The evolution and assessment of pharmaceutical care: Structure, processes, and outcomes

The evolution of pharmaceutical care is identified through a complete review of the literature published in the American Journal of Health-System Pharmacy, the sole comprehensive publication of institutional pharmacy practice. The evolution is categorized according to characteristics of structure (organizational structure, the role of the pharmacist), process (drug delivery systems, formulary management, acquiring drug products, methods to impact drug therapy decisions), and outcomes (cost of drug delivery, cost of drug acquisition and use, improved safety, improved health outcomes) recorded from the 1950s through the 1990s. While significant progress has been made in implementing basic drug distribution systems, levels of pharmacy involvement with direct patient care is still limited.^ A new practice framework suggests enhanced direct patient care involvement through increase in the efficiency and effectiveness of traditional pharmacy services. Recommendations advance internal and external organizational structure relationships that position pharmacists to fully use their unique skills and knowledge to impact drug therapy decisions and outcomes. Specific strategies facilitate expansion of the breadth and scope of each process component in order to expand the depth of integration of pharmacy and pharmaceutical care within the broad healthcare environment. Economic evaluation methods formally evaluate the impact of both operational and clinical interventions.^ Outcome measurements include specific recommendations and methods to increase efficiency of drug acquisition, emphasizing pharmacists' roles that impact physician prescribing decisions. Effectiveness measures include those that improve safety of drug distribution systems, decrease the potential of adverse drug therapy events, and demonstrate that pharmaceutical care can significantly contribute to improvement in overall health status.^ The implementation of the new framework is modeled on a case study at the M.D. Anderson Cancer Center. The implementation of several new drug distribution methods facilitated the redeployment of personnel from distributive functions to direct patient care activities with significant personnel and drug cost reduction. A cost-benefit analysis illustrates that framework process enhancements produced a benefit-to-cost ratio of 7.9. In addition, measures of effectiveness demonstrated significant levels of safety and enhanced drug therapy outcomes. ^

A novel host factor for integration of mycobacteriophage L5

Bacterial integration host factors (IHFs) play central roles in the cellular processes of recombination, DNA replication, transcription, and bacterial pathogenesis. We describe here a novel mycobacterial IHF (mIHF) of Mycobacterium smegmatis and Mycobacterium tuberculosis that stimulates integration of mycobacteriophage L5. mIHF is the product of a single gene and is unrelated at the sequence level to other integration host factors. By itself, mIHF does not bind preferentially to attP DNA, although it significantly alters the pattern of integrase (Int) binding, promoting the formation of specific integrase–mIHF–attP intasome complexes.

Hypothalamic integration of body fluid regulation.

The progression of animal life from the paleozoic ocean to rivers and diverse econiches on the planet's surface, as well as the subsequent reinvasion of the ocean, involved many different stresses on ionic pattern, osmotic pressure, and volume of the extracellular fluid bathing body cells. The relatively constant ionic pattern of vertebrates reflects a genetic "set" of many regulatory mechanisms--particularly renal regulation. Renal regulation of ionic pattern when loss of fluid from the body is disproportionate relative to the extracellular fluid composition (e.g., gastric juice with vomiting and pancreatic secretion with diarrhea) makes manifest that a mechanism to produce a biologically relatively inactive extracellular anion HCO3- exists, whereas no comparable mechanism to produce a biologically inactive cation has evolved. Life in the ocean, which has three times the sodium concentration of extracellular fluid, involves quite different osmoregulatory stress to that in freshwater. Terrestrial life involves risk of desiccation and, in large areas of the planet, salt deficiency. Mechanisms integrated in the hypothalamus (the evolutionary ancient midbrain) control water retention and facilitate excretion of sodium, and also control the secretion of renin by the kidney. Over and above the multifactorial processes of excretion, hypothalamic sensors reacting to sodium concentration, as well as circumventricular organs sensors reacting to osmotic pressure and angiotensin II, subserve genesis of sodium hunger and thirst. These behaviors spectacularly augment the adaptive capacities of animals. Instinct (genotypic memory) and learning (phenotypic memory) are melded to give specific behavior apt to the metabolic status of the animal. The sensations, compelling emotions, and intentions generated by these vegetative systems focus the issue of the phylogenetic emergence of consciousness and whether primal awareness initially came from the interoreceptors and vegetative systems rather than the distance receptors.

