An exploration of pharmacy-specific reasons for non-adherence to prescribed medicines in a socioeconomically deprived, ethnically diverse UK cohort

Methods - Ethical approval for the study was granted by both the local National Health Service (NHS) Research Ethics Committee (REC) and Aston University’s REC. Seven focus groups were conducted between October and December 2011 in medical or community settings within inner-city Birmingham (UK). Discussions were guided by a theme plan which was developed from key themes identified by a literature review and piloted via a Patient Consultation Group. Each focus group had between 3 and 7 participants. The groups were digitally recorded and subsequently transcribed verbatim. The transcriptions were then subjected to thematic analysis via constant comparison in order to identify emerging themes. Results - Participants recognised the pharmacist as an expert source of advice about prescribed medicines, a source they frequently felt a need to consult as a result of the inadequate supply of medicines information from the prescriber. However, an emerging theme was a perception that pharmacists had an oblique profit motive relating to the supply of generic medicines with frequent changes to the ‘brand’ of generic supplied being attributed to profit-seeking by pharmacists. Such changes had a negative impact on the patient’s perceived efficacy of the therapy which may make non-adherence more likely. Conclusions - Whilst pharmacists were recognised as medicines experts, trust in the pharmacist was undermined by frequent changes to generic medicines. Such changes have the potential to adversely impact adherence levels. Further, quantitative research is recommended to examine if such views are generalisable to the wider population of Birmingham and to establish if such views impact on adherence levels.

Employment outcomes and plant closure in a post-industrial city:an analysis of the labour market studies of MG Rover workers three years on

This paper examines how the loss of 6300 jobs from the closure of MG Rover (MGR) in the city of Birmingham (UK) in April 2005 affected the employment trajectories of ex-workers, in the context of wider structural change and efforts at urban renewal. The paper presents an analysis of a longitudinal survey of 300 ex-MGR workers, and examines to what extent the state of local labour markets and workers’ geographical mobility—as well as the effectiveness of the immediate policy response and longer-term local economic strategies—may have helped to balance the impacts of personal attributes associated with workers’ employability and their reabsorption into the labour markets. It is found that the relative buoyancy of the local economy, the success of longer-run efforts at diversification and a strong policy response and retraining initiative helped many disadvantaged workers to find new jobs in the medium term. However, the paper also highlights the unequal employment outcomes and trajectories that many lesser-skilled workers faced. It explores the policy issues arising from such closures and their aftermath, such as the need to co-ordinate responses, to retain institutional capacity, to offer high-quality training and education resources to workers and, where possible, to slow down such closure processes to enable skills to be retained and reused within the local economy.

Mixed communities: a new approach to spatially-concentrated poverty in England

This article examines the adoption, by the New Labour government, of a mixed communities approach to the renewal of disadvantaged neighbourhoods in England. It argues that while there are continuities with previous policy, the new approach represents a more neoliberal policy turn in three respects: its identification of concentrated poverty as the problem; its faith in market-led regeneration; and its alignment with a new urban policy agenda in which cities are gentrified and remodelled as sites for capital accumulation through entrepreneurial local governance. The article then draws on evidence from the early phases of the evaluation of the mixed community demonstration projects to explore how the new policy approach is playing out at a local level, where it is layered upon existing policies, politics and institutional relationships. Tensions between neighbourhood and strategic interests, community and capital are evident as the local projects attempt neighbourhood transformation, while seeking to protect the rights and interests of existing residents. Extensive community consultation efforts run parallel with emergent governance structures, in which local state and capital interests combine and communities may effectively be disempowered. Policies and structures are still evolving and it is not yet entirely clear how these tensions will be resolved, especially in the light of a collapsing housing market, increased poverty and demand for affordable housing, and a shortage of private investment.

Widening access to Higher Education:an evaluative case study of a foundation year alternative to access

Universities are encouraged to widen access to a broad range of applicants, including mature students taking Access qualifications. Admissions tutors can find it difficult to compare and choose between Access and A-level applications, and Access applicants for popular courses may be disadvantaged relative to students with good A-levels. In this evaluative case study a foundation year designed to avoid Access selection problems and widen participation in psychology, biology, optometry and pharmacy is reviewed. Progression and success rates are compared to national averages for Access courses and issues in Foundation Year management considered. The Foundation Year is rejected as unsatisfactory and it is concluded that widening participation for mature students can be achieved through Access courses. Difficulties in achieving this for high-demand courses in leading universities are discussed.

