Methodology for assessing the appropriateness of Continuing Professional Development for pharmacy professionals’ revalidation

From April 2010, the General Pharmaceutical Council (GPhC) will be responsible for the statutory regulation of pharmacists and pharmacy technicians in Great Britain (GB).[1] All statutorily regulated health professionals will need to periodically demonstrate their fitness-to-practise through a process of revalidation.[2] One option being considered in GB is that continuing professional development (CPD) records will form a part of the evidence submitted for revalidation, similar to the system in New Zealand.[3] At present, pharmacy professionals must make a minimum of nine CPD entries per annum from 1 March 2009 using the Royal Pharmaceutical Society of Great Britain (RPSGB) CPD framework. Our aim was to explore the applicability of new revalidation standards within the current CPD framework. We also wanted to review the content of CPD portfolios to assess strengths and qualities and identify any information gaps for the purpose of revalidation.

The benefits of providing benefit information in a patient information leaflet

Objective: To examine the effects of providing two different types of written information about medicine benefits in a patient information leaflet (PIL). Setting: Participants were 358 adult volunteers from the general population recruited from a London railway station and central Reading. Method: The study used a controlled empirical methodology in which people were given a hypothetical, but realistic, scenario about visiting their doctor and being prescribed medication. They then read an information leaflet about the medicine that contained neither, one, or both benefit statements, and finally completed a number of Likert rating scales. Outcome measures included perceived satisfaction and helpfulness of the information, effectiveness and appropriateness of the medicine, benefit and risk to health, and intention to comply. Key findings: Both types of benefit information led to significantly higher ratings on all of the measures taken. Conclusions: Provision of a relatively short ‘benefit’ statement can significantly improve people’s judgements and intention to take a medicine. The findings are important and timely as the European Union is currently considering reviewing their regulations to allow for the inclusion of limited non-promotional benefit information in PILs.

Suitability of pesticide risk indicators for less developed countries: a comparison

Pesticide risk indicators provide simple support in the assessment of environmental and health risks from pesticide use, and can therefore inform policies to foster a sustainable interaction of agriculture with the environment. For their relative simplicity, indicators may be particularly useful under conditions of limited data availability and resources, such as in Less Developed Countries (LDCs). However, indicator complexity can vary significantly, in particular between those that rely on an exposure–toxicity ratio (ETR) and those that do not. In addition, pesticide risk indicators are usually developed for Western contexts, which might cause incorrect estimation in LDCs. This study investigated the appropriateness of seven pesticide risk indicators for use in LDCs, with reference to smallholding agriculture in Colombia. Seven farm-level indicators, among which 3 relied on an ETR (POCER, EPRIP, PIRI) and 4 on a non-ETR approach (EIQ, PestScreen, OHRI, Dosemeci et al., 2002), were calculated and then compared by means of the Spearman rank correlation test. Indicators were also compared with respect to key indicator characteristics, i.e. user friendliness and ability to represent the system under study. The comparison of the indicators in terms of the total environmental risk suggests that the indicators not relying on an ETR approach cannot be used as a reliable proxy for more complex, i.e. ETR, indicators. ETR indicators, when user-friendly, show a comparative advantage over non-ETR in best combining the need for a relatively simple tool to be used in contexts of limited data availability and resources, and for a reliable estimation of environmental risk. Non-ETR indicators remain useful and accessible tools to discriminate between different pesticides prior to application. Concerning the human health risk, simple algorithms seem more appropriate for assessing human health risk in LDCs. However, further research on health risk indicators and their validation under LDC conditions is needed.

Confucius, constructivism and the impact of continuing professional development on teachers of English in China

In this article we explore issues around the sustainability and appropriateness of professional development for secondary teachers of English in China offered by overseas providers from the perspective of teachers who completed courses at the University of Reading between 2003 and 2010. We start by offering an overview of English teaching in China. We then describe the collection and analysis of interviews and focus groups discussions involving former participants, their teaching colleagues and senior management, as well as classroom observation. Evidence is presented for changes in teachers’ philosophies of education directly attributable to participation in the courses; for improved teacher competencies (linguistic, cultural and pedagogical) in the classroom; and for the ways in which returnees are undertaking new roles and responsibilities which exploit their new understandings. Finally, we discuss the implications of these findings for both providers and sponsors of CPD for English language teachers. We conclude that the recognition of English as an essential element in the modernisation of China, together with the growing awareness of the weaknesses of traditional approaches to the teaching of the language, has opened up new spaces for dialogue concerning pedagogy and professional practice. It is clearly important, however, that new approaches to the teaching of English are presented in a way which allows teachers to decide which elements should be incorporated into their teaching and how.