Integration of multiple repeats of geminiviral DNA into the nuclear genome of tobacco during evolution.

Integration of viral DNA into the host nuclear genome, although not unusual in bacterial and animal systems, has surprisingly not been reported for plants. We have discovered geminvirus-related DNA (GRD) sequences, in the form of distinct sets of multiple direct repeats comprising three related repeat classes, situated in a unique locus in the Nicotiana tabacum (tobacco) nuclear genome. The organization of these sequences is similar or identical in eight different tobacco cultivars we have examined. DNA sequence analysis reveals that each repeat has sequences most resembling those of the New World geminiviral DNA replication origin plus the adjacent AL1 gene, encoding the viral replication protein. We believe these GRD sequences originated quite recently in Nicotiana evolution through integration of geminiviral DNA by some combination of the processes of illegitimate recombination, amplification, deletions, and rearrangements. These events must have occurred in plant tissue that was subsequently able to contribute to meristematic tissue yielding gametes. GRD may have been retained in tobacco by selection or by random fixation in a small evolving population. Although we cannot detect transcription of these sequences, this does not exclude the possibility that they may originally have been expressed.

Belarus-Russia: Whither Integration? OSW Point of View (unspecified), May 2003

Of the re-integration processes currently taking place in the former Soviet Union, the formation of a Russian-Belarusian so-called 'Union State' is one of the most advanced. A customs union was formally announced between the two countries as early as 1995 and the process of constructing the Union State itself was launched in December 1999. However, both events were largely driven by the perceived need to match societal demands, without much concrete action and the Union State remained largely 'virtual'. Only in the last few years has the Russian initiative allowed for moving from symbolic gestures to political action and since late 2002 debate and policy have intensified on specific issues of economic and political co-operation. However, despite such advances in the integration process, its objectives remain vague and there is little or no agreement on the principles that should govern the process. Furthermore, current bilateral relations questions still dominate the dialogue. The project seems at present to be driven mainly by the political interests of both countries' presidents and also, to a lesser extent, by the interests of business, political, military and security elites, each apparently motivated by self- and group-interest in the emerging dialogue of integration. In contrast to EU integration, the societies of the two countries involved appear to have had little or no say in the process. Thus, several questions naturally arise. What is the real nature of such integration? What motivates the parties involved? What stage has the process reached? What likely future course will it take? What might be the consequences of it for Belarusian independence? Answers to these questions should ultimately determine the stance and policies of the enlarged EU in this area.

The practice and process of delivering integration through strategic planning

This paper explains how strategic planning is able to deliver strategic integration within organizations. While communication and participation within planning processes are perceived to have an integrative effect, we argue that these effects are unlikely to arise simply from bringing people together. Rather, we suggest that, given the varying interests of actors in different business units, integration will only arise from active negotiations and compromises between these actors. The paper is based upon a case of strategic planning in a multinational that was attempting to develop greater strategic integration across Europe. Drawing upon an activity theory framework, we examine how a common strategy emerges over time through modifications to the planning process and to different actors’ roles within it. The findings are used to develop a process model that shows how different business unit characteristics of planning experience and relative power shape different experiences of communication and participation activities and different processes for achieving integration. The paper concludes with a discussion of how this process model contributes to the literature on strategic planning, political processes of strategy-making, and strategy-as-practice.

