Blastocyst environment and its influence on offspring cardiovascular health:the heart of the matter

The development of adult-onset diseases such as type II diabetes, obesity and cardiovascular disease is traditionally attributed to adult lifestyle characteristics such as a lack of physical exercise, poor diet and smoking. However, evidence from both human and animal model studies has demonstrated that environmental factors such as an imbalance or reduction in maternal nutrition during gestation can have adverse effects on offspring metabolism and cardiovascular health. The severity and nature of the phenotypic changes induced in offspring is influenced by the period of gestation manipulated. In particular, the mammalian preimplantation embryo in different animal models displays particular sensitivity to environmental factors, either in vivo (maternal diet) or in vitro (embryo culture) that is associated with the onset of cardiovascular dysfunction in adult life. The detailed mechanisms by which environmental conditions can alter postnatal cardiovascular physiology are poorly understood. However, various factors including endothelial function, vascular responsiveness, the renin-angiotensin system, kidney structure and early postnatal growth dynamics have all been recognize as potential contributors. Here, we review the relationship between preimplantation embryo environment and postnatal cardiovascular disease risk, and consider biochemical, molecular, genetic and physiological pathways implicated in this association. © 2009 The Authors Journal compilation © 2009 Anatomical Society of Great Britain and Ireland.

A comparative study of hospital management in Great Britain and Brazil : cost information use

In Great Britain and Brazil healthcare is free at the point of delivery and based study only on citizenship. However, the British NHS is fifty-five years old and has undergone extensive reforms. The Brazilian SUS is barely fifteen years old. This research investigated the middle management mediation role within hospitals comparing managerial planning and control using cost information in Great Britain and Brazil. This investigation was conducted in two stages entailing quantitative and qualitative techniques. The first stage was a survey involving managers of 26 NHS Trusts in Great Britain and 22 public hospitals in Brazil. The second stage consisted of interviews, 10 in Great Britain and 22 in Brazil, conducted in four selected hospitals, two in each country. This research builds on the literature by investigating the interaction of contingency theory and modes of governance in a cross-national study in terms of public hospitals. It further builds on the existing literature by measuring managerial dimensions related to cost information usefulness. The project unveils the practice involved in planning and control processes. It highlights important elements such as the use of predictive models and uncertainty reduction when planning. It uncovers the different mechanisms employed on control processes. It also depicts that planning and control within British hospitals are structured procedures and guided by overall goals. In contrast, planning and control processes in Brazilian hospitals are accidental, involving more ad hoc actions and a profusion of goals. The clinicians in British hospitals have been integrated into the management hierarchy. Their use of cost information in planning and control processes reflects this integration. However, in Brazil, clinicians have been shown to operate more independently and make little use of cost information but the potential signalled for cost information use is seen to be even greater than that of their British counterparts.

In-vitro and in-vivo antivenin activity of 2-[2-(5,5,8a-trimethyl-2- methylene-decahydro-naphthalen-1-yl)-ethylidene]-succinaldehyde against Ophiophagus hannah venom

Objectives Curcuma zedoaroides A. Chaveerach & T. Tanee, locally known as Wan-Paya-Ngoo-Tua-Mia, is commonly used in the North-Eastern part of Thailand as a 'snakebite antidote'. The aim of this study was to isolate the active compound from the rhizome of C. zedoaroides, to determine its structure and to assess its antagonistic activity in vitro and in vivo against King cobra venom. Methods The active compound was obtained from C. zedoaroides by extraction with acetone followed by purification using column chromatography; its X-ray structure was determined. Its inhibition of venom lethality was studied in vitro in rat phrenic nerve-hemidiaphragms and in vivo in mice. Key findings The acetone extract of the Curcuma rhizomes contained a C20 dialdehyde, [2-(5,5,8a-trimethyl-2-methylene-decahydro-naphthalen-1-yl)-ethylidene] -succinaldehyde, as the major component. The isolated curcuma dialdehyde was found active in vitro and in vivo for antivenin activity against the King cobra venom. Using isolated rat phrenic nerve-hemidiaphragm preparations, a significant antagonistic effect on the inhibition of neuromuscular transmission was observed in vitro. Inhibition on muscle contraction, produced by the 4 μg/ml venom, was reversed by 2-16 μg/ml of Curcuma dialdehyde in organ bath preparations over a period of 2 h. Mice intraperitoneally injected with 0.75 mg/kg venom and dialdehyde at 100 mg/kg had a significantly increased survival time. Injection of Curcuma dialdehyde (100 mg/kg) 30 min before the subcutaneous injection of the venom resulted in a 100% survival time after 2 h compared with 0% for the control group. Conclusions The in vitro and in vivo evaluation confirmed the medicinal use of traditional snake plants against snakebites. The bioactivity is linked to an isolated molecule and not a result of synergistic effects of a mixture. The active compound was isolated and the structure fully elucidated, including its stereochemistry. This dialdehyde is a versatile chemical building block and can be easily obtained from this plant source. © 2010 Royal Pharmaceutical Society of Great Britain.