Individual differences in human-computer interaction

This thesis initially presents an 'assay' of the literature pertaining to individual differences in human-computer interaction. A series of experiments is then reported, designed to investigate the association between a variety of individual characteristics and various computer task and interface factors. Predictor variables included age, computer expertise, and psychometric tests of spatial visualisation, spatial memory, logical reasoning, associative memory, and verbal ability. These were studied in relation to a variety of computer-based tacks, including: (1) word processing and its component elements; (ii) the location of target words within passages of text; (iii) the navigation of networks and menus; (iv) command generation using menus and command line interfaces; (v) the search and selection of icons and text labels; (vi) information retrieval. A measure of self-report workload was also included in several of these experiments. The main experimental findings included: (i) an interaction between spatial ability and the manipulation of semantic but not spatial interface content; (ii) verbal ability being only predictive of certain task components of word processing; (iii) age differences in word processing and information retrieval speed but not accuracy; (iv) evidence of compensatory strategies being employed by older subjects; (v) evidence of performance strategy differences which disadvantaged high spatial subjects in conditions of low spatial information content; (vi) interactive effects of associative memory, expertise and command strategy; (vii) an association between logical reasoning and word processing but not information retrieval; (viii) an interaction between expertise and cognitive demand; and (ix) a stronger association between cognitive ability and novice performance than expert performance.

Accessibility, deprivation and rural planning policies.

Since the Second World War a range of policies have been implemented by central and local government agencies, with a view to improving accessibility to facilities, housing and employment opportunities within rural areas. It has been suggested that a lack of reasonable access to a range of such facilities and opportunities constitutes a key aspect of deprivation or disadvantage for rural residents. Despite considerable interest, very few attempts have been made to assess the nature and incidence of this disadvantage or the reaction of different sections of the population of rural areas to it. Moreover, almost all previous assessments have relied on so-called 'objective' measures of accessibility and disadvantage and failed to consider the relationship between such measures and 'subjective' measures such as individual perceptions. It is this gap in knowledge that the research described in this thesis has addressed. Following a critical review of relevant literature the thesis describes the way in which data on 'objective' and 'subjective' indicators of accessibility and behavioural responses to accessibility problems was collected, in six case study areas in Shropshire. Analysis of this data indicates that planning and other government policies have failed to significantly improve rural resident's accessibility to their basic requirements, and may in some cases have exacerbated it, and that as a result certain sections of the rural population are relatively disadvantaged. Moreover, analysis shows that .certain aspects of individual subjective' assessments of such accessibility disadvantage are significantly associated with more easily-obtained 'objective' measures. By using discriminant analysis the research demonstrates that it is possible to predict the likely levels of satisfaction with access to facilities from a range of 'objective' measures. The research concludes by highlighting the potential practical applications of such indicators in policy formulation, policy appraisal and policy evaluation.

Planning for cycling in the West Midlands

The issues involved in planning for pedal cyclists are examined with reference to the West Midlands County. Working with a local cycling campaign group, the researcher uses action research methods to investigate and influence the campaign. Development of cycle planning is traced through the literature, focusing on bicycle ownership, bicycle use and cycling policy. UK practice is contrasted with the integrated approach of other countries. An extensive bibliography is provided. Local authority cycle planning through the TPP process is systematically assessed over three years. This provides a context for the information regarding cycling in the West Midlands. Existing data is presented from the 1981 Census and local police road accident and bicycle theft records. The developing relationship between the local authority and the cycle campaign group is narrated in detail, explaining the problems that can beset efforts to improve conditions for cyclists. The researcher was closely involved in this interaction, particularly with policy and a major public inquiry. A survey of the Cycle Campaign Network indicates that the local group was not atypical. To provide information relevant to the local campaign and for effective local planning, a survey of 3,500 West Midlands residents was conducted using a novel combination of questionnaires and interviews. It shows that 1) Bicycle ownership and use is considerably higher than indicated by the 1978/9 National Travel Survey 2) Cycling is most import to certain disadvantaged sections of the community, particularly the young, those without access to a car and in the lower SEGs. The broader issues of transport policy are discussed, concluding that cycling is regarded as a marginal activity and that changes in general transport policy, land use planning and fiscal arrangements are necessary conditions for cycle planning to succeed. An integrated package of cycling measures involving engineering, education, enforcement and encouragement is also required. Recommendations are made concerning central government, local authorities and cycle campaign groups. Subjects for further research are identified.

