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).

Technological innovation in the context of PPPs: incentives, opportunities and actions

From a construction perspective, Public-Private Partnership projects (PPPs) are often credited as providing real incentives for the actors involved as well as a business environment that is conducive to innovation and improved practices. The validity of four common rhetorical arguments used to promote the PPP procurement route is explored: collaborative working, design freedom, long-term commitment and risk transfer. Particular interest is given to the extent to which espoused intentions correlate with experienced realities in allowing actors involved in the design and construction phases to be presented with, and able to exploit, opportunities for technological innovation. It is argued that there is reason to be cautious in fully accepting the purported benefits of the PPP framework and that the arguments often presented need to be revised. Alternative interpretations are provided.

fMRI delineation of working memory for emotional prosody in the brain: commonalities with the lexico-semantic emotion network

Decoding emotional prosody is crucial for successful social interactions, and continuous monitoring of emotional intent via prosody requires working memory. It has been proposed by Ross and others that emotional prosody cognitions in the right hemisphere are organized in an analogous fashion to propositional language functions in the left hemisphere. This study aimed to test the applicability of this model in the context of prefrontal cortex working memory functions. BOLD response data were therefore collected during performance of two emotional working memory tasks by participants undergoing fMRI. In the prosody task, participants identified the emotion conveyed in pre-recorded sentences, and working memory load was manipulated in the style of an N-back task. In the matched lexico-semantic task, participants identified the emotion conveyed by sentence content. Block-design neuroimaging data were analyzed parametrically with SPM5. At first, working memory for emotional prosody appeared to be right-lateralized in the PFC, however, further analyses revealed that it shared much bilateral prefrontal functional neuroanatomy with working memory for lexico-semantic emotion. Supplementary separate analyses of males and females suggested that these language functions were less bilateral in females, but their inclusion did not alter the direction of laterality. It is concluded that Ross et al.'s model is not applicable to prefrontal cortex working memory functions, that evidence that working memory cannot be subdivided in prefrontal cortex according to material type is increased, and that incidental working memory demands may explain the frontal lobe involvement in emotional prosody comprehension as revealed by neuroimaging studies. (c) 2007 Elsevier Inc. All rights reserved.

Working together? Parent and local authority views on the process of obtaining appropriate educational provision for children with autism spectrum disorders

Background: There is general agreement across all interested parties that a process of working together is the best way to determine which school or educational setting is right for an individual child with autism spectrum disorder. In the UK, families and local authorities both desire a constructive working relationship and see this as the best means by which to reach an agreement to determine where a child should be educated. It has been shown in published works 1 1. Batten and colleagues (Make schools make sense. Autism and education: the reality for families today; London: The National Autistic Society, 2006). View all notes that a constructive working relationship is not always achieved. Purpose: This small-scale study aims to explore the views of both parents and local authorities, focussing on how both parties perceive and experience the process of determining educational provision for children with autism spectrum disorders (ASD) within an English context. Sample, design and method: Parental opinion was gathered through the use of a questionnaire with closed and open responses. The questionnaire was distributed to two national charities, two local charities and 16 specialist schools, which offered the questionnaire to parents of children with ASD, resulting in an opportunity sample of 738 returned surveys. The views of local authority personnel from five local authorities were gathered through the use of semi-structured interviews. Data analyses included quantitative analysis of the closed response questionnaire items, and theme-based qualitative analysis of the open responses and interviews with local authority personnel. Results: In the majority of cases, parents in the survey obtained their first choice placement for their child. Despite this positive outcome, survey data indicated that parents found the process bureaucratic, stressful and time consuming. Parents tended to perceive alternative placement suggestions as financially motivated rather than in the best interests of the child. Interviews with local authority personnel showed an awareness of these concerns and the complex considerations involved in determining what is best for an individual child. Conclusions: This small-scale study highlights the need for more effective communication between parents of children with ASDs and local authority personnel at all stages of the process

The transition of the Polish real estate market within a Central and Eastern European context

The real estate market in Poland is a relatively immature market, but one that has been experiencing substantial transformation. The development of the market has been encouraged by a number of factors, including changes arising as a result of new legislation and the migration of capital between capital markets. The progress of the real estate sector towards a western style competitive market has taken place within the gradual transformation of the Polish economy into a free market economy. As investment grade property is in relatively short supply in Poland, investors consider opportunities within the wider CEE block. An analysis of the risk-return characteristics of the three largest CEE real estate markets namely, Poland, Hungary and Czech Republic, shows that the returns in these markets have been negatively correlated with the UK. As these economies and markets evolve, and being part of the wider EU trading block, their economic performance will slowly converge and become more synchronized with their western counterparts. However, the catch-up of the CEE markets to western European performance cycles will be protracted and consequently there are likely to be significant ongoing portfolio risk reduction opportunities

