Roles of the non-medical prescribing leads within organisations across a Strategic Health Authority: perceived functions and factors supporting the role

Objectives Extending the roles of nurses, pharmacists and allied health professionals to include prescribing has been identified as one way of improving service provision. In the UK, over 50 000 non-medical healthcare professionals are now qualified to prescribe. Implementation of non-medical prescribing ( NMP) is crucial to realise the potential return on investment. The UK Department of Health recommends a NMP lead to be responsible for the implementation of NMP within organisations. The aim of this study was to explore the role of NMP leads in organisations across one Strategic Health Authority (SHA) and to inform future planning with regards to the criteria for those adopting this role, the scope of the role and factors enabling the successful execution of the role. Methods Thirty-nine NMP leads across one SHA were approached. Semi-structured telephone interviews were conducted. Issues explored included the perceived role of the NMP lead, safety and clinical governance procedures and facilitators to the role. Transcribed audiotapes were coded and analysed using thematic analytical techniques. Key findings In total, 27/39 (69.2%) NMP leads were interviewed. The findings highlight the key role that the NMP lead plays with regards to the support and development of NMP within National Health Service trusts. Processes used to appoint NMP leads lacked clarity and varied between trusts. Only two NMP leads had designated or protected time for their role. Strategic influence, operational management and clinical governance were identified as key functions. Factors that supported the role included organisational support, level of influence and dedicated time. Conclusion The NMP lead plays a significant role in the development and implementation of NMP. Clear national guidance is needed with regards to the functions of this role, the necessary attributes for individuals recruited into this post and the time that should be designated to it. This is important as prescribing is extended to include other groups of non-medical healthcare professionals.

Advanced source apportionment of size-resolved trace elements at multiple sites in London during winter

Trace element measurements in PM10–2.5, PM2.5–1.0 and PM1.0–0.3 aerosol were performed with 2 h time resolution at kerbside, urban background and rural sites during the ClearfLo winter 2012 campaign in London. The environment-dependent variability of emissions was characterized using the Multilinear Engine implementation of the positive matrix factorization model, conducted on data sets comprising all three sites but segregated by size. Combining the sites enabled separation of sources with high temporal covariance but significant spatial variability. Separation of sizes improved source resolution by preventing sources occurring in only a single size fraction from having too small a contribution for the model to resolve. Anchor profiles were retrieved internally by analysing data subsets, and these profiles were used in the analyses of the complete data sets of all sites for enhanced source apportionment. A total of nine different factors were resolved (notable elements in brackets): in PM10–2.5, brake wear (Cu, Zr, Sb, Ba), other traffic-related (Fe), resuspended dust (Si, Ca), sea/road salt (Cl), aged sea salt (Na, Mg) and industrial (Cr, Ni); in PM2.5–1.0, brake wear, other traffic-related, resuspended dust, sea/road salt, aged sea salt and S-rich (S); and in PM1.0–0.3, traffic-related (Fe, Cu, Zr, Sb, Ba), resuspended dust, sea/road salt, aged sea salt, reacted Cl (Cl), S-rich and solid fuel (K, Pb). Human activities enhance the kerb-to-rural concentration gradients of coarse aged sea salt, typically considered to have a natural source, by 1.7–2.2. These site-dependent concentration differences reflect the effect of local resuspension processes in London. The anthropogenically influenced factors traffic (brake wear and other traffic-related processes), dust and sea/road salt provide further kerb-to-rural concentration enhancements by direct source emissions by a factor of 3.5–12.7. The traffic and dust factors are mainly emitted in PM10–2.5 and show strong diurnal variations with concentrations up to 4 times higher during rush hour than during night-time. Regionally influenced S-rich and solid fuel factors, occurring primarily in PM1.0–0.3, have negligible resuspension influences, and concentrations are similar throughout the day and across the regions.