White working-class neighbourhoods:common themes and policy suggestions

What does it mean to be white and working class in modern Britain? The Joseph Rowntree Foundation’s studies of traditionally white estates in Bradford, London, Coventry and Birmingham are part of a growing body of research into ‘white identities’. This paper: • identifies common findings from JRF research into traditionally white estates, in the context of other similar work; • suggests how issues of white identity can be better understood and makes recommendations for policy and practice. Key points: • Profound economic and social change has increased isolation and fear in traditionally white estates. Residents often claim that things were better in the past. • ‘Estatism’ refers to specific social dynamics associated with council estates and prejudice towards residents based on where they live. This can result in lowered self-esteem and reluctance to participate in community campaigns. • People on traditionally white estates often feel they are not listened to by outside agencies. Consultations can raise hopes but ultimately reinforce disengagement. Initiatives to ensure equality have become associated with political correctness (‘PC’). • White working-class people feel they are bound by values of hard work, reciprocity and support. They are frustrated by the closure and lack of access to community facilities. The social class system simultaneously disadvantages the working class while giving advantage to other classes. • There is a strong desire for allocation of resources to be fair, with a widespread perception that minorities are given preference. Blaming incomers for decline is common, with the target of blame differing between sites. Participants did not want to be considered racist and felt that labelling ideas as racist prevents discussion. Similarly, the term ‘PC’ can also be used to shut down debate. • Recommendations include community-twinning, new ways of accessing local authorities, involvement from the private sector in disadvantaged areas and local panels to define and develop the ‘Big Society’. Initiatives aimed solely at white working-class people are unlikely to be successful.

A management tool for developing the relationships between large purchasing organisations and small ethnic minority suppliers

Purpose: The purpose of this paper is to scrutinise the characteristics of the relationship between large purchasing organisations (LPOs) and ethnic minority suppliers (EMSs) engaging with supplier diversity programmes and provide an assessment and developmental framework for such organisations. Design/methodology/approach: Having considered an array of purchaser-supplier relationship frameworks in relevant streams of literature, the paper draws on Lamming et al.'s framework to advance a tool for assessing and developing the relationship between LPOs and EMSs. Findings: The submitted relationship assessment and development framework brings in sharp focus the characteristics of the relationship between LPO and EMS, providing a systematic way to examine the inter-organisational context within which EMS development takes place. Research limitations/implications: The framework submitted could signpost future research in this field, which should take a longitudinal, processual approach. This is necessary to provide opportunities to examine the dynamics underlying the development of potent LPO-EMS relationships in a variety of settings, including negative instances. Practical implications: The paper has implications for corporate policy making and practice in this arena. Assessing the potency of LPOs-EMSs relationships by applying the proffered tool can help both parties engage with supplier diversity, to develop fruitful relationships that enhance their competitiveness. Social implications: The latter can have social implications, as EMSs often operate in and employ people from disadvantaged communities. Originality/value: The framework advanced in this article constitutes a novel tool that highlights the areas in which LPOs and EMSs should channel their efforts, in order to develop a potent relationship between them, which underpins the development of EMSs' supply capabilities. © Emerald Group Publishing Limited.

Entry characteristics and academic performance of students in a master of pharmacy degree program in the United Kingdom

Objective. Evaluate the characteristics of a cohort of Master of Pharmacy (MPharm) students upon entry and examine any associations between entry qualifications, type of school attended, socioeconomic deprivation, age and academic performance in the MPharm programme. Methods. A retrospective cohort analysis of data recorded on Aston University’s central database for each individual exiting the MPharm programme during the five year period 2005-6 – 2009-10 (n=644). Results. Entrants were disproportionately drawn from socioeconomically deprived areas and independent (private) schools. Achievement prior to admission was related to the type of school attended but not to deprivation. Performance on the programme was not related to type of school or deprivation but was strongly correlated with prior achievements. Conclusions. Prior achievement is the most important predictor of performance on the MPharm programme but the superior prior achievement of independent school pupils is not seen at the point of graduation. This may have implications for admissions policies.