Patents for plants: context and current status

One of the important themes in any discussion concerning the application of genetic transformation technology in horticulture or elsewhere is the role of Intellectual Property Rights (IPR). This term covers both the content of patents and the confidential expertise, usually related to methodology and referred to as “Trade Secrets”. This review will explain the concepts behind patent protection, and will discuss the wide-ranging scope of existing patents that cover novel genotypes of plants as well as all aspects of transgenic technology, from selectable markers and novel promoters to methods of gene introduction. Although few of these patents have any significant commercial value there are a small number of key patents that may restrict the “freedom to operate” of any company seeking to exploit the methods in the production of transgenic varieties. Over the last twenty years, these restrictions have forced extensive cross-licensing between ag-biotech companies and have been one of the driving forces behind the consolidation of these companies. Although such issues may have limited relevance in the horticultural sector, and are often considered to be of little interest to the academic scientist working in the public sector, they are of great importance in any debate about the role of “public-good breeding” and of the relationship between the public and private sectors.

Area-wide development viability appraisals: the concept of threshold land value within a UK planning context

Area-wide development viability appraisals are undertaken to determine the economic feasibility of policy targets in relation to planning obligations. Essentially, development viability appraisals consist of a series of residual valuations of hypothetical development sites across a local authority area at a particular point in time. The valuations incorporate the estimated financial implications of the proposed level of planning obligations. To determine viability the output land values are benchmarked against threshold land value and therefore the basis on which this threshold is established and the level at which it is set is critical to development viability appraisal at the policy-setting (area-wide) level. Essentially it is an estimate of the value at which a landowner would be prepared to sell. If the estimated site values are higher than the threshold land value the policy target is considered viable. This paper investigates the effectiveness of existing methods of determining threshold land value. They will be tested against the relationship between development value and costs. Modelling reveals that threshold land value that is not related to shifts in development value renders marginal sites unviable and fails to collect proportionate planning obligations from high value/low cost sites. Testing the model against national average house prices and build costs reveals the high degree of volatility in residual land values over time and underlines the importance of making threshold land value relative to the main driver of this volatility, namely development value.

Variation, asymmetry and working memory in the process of second language acquisition

Calls for understanding the interface between L2 linguistic knowledge and development (Gregg 1996; Carroll 2001; Towell 2003) provide a context for analysing the role of memory (Paradis 2004), specifically working memory (Baddeley 1986, 2003) in L2 development. Miyake and Friedman (1998) have claimed that Working Memory (WM) may be the key to L2 acquisition, especially in explaining individual variation in L2 acquisition. Recent findings found a robust connection between greater working memory (WM) capacity and rapid, successful acquisition of L2 vocabulary, reading and oral fluency (Service 1992; Harrington and Sawyer 1992; Fortkamp 1999). This study adds to the growing body of research by investigating correlations between WM and variation in grammatical development, focusing on asymmetries in processing L2 English wh-constructions in an immersion setting.

Flexibility of representational states in working memory

The relationship between working memory (WM) and attention is a highly interdependent one, with evidence that attention determines the state in which items in WM are retained. Through focusing of attention, an item might be held in a more prioritized state, commonly termed as the focus of attention (FOA). The remaining items, although still retrievable, are considered to be in a different representational state. One means to bring an item into the FOA is to use retrospective cues (‘retro-cues’) which direct attention to one of the objects retained in WM. Alternatively, an item can enter a privileged state once attention is directed towards it through bottom-up influences (e.g. recency effect) or by performing an action on one of the retained items (‘incidental’ cueing). In all these cases, the item in the FOA is recalled with better accuracy compared to the other items in WM. Far less is known about the nature of the other items in WM and whether they can be flexibly manipulated in and out of the FOA. We present data from three types of experiments as well as transcranial magnetic stimulation to early visual cortex to manipulate the item inside FOA. Taken together, our results suggest that the context in which items are retained in WM matters. When an item remains behaviourally relevant, despite not being inside the FOA, re-focusing attention upon it can increase its recall precision. This suggests that a non-FOA item can be held in a state in which it can be later retrieved. However, if an item is rendered behaviourally unimportant because it is very unlikely to be probed, it cannot be brought back into the FOA, nor recalled with high precision. Under such conditions, some information appears to be irretrievably lost from WM. These findings, obtained from several different methods, demonstrate quite considerable flexibility with which items in WM can be represented depending upon context. They have important consequences for emerging state-dependent models of WM.