Kerb and urban increment of highly time-resolved trace elements in PM10, PM2.5 and PM1.0 winter aerosol in London during ClearfLo 2012

Ambient concentrations of trace elements with 2 h time resolution were measured in PM10–2.5, PM2.5–1.0 and PM1.0–0.3 size ranges at kerbside, urban background and rural sites in London during winter 2012. Samples were collected using rotating drum impactors (RDIs) and subsequently analysed with synchrotron radiation-induced X-ray fluorescence spectrometry (SR-XRF). Quantification of kerb and urban increments (defined as kerb-to-urban and urban-to-rural concentration ratios, respectively), and assessment of diurnal and weekly variability provided insight into sources governing urban air quality and the effects of urban micro-environments on human exposure. Traffic-related elements yielded the highest kerb increments, with values in the range of 10.4 to 16.6 for SW winds (3.3–6.9 for NE) observed for elements influenced by brake wear (e.g. Cu, Sb, Ba) and 5.7 to 8.2 for SW (2.6–3.0 for NE) for other traffic-related processes (e.g. Cr, Fe, Zn). Kerb increments for these elements were highest in the PM10–2.5 mass fraction, roughly twice that of the PM1.0–0.3 fraction. These elements also showed the highest urban increments (~ 3.0), although no difference was observed between brake wear and other traffic-related elements. All elements influenced by traffic exhibited higher concentrations during morning and evening rush hours, and on weekdays compared to weekends, with the strongest trends observed at the kerbside site, and additionally enhanced by winds coming directly from the road, consistent with street canyon effects. Elements related to mineral dust (e.g. Al, Si, Ca, Sr) showed significant influences from traffic-induced resuspension, as evidenced by moderate kerb (3.4–5.4 for SW, 1.7–2.3 for NE) and urban (~ 2) increments and increased concentrations during peak traffic flow. Elements related to regional transport showed no significant enhancement at kerb or urban sites, with the exception of PM10–2.5 sea salt (factor of up to 2), which may be influenced by traffic-induced resuspension of sea and/or road salt. Heavy-duty vehicles appeared to have a larger effect than passenger vehicles on the concentrations of all elements influenced by resuspension (including sea salt) and wearing processes. Trace element concentrations in London were influenced by both local and regional sources, with coarse and intermediate fractions dominated by traffic-induced resuspension and wearing processes and fine particles influenced by regional transport.

From the Hill

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Estratégias de combate a inflação: âncora cambial versus âncora monetária

Nós investigamos conceito de âncora nominal de uma economia aberta analisamos comportamento dinâmico de algumas variáveis econômicas importantes tais como inflação desemprego taxa real de câmbio durante processo de desinflação. Utilizando uma versão do Modelo Mundell-Fleming onde inércia introduzida através de expectativas adaptativas nós confrontamos estabilização baseada na taxa de câmbio(âncora cambial) com àquela baseada no controle de algum agregado monetário(âncora monetária). Nós mostramos que embora âncora cambial possua um efeito inicial expansionista sobre nível de atividade econômica, oposto ocorrendo com âncora monetária, recessão necessária para derrubar inflação independe da âncora nominal adotada, concluindo que estratégia anti-inflacionária ótima depende das preferências intertemporais dos policy-makers isto é, de como eles desejam distribuir os custos da estabilização ao longo do tempo de modo maximizar bem-estar social.

Hope, risk perception and propensity to indebtedness

Hope is an important construct in marketing, once it is an antecedent of important marketing variables, such as trust, expectation and satisfaction (MacInnis & de Mello, 2005, Almeida, Mazzon & Botelho, 2007). Specifically, the literature suggests that hope can play an important influence on risk perception (Almeida, 2010, Almeida et al., 2007, Fleming, 2008, MacInnis & de Mello, 2005) and propensity to indebtedness (Fleming, 2008). Thus, this thesis aims to investigate the relations among hope, risk perception related to purchasing and consumption and propensity to indebtedness, by reviewing the existing literature and conducting two empirical researches. The first of them is a laboratory experiment, which accessed hope and risk perception of getting a mortgage loan. The second is a survey, investigating university students’ propensity to get indebted to pay for their university tuition, analyzed through the method of Structural Equations Modeling (SEM). These studies found that hope seems to play an important role on propensity to indebtedness, as higher levels of hope predicted an increase in the propensity to accept the mortgage loan, independent of actual risks, and an increase in the propensity of college students to get indebted to pay for their studies. In addition, the first study suggests that hope may lead to a decrease in risk perception, which, however, has not been confirmed by the second study. Finally, this research offers some methodological contributions, due to the fact that it is the first study using an experimental method to study hope in Brazil and, worldwide, it is the first study investigating the relation among hope, risk perception and propensity to indebtedness, which proved to be important influences in consumer behavior

