Earthworms produce granules of intricately zoned calcite

Earthworms of the family Lumbricidae, which includes many common species, produce and secrete up to millimeter-sized calcite granules, and the intricate fine-scale zoning of their constituent crystals is unique for a biomineral. Granule calcite is produced by crystallization of amorphous calcium carbonate (ACC) that initially precipitates within the earthworm calciferous glands, then forms protogranules by accretion on quartz grain cores. Crystallization of ACC is mediated by migrating fluid films and is largely complete within 24 11 of ACC production and before granules leave the earthworm. Variations in the density of defects formed as a byproduct of trace element incorporation during calcite crystall growth have generated zoning that can be resolved by cathodoluminescence imaging at ultraviolet to blue wavelengths and using the novel technique of scanning electron microscope charge contrast imaging. Mapping of calcite crystal orientations by electron backscatter diffraction reveals an approximate radial fabric to the granules that reflects crystal growth from internal nucleation sites toward their margins. The survival within granules of ACC inclusions for months after they enter soils indicates that they crystallize only within the earthworm and in the presence of fluids containing biochemical catalysts. The earthworm probably promotes crystallization of ACC in order to prevent remobilization of the calcium carbonate by dissolution. Calcite granules vividly illustrate the role of transient precursors in biomineralization, but the underlying question of why earth-worms produce granules in volumes sufficient to have a measurable impact on soil carbon cycling remains to be answered.

What is the new medicines use review ‘patient survey’ attempting to capture in the context of existing patient satisfaction with pharmacy questionnaires and a new conceptual framework?

The community pharmacy service medicines use review (MUR) was introduced in 2005 ‘to improve patient knowledge, concordance and use of medicines’ through a private patient–pharmacist consultation. The MUR presents a fundamental change in community pharmacy service provision. While traditionally pharmacists are dispensers of medicines and providers of medicines advice, and patients as recipients, the MUR considers pharmacists providing consultation-type activities and patients as active participants. The MUR facilitates a two-way discussion about medicines use. Traditional patient–pharmacist behaviours transform into a new set of behaviours involving the booking of appointments, consultation processes and form completion, and the physical environment of the patient–pharmacist interaction moves from the traditional setting of the dispensary and medicines counter to a private consultation room. Thus, the new service challenges traditional identities and behaviours of the patient and the pharmacist as well as the environment in which the interaction takes place. In 2008, the UK government concluded there is at present too much emphasis on the quantity of MURs rather than on their quality.[1] A number of plans to remedy the perceived imbalance included a suggestion to reward ‘health outcomes’ achieved, with calls for a more focussed and scientific approach to the evaluation of pharmacy services using outcomes research. Specifically, the UK government set out the main principal research areas for the evaluation of pharmacy services to include ‘patient and public perceptions and satisfaction’as well as ‘impact on care and outcomes’. A limited number of ‘patient satisfaction with pharmacy services’ type questionnaires are available, of varying quality, measuring dimensions relating to pharmacists’ technical competence, behavioural impressions and general satisfaction. For example, an often cited paper by Larson[2] uses two factors to measure satisfaction, namely ‘friendly explanation’ and ‘managing therapy’; the factors are highly interrelated and the questions somewhat awkwardly phrased, but more importantly, we believe the questionnaire excludes some specific domains unique to the MUR. By conducting patient interviews with recent MUR recipients, we have been working to identify relevant concepts and develop a conceptual framework to inform item development for a Patient Reported Outcome Measure questionnaire bespoke to the MUR. We note with interest the recent launch of a multidisciplinary audit template by the Royal Pharmaceutical Society of Great Britain (RPSGB) in an attempt to review the effectiveness of MURs and improve their quality.[3] This template includes an MUR ‘patient survey’. We will discuss this ‘patient survey’ in light of our work and existing patient satisfaction with pharmacy questionnaires, outlining a new conceptual framework as a basis for measuring patient satisfaction with the MUR. Ethical approval for the study was obtained from the NHS Surrey Research Ethics Committee on 2 June 2008. References 1. Department of Health (2008). Pharmacy in England: Building on Strengths – Delivering the Future. London: HMSO. www. official-documents.gov.uk/document/cm73/7341/7341.pdf (accessed 29 September 2009). 2. Larson LN et al. Patient satisfaction with pharmaceutical care: update of a validated instrument. JAmPharmAssoc 2002; 42: 44–50. 3. Royal Pharmaceutical Society of Great Britain (2009). Pharmacy Medicines Use Review – Patient Audit. London: RPSGB. http:// qi4pd.org.uk/index.php/Medicines-Use-Review-Patient-Audit. html (accessed 29 September 2009).