Comparative physical, mechanical and crystallographic properties of a series of gemfibrozil salts

Objectives Understanding the impact of the counterion on the properties of an acidic or basic drug may influence the choice of salt form, especially for less potent drugs with a high drug load per unit dose. The aim of this work was to determine the influence of the hydrogen bonding potential of the counterion on the crystal structure of salts of the poorly soluble, poorly compressible, acidic drug gemfibrozil and to correlate these with mechanical properties. Methods Compacts of the parent drug and the salts were used to determine Young's modulus of elasticity using beam bending tests. Crystal structures were determined previously from X-ray powder diffraction data. Key findings The free acid, tert-butylamine, 2-amino-2-methylpropan-1-ol and 2-amino-2-methylpropan-1, 3-diol salts had a common crystal packing motif of infinite hydrogen-bonded chains with cross-linking between pairs of adjacent chains. The tromethamine (trsi) salt, with different mechanical properties, had a two-dimensional sheet-like network of hydrogen bonds, with slip planes, forming a stiffer compact. Conclusions The type of counter ion is important in determining mechanical properties and could be selected to afford slip and plastic deformation. © 2010 Royal Pharmaceutical Society of Great Britain.

Developing the public health function of locum pharmacists under the auspices of the new pharmacy contract

Focal Point - There are reduced opportunities for locum pharmacists to access training and education that meets their needs and enables them to play a full role under the new pharmacy contract - Eighty-six per cent of locums consider themselves to be more health professional than business person, compared to just 48% of pharmacy owners - Forty per cent of locums believe that a lack of access to training is a major barrier to the development of their public health function - While locum pharmacists are arguably more likely to embrace 'professionalising', patient-care-based roles, they are also the group least likely to be able to access the necessary training to fulfill such roles Introduction It has been suggested that locum pharmacists do not want the business-based responsibilities (e.g. staff management, meeting targets, etc) that come with pharmacy management.1 Research also suggests that locums derive great satisfaction from the health-professional aspects of the pharmacists’ role (e.g. patient contact, the provision of advice, etc).1 However, upon the introduction of the new pharmacy contract (April 2005), concerns were expressed that it was becoming increasingly difficult for locum pharmacists to access training and education that would meet their needs and enable them to play a full role under the new framework.2,3 Method After piloting, in August 2006 a self-completion postal questionnaire was sent to a random sample of practising community pharmacists, stratified for country and sex, within Great Britain (n = 1998), with a follow-up to non-responders 4 weeks later. Data were analysed using SPSS (v12.0). A final response rate of 51% (n = 1023/1998) was achieved. Respondents were asked ‘indicate how you view yourself as a pharmacist’ – in terms of their relative focus on the health-professional and business aspects of their role. Respondents were also asked ‘do you consider a lack of training opportunities to be a barrier to the development of the public health role of community pharmacists?’. Results Locums were significantly more likely than owners or employees to consider each factor a major barrier. Discussion Four in 10 locums consider a lack of training opportunities to constitute a major barrier to the development of their public health function. Pharmacy may not be able to provide the services required of it by the policy agenda if pharmacists are unable to be involved in extended role activities through a lack of training opportunities. Therefore, the paradox that needs to be addressed is that while locum pharmacists are arguably more likely to embrace ‘professionalising’, patient-care-based roles, they are also the group least likely to be able to access training to fulfil such roles. The training needs of this large subset of the pharmacist population need to be assessed and met if the whole community pharmacy workforce is going to maximise its contribution to public health under the new contractual framework. References 1 Shann P, Hassell K. An exploration of the diversity and complexity of the pharmacy locum workforce. London: Royal Pharmaceutical Society of Great Britain; 2004. 2 Almond M. Locums – key players in workforce – cast adrift as contract launched. Pharm J 2005;274:420. 3 Bishop DH. A lack of appreciation of what really happens. Pharm J 2005;274:451.

What purpose does the MPharm research project serve?

