Community pharmacy in a commissioning-led NHS:can pharmacy compete effectively?

Introduction – The commissioning of services has been a core responsibility of English Primary Care Trusts (PCTs) since 2002. Primary care organisations (PCOs) in Scotland, Wales and Northern Ireland have also increased their commissioning activities but with, arguably, less fervour than their English counterparts. The commissioning function of English PCTs has been reinforced by the introduction of new contractual frameworks across primary care – for medical services, dentistry and pharmacy. The new pharmaceutical services contract for England and Wales introduced an “enhanced” category of services, the provision of which is dependent on the commissioning decisions of local PCTs. As the NHS, most pertinently in England, continues its transformation from a provider to a commissioner of healthcare, the ability of pharmacy to compete effectively for funding is likely to become increasingly important. 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. Within the section of the questionnaire relating to service provision, respondents were asked “do you believe that pharmacy will be able to compete effectively with other healthcare providers for access to additional funding to develop services that address a public health need identified by your local Primary Care Organisation (PCO), e.g. PCT/LHB etc.?”. Answers were recorded on a three-point scale; pharmacy “will”, “may”, or “will not” be able to compete effectively for funding. Results - The attitudes of pharmacists showed variation depending on the type of pharmacy they worked in (supermarket, multiple (outlets (n)=200), large chain (200>n>20), small chain (20=n>5), or independent (n=5)) (?2 test with p=0.001). Over a third of survey pharmacists working in small chains and independents (37% (n=21/57) and 33% (n=113/341) respectively) believed that pharmacy would not be able to compete effectively for funding compared to 23% (n=15/65) for supermarket pharmacists, 22% (n=21/97) for pharmacists employed by large chains and just 18% (n=62/353) for pharmacists employed most regularly in multiples. Furthermore, attitudes also varied between the countries of residence of respondents (?2 test with p<0.05). 27% (n=242/893) of pharmacists resident in England and Wales believed that pharmacy would not be able to compete compared to 16% (n=18/116) of pharmacists resident in Scotland. Conclusions – It would appear that community pharmacists believe that the larger pharmacy chains and supermarkets will occupy an advantageous position in terms of attracting finance to develop services. This could have notable implications for service provision across the sector. If corporate pharmacy chains were to monopolise commissioning monies then the proportion of funding available to independents will be diminished; arguably further hastening their demise, as well as stifling the professional development of pharmacists employed within the independent sector. These findings, when combined with the variation observed between UK pharmacists operating under different contractual frameworks, may be a reflection of the divergent policy in the different administrations with developments in England, including the new pharmacy contract, reflecting a market-based approach with Scotland taking a near opposite stance with service integration and a commitment to new public health. However, it should be acknowledged that the questionnaire did not allow for detection of ambiguities in, or misunderstandings of, the survey question and this should be considered as a limitation of the research.

e-Business in supply chain management

E-business is concerned with the use of the Internet to link companies with their suppliers, customers and other trading partners. As a business concept, it has evolved significantly since its introduction in the 1990’s in parallel with the rapid rate of development of information technology (IT) during this period. Supply chain management (SCM) is fundamentally concerned with integration of activities both with and between organisations. IT plays a crucial role in SCM as a key enabler of supply chain integration (SCI). This chapter sets out the role of e-business concepts in the context of the supply chain challenges faced by firms. It specifically explores the role of e-procurement as an example of how e-business concepts have been applied to one key SCM activity, namely purchasing and procurement. In this context, the chapter examines the nature and evolution of e-marketplaces and goes on to identify key adoption drivers and benefits based on recent research. This research identifies key adoption drivers and benefits but also recognises that there are many barriers that ongoing research needs to address if the potential of e-business is to be fulfilled.

Image Quotient Set Transforms in Segmentation Problems

Image content interpretation is much dependent on segmentations efficiency. Requirements for the image recognition applications lead to a nessesity to create models of new type, which will provide some adaptation between law-level image processing, when images are segmented into disjoint regions and features are extracted from each region, and high-level analysis, using obtained set of all features for making decisions. Such analysis requires some a priori information, measurable region properties, heuristics, and plausibility of computational inference. Sometimes to produce reliable true conclusion simultaneous processing of several partitions is desired. In this paper a set of operations with obtained image segmentation and a nested partitions metric are introduced.

Key Agreement Protocol (KAP) Based on Matrix Power Function

* Work is partially supported by the Lithuanian State Science and Studies Foundation.