Measures of observation impact in non-Gaussian data assimilation

ABSTRACT Non-Gaussian/non-linear data assimilation is becoming an increasingly important area of research in the Geosciences as the resolution and non-linearity of models are increased and more and more non-linear observation operators are being used. In this study, we look at the effect of relaxing the assumption of a Gaussian prior on the impact of observations within the data assimilation system. Three different measures of observation impact are studied: the sensitivity of the posterior mean to the observations, mutual information and relative entropy. The sensitivity of the posterior mean is derived analytically when the prior is modelled by a simplified Gaussian mixture and the observation errors are Gaussian. It is found that the sensitivity is a strong function of the value of the observation and proportional to the posterior variance. Similarly, relative entropy is found to be a strong function of the value of the observation. However, the errors in estimating these two measures using a Gaussian approximation to the prior can differ significantly. This hampers conclusions about the effect of the non-Gaussian prior on observation impact. Mutual information does not depend on the value of the observation and is seen to be close to its Gaussian approximation. These findings are illustrated with the particle filter applied to the Lorenz ’63 system. This article is concluded with a discussion of the appropriateness of these measures of observation impact for different situations.

Individual assets, market structure and the drivers of return

Much UK research and market practice on portfolio strategy and performance benchmarking relies on a sector‐geography subdivision of properties. Prior tests of the appropriateness of such divisions have generally relied on aggregated or hypothetical return data. However, the results found in aggregate may not hold when individual buildings are considered. This paper makes use of a dataset of individual UK property returns. A series of multivariate exploratory statistical techniques are utilised to test whether the return behaviour of individual properties conforms to their a priori grouping. The results suggest strongly that neither standard sector nor regional classifications provide a clear demarcation of individual building performance. This has important implications for both portfolio strategy and performance measurement and benchmarking. However, there do appear to be size and yield effects that help explain return behaviour at the property level.

Rapeseed cytoplasm gives advantage in wild relatives and complicates genetically modified crop biocontainment

Biocontainment methods for genetically modified crops closest to commercial reality (chloroplast transformation, male sterility) would be compromised (in absolute terms) by seed-mediated gene flow leading to chloroplast capture. Even in these circumstances, however, it can be argued that biocontainment still represses transgene movement, with the efficacy depending on the relative frequency of seed-and pollen-mediated gene flow. In this study, we screened for crop-specific chloroplast markers from rapeseed (Brassica napus) amongst sympatric and allopatric populations of wild B. oleracea in natural cliff-top populations and B. rapa in riverside and weedy populations. We found only modest crop chloroplast presence in wild B. oleracea and in weedy B. rapa, but a surprisingly high incidence in sympatric (but not in allopatric) riverside B. rapa populations. Chloroplast inheritance models indicate that elevated crop chloroplast acquisition is best explained if crop cytoplasm confers selective advantage in riverside B. rapa populations. Our results therefore imply that chloroplast transformation may slow transgene recruitment in two settings, but actually accelerate transgene spread in a third. This finding suggests that the appropriateness of chloroplast transformation for biocontainment policy depends on both context and geographical location.

Using artefacts to mediate understanding in design conversations

The journey from the concept of a building to the actual built form is mediated with the use of various artefacts, such as drawings, product samples and models. These artefacts are produced for different purposes and for people with different levels of understanding of the design and construction processes. This paper studies design practice as it occurs naturally in a real-world situation by observing the conversations that surround the use of artefacts at the early stages of a building's design. Drawing on ethnographic data, insights are given into how the use of artefacts can reveal a participant's understanding of the scheme. The appropriateness of the method of conversation analysis to reveal the users' understanding of a scheme is explored by observing spoken micro-interactional behaviours. It is shown that the users' understanding of the design was developed in the conversations around the use of artefacts, as well as the knowledge that is embedded in the artefacts themselves. The users' confidence in the appearance of the building was considered to be gained in conversation, rather than the ability of the artefacts to represent a future reality.