A retrospective audit of medicines use review forms

The medicines use review (MUR) service was introduced in England and Wales in 2005 to improve patients’ knowledge and use of medicines through a private, patient–pharmacist consultation. The pharmacist completes a standard form as a record of the MUR consultation and the patient receives a copy. The 2008 White Paper, Pharmacy in England[1] notes some MURs are of poor or questionable quality and there are anecdotal reports that pharmacists elect to conduct ‘easy’ MURs with patients on a single prescribed medicine only.[2] In 2009, the Royal Pharmaceutical Society of Great Britain (RPSGB) launched a multi-disciplinary audit template to review the effectiveness of MURs and improve their quality.[3] Prior to this, we conducted a retrospective MUR audit in a 1-month period in 2008. Our aims were to report on findings from this audit and the validity of using MUR forms as data for audit.

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.

Clastic and core lava components of a silicic lava dome

The formation of a lava dome involves fractionation of the lava into core and clastic components. We show that for three separate, successive andesitic lava domes that grew at Soufrière Hills volcano, Montserrat, between 1999 and 2007, the volumetric proportion of the lava converted to talus or pyroclastic flow deposits was 50%–90% of the lava extruded. Currently, only 8% of the total magma extruded during the 1995–2007 eruption remains as core lava. The equivalent representation in the geological record will probably be even lower. Most of the lava extruded at the surface flowed no further than 150–300 m from the vent before disaggregation, resulting in a lava core whose shape tends to a cylinder. Moderate to high extrusion rates at the Soufrière Hills domes may have contributed to the large clastic fraction observed. Creating talus dissipates much of the energy that would otherwise be stored in the core lava of domes. The extreme hazards from large pyroclastic flows and blasts posed by wholesale collapse of a lava dome depend largely on the size of the lava core, and hence on the aggregate history of the partitioning process, not on the size of the dome.

Geoarchaeology and the value of multidisciplinary palaeoenvironmental approaches: a case study from the Tehran Plain, Iran

Tepe Pardis, a significant Neolithic–Chalcolithic site on the Tehran Plain in Iran, is, like many sites in the area, under threat from development. The site contains detailed evidence of (1) the Neolithic–Chalcolithic transition, (2) an Iron Age cemetery and (3) how the inhabitants adapted to an unstable fan environment through resource exploitation (of clay deposits for relatively large-scale ceramic production by c. 5000 BC, and importantly, possible cutting of artificial water channels). Given this significance, models have been produced to better understand settlement distribution and change in the region. However, these models must be tied into a greater understanding of the impact of the geosphere on human development over this period. Forming part of a larger project focusing on the transformation of simple, egalitarian Neolithic communities into more hierarchical Chalcolithic ones, the site has become the focus of a multidisciplinary project to address this issue. Through the combined use of sedimentary and limited pollen analysis, radiocarbon and optically stimulated luminescence dating (the application of the last still rare in Iran), a greater understanding of the impact of alluvial fan development on human settlement through alluviation and the development of river channel sequences is possible. Notably, the findings presented here suggest that artificial irrigation was occurring at the site as early as 6.7±0.4 ka (4300–5100 BC).

Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA)

As the mean age of the global population increases, breast cancer in older individuals will be increasingly encountered in clinical practice. Management decisions should not be based on age alone. Establishing recommendations for management of older individuals with breast cancer is challenging because of very limited level 1 evidence in this heterogeneous population. In 2007, the International Society of Geriatric Oncology (SIOG) created a task force to provide evidence-based recommendations for the management of breast cancer in elderly individuals. In 2010, a multidisciplinary SIOG and European Society of Breast Cancer Specialists (EUSOMA) task force gathered to expand and update the 2007 recommendations. The recommendations were expanded to include geriatric assessment, competing causes of mortality, ductal carcinoma in situ, drug safety and compliance, patient preferences, barriers to treatment, and male breast cancer. Recommendations were updated for screening, primary endocrine therapy, surgery, radiotherapy, neoadjuvant and adjuvant systemic therapy, and metastatic breast cancer.

Timing and structure of the 8.2 kyr B.P. event inferred from δ18O records of stalagmites from China, Oman, and Brazil

Oxygen isotope records of stalagmites from China and Oman reveal a weak summer monsoon event, with a double-plunging structure, that started 8.21 ± 0.02 kyr B.P. An identical but antiphased pattern is also evident in two stalagmite records from eastern Brazil, indicating that the South American Summer Monsoon was intensified during the 8.2 kyr B.P. event. These records demonstrate that the event was of global extent and synchronous within dating errors of <50 years. In comparison with recent model simulations, it is plausible that the 8.2 kyr B.P. event can be tied in changes of the Atlantic Meridional Overturning Circulation triggered by a glacial lake draining event. This, in turn, affected North Atlantic climate and latitudinal position of the Intertropical Convergence Zone, resulting in the observed low-latitude monsoonal precipitation patterns.

Humid periods in southern Arabia: windows of opportunity for modern human dispersal.

Arabia is a key area for the dispersal of anatomically modern humans (AMH, Homo sapiens) out of Africa. Given its modern hostile environment, the question of the timing of dispersal is also a question of climatic conditions. Fresh water and food were crucial factors facilitating AMH expansions into Arabia. By dating relict lake deposits, four periods of lake formation were identified: one during the early Holocene and three during the late Pleistocene centered ca. 80, ca. 100, and ca. 125 ka. Favorable environmental conditions during these periods allowed AMH to migrate across southern Arabia. Between ca. 75 and 10.5 ka, arid conditions prevailed and turned southern Arabia into a natural barrier for human dispersal. Thus, expansion of AMH through the southern corridor into Asia must have taken place before 75 ka, possibly in multiple dispersals.

Quantitative estimates of glacial and Holocene temperature and precipitation change in lowland Amazonian Bolivia

Quantitative estimates of temperature and precipitation change during the late Pleistocene and Holocene have been difficult to obtain for much of the lowland Neotropics. Using two published lacustrine pollen records and a climate-vegetation model based on the modern abundance distributions of 154 Neotropical plant families, we demonstrate how family-level counts of fossil pollen can be used to quantitatively reconstruct tropical paleoclimate and provide needed information on historic patterns of climatic change. With this family-level analysis, we show that one area of the lowland tropics, northeastern Bolivia, experienced cooling (1–3 °C) and drying (400 mm/yr), relative to present, during the late Pleistocene (50,000–12,000 calendar years before present [cal. yr B.P.]). Immediately prior to the Last Glacial Maximum (LGM, ca. 21,000 cal. yr B.P.), we observe a distinct transition from cooler temperatures and variable precipitation to a period of warmer temperatures and relative dryness that extends to the middle Holocene (5000–3000 cal. yr B.P.). This prolonged reduction in precipitation occurs against the backdrop of increasing atmospheric CO2 concentrations, indicating that the presence of mixed savanna and dry-forest communities in northeastern Bolivia durng the LGM was not solely the result of low CO2 levels, as suggested previously, but also lower precipitation. The results of our analysis demonstrate the potential for using the distribution and abundance structure of modern Neotropical plant families to infer paleoclimate from the fossil pollen record.