenic bacterial magnetite, whereas during periods of increased erosion, anti-ferromagetic minerals (haematite and/or goethite) become more important, as well as both paramagnetic minerals and super-paramagnetic magnetite. Analysis of the alkenone, U37k′, record provides an indication of possible changes in sea surface temperature during the period, but it is premature to place too much reliance on these inferred changes until the indirect effects of past changes in the depth of the halocline and in circulation have been more fully evaluated. The combination of methods used and the results obtained illustrate the potential value of such high resolution near-shore marine sedimentary sequences for recording wide-scale human impact, documenting the effects of this on marine sedimentation and fauna and, potentially, disentangling evidence for human activities from that for past changes in climate.

A 45 kyr palaeoclimate record from the lowland interior of tropical South America

We present a well-dated, high-resolution, ~ 45 kyr lake sediment record reflecting regional temperature and precipitation change in the continental interior of the Southern Hemisphere (SH) tropics of South America. The study site is Laguna La Gaiba (LLG), a large lake (95 km2) hydrologically-linked to the Pantanal, an immense, seasonally-flooded basin and the world's largest tropical wetland (135,000 km2). Lake-level changes at LLG are therefore reflective of regional precipitation. We infer past fluctuations in precipitation at this site through changes in: i) pollen-inferred extent of flood-tolerant forest; ii) relative abundance of terra firme humid tropical forest versus seasonally-dry tropical forest pollen types; and iii) proportions of deep- versus shallow-water diatoms. A probabilistic model, based on plant family and genus climatic optima, was used to generate quantitative estimates of past temperature from the fossil pollen data. Our temperature reconstruction demonstrates rising temperature (by 4 °C) at 19.5 kyr BP, synchronous with the onset of deglacial warming in the central Andes, strengthening the evidence that climatic warming in the SH tropics preceded deglacial warming in the Northern Hemisphere (NH) by at least 5 kyr. We provide unequivocal evidence that the climate at LLG was markedly drier during the last glacial period (45.0–12.2 kyr BP) than during the Holocene, contrasting with SH tropical Andean and Atlantic records that demonstrate a strengthening of the South American summer monsoon during the global Last Glacial Maximum (~ 21 kyr BP), in tune with the ~ 20 kyr precession orbital cycle. Holocene climate conditions occurred as early as 12.8–12.2 kyr BP, when increased precipitation in the Pantanal catchment caused heightened flooding and rising lake levels in LLG. In contrast to this strong geographic variation in LGM precipitation across the continent, expansion of tropical dry forest between 10 and 3 kyr BP at LLG strengthens the body of evidence for widespread early–mid Holocene drought across tropical South America.

Differentiation between Neotropical rainforest, dry forest and savannah ecosystems by their modern pollen spectra and implications for the fossil pollen record

Accurate differentiation between tropical forest and savannah ecosystems in the fossil pollen record is hampered by the combination of: i) poor taxonomic resolution in pollen identification, and ii) the high species diversity of many lowland tropical families, i.e. with many different growth forms living in numerous environmental settings. These barriers to interpreting the fossil record hinder our understanding of the past distributions of different Neotropical ecosystems and consequently cloud our knowledge of past climatic, biodiversity and carbon storage patterns. Modern pollen studies facilitate an improved understanding of how ecosystems are represented by the pollen their plants produce and therefore aid interpretation of fossil pollen records. To understand how to differentiate ecosystems palynologically, it is essential that a consistent sampling method is used across ecosystems. However, to date, modern pollen studies from tropical South America have employed a variety of methodologies (e.g. pollen traps, moss polsters, soil samples). In this paper, we present the first modern pollen study from the Neotropics to examine the modern pollen rain from moist evergreen tropical forest (METF), semi-deciduous dry tropical forest (SDTF) and wooded savannah (cerradão) using a consistent sampling methodology (pollen traps). Pollen rain was sampled annually in September for the years 1999–2001 from within permanent vegetation study plots in, or near, the Noel Kempff Mercado National Park (NKMNP), Bolivia. Comparison of the modern pollen rain within these plots with detailed floristic inventories allowed estimates of the relative pollen productivity and dispersal for individual taxa to be made (% pollen/% vegetation or ‘p/v’). The applicability of these data to interpreting fossil records from lake sediments was then explored by comparison with pollen assemblages obtained from five lake surface samples.