A relação entre a Floresta Nacional de São Francisco de Paula e sua população associada : uma perspectiva polissêmica

As pesquisas sobre a percepção de usuários de Unidades de Conservação (UC) oferecem instrumentos para o entendimento de comportamentos e auxiliam na Educação Ambiental (EA) e no Processo de Gestão Ambiental. O plano de manejo de uma UC deve proporcionar condições para aquisição de conhecimentos, habilidades e o desenvolvimento de atitudes visando à participação individual e coletiva das populações associadas às UCs, na gestão dos recursos ambientais, e na concepção e aplicação das decisões que afetam a qualidade dos meios físico, natural e sócio-cultural. O objetivo deste trabalho é estudar a população associada à Floresta Nacional de São Francisco de Paula, contribuindo para a atualização do Plano de Manejo dessa UC, no que se refere ao Programa de Educação e Interpretação Ambiental, Uso Público e Programa de Monitoramento Ambiental, numa perspectiva de inserção dessa comunidade nas questões ambientais. Os dados desta pesquisa quali-quantitativa foram obtidos no período de abril de 2005 a março de 2006, pela técnica de entrevistas estruturadas ou não, registros no diário de campo, fotografias e pesquisa documental. Os entrevistados foram: moradores do entorno legal da FLONA-SFP, coletores de pinhão, técnicos administrativos da FLONA-SFP e visitantes (alunos, professores, pesquisadores, turistas). Concluiu-se, que não existem conflitos entre a população associada e a FLONA-SFP; a população associada, residente no entorno, reconhece a importância da FLONA-SFP, anseia por orientações técnicas e desconhece a existência do Conselho Consultivo da FLONA-SFP; é imprescindível a organização de um Programa de EA com objetivo geral de servir como instrumento de envolvimento e participação pública, abrindo um diálogo com a comunidade a fim de estimular o uso de outros recursos não-madeiráveis como alternativa de renda e uso sustentável da unidade. No que se refere ao Programa de Uso Público da FLONA-SFP para pesquisa, educação e turismo, essa UC atende às necessidades atuais dos usuários. Quanto ao Programa de Monitoramento Ambiental, deve-se dar atenção aos processos de uso de agrotóxicos e às orientações e estímulo à população rural do entorno em relação ao uso de técnicas agrícolas menos impactantes. O plano de manejo da FLONA-SFP deve servir também aos interesses da população associada, que através dos saberes locais, vêm mantendo as premissas básicas para conservação da biodiversidade e sociodiversidade dessa UC.

Foucault : a experiência da amizade

Exaltée par la philosophie et reléguée à second plan par la sociologie, pour son appartenance à la vie privée, l amitié devient, à partir des anées 70, um thème d intétêret nom plus sous la perspective classique de la philia, avec son insistance sur la fraternité, égalité et dans l équivalence des amis.Les études de Hannah Arendt,Blanchot,Derrida et Foucault déséquilibrent cette vison, et la rédéfinissent em tant qu ne rapport qui donne lieu à l alterité et permet les manifestations des singularités entre amis. En reprendant ces penseurs, Michel Foucault tente réhabililiter l amitié en tant qu ne éthique et une esthétique de l existence qui conduit à la transformation du sujet, stylisant son existence dans la présence de l autre. Basés sur cette réhabilitation, nous penserons l amitié comme une expérience éthique et afective intense qui cherche autotransformation des amis, une forme de vie qui refuse les formes imposées de rapports et subjectivités

A escrita do tempo e a poética do espaço:história e espaço no livro Geografia do Brasil Holandês de Luís da Câmara Cascudo