Emissziós jogok közgazdasági relevanciája és számviteli leképezése (Economic relevancy and accounting mapping of emission rights)

A cikk bemutatja, hogy az emissziós jogok mérleg- és beszámoló-képességi kritériumai milyen leképezést tesznek lehetővé a jelenleg érvényes Nemzetközi Pénzügyi Beszámolási Standardokban (IFRS, International Financial Reporting Standards). A vizsgálat fókuszában az üzemeltető áll, aki az Európai Unió kibocsátás-kereskedelmi rendszerének hatálya alá tartozik, azaz ipari tevékenysége folytán szén-dioxiddal szennyezi a Föld légterét. Az üzemeltető mint az emissziós jog tulajdonosa jelenik meg. A cikk megvizsgálja mindazokat a folyamatokat, melynek eredményeképpen birtokolhatja ezeket az egységeket, valamint azt, hogy az IFRS-ek milyen lehetőséget nyújtanak a különböző forrásból származó jogosultságok értékelésére. / === / The author presents that accounting and report ability criteria of the emission rights what mapping allows in the current International Financial Standards. The study focuses on the operator, who is the subject of the European Union Emissions Trading Scheme, whose industrial activities pollute with carbon dioxide to the earth’s atmosphere. The operator, as the owner of emission rights is displayed. This article examines those processes, which resulted in these units may be owned, and that what possibility is provided by IFRSs to evaluate rights from different sources.

Action Plan to Conserve the Native Plants of Florida

In this document, a strategy aimed at conserving the native flora of Florida is presented. The strategy is developed in a four-step sequence. Following the Introduction (Part I), The Florida Native Plant Resource (Part II) describes the resource and the threats to it. That section includes a brief description of the vegetation of Florida prior to the demographic explosion of the last century, a report on the current status of plants in the state, and discussion of some factors responsible for the evident and continuing decline in the quality and quantity of the vegetation resource. In Part III (The Florida Plant Conservation Process), an explicit goal for plant conservation in Florida is expressed, a model describing the plant conservation process is presented, and activities included with each component of the model are examined and evaluated for the state as a whole. Finally, in Part IV (Recommendations To Improve The Process), changes are presented that we believe would help create a more effective plant conservation environment in Florida.

Florida International University 3.0: A New Strategic Paradigm

Details objectives and plans for future development of Florida International University campuses, educational programs, and operations with an emphasis on focus, excellence, efficiency, and innovation.

Allatotropin: An Ancestral Myotropic Neuropeptide Involved in Feeding

Background Cell-cell interactions are a basic principle for the organization of tissues and organs allowing them to perform integrated functions and to organize themselves spatially and temporally. Peptidic molecules secreted by neurons and epithelial cells play fundamental roles in cell-cell interactions, acting as local neuromodulators, neurohormones, as well as endocrine and paracrine messengers. Allatotropin (AT) is a neuropeptide originally described as a regulator of Juvenile Hormone synthesis, which plays multiple neural, endocrine and myoactive roles in insects and other organisms. Methods A combination of immunohistochemistry using AT-antibodies and AT-Qdot nanocrystal conjugates was used to identify immunoreactive nerve cells containing the peptide and epithelial-muscular cells targeted by AT in Hydra plagiodesmica. Physiological assays using AT and AT- antibodies revealed that while AT stimulated the extrusion of the hypostome in a dose-response fashion in starved hydroids, the activity of hypostome in hydroids challenged with food was blocked by treatments with different doses of AT-antibodies. Conclusions AT antibodies immunolabeled nerve cells in the stalk, pedal disc, tentacles and hypostome. AT-Qdot conjugates recognized epithelial-muscular cell in the same tissues, suggesting the existence of anatomical and functional relationships between these two cell populations. Physiological assays indicated that the AT-like peptide is facilitating food ingestion. Significance Immunochemical, physiological and bioinformatics evidence advocates that AT is an ancestral neuropeptide involved in myoregulatory activities associated with meal ingestion and digestion.

Landscape Pattern – Marl Prairie/Slough Gradient: Vegetation Composition along the Gradient and Decadal Vegetation Change Pattern in Shark Slough: Annual Report 2012

In the southern Everglades, vegetation in both the marl prairie and ridge and slough landscapes is sensitive to large-scale restoration activities associated with the Comprehensive Everglades Restoration Plan (CERP) authorized by the Water Resources Development Act (WRDA) 2000 to restore the south Florida ecosystem. More specifically, changes in hydrologic regimes at both local and landscape scales are likely to affect vegetation composition along marl prairie-slough gradient resulting in a shift in boundary between plant communities in these landscapes. To strengthen our ability to assess how vegetation would respond to changes in underlying ecosystem drivers along the gradient, an improved understanding of reference conditions of plant community structure and function, and their responses to major stressors is important. In this regard, a study of vegetation structure and composition in relation to physical and biological processes along the marl prairie-slough gradient was initiated in 2005, and has continued through 2012 with funding from US Army Corps of Engineers (USACOE) (Cooperative Agreement # W912HZ-09-2-0018 Modification No.: P00002). This study addresses the hypothesis with respect to RECOVER-MAP monitoring item 3.1.3.5 – “Marl Prairie/Slough Gradients; patterns and trends in Shark Slough marshes and associated marl prairies”.

