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.

The uniqueness of signature problem in the non-Markov setting

We establish a general framework for a class of multidimensional stochastic processes over [0,1] under which with probability one, the signature (the collection of iterated path integrals in the sense of rough paths) is well-defined and determines the sample paths of the process up to reparametrization. In particular, by using the Malliavin calculus we show that our method applies to a class of Gaussian processes including fractional Brownian motion with Hurst parameter H>1/4, the Ornstein–Uhlenbeck process and the Brownian bridge.

Elephants in pyjamas: testing the weak central coherence account of autism spectrum disorders using a syntactic disambiguation task

According to the weak central coherence (CC) account individuals with autism spectrum disorders (ASD) exhibit enhanced local processing and weak part-whole integration. CC was investigated in the verbal domain. Adolescents, recruited using a 2 (ASD status) by 2 (language impairment status) design, completed an aural forced choice comprehension task involving syntactically ambiguous sentences. Half the picture targets depicted the least plausible interpretation, resulting in longer RTs across groups. These were assumed to reflect local processing. There was no ASD by plausibility interaction and consequently little evidence for weak CC in the verbal domain when conceptualised as enhanced local processing. Furthermore, there was little evidence that the processing of syntactically ambiguous sentences differed as a function of ASD or language-impairment status.

The non-conservation of potential vorticity by a dynamical core compared with the effects of parametrized physical processes

Numerical models of the atmosphere combine a dynamical core, which approximates solutions to the adiabatic, frictionless governing equations for fluid dynamics, with tendencies arising from the parametrization of other physical processes. Since potential vorticity (PV) is conserved following fluid flow in adiabatic, frictionless circumstances, it is possible to isolate the effects of non-conservative processes by accumulating PV changes in an air-mass relative framework. This “PV tracer technique” is used to accumulate separately the effects on PV of each of the different non-conservative processes represented in a numerical model of the atmosphere. Dynamical cores are not exactly conservative because they introduce, explicitly or implicitly, some level of dissipation and adjustment of prognostic model variables which acts to modify PV. Here, the PV tracers technique is extended to diagnose the cumulative effect of the non-conservation of PV by a dynamical core and its characteristics relative to the PV modification by parametrized physical processes. Quantification using the Met Office Unified Model reveals that the magnitude of the non-conservation of PV by the dynamical core is comparable to those from physical processes. Moreover, the residual of the PV budget, when tracing the effects of the dynamical core and physical processes, is at least an order of magnitude smaller than the PV tracers associated with the most active physical processes. The implication of this work is that the non-conservation of PV by a dynamical core can be assessed in case studies with a full suite of physics parametrizations and directly compared with the PV modification by parametrized physical processes. The nonconservation of PV by the dynamical core is shown to move the position of the extratropical tropopause while the parametrized physical processes have a lesser effect at the tropopause level.

Antimicrobial Photodynamic Therapy in the Non-Surgical Treatment of Aggressive Periodontitis: Cytokine Profile in Gingival Crevicular Fluid, Preliminary Results

Background: Aggressive periodontitis is a specific form of periodontal disease that is characterized by rapid attachment loss and bone destruction. Cytokine profiles are of considerable value when studying disease course during treatment. The aim of this trial was to investigate cytokine levels in the gingival crevicular fluid (GCF) of patients with aggressive periodontitis, after treatment with photodynamic therapy (PDT) or scaling and root planing (SRP), in a split-mouth design on -7, 0, +1, +7, +30, and +90 days. Methods: Ten patients were randomly treated with PDT using a laser source associated with a photosensitizer or SRP with hand instruments. GCF samples were collected, and the concentrations of tumor necrosis factor-alpha (TNF-alpha) and receptor activator of nuclear factor-kappa B ligand (RANKL) were determined by enzyme-linked immunosorbent assays. The data were analyzed using generalized estimating equations to test the associations among treatments, evaluated parameters, and experimental times (alpha = 0.05). Results: Non-surgical periodontal treatment with PDT or SRP led to statistically significant reductions in TNF-alpha level 30 days following treatment. There were similar levels of TNF-alpha and RANKL at the different time points in both groups, with no statistically significant differences. Conclusion: SRP and PDT had similar effects on crevicular TNF-alpha and RANKL levels in patients with aggressive periodontitis. J Periodontol 2009;80:98-105.