In 2004, the Royal Pharmaceutical Society of Great Britain (RPSGB) funded research on teaching, learning and assessment within the UK undergraduate pharmacy degree (MPharm), including the compulsory final year project. Documentary analysis showed that all schools met the project requirement, although there were wide variations in the relative contribution of the project to the final year mark and the degree classification. Interviews with staff revealed that organisation of research projects was complex and time consuming and exacerbated by increasing student numbers and the impact of research ethics. 61% of students, surveyed via a self-completion questionnaire (response rate 50.6%) perceived the research project to be very or fairly important. Whilst 47% considered that they had enough choice of topic and 37% said that their training in research methods provided a good foundation for their project, this suggests scope for improvement. In the UK, there are legislative changes impending which may provide an opportunity to review the future purpose and feasibility of a "significant" final year project within the MPharm.

Pharmacy legislation:public protector or professional hindrance?

Pharmacy originates from a background of medication compounding and supply. More recently, this role has developed away from an absolute focus on the supply of pharmaceuticals with, for example, the advent of pharmacist prescribing. Nevertheless, for a majority of the profession, medication supply remains a core activity. Regulation of the pharmacy profession is now the responsibility of the General Pharmaceutical Council, although up until 27 September 2010, this role fell to the Royal Pharmaceutical Society of Great Britain (RPSGB). Before this change, in one of the most high-profile legal cases involving a pharmacist in a professional capacity, R. v Lee, a pharmacist was prosecuted firstly for gross negligence manslaughter, later revised to offences under the Medicines Act 1968, for a single error relating to medication supply, and was given a suspended custodial sentence. Offences against sections 64 or 85 of the Medicines Act are absolute offences and there is no due diligence defence. Prosecution of a pharmacist for the supply of incorrect medication may seem a measured course of action to protect the public from the wrongful supply of potent pharmacotherapeutic agents; however, further analysis of Lee indicates that this approach may be counterproductive. An appeal of the original conviction in the Lee case has resulted in a clarification of the interpretation of section 85(5); however currently, prosecutions under section 64 are still a possibility. Owing to the seriousness of a criminal conviction under section 64, this continuation will potentially stifle the profession's ability to learn from dispensing errors. © The Author [2013]. Published by Oxford University Press; all rights reserved.

The UK MPharm (1) - are we over reliant on traditional teaching methods?

Introduction-The design of the UK MPharm curriculum is driven by the Royal Pharmaceutical Society of Great Britain (RPSGB) accreditation process and the EU directive (85/432/EEC).[1] Although the RPSGB is informed about teaching activity in UK Schools of Pharmacy (SOPs), there is no database which aggregates information to provide the whole picture of pharmacy education within the UK. The aim of the teaching, learning and assessment study [2] was to document and map current programmes in the 16 established SOPs. Recent developments in programme delivery have resulted in a focus on deep learning (for example, through problem based learning approaches) and on being more student centred and less didactic through lectures. The specific objectives of this part of the study were (a) to quantify the content and modes of delivery of material as described in course documentation and (b) having categorised the range of teaching methods, ask students to rate how important they perceived each one for their own learning (using a three point Likert scale: very important, fairly important or not important). Material and methods-The study design compared three datasets: (1) quantitative course document review, (2) qualitative staff interview and (3) quantitative student self completion survey. All 16 SOPs provided a set of their undergraduate course documentation for the year 2003/4. The documentation variables were entered into Excel tables. A self-completion questionnaire was administered to all year four undergraduates, using a pragmatic mixture of methods, (n=1847) in 15 SOPs within Great Britain. The survey data were analysed (n=741) using SPSS, excluding non-UK students who may have undertaken part of their studies within a non-UK university. Results and discussion-Interviews showed that individual teachers and course module leaders determine the choice of teaching methods used. Content review of the documentary evidence showed that 51% of the taught element of the course was delivered using lectures, 31% using practicals (includes computer aided learning) and 18% small group or interactive teaching. There was high uniformity across the schools for the first three years; variation in the final year was due to the project. The average number of hours per year across 15 schools (data for one school were not available) was: year 1: 408 hours; year 2: 401 hours; year 3: 387 hours; year 4: 401 hours. The survey showed that students perceived lectures to be the most important method of teaching after dispensing or clinical practicals. Taking the very important rating only: 94% (n=694) dispensing or clinical practicals; 75% (n=558) lectures; 52% (n=386) workshops, 50% (n=369) tutorials, 43% (n=318) directed study. Scientific laboratory practices were rated very important by only 31% (n=227). The study shows that teaching of pharmacy to undergraduates in the UK is still essentially didactic through a high proportion of formal lectures and with high levels of staff-student contact. Schools consider lectures still to be the most cost effective means of delivering the core syllabus to large cohorts of students. However, this does limit the scope for any optionality within teaching, the scope for small group work is reduced as is the opportunity to develop multi-professional learning or practice placements. Although novel teaching and learning techniques such as e-learning have expanded considerably over the past decade, schools of pharmacy have concentrated on lectures as the best way of coping with the huge expansion in student numbers. References [1] Council Directive. Concerning the coordination of provisions laid down by law, regulation or administrative action in respect of certain activities in the field of pharmacy. Official Journal of the European Communities 1985;85/432/EEC. [2] Wilson K, Jesson J, Langley C, Clarke L, Hatfield K. MPharm Programmes: Where are we now? Report commissioned by the Pharmacy Practice Research Trust., 2005.