Incrustação em poço produtor de petróleo e gás natural: um estudo de caso

Water and gas is a common by - product of the oil production process. Production may be compromised by the precipitation of inorganic salts in both the reservoir and producing well, through scale formation. This precipitation is likely the cause of the formation damage. High temperatures and h igh pressures (HTHP) may favor the precipitation of insoluble salts. The most common types of scale in oil fields are calcium carbonate and calcium sulphate, strontium and barium sulphate. New types of scale formation have attracted special attention such as zinc sulphide and lead. This precipitation may occur in the pores of reservoir rocks, in the production string and in equipment, causing obstructions and consequent production losses. In this study, the influence of well depth on incrustation compositio n was investigated to design removal treatments and assess the behavior of these deposits along the string, through the analysis of pressure and temperature. Scale residues were recovered from the inside of the production string of an oil and gas well duri ng the string removal operation. A total of 10 samples from different depths (15.4 m to 4061.5 m) were obtained. Initially a dissolution test was conducted in weak acid, similar to that used in removal operations with this type of scale formation. Majority composition was defined and confirmed by dissolution tests using X - Ray Fluorescence Spectroscopy (XRF), X - Ray Diffraction (XRD) and Scanning Electron Microscope (SEM) techniques. Residues with distinct characteristics were observed in different proportion s, showing a tendency toward increased and/or decreased mass with depth. In the samples closest to the surface, typical sandstone residues were found, with calcium (45% Ca) as the metal of highest concentration. The obtained results indicate correlations o f the scale types studied with the depth and, consequently, with the thermodynamic conditions of pressure and temperature.

Estudo comparativo de diferentes sistemas de injeção de vapor aplicados à remediação de solos contaminados por diesel

Among the potentially polluting economic activities that compromise the quality of soil and groundwater stations are fuel dealers. Leakage of oil derived fuels in underground tanks or activities improperly with these pollutants can contaminate large areas, causing serious environmental and toxicological problems. The number of gas stations grew haphazardly, without any kind of control, thus the environmental impacts generated by these enterprises grew causing pollution of soil and groundwater. Surfactants using various techniques have been proposed to remedy this kind of contamination. This study presents innovation as the application of different systems containing surfactant in the vapor phase and compares their diesel removal efficiencies of soil containing this contaminant. For this, a system that contains seven injection wells the following vaporized solutions: water, surfactant solution, microemulsion and nanoemulsion, The surfactants used were saponified coconut oil (OCS), in aqueous solution and an ethoxylated alcohol UNTL-90: aqueous solution , and nanoemulsion and microemulsion systems. Among the systems investigated, the nanoemulsion showed the highest efficiency, achieving 88% removal of residual phase diesel, the most ecologically and technically feasible by a system with lower content of active matter

Quedas em idosos assistidos na estratégia saúde da família: frequência e fatores associados

The growth of the elderly population is a global phenomenon and, in Brazil, this transformation is happening in a very rapid rhythm. With the current population aging, this emerging age group will need more health care and attention. One of the characteristics of the population aging is the progressive accumulation of disabilities, which makes it more vulnerable to falls. This study was developed with the purpose of knowing the episode falls in the scope of an elderly population treated at a Family Health Unit. It is a research with cross-sectional nature, and its sample was composed by 121 elderly. The research was approved by the Ethics Committee of HUOL, with Opinion nº 816.022. We applied a questionnaire to the participants, and the results were statistically analyzed by using Chi-square test and Fisher’s exact test to verify the association between variables. In order to perform a multivariate analysis, we used the method of the Binomial Logistic Regression. For both tests, we accepted significance p<0,05 and CI of 95%. The results prove that the majority belongs to the female gender (76,9%); the age group of elderly reaches 88,4% and 11,6% is over-aged; regarding the marital status, 35,3% are married and 29,4% widowed; 92,1% with family income between one and two minimum wages; and 91,8% live with their partners and/or children. Regarding the frequency of falls, we found that 61,2% of the surveyed elderly suffered one or more falls in 2014. As associated factors, it became clear that 73,8% were due to extrinsic factors, 6,4% to intrinsic factors and 21,4% to both factors. As a consequence of the fall, we found that 89,2% have fear of falling again, 37,3% showed anxiety and 13,3% had their ambulation affected. Concerning the exposure to the risk factors, the most prevalent places were: street/avenue (31,0%), pavement (19,0%), living room (14,3%) and courtyard/backyard (10,7%). The study has proven a statistically significant association among female gender (p=0,001), rubble/objects in the backyard (p=0,015) and furniture that may cause accidents (p=0,005). It was evident among the elderly people surveyed, 72.7% receive little information about falls, being a risk factor for falls. We conclude that there is a high frequency of falls in the surveyed elderly, thereby constituting a worrisome data because this event in the elderly population is a serious matter, which raises the need to ensure them a safe environment in their homes and, above all, outside them. The information provided by the Family Health Strategy team are important to avoid these occurrences, which reinforces the need for developing health education activities together with the population as a way to prevent and reduce the occurrence of falls, thereby improving the quality of life of elderly.

