An examination of the UK community pharmacist's role in facilitating patient self-management of cardiovascular disease through lifestyle behaviours

The progression of cardiovascular disease (CVD) is largely modifiable through lifestyle behaviours. UK pharmacists are contractually obliged to facilitate patient self-management of chronic conditions such as CVD. Pharmacists are easily accessible health professionals who are well placed to identify “at risk” patients through medication regimes. Research has identified varying attitudes towards and levels of involvement in pharmacist-led health promotion activity. Given the diverse and exploratory nature of the work, a pragmatic, mixed methods approach was used to explore community pharmacists’ role in facilitating patient self-management of CVD. The thesis presents four studies: a qualitative study with pharmacists; a cross sectional questionnaire of community pharmacists; a systematic review and a qualitative study with patients with CVD. The qualitative study with pharmacists gave an insight into pharmacists’ experiences of giving patients with CVD lifestyle advice and the factors underpinning commonly cited barriers to providing public health services. This informed the development of the cross-sectional questionnaire which identified the predictors of pharmacists’ intentions to give two different types of advice to facilitate patient self-management. The systematic review identified a small number of interventions to prepare pharmacists to facilitate patient lifestyle behaviour change and evaluated the theories and behaviour change techniques used in successful interventions; however due to poor study quality and poor reporting of the interventions limited conclusions about the efficacy of the interventions could reliably be drawn. Finally, the qualitative study gave an insight into the experiences of patients with CVD using community pharmacy services and their expectations of the service they receive from community pharmacists. Recommendations about changes to pharmacy policy and practice in order to support pharmacists’ provision of CVD self-management advice are made.

Self-adaptive volunteered services composition through stimulus-and time-awareness

Volunteered Service Composition (VSC) refers to the process of composing volunteered services and resources. These services are typically published to a pool of voluntary resources. Selection and composition decisions tend to encounter numerous uncertainties: service consumers and applications have little control of these services and tend to be uncertain about their level of support for the desired functionalities and non-functionalities. In this paper, we contribute to a self-awareness framework that implements two levels of awareness, Stimulus-awareness and Time-awareness. The former responds to basic changes in the environment while the latter takes into consideration the historical performance of the services. We have used volunteer service computing as an example to demonstrate the benefits that self-awareness can introduce to self-adaptation. We have compared the Stimulus-and Time-awareness approaches with a recent Ranking approach from the literature. The results show that the Time-awareness level has the advantage of satisfying higher number of requests with lower time cost.

Self-adapting parallel metric-space search engine for variable query loads

This research focuses on automatically adapting a search engine size in response to fluctuations in query workload. Deploying a search engine in an Infrastructure as a Service (IaaS) cloud facilitates allocating or deallocating computer resources to or from the engine. Our solution is to contribute an adaptive search engine that will repeatedly re-evaluate its load and, when appropriate, switch over to a dierent number of active processors. We focus on three aspects and break them out into three sub-problems as follows: Continually determining the Number of Processors (CNP), New Grouping Problem (NGP) and Regrouping Order Problem (ROP). CNP means that (in the light of the changes in the query workload in the search engine) there is a problem of determining the ideal number of processors p active at any given time to use in the search engine and we call this problem CNP. NGP happens when changes in the number of processors are determined and it must also be determined which groups of search data will be distributed across the processors. ROP is how to redistribute this data onto processors while keeping the engine responsive and while also minimising the switchover time and the incurred network load. We propose solutions for these sub-problems. For NGP we propose an algorithm for incrementally adjusting the index to t the varying number of virtual machines. For ROP we present an ecient method for redistributing data among processors while keeping the search engine responsive. Regarding the solution for CNP, we propose an algorithm determining the new size of the search engine by re-evaluating its load. We tested the solution performance using a custom-build prototype search engine deployed in the Amazon EC2 cloud. Our experiments show that when we compare our NGP solution with computing the index from scratch, the incremental algorithm speeds up the index computation 2{10 times while maintaining a similar search performance. The chosen redistribution method is 25% to 50% faster than other methods and reduces the network load around by 30%. For CNP we present a deterministic algorithm that shows a good ability to determine a new size of search engine. When combined, these algorithms give an adapting algorithm that is able to adjust the search engine size with a variable workload.

Multiple roles for executive control in belief-desire reasoning:distinct neural networks are recruited for self perspective inhibition and complexity of reasoning

Belief-desire reasoning is a core component of 'Theory of Mind' (ToM), which can be used to explain and predict the behaviour of agents. Neuroimaging studies reliably identify a network of brain regions comprising a 'standard' network for ToM, including temporoparietal junction and medial prefrontal cortex. Whilst considerable experimental evidence suggests that executive control (EC) may support a functioning ToM, co-ordination of neural systems for ToM and EC is poorly understood. We report here use of a novel task in which psychologically relevant ToM parameters (true versus false belief; approach versus avoidance desire) were manipulated orthogonally. The valence of these parameters not only modulated brain activity in the 'standard' ToM network but also in EC regions. Varying the valence of both beliefs and desires recruits anterior cingulate cortex, suggesting a shared inhibitory component associated with negatively valenced mental state concepts. Varying the valence of beliefs additionally draws on ventrolateral prefrontal cortex, reflecting the need to inhibit self perspective. These data provide the first evidence that separate functional and neural systems for EC may be recruited in the service of different aspects of ToM.