When do export subsidies have a redistributional role? Reply

Our differences are three. The first arises from the belief that "... a nonzero value for the optimally chosen policy instrument implies that the instrument is efficient for redistribution" (Alston, Smith, and Vercammen, p. 543, paragraph 3). Consider the two equations: (1) o* = f(P3) and (2) = -f(3) ++r h* (a, P3) representing the solution to the problem of maximizing weighted, Marshallian surplus using, simultaneously, a per-unit border intervention, 9, and a per-unit domestic intervention, wr. In the solution, parameter ot denotes the weight applied to producer surplus; parameter p denotes the weight applied to government revenues; consumer surplus is implicitly weighted one; and the country in question is small in the sense that it is unable to affect world price by any of its domestic adjustments (see the Appendix). Details of the forms of the functions f((P) and h(ot, p) are easily derived, but what matters in the context of Alston, Smith, and Vercammen's Comment is: Redistributivep referencest hatf avorp roducers are consistent with higher values "alpha," and whereas the optimal domestic intervention, 7r*, has both "alpha and beta effects," the optimal border intervention, r*, has only a "beta effect,"-it does not have a redistributional role. Garth Holloway is reader in agricultural economics and statistics, Department of Agricultural and Food Economics, School of Agriculture, Policy, and Development, University of Reading. The author is very grateful to Xavier Irz, Bhavani Shankar, Chittur Srinivasan, Colin Thirtle, and Richard Tiffin for their comments and their wisdom; and to Mario Mazzochi, Marinos Tsigas, and Cal Turvey for their scholarship, including help in tracking down a fairly complete collection of the papers that cite Alston and Hurd. They are not responsible for any errors or omissions. Note, in equation (1), that the border intervention is positive whenever a distortion exists because 8 > 0 implies 3 - 1 + 8 > 1 and, thus, f((P) > 0 (see Appendix). Using Alston, Smith, and Vercammen's definition, the instrument is now "efficient," and therefore has a redistributive role. But now, suppose that the distortion is removed so that 3 - 1 + 8 = 1, 8 = 0, and consequently the border intervention is zero. According to Alston, Smith, and Vercammen, the instrument is now "inefficient" and has no redistributive role. The reader will note that this thought experiment has said nothing about supporting farm incomes, and so has nothing whatsoever to do with efficient redistribution. Of course, the definition is false. It follows that a domestic distortion arising from the "excess-burden argument" 3 = 1 + 8, 8 > 0 does not make an export subsidy "efficient." The export subsidy, having only a "beta effect," does not have a redistributional role. The second disagreement emerges from the comment that Holloway "... uses an idiosyncratic definition of the relevant objective function of the government (Alston, Smith, and Vercammen, p. 543, paragraph 2)." The objective function that generates equations (1) and (2) (see the Appendix) is the same as the objective function used by Gardner (1995) when he first questioned Alston, Carter, and Smith's claim that a "domestic distortion can make a border intervention efficient in transferring surplus from consumers and taxpayers to farmers." The objective function used by Gardner (1995) is the same objective function used in the contributions that precede it and thus defines the literature on the debate about borderversus- domestic intervention (Streeten; Yeh; Paarlberg 1984, 1985; Orden; Gardner 1985). The objective function in the latter literature is the same as the one implied in another literature that originates from Wallace and includes most notably Gardner (1983), but also Alston and Hurd. Amer. J. Agr. Econ. 86(2) (May 2004): 549-552 Copyright 2004 American Agricultural Economics Association This content downloaded on Tue, 15 Jan 2013 07:58:41 AM All use subject to JSTOR Terms and Conditions 550 May 2004 Amer. J. Agr. Econ. The objective function in Holloway is this same objective function-it is, of course, Marshallian surplus.1 The third disagreement concerns scholarship. The Comment does not seem to be cognizant of several important papers, especially Bhagwati and Ramaswami, and Bhagwati, both of which precede Corden (1974, 1997); but also Lipsey and Lancaster, and Moschini and Sckokai; one important aspect of Alston and Hurd; and one extremely important result in Holloway. This oversight has some unfortunate repercussions. First, it misdirects to the wrong origins of intellectual property. Second, it misleads about the appropriateness of some welfare calculations. Third, it prevents Alston, Smith, and Vercammen from linking a finding in Holloway (pp. 242-43) with an old theorem (Lipsey and Lancaster) that settles the controversy (Alston, Carter, and Smith 1993, 1995; Gardner 1995; and, presently, Alston, Smith, and Vercammen) about the efficiency of border intervention in the presence of domestic distortions.

