Pharmacy and public health: examining the link between strategy and practice

Despite having been described by the then (2003) Chief Pharmaceutical Officer for England as ·probably the biggest untapped resource for health improvement", the development of the public health function of community pharmacists has been limited. However, devolution of healthcare budgets has led 10 differential rates of development of the public health function in each administration of the UK (England, Scotland, Wales and Northern Ireland). This is measured and reflected upon in this thesis. Two large-scale surveys were conducted, one of key strategic personnel (Directors of Public Health and Chief Pharmacists) in Primary Care Organisations (PCOs) and one of practicing community pharmacists. This research highlights the fact that community pharmacists have developed an individualistic, service-based approach to their engagement with public health that is contrary to the more collective approach adopted by the wider public health movement. The study measures the scope and level of health-improving services through community pharmacy across the UK and shows that the nature of the pharmacy contractor (independent, multiple etc.) may impact on the range and nature of services provided. Survey data also suggest that attitudes towards pharmacy involvement in the public health agenda vary markedly between Directors of Public Health, PCO Chief Pharmacists, and community pharmacists. Furthermore, within the community pharmacist population, attitudes are affected by a wide range of factors including the nature of employment (owner, employee, self-employed) and the type of employing pharmacy (independent, multiple etc.). Implications for policy and areas for further research aimed at maximising the public health function of community pharmacists are suggested.

The evaluation and development of the lead authority partnership scheme as a central intervention strategy for health and safety enforcement by local authorities

The research comprises a suite of studies that examines and develops the Lead Authority Partnership Scheme (LAPS) as a central intervention strategy for health and safety by local authority (LA) enforcers. Partnership working is a regulatory concept that in recent years has become more popular but there has been little research conducted to investigate, explore and evaluate its practical application. The study reviewed two contrasting approaches to partnership working between LAs and businesses, both of which were intended to secure improvements in the consistency of enforcement by the regulators and in the health and safety management systems of the participating businesses. The first was a well-established and highly prescriptive approach that required a substantial resource commitment on the part of the LA responsible for conducting a safety management review (SMR) of the business. As a result of his evaluation of the existing ‘full SMR’ scheme, the author developed a second, more flexible approach to partnership working. The research framework was based upon a primarily qualitative methodology intended to investigate and explore the impact of the new flexible arrangements for partnership working. The findings from this study of the flexible development of the scheme were compared and contrasted with those from studies of the established ‘full SMR’ scheme. A substantial degree of triangulation was applied in an attempt to strengthen validity and broaden applicability of the research findings. Key informant interviews, participant observation, document/archive reviews, questionnaires and surveys all their particular part to play in the overall study. The findings from this research revealed that LAPS failed to deliver consistency of LA enforcement across multiple-outlet businesses and the LA enforced business sectors. Improvement was however apparent in the safety management systems of the businesses participating in LAPS. Trust between LA inspector and safety professional was key to the success of the partnerships as was the commitment of these key individuals. Competition for precious LA resources, the priority afforded to food safety over health and safety, the perceived high resource demands of LAPS, and the structure and culture of LAs were identified as significant barriers to LA participation. Flexible approaches, whilst addressing the resource issues, introduced some fresh concerns relating to credibility and delivery. Over and above the stated aims of the scheme, LAs and businesses had their own reasons for participation, notably the personal development of individuals and kudos for the organisation. The research has explored the wider implications for partnership working with the overall conclusion it is most appropriately seen as a strategic level element within a broader structured intervention strategy.

The development of a solid waste management strategy

This research is concerned with the application of operational research techniques in the development of a long- term waste management policy by an English waste disposal authority. The main aspects which have been considered are the estimation of future waste production and the assessment of the effects of proposed systems. Only household and commercial wastes have been dealt with in detail, though suggestions are made for the extension of the effect assessment to cover industrial and other wastes. Similarly, the only effects considered in detail have been costs, but possible extensions are discussed. An important feature of the study is that it was conducted in close collaboration with a waste disposal authority, and so pays more attention to the actual needs of the authority than is usual in such research. A critical examination of previous waste forecasting work leads to the use of simple trend extrapolation methods, with some consideration of seasonal effects. The possibility of relating waste production to other social and economic indicators is discussed. It is concluded that, at present, large uncertainties in predictions are inevitable; waste management systems must therefore be designed to cope with this uncertainty. Linear programming is used to assess the overall costs of proposals. Two alternative linear programming formulations of this problem are used and discussed. The first is a straightforward approach, which has been .implemented as an interactive computer program. The second is more sophisticated and represents the behaviour of incineration plants more realistically. Careful attention is paid to the choice of appropriate data and the interpretation of the results. Recommendations are made on methods for immediate use, on the choice of data to be collected for future plans, and on the most useful lines for further research and development.