Examination of the predictive value of structural magnetic resonance scans in bipolar disorder:a pattern classification approach

Background - Bipolar disorder (BD) is one of the leading causes of disability worldwide. Patients are further disadvantaged by delays in accurate diagnosis ranging between 5 and 10 years. We applied Gaussian process classifiers (GPCs) to structural magnetic resonance imaging (sMRI) data to evaluate the feasibility of using pattern recognition techniques for the diagnostic classification of patients with BD. Method - GPCs were applied to gray (GM) and white matter (WM) sMRI data derived from two independent samples of patients with BD (cohort 1: n = 26; cohort 2: n = 14). Within each cohort patients were matched on age, sex and IQ to an equal number of healthy controls. Results - The diagnostic accuracy of the GPC for GM was 73% in cohort 1 and 72% in cohort 2; the sensitivity and specificity of the GM classification were respectively 69% and 77% in cohort 1 and 64% and 99% in cohort 2. The diagnostic accuracy of the GPC for WM was 69% in cohort 1 and 78% in cohort 2; the sensitivity and specificity of the WM classification were both 69% in cohort 1 and 71% and 86% respectively in cohort 2. In both samples, GM and WM clusters discriminating between patients and controls were localized within cortical and subcortical structures implicated in BD. Conclusions - Our results demonstrate the predictive value of neuroanatomical data in discriminating patients with BD from healthy individuals. The overlap between discriminative networks and regions implicated in the pathophysiology of BD supports the biological plausibility of the classifiers.

The Aston Medication Adherence Study:mapping the adherence patterns of an inner-city population

Background: The Aston Medication Adherence Study was designed to examine non-adherence to prescribed medicines within an inner-city population using general practice (GP) prescribing data. Objective: To examine non-adherence patterns to prescribed oralmedications within three chronic disease states and to compare differences in adherence levels between various patient groups to assist the routine identification of low adherence amongst patients within the Heart of Birmingham teaching Primary Care Trust (HoBtPCT). Setting: Patients within the area covered by HoBtPCT (England) prescribed medication for dyslipidaemia, type-2 diabetes and hypothyroidism, between 2000 and 2010 inclusively. HoBtPCT's population was disproportionately young,with seventy per cent of residents fromBlack and Minority Ethnic groups. Method: Systematic computational analysis of all medication issue data from 76 GP surgeries dichotomised patients into two groups (adherent and non-adherent) for each pharmacotherapeutic agent within the treatment groups. Dichotomised groupings were further analysed by recorded patient demographics to identify predictors of lower adherence levels. Results were compared to an analysis of a self-reportmeasure of adherence [using the Modified Morisky Scale© (MMAS-8)] and clinical value data (cholesterol values) from GP surgery records. Main outcome: Adherence levels for different patient demographics, for patients within specific longterm treatment groups. Results: Analysis within all three groups showed that for patients with the following characteristics, adherence levels were statistically lower than for others; patients: younger than 60 years of age; whose religion is coded as "Islam"; whose ethnicity is coded as one of the Asian groupings or as "Caribbean", "Other Black" and "African"; whose primary language is coded as "Urdu" or "Bengali"; and whose postcodes indicate that they live within the most socioeconomically deprived areas of HoBtPCT. Statistically significant correlations between adherence status and results from the selfreport measure of adherence and of clinical value data analysis were found. Conclusion: Using data fromGP prescribing systems, a computerised tool to calculate individual adherence levels for oral pharmacotherapy for the treatment of diabetes, dyslipidaemia and hypothyroidism has been developed.The tool has been used to establish nonadherence levels within the three treatment groups and the demographic characteristics indicative of lower adherence levels, which in turn will enable the targeting of interventional support within HoBtPCT. © Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013.