Working through the layers: curriculum implementation in language education

This chapter presents findings on English Language instruction at the lower primary level in the context of policies for curricular innovation at national, school and classroom levels. The focus is on policies which connect national and school levels, and on how they might be interpreted when implemented in multiple schools within Singapore’s educational system. Referring to case studies in two schools and to individual lesson observations in 10 schools, we found much agreement with national policies in terms of curriculum (i.e. lesson content and activity selection),leading to great uniformity in the lessons taught by different teachers in different schools. In addition, we found that schools had an important mediating influence on implementation of national policies. However, adoptions and adaptations of policy innovations at the classroom level were somewhat superficial as they were more related to changes in educational facilities and procedures than in philosophies.

Adaptive social protection: mapping the evidence and policy context in the agriculture sector in south Asia

An aim of government and the international community is to respond to global processes and crises through a range of policy and practical approaches that help limit damage from shocks and stresses. Three approaches to vulnerability reduction that have become particularly prominent in recent years are social protection (SP), disaster risk reduction (DRR) and climate change adaptation (CCA). Although these approaches have much in common, they have developed separately over the last two decades. However, given the increasingly complex and interlinked array of risks that poor and vulnerable people face, it is likely that they will not be sufficient in the long run if they continue to be applied in isolation from one another. In recognition of this challenge, the concept of Adaptive Social Protection (ASP) has been developed. ASP refers to a series of measures which aims to build resilience of the poorest and most vulnerable people to climate change by combining elements of SP, DRR and CCA in programmes and projects. The aim of this paper is to provide an initial assessment of the ways in which these elements are being brought together in development policy and practice. It does this by conducting a meta-analysis of 124 agricultural programmes implemented in five countries in south Asia. These are Afghanistan, Bangladesh, India, Nepal and Pakistan. The findings show that full integration of SP, DRR and CCA is relatively limited in south Asia, although there has been significant progress in combining SP and DRR in the last ten years. Projects that combine elements of SP, DRR and CCA tend to emphasise broad poverty and vulnerability reduction goals relative to those that do not. Such approaches can provide valuable lessons and insights for the promotion of climate resilient livelihoods amongst policymakers and practitioners.

Social and ecological drivers of success in agri-environment schemes: the roles of farmers and environmental context

1. Agri-environment schemes remain a controversial approach to reversing biodiversity losses, partly because the drivers of variation in outcomes are poorly understood. In particular, there is a lack of studies that consider both social and ecological factors. 2. We analysed variation across 48 farms in the quality and biodiversity outcomes of agri-environmental habitats designed to provide pollen and nectar for bumblebees and butterflies or winter seed for birds. We used interviews and ecological surveys to gather data on farmer experience and understanding of agri-environment schemes, and local and landscape environmental factors. 3. Multimodel inference indicated social factors had a strong impact on outcomes and that farmer experiential learning was a key process. The quality of the created habitat was affected positively by the farmer’s previous experience in environmental management. The farmer’s confidence in their ability to carry out the required management was negatively related to the provision of floral resources. Farmers with more wildlife-friendly motivations tended to produce more floral resources, but fewer seed resources. 4. Bird, bumblebee and butterfly biodiversity responses were strongly affected by the quantity of seed or floral resources. Shelter enhanced biodiversity directly, increased floral resources and decreased seed yield. Seasonal weather patterns had large effects on both measures. Surprisingly, larger species pools and amounts of semi-natural habitat in the surrounding landscape had negative effects on biodiversity, which may indicate use by fauna of alternative foraging resources. 5. Synthesis and application. This is the first study to show a direct role of farmer social variables on the success of agri-environment schemes in supporting farmland biodiversity. It suggests that farmers are not simply implementing agri-environment options, but are learning and improving outcomes by doing so. Better engagement with farmers and working with farmers who have a history of environmental management may therefore enhance success. The importance of a number of environmental factors may explain why agri-environment outcomes are variable, and suggests some – such as the weather – cannot be controlled. Others, such as shelter, could be incorporated into agri-environment prescriptions. The role of landscape factors remains complex and currently eludes simple conclusions about large-scale targeting of schemes.

A new pattern for historical geography: working with enthusiast communities and public history

This paper argues for the adoption of participatory approaches in historical geography, drawing on the author's experience in working with enthusiast communities in the UK in the context of collaborative research with the Science Museum and ideas of public history and geography.