The UK MPharm (2) - Do we over assess?

Introduction-The pace of structural change in the UK health economies, the new focus on regulation and the breaking down of professional boundaries means that the Royal Pharmaceutical Society of Great Britain (RPSGB) has to continually review the scope, range and outputs of education provided by schools of pharmacy (SOPs). In SOPs, the focus is on equipping students with the knowledge, skills and attitudes necessary to successfully engage with the pre-registration year. The aim of this study [1] was to map current programmes and undergraduate experiences to inform the RPSGB debate. The specific objectives of this paper are to describe elements of the survey of final year undergraduates, to explore student opinions and experiences of their workload, teaching, learning and assessment. Material and methods-The three main research techniques were: (1) quantitative course document review, (2) qualitative staff interview and (3) quantitative student self completion survey. The questions in the survey were based on findings from exploratory focus group work with BPSA (British Pharmaceutical Students’ Association) members and were designed to ascertain if views expressed in the focus groups on the volume and format of assessments were held by the general student cohort. The student self completion questionnaire consisting of 31 questions, was administered in 2005 to all (n=1847) final year undergraduates, using a pragmatic mixture of methods. The sample was 15 SOPs within the UK (1 SOP opted out). The total response rate was 50.62% (n=935): it varied by SOP from 14.42% to 84.62%. The survey data were analysed (n=741) using SPSS, excluding non-UK students who may have undertaken part of their studies within a non-UK university. Results and discussion • 76% (n=562) respondents considered that the amount of formal assessment was about right, 21% (n=158) thought it was too much. • There was agreement that the MPharm seems to have more assessment than other courses, with 63% (n=463) strongly agreeing or agreeing. • The majority considered the balance between examinations and coursework was about right (67%, n=498), with 27% (n=198) agreeing that the balance was too far weighted towards examinations. • 57% (n=421) agreed that the focus of MPharm assessment was too much towards memorised knowledge, 40% (n=290) that it was about right. • 78% (n= 575) agreed with the statement “Assessments don’t measure the skills for being a pharmacist they just measure your knowledge base”. Only 10% (n=77) disagreed. • Similarly 49% (n=358) disagreed with, and 35% (n=256) were not sure about the statement “I consider that the assessments used in the MPharm course adequately measure the skills necessary to be a pharmacist”. Only 17% (n=124) agreed. Experience from this study shows the difficulty of administering survey instruments through UK Schools of Pharmacy. It is heavily dependent on timing, goodwill and finding the right person. The variability of the response rate between SOPs precluded any detailed analysis by School. Nevertheless, there are some interesting results. Issues raised in the exploratory focus group work about amount of assessment and over reliance on knowledge have been confirmed. There is a real debate to be had about the extent to which the undergraduate course, which must instil scientific knowledge, can provide students with the requisite qualities, skills, attitudes and behaviour that are more easily acquired in the pre-registration year. References [1] Wilson K, Jesson J, Langley C, Clarke L, Hatfield K. MPharm Programmes: Where are we now? Report commissioned by the Pharmacy Practice Research Trust., 2005.

A study in Britain and France of the development of cross-cultural in-house sales training using distance learning.

The thesis is concerned with cross-cultural distance learning in two countries: Great Britain and France. Taking the example of in-house sales training, it argues that it is possible to develop courses for use in two or more countries of differing culture and language. Two courses were developed by the researcher. Both were essentially print-based distance-learning courses designed to help salespeople achieve a better understanding of their customers. One used a quantitative, the other qualitative approach. One considered the concept of the return on investment and the other, for which a video support was also developed, considered the analysis of a customer's needs. Part 1 of the thesis considers differences in the training context between France and Britain followed by a review of the learning process with reference to distance learning. Part 2 looks at the choice of training medium course design and evaluation and sets out the methodology adopted, including problems encountered in this type of fieldwork. Part 3 analyses the data and draws conclusions from the findings, before offering a series of guidelines for those concerned with the development of cross-cultural in-house training courses. The results of the field tests on the two courses were analysed in relation to the socio-cultural, educational and experiential background of the learners as well as their preferred learning styles. The thesis argues that it is possible to develop effective in-house sales training courses to be used in two cultures and identifies key considerations which need to be taken into account when carrying out this type of work.