Gradient competence at the syntax-discourse interface

In this article, we present additional support of Duffield's (2003, 2005) distinction between Underlying Competence and Surface Competence. Duffield argues that a more fine-grained distinction between levels of competence and performance is warranted and necessary. While underlying competence is categorical, surface competence is more probabilistic and gradient, being sensitive to lexical and constructional contingencies, including the contextual appropriateness of a given construction. We examine a subset of results from a study comparing native and learner competence of properties at the syntax-discourse interface. Specifically, we look at the acceptability of Clitic Right Dislocation in native and L2 Spanish, in discourse-appropriate context. We argue that Duffield's distinction is a possible explanation of our results.

Using lexical diversity measures to operationalise language dominance in bilinguals

Treffers-Daller and Korybski propose to operationalize language dominance on the basis of measures of lexical diversity, as computed, in this particular study, on transcripts of stories told by Polish-English bilinguals in each of their languages They compute four different Indices of Language Dominance (ILD) on the basis of two different measures of lexical diversity, the Index of Guiraud (Guiraud, 1954) and HD-D (McCarthy & Jarvis, 2007). They compare simple indices, which are based on subtracting scores from one language from scores for another language, to more complex indices based on the formula Birdsong borrowed from the field of handedness, namely the ratio of (Difference in Scores) / (Sum of Scores). Positive scores on each of these Indices of Language Dominance mean that informants are more English-dominant and negative scores that they are more Polish-dominant. The authors address the difficulty of comparing scores across languages by carefully lemmatizing the data. Following Flege, Mackay and Piske (2002) they also look into the validity of these indices by investigating to what extent they can predict scores on other, independently measured variables. They use correlations and regression analysis for this, which has the advantage that the dominance indices are used as continuous variables and arbitrary cut-off points between balanced and dominant bilinguals need not be chosen. However, they also show how the computation of z-scores can help facilitate a discussion about the appropriateness of different cut-off points across different data sets and measurement scales in those cases where researchers consider it necessary to make categorial distinctions between balanced and dominant bilinguals. Treffers-Daller and Korybski correlate the ILD scores with four other variables, namely Length of Residence in the UK, attitudes towards English and life in the UK, frequency of usage of English at home and frequency of code-switching. They found that the indices correlated significantly with most of these variables, but there were clear differences between the Guiraud-based indices and the HDD-based indices. In a regression analysis three of the measures were also found to be a significant predictor of English language usage at home. They conclude that the correlations and the regression analyses lend strong support to the validity of their approach to language dominance.

The Cognitive Behaviour Therapy Scale for Children and Young People (CBTS-CYP): development and psychometric properties

Background: There is increased interest in developing training in cognitive behaviour therapy (CBT) with children and young people. However, the assessment of clinical competence has relied upon the use of measures such as the Cognitive Therapy Scale-Revised (CTSR: Blackburn et al., 2001) which has been validated to assess competence with adults. The appropriateness of this measure to assess competence when working with children and young people has been questioned. Aim: This paper describes the development and initial evaluation of the Cognitive Behaviour Therapy Scale for Children and Young People (CBTSCYP) developed specifically to assess competence in CBT with children and young people. Method: A cross section of child CBT practitioners (n = 61) were consulted to establish face validity. Internal reliability, convergent validity and discriminative ability were assessed in two studies. In the first, 12 assessors independently rated a single video using both the Cognitive Behaviour Therapy Scale for Children and Young People (CBTS-CYP) and Cognitive Therapy Scale-Revised (CTS-Revised: Blackburn et al., 2001). In the second, 48 different recordings of CBT undertaken with children and young people were rated on both the CBTS-CYP and CTS-R. Results: Face validity and internal reliability of the CBTS-CYP were high, and convergent validity with the CTS-R was good. The CBTS-CYP compared well with the CTSR in discriminative ability. Conclusion: The CBTS-CYP provides an appropriate way of assessing competence in using CBT with children and young people. Further work is required to assess robustness with younger children and the impact of group training in reducing interrater variations.

