Coronary heart disease risk screening: the community pharmacy Healthy Heart Assessment Service

Objectives We examined the characteristics and CHD risks of people who accessed the free Healthy Heart Assessment (HHA) service operated by a large UK pharmacy chain from August 2004 to April 2006. Methods Associations between participants’ gender, age, and socioeconomics were explored in relation to calculated 10-year CHD risks by cross-tabulation of the data. Specific associations were tested by forming contingency tables and using Pearson chi-square (χ2). Results Data from 8,287 records were analysable; 5,377 were at low and 2,910 at moderate-to-high CHD risk. The likelihood of moderate-to-high risk for a male versus female participant was significantly higher with a relative risk ratio (RRR) 1.72 (P < 0.001). A higher percentage of those in socioeconomic categories ‘constrained by circumstances’ (RRR 1.15; P < 0.05) and ‘blue collar communities’ (RRR 1.13; P < 0.05) were assessed with moderate-to-high risk compared to those in ‘prospering suburbs’. Conclusions People from ‘hard-to-reach’ sectors of the population, men and people from less advantaged communities, accessed the HHA service and were more likely to return moderate-to-high CHD risk. Pharmacists prioritised provision of lifestyle information above the sale of a product. Our study supports the notion that pharmacies can serve as suitable environments for the delivery of similar screening services.

How was patient empowerment portrayed in information leaflets describing the community pharmacy Medicines Use Review service in the UK?

Objective The Medicines Use Review (MUR) community pharmacy service was introduced in 2005 to enhance patient empowerment but the service has not been taken up as widely as expected. We investigated the depiction of the patient–pharmacist power relationship within MUR patient information leaflets. Methods We identified 11 MUR leaflets including the official Department of Health MUR booklet and through discourse analysis examined the way language and imagery had been used to symbolise and give meaning to the MUR service, especially the portrayal of the patient–pharmacist interactions and the implied power relations. Results A variety of terminology was used to describe the MUR, a service that aimed ultimately to produce more informed patients through the information imparted by knowledgeable, skilled pharmacists. Conclusion The educational role of the MUR overshadowed the intended patient empowerment that would take place with a true concordance-centred approach. Although patient empowerment was implied, this was within the boundaries of the biomedical model with the pharmacist as the expert provider of medicines information. Practice implications If patient empowerment is to be conveyed this needs to be communicated to patients through consistent use of language and imagery that portrays the inclusivity intended.

What is wrong with the global support facility for small-scale mining?

The World Bank, United Nations and UK Department for International Development (DfID) have spearheaded a recent global drive to regularize artisanal and small-scale mining (ASM), and provide assistance to its predominantly impoverished participants. To date, millions of dollars have been pledged toward the design of industry-specific policies and regulations; implementation of mechanized equipment; extension; and the launch of alternative livelihood (AL) programmes aimed at diversifying local economies. Much of this funding, however, has failed to facilitate marked improvements, and in many cases, has exacerbated problems. This paper argues that a poor understanding of artisanal, mine-community dynamics and operators’ needs has, in a number of cases, led to the design and implementation of inappropriate industry support schemes and interventions. The discussion focuses upon experiences from sub-Saharan Africa, where ASM is in the most rudimentary of states.

Describing Earth system simulations with the Metafor CIM

The Metafor project has developed a common information model (CIM) using the ISO19100 series for- malism to describe numerical experiments carried out by the Earth system modelling community, the models they use, and the simulations that result. Here we describe the mechanism by which the CIM was developed, and its key properties. We introduce the conceptual and application ver- sions and the controlled vocabularies developed in the con- text of supporting the fifth Coupled Model Intercomparison Project (CMIP5). We describe how the CIM has been used in experiments to describe model coupling properties and de- scribe the near term expected evolution of the CIM.

Evaluation of modelled regional water balance using lake status data: a comparison of 6ka simulations with the NCAR CCM

Variations in lake area and depth reflect climatically induced changes in the water balance of overflowing as well as closed lakes. A new global data base of lake status has been assembled, and is used to compare two simulations for 6 ka (6000 yr ago) made with successive R15 versions of the NCAR Community Climate Model (CCM). Simulated water balance was expressed as anomalies of annual precipitation minus evaporation (P-E); observed water balance as anomalies of lake status. Comparisons were made visually, by comparing regional averages, and by a statistic that compares the signs of simulated P-E anomalies (smoothly interpolated to the lake sites) with the status anomalies. Both CCM0 and CCM1 showed enhanced Northern-Hemisphere monsoons at 6 ka. Both underestimated the effect, but CCM1 fitted the spatial patterns better. In the northern mid- and high-latitudes the two versions differed more, and fitted the data less satisfactorily. CCM1 performed better than CCM0 in North America and central Eurasia, but not in Europe. Both models (especially CCM0) simulated excessive aridity in interior Eurasia. The models were systematically wrong in the southern mid-latitudes. Problems may have been caused by inadequate treatment of changes in sea-surface conditions in both models. Palaeolake status data will continue to provide a benchmark for the evaluation of modelling improvements.

Care in the community? Interpretations of a fractured goat bone from Neolithic Jarmo, Iraq

A case study of a goat metatarsal exhibiting a complex diaphyseal fracture from Pottery Neolithic Jarmo in the Central Zagros region of the eastern Fertile Crescent is here described and analysed. The Central Zagros is one of the areas with the earliest evidence for goat domestication. The significance of the pathology may be viewed within the context of domestic goat ecology in the landscape of Jarmo, potentially impacting browsing behaviour (goats raise themselves on their hind limbs to browse) and movement with the herd in the landscape (the terrain around Jarmo is very steep in places, which would be difficult for an animal to navigate on three legs). In the light of this, possible levels of care that the Neolithic human community may have afforded this animal are discussed – from a situation where therapeutic intervention may have occurred, to one of stall confinement of the animal to allow the pathology to heal, to a position of simple awareness of the condition – and how this impacts on our understanding of changes in attitudes towards animals through the process of domestication.