The non-coding RNA BC1 is down-regulated in the hippocampus of Wistar Audiogenic Rat (WAR) strain after audiogenic kindling

The aim of this study was to identify molecular pathways involved in audiogenic seizures in the epilepsy-prone Wistar Audiogenic Rat (WAR). For this, we used a suppression-subtractive hybridization (SSH) library from the hippocampus of WARs coupled to microarray comparative gene expression analysis, followed by Northern blot validation of individual genes. We discovered that the levels of the non-protein coding (npc) RNA BC1 were significantly reduced in the hippocampus of WARs submitted to repeated audiogenic seizures (audiogenic kindling) when compared to Wistar resistant rats and to both naive WARs and Wistars. By quantitative in situ hybridization, we verified lower levels of BC1 RNA in the GD-hilus and significant signal ratio reduction in the stratum radiatum and stratum pyramidale of hippocampal CA3 subfield of audiogenic kindled animals. Functional results recently obtained in a BC1-/- mouse model and our current data are supportive of a potential disruption in signaling pathways, upstream of BC1, associated with the seizure susceptibility of WARs. (C) 2010 Elsevier B.V. All rights reserved.

The non-twist standard map with robust tori

The non-twist standard map occurs frequently in many fields of science specially in modelling the dynamics of the magnetic field lines in tokamaks. Robust tori, dynamical barriers that impede the radial transport among different regions of the phase space, are introduced in the non-twist standard map in a conservative fashion. The resulting non-twist standard map with robust tori is an improved model to study transport barriers in plasmas confined in tokamaks.

Semiclassical and quantum motions on the non-commutative plane

We study the canonical and the coherent state quantizations of a particle moving in a magnetic field on the non-commutative plane. Using a theta-modified action, we perform the canonical quantization and analyze the gauge dependence of the theory. We compare coherent states quantizations obtained through Malkin-Man`ko states and circular squeezed states. The relation between these states and the ""classical"" trajectories is investigated, and we present numerical explorations of some semiclassical quantities. (C) 2009 Elsevier B.V. All rights reserved.

Relics of eclogite facies assemblages in the Ceara Central Domain, NW Borborema Province, NE Brazil: Implications for the assembly of West Gondwana

The Borborema Province, in the NE of Brazil, is a rather complex piece in the Brazil-Africa puzzle as it represents the junction of the Dahomeyide/Pharusian, Central African, Aracuai and Brasilia fold belts located between the West-African/Sao Luis, Congo/Sao Francisco and Amazonas craton. The correlation between the Dahomeyides from W-Africa (Ghana, Benin, Togo, and Mali) and the Borborema Province involves the Medio Coreau and Central Ceara domains. The inferred continuation of the main oceanic suture zone exposed in the Dahomeyides of W Africa is buried beneath the Phanerozoic Parnaiba Basin in Brazil (northwest of the Medio Coreau domain) where some high density gravity anomalies may represent hidden remnants of an oceanic suture. In addition to this major suture a narrow, nearly continuous strip composed of mainly mafic pods containing relics of eclogite-facies assemblages associated with partially migmatized granulite-facies metapelitic gneisses has been found further east in the NW Borborema Province. These high pressure mafic rocks, interpreted as retrograded eclogites, are located between the Transbrasiliano Lineament and the Santa Quiteria continental arc and comprise primitive to evolved arc-related rocks with either arc- or MORB-type imprints that can indicate either deep subduction of oceanic lithosphere or roots of continental and oceanic magmatic arcs. Average peak P-T conditions under eclogite-facies metamorphism (T=770 degrees C and P = 17.3 kbar) were estimated using garnet-clinopyroxene thermometry and Jd content in clinopyroxene. Transition to granulite-facies conditions, as well as later widespread re-equilibration under amphibolite facies, were registered both in the basic and the metapelitic rocks and suggest a clockwise P-T path characterized by an increase in temperature followed by strong decompression. A phenomenon possibly related to the exhumation of a highly thickened crust associated with the suturing of the Medio Coreau and Central Ceara domains, two distinct crustal blocks separated by the Transbrasiliano Lineament. (C) 2009 International Association for Gondwana Research. Published by Elsevier B.V. All rights reserved.