A rare structure at the syntax-discourse interface: heritage and Spanish-dominant native speakers weigh in

The present study examines knowledge of the discourse-appropriateness of Clitic Right Dislocation (CLRD) in a population of Heritage (HS) and Spanish-dominant Native Speakers in order to test the predictions of the Interface Hypothesis (IH; Sorace 2011). The IH predicts that speakers in language contact situations will experience difficulties with integrating information involving the interface of syntax and discourse modules. CLRD relates a dislocated constituent to a discourse antecedent, requiring integration of syntax and pragmatics. Results from an acceptability judgment task did not support the predictions of the IH. No statistical differences between the HSs’ performance and that of L1-dominant native speakers were evidenced when participants were presented with an offline task. Thus, our study did not find any evidence of “incomplete acquisition” (Montrul 2008) as it pertains to this specific linguistic structure.

Uptake of a free coronary heart disease risk screening programme in community pharmacy: the Healthy Heart Assessment service

Introduction Health promotion (HP) aims to enhance good health while preventing ill-health at three levels of activity; primary (preventative), secondary (diagnostic) and tertiary (management).1 It can range from simple provision of health education to ongoing support, but the effectiveness of HP is ultimately dependent on its ability to influence change. HP as part of the Community Pharmacy Contract (CPC) aims to increase public knowledge and target ‘hard-to-reach’ individuals by focusing mainly on primary and tertiary HP. The CPC does not include screening programmes (secondary HP) as a service. Coronary heart disease (CHD) is a significant cause of morbidity and mortality in the UK. While there is evidence to support the effectiveness of some community pharmacy HP strategies in CHD, there is paucity of research in relation to screening services.2 Against this background, Alliance Pharmacy introduced a free CHD risk screening programme to provide tailored HP advice as part of a participant–pharmacist consultation. The aim of this study is to report on the CHD risk levels of participants and to provide a qualitative indication of consultation outcomes. Methods Case records for 12 733 people who accessed a free CHD risk screening service between August 2004 and April 2006 offered at 217 community pharmacies were obtained. The service involved initial self-completion of the Healthy Heart Assessment (HHA) form and measurement of height, weight, body mass index, blood pressure, total cholesterol and highdensity lipoprotein levels by pharmacists to calculate CHD risk.3 Action taken by pharmacists (lifestyle advice, statin recommendation or general practitioner (GP) referral) and qualitative statements of advice were recorded, and a copy provided to the participants. The service did not include follow-up of participants. All participants consented to taking part in evaluations of the service. Ethical committee scrutiny was not required for this service development evaluation. Results Case records for 10 035 participants (3658 male) were evaluable; 5730 (57%) were at low CHD risk (<15%); 3636 (36%) at moderate-to-high CHD risk (≥15%); and 669 (7%) had existing heart disease. A significantly higher proportion of male (48% versus 30% female) participants were at moderate- to-high risk of CHD (chi-square test; P < 0.005). A range of outcomes resulted from consultations. Lifestyle advice was provided irrespective of participants’ CHD risk or existing disease. In the moderate-to-high-risk group, of which 52% received prescribed medication, lifestyle advice was recorded for 62%, 16% were referred and 34% were advised to have a re-assessment. Statin recommendations were made in 1% of all cases. There was evidence of supportive and motivational statements in the advice recorded. Discussion Pharmacists were able to identify individuals’ level of CHD risk and provide them with bespoke advice. Identification of at-risk participants did not automatically result in referrals or statin recommendation. One-third of those accessing the screening service had moderate-to-high risk of CHD, a significantly higher proportion of whom were men. It is not known whether these individuals had been previously exposed to HP but presumably by accessing this service they may have contemplated change. As effectiveness of HP advice will depend among other factors on ability to influence change, future consultations may need to explore patients’ attitude towards change in relation to the Trans Theoretical Model4 to better tailor HP advice. The high uptake of the service by those at moderate-to-high CHD risk indicates a need for this type of screening programme in community pharmacy, perhaps specifically to reach men who access medical services less.