Cross-country and inter-temporal analysis of Supply Chain Integration (SCI): China, Hungary and the Netherlands - changes in SCI from 1996 to 2008

Using plant level data from a global survey with multiple time frames, one begun in the late 1990s, this paper introduces measures of supply chain integration and discusses the dynamic relationship between the level of integration and a set of internal and external performance measurements. Specifically, data from Hungary, The Netherlands and The People’s Republic of China are used in the analyses. The time frames considered range from the late 1990s till 2009, encompassing major changes and transitions. Our results seem to indicate that SCI has an underlying structure of four sets of indicators, namely: (1) delivery frequency from the supplier or to the customer; (2) sharing internal processes with suppliers; (3) sharing internal processes with buyers and (4) joint facility location with partners. The differences between groups in terms of several performance measures proved to be small, being mostly statistically insignificant - but looking at the ANOVA table we can conclude that in this sample of companies those having joint location with their partners seem to outperform others.

Reflections on the criterion of (in)dependence within clause integration

This article, based on theoretical and bibliographic assumptions, aims to discuss the concept of syntactic and semantic (in)dependence  with respect to the canonical processes of subordination and coordination. It is commonly stated that the coordinate clauses are independent and the subordinate ones are dependent. This correlation, however, has received criticism over time, especially in modern works. After all, it is not always clear whether the (in)dependence is of semantic or syntactic basis. In addition, there are borderline cases in which it is not possible to clearly define if a structure has all the features of a subordinate or coordinate construction. The proposal developed by Usage-Based Functional Linguistics resizes the criterion of (in)dependence, comparing it with the embedding in a scalar and gradient proposal. Based on the theory of prototypes, the Usage-Based Functional Linguistics presents a descriptive alternative to the question of (in)dependence, more faithful to the effective use of language, as it becomes evident in the researches carried out by Brazilian and foreign authors.

Maintenance chain integration using Petri-net enabled multiagent system modeling and implementation approach

Engineering asset management (EAM) is a broad discipline and the EAM functions and processes are characterized by its distributed nature. However, engineering asset nowadays mostly relies on self-maintained experiential rule bases and periodic maintenance, which is lacking a collaborative engineering approach. This research proposes a collaborative environment integrated by a service center with domain expertise such as diagnosis, prognosis, and asset operations. The collaborative maintenance chain combines asset operation sites, service center (i.e., maintenance operation coordinator), system provider, first tier collaborators, and maintenance part suppliers. Meanwhile, to realize the automation of communication and negotiation among organizations, multiagent system (MAS) technique is applied to enhance the entire service level. During the MAS design processes, this research combines Prometheus MAS modeling approach with Petri-net modeling methodology and unified modeling language to visualize and rationalize the design processes of MAS. The major contributions of this research include developing a Petri-net enabled Prometheus MAS modeling methodology and constructing a collaborative agent-based maintenance chain framework for integrated EAM.

Diagnosed artist : what is the understanding of 'artist' held by a person with a mental illness?

What is the understanding of ‘artist’ held by a person with a mental illness? Being diagnosed with a mental illness often results in social isolation. Art programs are often used to address this isolation, and to expedite positive mental health and wellbeing. In these programs the cultural value of art can be moderated and replaced with therapeutic meanings or used for purposes of community integration. Some individuals develop artistic identities within these programs. These artists personify representative tensions within the art world. Artists with mental illness are symbolically positioned within the history of art as holding special creative providence and, yet are also viewed as having a peripheral position outside the cultural framework of the art world. This research engaged with eight artists to determine the understanding of artist held by a person with a mental illness. Through shared activities around the curatorial aspects of an exhibition entitled "Artist Citizen" the impact of illness, culture and alterity were examined. Overlapping approaches of Community Cultural Development and Participatory Action Research have been used. A perspective of alterity is given which was apparent in transformative processes of the research. This thesis shows that alterity and difference are both important social resources as well as positions of isolation and discrimination. Finally, conclusions are presented that indicated that a more nuanced understanding of alterity offers potential to discussions of the complex experiences of a person with a mental illness to negotiate subjective constructions of an identity for participation in broader political, social, health and cultural contexts.

Challenges in the context-aware management of business processes : a multiple case study

Current conceptualizations of organizational processes consider them as internally optimized yet static systems. Still, turbulences in the contextual environment of a firm often lead to adaptation requirements that these processes are unable to fulfil. Based on a multiple case study of the core processes of two large organizations, we offer an extended conceptualisation of business processes as complex adaptive systems. This conceptualization can enable firms to optimise business processes by analysing operations in different contexts and by examining the complex interaction between external, contextual elements and internal agent schemata. From this analysis, we discuss how information technology can play a vital goal in achieving this goal by providing discovery, analysis, and automation support. We detail implications for research and practice.