Development and deployment of an autonomous micro-drilling system for cochleostomy

This thesis describes the design and development of an autonomous micro-drilling system capable of accurately controlling the penetration of complaint tissues and its application to the drilling of the cochleostomy; a key stage in the cochlea implant procedure. The drilling of the cochleostomy is a precision micro-surgical task in which the control of the burr penetration through the outer bone tissue of the cochlea is vital to prevent damage to the structures within and requires a high degree of skill to perform successfully. The micro-drilling system demonstrates that the penetration of the cochlea can be achieved consistently and accurately. Breakthrough can be detected and controlled to within 20µm of the distal surface and the hole completed without perforation of the underlying endosteal membrane, leaving the membranous cochlea intact. This device is the first autonomous surgical tool successfully deployed in the operating theatre. The system is unique due to the way in which it uses real-time data from the cutting tool to derive the state of the tool-tissue interaction. Being a smart tool it uses this state information to actively control the way in which the drilling process progresses. This sensor guided strategy enables the tool to self-reference to the deforming tissue and navigate without the need for pre-operative scan data. It is this capability that enables the system to operate in circumstances where the tissue properties and boundary conditions are unknown, without the need to restrain the patient.

The role of self-regulation in developing leaders:a longitudinal field experiment

A longitudinal field experiment examined a leader self-regulation intervention in teams engaged in a Business Strategy Module (BSM) of a University course. The BSM, which is an integral part of the degree programme, involved teams of four or five individuals, under the direction of a leader, working on a (simulated) car manufacturing task over a period of 24. weeks. Various aspects of team performance contributed towards module assessment. All leaders received multi-source feedback of leader task-relevant capabilities (from the leader, followers and module tutor). Leaders were randomly allocated into a self-regulation intervention (15 leaders, 46 followers) or control (25 leaders, 109 followers) conditions. The intervention, which was run by an independent coach, was designed to improve leaders' use of self-regulatory processes to aid the development of task-relevant leadership competencies. Survey data was collected from the leaders and followers (on three occasions: pre- and two post-test intervention), team financial performance (three occasions: post-test) and a final team report (post-test). The leader self-regulation intervention led to increased followers' ratings of leader's effectiveness, higher team financial performance and higher final team grade compared to the control (non-intervention) condition. Furthermore, the benefits of the self-regulation intervention were mediated by leaders' attaining task-relevant competencies. © 2013.

A new dynamic framework for managing ERP development and enterprise strategy

The enterprise management (EM) approach provides a holistic view of organizations and their related information systems. In order to align information technology (IT) innovation with global markets and volatile virtualization, traditional firms are seeking to reconstruct their enterprise structures alongside repositioning strategy and establish new information system (IS) architectures to transform from single autonomous entities into more open enterprises supported by new Enterprise Resource Planning (ERP) systems. This chapter shows how ERP engage-abilities cater to three distinctive EM patterns and resultant strategies. The purpose is to examine the presumptions and importance of combing ERP and inter-firm relations relying on the virtual value chain concept. From a review of the literature on ERP development and enterprise strategy, exploratory inductive research studies in Zoomlion and Lanye have been conducted. In addition, the authors propose a dynamic conceptual framework to demonstrate the adoption and governance of ERP in the three enterprise management forms and points to a new architectural type (ERPIII) for operating in the virtual enterprise paradigm. © 2012, IGI Global.