In 1956, Luís da Câmara Cascudo published his book Geografia do Brasil Holandês. In this book, he studied and described a space - the Dutch Brazil - from a geographical and historical perspective. To do this, he articulated both perspectives from the point of view of his own reading of the History of Nordeste , establishing a dialogue with the historiographical tradition of the study of the Dutch Brazil in Pernambuco. When portraying the Dutch presence in Nordeste, Cascudo articulated a drama in which the Dutch would have their history described as a typically tragic plot, portrayed as if they were already condemned to failure in advance. To this tragedy he opposed a predominantly comic Portuguese plot, as if the Portuguese victory over the Dutch was as desirable as inevitable for the space of Nordeste . When narrating the clash between the Dutch and the Portuguese for the space of Nordeste , however, Cascudo ended up delineating his own place of speech, as a spokesperson for the identity of the potiguar space in opposition to the pernabucano space described by Freyre and Gonsalves de Mello. In this way, the space of Rio Grande do Norte would have its own identity, constructed from de Dutch absence and constituted from the Portuguese legacy contrarily to the space of Pernambuco, narrated from an articulation and a conciliation of the Flemish and Lusitan legacy, even though highlighting the latter. While the Dutch would had been a constant presence in the history of Pernambuco for Freyre and Gonsalves de Mello, they wouldn t have gone beyond legend in the space of Rio Grande do Norte, removed from its geography and erased from its history. When describing de geography of the potiguar space, therefore, Cascudo articulates the inexistence of the History of a time dominated by the Fleming with the search of a Portuguese space, trough the narration of its origins and constitution, as well as the registry of the characteristics of its legacy

Pion interactions in the X(3872)

We consider pion interactions in an effective field theory of the narrow resonance X(3872), assuming it is a weakly bound molecule of the charm mesons D-0(D) over bar (*0) and D-*0(D) over bar (0). Since the hyperfine splitting of the D-0 and D-*0 is only 7 MeV greater than the neutral pion mass, pions can be produced near threshold and are nonrelativistic. We show that pion exchange can be treated in perturbation theory and calculate the next-to-leading-order correction to the partial decay width Gamma[X -> D-0(D) over bar (0)pi(0)].

Leituras sobre usuário e uso de informação na Ciência da Informação

Considering aspects of international literature in the area of Information Science (IS) regarding need, search, behavior and use of information, this study aims to explore the historical path and interpretations of the concepts of user and use of information, under the support reference of the notions of information system and subject agency. For such, a corpus was formed with 15 literature reviews of the Annual Review of Information Science and Technology - ARIST - which brought a theoretical panorama on the concepts here studied. The analysis of these reviews was tooled with categorizations of the use of information proposed by Rachel Anne Fleming-May, making it possible to situate two initial phases identified, particularized for orbiting a notion of information system, being the first phase characterized by a more static conception of system and the second by a more dynamic meaning. Finally, a third and last phase was found in reading ARIST, which was better visualized after the year 2000. In the first decade of the 21st century, studies started considering, complementarily to previous phases, the agency of subjects from the notions of interaction and context, in actions of use, production and appropriation of information and knowledge.

Taxonomic study on the molluscs collected in Marion-Dufresne expedition (MD55) to SE Brazil: Xenophoridae, Cypraeoidea, mitriforms and Terebridae (Caenogastropoda)