Exploring the social behaviour of domestic dogs (Canis familiaris) in a public off-leash dog park

The growing popularity of dog parks has created an opportunity to learn more about interactions between companion dogs. Dog-dog behaviour in a public off-leash dog park was described and analyzed using a motivationally-neutral approach. I observed focal dogs from park entry for 400 s and constructed activity time budgets (percentages of time spent with dogs, humans, etc.); rates of socially-relevant dog behaviours (e.g., snout-muzzle contact, physical contact) were also calculated. On average, focal dogs spent 50% of their time alone, nearly 40% with other dogs and 11% in other activities; time with dogs decreased and time alone increased over the first six minutes. Some behaviours were very frequent (i.e., more than 90% of focal dogs initiated and received snout-muzzle contact to the anogenital and head areas, while others were rare (i.e., 9% and 12% of focal dogs initiated and received lunge approaches, respectively). Dog density and focal dog age, sex, neuter status, and size were found to influence some behavioural variables. Future studies should continue to investigate the diverse range of canid behaviours and factors that influence social behaviours in dog park settings.

Measuring the impact of a quality improvement collaboration to decrease maternal mortality in a Ghanaian regional hospital.

OBJECTIVE: To evaluate the performance of a continuous quality improvement collaboration at Ridge Regional Hospital, Accra, Ghana, that aimed to halve maternal and neonatal deaths. METHODS: In a quasi-experimental, pre- and post-intervention analysis, system deficiencies were analyzed and 97 improvement activities were implemented from January 2007 to December 2011. Data were collected on outcomes and implementation rates of improvement activities. Severity-adjustment models were used to calculate counterfactual mortality ratios. Regression analysis was used to determine the association between improvement activities, staffing, and maternal mortality. RESULTS: Maternal mortality decreased by 22.4% between 2007 and 2011, from 496 to 385 per 100000 deliveries, despite a 50% increase in deliveries and five- and three-fold increases in the proportion of pregnancies complicated by obstetric hemorrhage and hypertensive disorders of pregnancy, respectively. Case fatality rates for obstetric hemorrhage and hypertensive disorders of pregnancy decreased from 14.8% to 1.6% and 3.1% to 1.1%, respectively. The mean implementation score was 68% for the 97 improvement processes. Overall, 43 maternal deaths were prevented by the intervention; however, risk severity-adjustment models indicated that an even greater number of deaths was averted. Mortality reduction was correlated with 26 continuous quality improvement activities, and with the number of anesthesia nurses and labor midwives. CONCLUSION: The implementation of quality improvement activities was closely correlated with improved maternal mortality.

An empirical study of the variability in the composition of British freight trains

As part of the broader sustainability and economic efficiency agenda, European transport policy places considerable emphasis on improving rail’s competitiveness to increase its share of the freight market. Much attention is devoted to infrastructure characteristics which determine the number of freight trains which can operate and influence the operating characteristics of these trains. However, little attention has been devoted to the composition of the freight trains themselves, with scant published data relating to the practicalities of this important component of system utilisation and its impacts on rail freight viability and sustainability. This paper develops a better understanding of the extent to which freight train composition varies, through a large-scale empirical study of the composition of British freight trains. The investigation is based on a survey of almost 3,000 individual freight trains, with analysis at four levels of disaggregation, from the commodity groupings used in official statistics down to individual services. This provides considerable insight into rail freight operations with particular relevance to the efficiency of utilisation of trains using the available network paths. The results demonstrate the limitations of generalising about freight train formations since, within certain commodity groupings, considerable variability was identified even at fairly high levels of disaggregation.