Specialist business skills of international students

This paper follows on from that presented at the last BEST conference in Edinburgh (Higson & Hamilton-Jones(2004)). At that stage, the authors outlined their initial research work with students studying on the yearlong International Foundation programmes. at three local FE Colleges allied to Aston University. The research (funded by the University's Teaching Quality Enhancement Funds (TQEF) involved questionnaires and interviews with staff and students (the latter all from overseas). it aimed to identify ways to improve the learning experience of students on the International Foundation programmes, to aid their smooth transition to full degree programmes in Business and Management and to improve the progression rates of such students while studying at Aston. The initial research findings were used to design a module for those students' progress to degree programmes in Aston Business School. This paper discusses how the module was designed, its content and the assessment methods used to help determine whether students are achieving the learning outcomes. The basic principle was to identify areas of study where the International Foundation Programme students needed help in order to improve their learning styles to assist them with the requirements of other modules that they would be studying during their time at Aston. Particular emphasis was put on the need to develop active learners who were not disadvantaged by their lack of awareness of UK culture and society and who were as comfortable performing written work under examination conditions or presenting orally as their UK counterparts. An additional aim was to prepare these students for the placement year which was a compulsory part of their degree. The module, therefore, comprises a range of inputs for a number of staff, a company visit, weekly reflective learning leading to Personal Development Plan (PDP) work, formal examinations, presentations, group work •and individual case studies. This paper also reports on the initial reaction of the students and tutors to the new learning experience with currently 30 participants undertaking the module. Provisional findings suggest that the International Foundation programme has prepared the students well for degree-level work and that as a group of international students they are much more analytical and, after studying the module interactive than their counterparts who have come directly onto Aston degrees. It has shown them still to be quite passive learners, comfortable with facts and lecture-style learning environments, but less comfortable when asked to use their own initiatives. Continuing progress needs to be made in terms of encouraging them to develop a reflective approach to learning with the students taking some time to feel comfortable with an analytical approach to learning. In addition, im account of the students' reactions to having to work through a formal (PDP) and the results of their first assessments will be provided. At Aston, this work is being used as a pilot to recognise good practice with regards to work with further groups of international students. it is hoped that this would have widespread application across the sector.

Procedural justice in procurement management and inclusive interorganizational relations:An institutional perspective

This paper applies the concept of procedural justice to one of the most important focal points of interorganizational relations: the purchaser-supplier relationship. The few extant studies of the concept in the purchaser-supplier domain have overlooked an important aspect of this key relationship: that is, inclusiveness in procurement. This is despite the fact that interest in the specific empirical context of supply chain links between large purchasing organizations (LPOs) and ethnic minority suppliers (EMSs) from disadvantaged communities proceeds apace on both sides of the Atlantic. Institutional theory is used to examine the form that procedural justice takes in eight case studies of LPOs from the private and public sectors, which actively engage with inclusive procurement management initiatives in England. The guiding question is twofold: 'What may LPO approaches to installing procedural justice in procurement management entail?' and 'How are these approaches shaped?' This paper identifies specific approaches to installing procedural justice for inclusive procurement and submits theoretical propositions about how these are shaped. The study contributes to a macro-level assessment of procedural justice, i.e. interorganizational procedural justice, as a significant aspect of inclusive interorganizational relationships, which is a domain in need of theoretical development.

Entrepreneurship in the neighborhood:shifting patterns of economic activities in residential neighborhoods in five dutch cities

Cities are oftentimes seen as undergoing a process of "emergence" in the "new economy." However, this process has largely remained empirically underdetermined. This article examines the intra-city geography of emerging businesses in newly dominant sectors of the urban economy. The change in dominant sectors coincides with a shift towards small- and medium-sized businesses, creating new economic opportunities for urban residential areas. The residential neighborhood is introduced as a place where supply and demand side drivers operate to attract or limit such new economic activity. Allen Scott's perspective of the cognitive-cultural economy is used to analyze which neighborhoods are flourishing sites of the cognitive-cultural sectors. His perspective on industries that are on the rise in urban environments and their growth potential proves very valuable. Social demographic characteristics on the level of the neighborhood are used as predictors of the composition of the local economy. The analyses show that in particular wealthy, gentrified neighborhoods are more prone than others to becoming "hubs" of the cognitive-cultural economy. However, disadvantaged neighborhoods may under certain conditions serve as incubators for business start-ups as they offer low-rent office spaces. This has important consequences for their future economic growth potential as well as the distribution of successful businesses in the city. © 2013 Urban Affairs Association.