The lower central and derived series of the braid groups of the projective plane

In this paper, we determine the lower central and derived series for the braid groups of the projective plane. We are motivated in part by the study of Fadell-Neuwirth short exact sequences, but the problem is interesting in its own right. The n-string braid groups B(n)(RP(2)) of the projective plane RP(2) were originally studied by Van Buskirk during the 1960s. and are of particular interest due to the fact that they have torsion. The group B(1)(RP(2)) (resp. B(2)(RP(2))) is isomorphic to the cyclic group Z(2) of order 2 (resp. the generalised quaternion group of order 16) and hence their lower central and derived series are known. If n > 2, we first prove that the lower central series of B(n)(RP(2)) is constant from the commutator subgroup onwards. We observe that Gamma(2)(B(3)(RP(2))) is isomorphic to (F(3) X Q(8)) X Z(3), where F(k) denotes the free group of rank k, and Q(8) denotes the quaternion group of order 8, and that Gamma(2)(B(4)(RP(2))) is an extension of an index 2 subgroup K of P(4)(RP(2)) by Z(2) circle plus Z(2). As for the derived series of B(n)(RP(2)), we show that for all n >= 5, it is constant from the derived subgroup onwards. The group B(n)(RP(2)) being finite and soluble for n <= 2, the critical cases are n = 3, 4. We are able to determine completely the derived series of B(3)(RP(2)). The subgroups (B(3)(RP(2)))((1)), (B(3)(RP(2)))((2)) and (B(3)(RP(2)))((3)) are isomorphic respectively to (F(3) x Q(8)) x Z(3), F(3) X Q(8) and F(9) X Z(2), and we compute the derived series quotients of these groups. From (B(3)(RP(2)))((4)) onwards, the derived series of B(3)(RP(2)), as well as its successive derived series quotients, coincide with those of F(9). We analyse the derived series of B(4)(RP(2)) and its quotients up to (B(4)(RP(2)))((4)), and we show that (B(4)(RP(2)))((4)) is a semi-direct product of F(129) by F(17). Finally, we give a presentation of Gamma(2)(B(n)(RP(2))). (C) 2011 Elsevier Inc. All rights reserved.

Solving the non-convexity problem in some shopping-time and human-capital models

Several works in the shopping-time and in the human-capital literature, due to the nonconcavity of the underlying Hamiltonian, use Örst-order conditions in dynamic optimization to characterize necessity, but not su¢ ciency, in intertemporal problems. In this work I choose one paper in each one of these two areas and show that optimality can be characterized by means of a simple aplication of Arrowís (1968) su¢ ciency theorem.

Relative abundance and population biology of the non-indigenous crab Charybdis hellerii (Crustacea: Brachyura: Portunidae) in a southwestern Atlantic estuary-bay complex

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Quantitative and qualitative characteristics of the non-carcass components and the meat of lambs fed sunflower seeds and vitamin E

The objective of this investigation was to evaluate the weight and percentage of the non-carcass components and the mineral content (macro minerals and trace minerals), crude protein, ether extract, moisture and vitamin E of the heart, liver, tongue, lungs, reticulum, kidneys and meat from the longissimus dorsi of lambs in feedlot finishing. Thirty-two non-castrated Ile de France male lambs, fed diets containing sunflower seeds and vitamin E from 15 to 32 kg of body weight were allotted in a completely randomized design in a 2 × 2 factorial arrangement. The weight of the gastrointestinal tract was higher in the lambs fed diets containing vitamin E (10%). No difference was observed in the liver as to the mineral matter, crude protein, ether extract, moisture (2.01; 20.03; 2.39 and 74.78 g/100 g, respectively), the macro minerals and trace minerals, except iron. In the tongue, lungs, reticulum, kidneys and meat there was no in fluence of diets in the studied variables. The liver and the meat presented different values of crude protein (20.01 and 18.34 g/100 g, respectively), and the heart (1.03 mg/100 g) showed a higher content of vitamin E. High contents of manganese, zinc and copper were observed in the liver. The evaluated non-carcass components were nutritionally equal to the sheep meat, once, in addition to their high yield in relation to the body weight at slaughter, the non-carcass components are sources of nutrients.

The surface electromyography analysis of the non-plegic upper limb of hemiplegic subjects

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)