The deep-water molluscs collected during the expedition MD55 off SE Brazil have been gradually studied in some previous papers. The present one is focused on samples belonging to caenogastropod taxa Xenophoridae Troschel, 1852, Cypraeoidea Rafinesque, 1815, mitriforms and Terebridae Morch, 1852. Regarding the Xenophoridae, Onustus aquitanus n. sp. is a new species, collected off the littoral of Espirito Santo and Rio de Janeiro, Brazil, 430-637 m depth (continental slope). The main characters of the species include the small size (c. 20 mm), the proportionally wide shell, the white colour, the short peripheral flange, the oblique riblets weakly developed and a brown multispiral protoconch. This appears to be the smallest living species of the family, resembling in this aspect fossil species. In respect to the Cypraeoidea, the following results were obtained: family Cypraeidae Rafinesque, 1815: Erosaria acicularis (Gmelin, 1791) and Luria cinerea (Gmelin, 1791) had the deepest record, respectively 607-620 m and 295-940 m, although the samples were all dead, eroded shells. Family Lamellariidae d'Orbigny, 1841: a total of three lots were collected, provisionally identified as Lamellaria spp. as the samples consist of only vestigial shells; possibly each lot represents a different species. Family Pediculariidae Gray, 1853: a sample of Pedicularia tibia Simone, 2005 was found, expanding the range c. 1000 km southwards, from Ceara to Espirito Santo. Family Ovulidae Fleming, 1822: Pseudosimnia lacrima n. sp., collected off Espirito Santo, 607-620 m depth, is described here and is mainly characterised by its strong biconic outline, small size (c. 7 mm), and a thick peripheral callus. Family Triviidae Troschel, 1863: Cleotrivia antillarum (Schilder, 1922) is recorded for the first time as deep as 620 m, and its distribution expanded from Rio Grande do Norte to Espirito Santo; Dolichupis akangus n. sp. with rounded outline and c. 15 transverse ribs; D. pingius n. sp. with the outer lip expanded posteriorly and c. 10 ribs. In respect to the mitriform neogastropods, the following species are emphasised: family Costellariidae MacDonald, 1860: Vexillum sp., 607-620 m depth; Turricostellaria amphissa n. sp., 295 m depth; T. jukyry n. sp.; T. apyrahi n. sp., both 790-1575 m depth; T. ovir n. sp., 1200 m depth; Nodicostellaria crassa (Simone, 1995), 240-600 m depth, with extension northwards of the range up to Espirito Santo; Austromitra decresca n. sp., 60-105 m depth. Family Mitridae Swainson, 1829: Subcancilla joapyra n. sp., 295 m depth; S. cf. straminea (Adams, 1853), 607-620 m depth. Family Volutomitridae Gray, 1854: Microvoluta corona n. sp., 1500-1575 m depth. Family Mitromorphidae Casey, 1904: Mitromorpha sama n. sp., 607-940 m depth; M. mirim n. sp., 60105 m depth. Regarding the conoidean Terebridae, this paper is a complement of a previous study. It deals with a new species Terebra assu Simone n. sp., from the Abrolhos Bank, 295 m depth, characterised by its narrow outline, yellowish colour, weak sculpture on the last whorls, and a proportionally broad, paucispiral protoconch. A second finding of Terebra alagoensis Lima, Tenorio & Barros, 2007 expands the geographic range from Alagoas to north Espirito Santo. A discussion on the systematics of the "complex Terebra doellojuradoi" in South American coast is also provided, highlighting the improbability of synonymy between T. leptapsis Simone, 1999 and T doellojuradoi Carcelles, 1953. Differences in size, sculpture, spire angulation, aperture, and mainly in protoconch, indicate specific separations. The presently studied terebrids belong to the "complex Terebra doellojuradoi", which encompasses closely related, deep-water, small species, possessing a relatively high degree of endemicity.

Deposition, imaging, and clearance: what remains to be done?

Deposition and clearance studies are used during product development and in fundamental research. These studies mostly involve radionuclide imaging, but pharmacokinetic methods are also used to assess the amount of drug absorbed through the lungs, which is closely related to lung deposition. Radionuclide imaging may be two-dimensional (gamma scintigraphy or planar imaging), or three-dimensional (single photon emission computed tomography and positron emission tomography). In October 2009, a group of scientists met at the "Thousand Years of Pharmaceutical Aerosols" conference in Reykjavik, Iceland, to discuss future research in key areas of pulmonary drug delivery. This article reports the session on "Deposition, imaging and clearance." The objective was partly to review our current understanding, but more importantly to assess "what remains to be done?" A need to standardize methodology and provide a regulatory framework by which data from radionuclide imaging methods could be compared between centers and used in the drug approval process was recognized. There is also a requirement for novel radiolabeling methods that are more representative of production processes for dry powder inhalers and pressurized metered dose inhalers. A need was identified for studies to aid our understanding of the relationship between clinical effects and regional deposition patterns of inhaled drugs. A robust methodology to assess clearance from small conducting airways should be developed, as a potential biomarker for therapies in cystic fibrosis and other diseases. The mechanisms by which inhaled nanoparticles are removed from the lungs, and the factors on which their removal depends, require further investigation. Last, and by no means least, we need a better understanding of patient-related factors, including how to reduce the variability in pulmonary drug delivery, in order to improve the precision of deposition and clearance measurements.

Sputum inflammatory phenotypes are not stable in children with asthma

Two distinct, stable inflammatory phenotypes have been described in adults with asthma: eosinophilic and non-eosinophilic. Treatment strategies based on these phenotypes have been successful. This study evaluated sputum cytology in children with asthma to classify sputum inflammatory phenotypes and to assess their stability over time.