The development of maternal self-esteem

Although an important theoretical concept, little is known about the development of maternal self-esteem. This study explores the significance of maternal cognitions, psychopathological symptoms, and child temperament in the prediction of prenatal and postnatal maternal self-esteem. During pregnancy 162 women completed measures assessing their unhealthy core beliefs, psychopathological symptoms, and self-esteem. At 1 year postpartum 87 of these women completed measures assessing their self-esteem and their child's temperament. Overall maladaptive maternal core beliefs and psychopathological symptoms during pregnancy explained 19% of the variance in prenatal maternal self-esteem. Forty-two percent of the variance in maternal self-esteem at 1 year could be explained by a combination of prenatal maternal self-esteem, mental health symptoms, maternal core beliefs, and more unsociable infant temperament. Underlying maternal cognitive structures may be important in determining the development of maternal self-esteem. © 2007 2006 Michigan Association for Infant Mental Health.

Place-based economic development strategy in England:filling the missing space

This paper examines the implications of a place-based economic strategy in the context of the UK Coalition government's framework for achieving local growth and the creation of Local Economic Partnerships in England. It draws on the international literature to outline the basic foundations of place-based policy approaches. It explores two key features, particularly as they relate to governance institutions and to the role of knowledge. After examining key concepts in the place-based policy literature, such as 'communities of interest' and 'capital city' and 'local elites', it shows how they might be interpreted in an English policy context. The paper then discusses a place-based approach towards an understanding of the role of knowledge, linked to debates around 'smart specialisation'. In doing so, it shows why there is an important 'missing space' in local growth between the 'national' and the 'local' and how that space might be filled through appropriate governance institutions and policy responses. Overall, the paper outlines what a place-based approach might mean in particular for Central Government, in changing its approach towards sub-national places and for local places, in seeking to realise their own potential. Furthermore, it outlines what the 'missing space' is and how it might be filled, and therefore what a place-based sub-national economic strategy might address. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Parental confidence in managing food allergy:development of the Food Allergy Self-Efficacy Scale for parents (FASE-P)

Background: Food allergy is often a life-long condition that requires constant vigilance in order to prevent accidental exposure and avoid potentially life-threatening symptoms. Parents’ confidence in managing their child’s food allergy may relate to the poor quality of life anxiety and worry reported by parents of food allergic children. Objective: The aim of the current study was to develop and validate the first scale to measure parental confidence (self-efficacy) in managing food allergy in their child. Methods: The Food Allergy Self-Efficacy Scale for Parents (FASE-P) was developed through interviews with 53 parents, consultation of the literature and experts in the area. The FASE-P was then completed by 434 parents of food allergic children from a general population sample in addition to the General Self-Efficacy Scale (GSES), the Food Allergy Quality of Life Parental Burden Scale (FAQL-PB), the General Health Questionnaire (GHQ12) and the Food Allergy Impact Measure (FAIM). A total of 250 parents completed the re-test of the FASE-P. Results: Factor and reliability analysis resulted in a 21 item scale with 5 sub-scales. The overall scale and sub-scales has good to excellent internal consistency (α’s of 0.63-0.89) and the scale is stable over time. There were low to moderate significant correlations with the GSES, FAIM and GHQ12 and strong correlations with the FAQL-PB, with better parental confidence relating to better general self-efficacy, better quality of life and better mental health in the parent. Poorer self-efficacy was related to egg and milk allergy; self-efficacy was not related to severity of allergy. Conclusions and clinical relevance: The FASE-P is a reliable and valid scale for use with parents from a general population. Its application within clinical settings could aid provision of advice and improve targeted interventions by identifying areas where parents have less confidence in managing their child’s food allergy.

A new dynamic framework for managing ERP development and enterprise strategy

The enterprise management (EM) approach provides a holistic view of organizations and their related information systems. In order to align information technology (IT) innovation with global markets and volatile virtualization, traditional firms are seeking to reconstruct their enterprise structures alongside repositioning strategy and establish new information system (IS) architectures to transform from single autonomous entities into more open enterprises supported by new Enterprise Resource Planning (ERP) systems. This chapter shows how ERP engage-abilities cater to three distinctive EM patterns and resultant strategies. The purpose is to examine the presumptions and importance of combing ERP and inter-firm relations relying on the virtual value chain concept. From a review of the literature on ERP development and enterprise strategy, exploratory inductive research studies in Zoomlion and Lanye have been conducted. In addition, the authors propose a dynamic conceptual framework to demonstrate the adoption and governance of ERP in the three enterprise management forms and points to a new architectural type (ERPIII) for operating in the virtual enterprise paradigm.