Perceiving and pursuing novelty : a grounded theory of adolescent creativity

Creativity plays an increasingly important role in our personal, social, educational, and community lives. For adolescents, creativity can enable self-expression, be a means of pushing boundaries, and assist learning, achievement, and completion of everyday tasks. Moreover, adolescents who demonstrate creativity can potentially enhance their capacity to face unknown future challenges, address mounting social and ecological issues in our global society, and improve their career opportunities and contribution to the economy. For these reasons, creativity is an essential capacity for young people in their present and future, and is highlighted as a priority in current educational policy nationally and internationally. Despite growing recognition of creativity’s importance and attention to creativity in research, the creative experience from the perspectives of the creators themselves and the creativity of adolescents are neglected fields of study. Hence, this research investigated adolescents’ self-reported experiences of creativity to improve understandings of their creative processes and manifestations, and how these can be supported or inhibited. Although some aspects of creativity have been extensively researched, there were no comprehensive, multidisciplinary theoretical frameworks of adolescent creativity to provide a foundation for this study. Therefore, a grounded theory methodology was adopted for the purpose of constructing a new theory to describe and explain adolescents’ creativity in a range of domains. The study’s constructivist-interpretivist perspective viewed the data and findings as interpretations of adolescents’ creative experiences, co-constructed by the participants and the researcher. The research was conducted in two academically selective high schools in Australia: one arts school, and one science, mathematics, and technology school. Twenty adolescent participants (10 from each school) were selected using theoretical sampling. Data were collected via focus groups, individual interviews, an online discussion forum, and email communications. Grounded theory methods informed a process of concurrent data collection and analysis; each iteration of analysis informed subsequent data collection. Findings portray creativity as it was perceived and experienced by participants, presented in a Grounded Theory of Adolescent Creativity. The Grounded Theory of Adolescent Creativity comprises a core category, Perceiving and Pursuing Novelty: Not the Norm, which linked all findings in the study. This core category explains how creativity involved adolescents perceiving stimuli and experiences differently, approaching tasks or life unconventionally, and pursuing novel ideas to create outcomes that are not the norm when compared with outcomes by peers. Elaboration of the core category is provided by the major categories of findings. That is, adolescent creativity entailed utilising a network of Sub-Processes of Creativity, using strategies for Managing Constraints and Challenges, and drawing on different Approaches to Creativity – adaptation, transfer, synthesis, and genesis – to apply the sub-processes and produce creative outcomes. Potentially, there were Effects of Creativity on Creators and Audiences, depending on the adolescent and the task. Three Types of Creativity were identified as the manifestations of the creative process: creative personal expression, creative boundary pushing, and creative task achievement. Interactions among adolescents’ dispositions and environments were influential in their creativity. Patterns and variations of these interactions revealed a framework of four Contexts for Creativity that offered different levels of support for creativity: high creative disposition–supportive environment; high creative disposition–inhibiting environment; low creative disposition–supportive environment; and low creative disposition–inhibiting environment. These contexts represent dimensional ranges of how dispositions and environments supported or inhibited creativity, and reveal that the optimal context for creativity differed depending on the adolescent, task, domain, and environment. This study makes four main contributions, which have methodological and theoretical implications for researchers, as well as practical implications for adolescents, parents, teachers, policy and curriculum developers, and other interested stakeholders who aim to foster the creativity of adolescents. First, this study contributes methodologically through its constructivist-interpretivist grounded theory methodology combining the grounded theory approaches of Corbin and Strauss (2008) and Charmaz (2006). Innovative data collection was also demonstrated through integration of data from online and face-to-face interactions with adolescents, within the grounded theory design. These methodological contributions have broad applicability to researchers examining complex constructs and processes, and with populations who integrate multimedia as a natural form of communication. Second, applicable to creativity in diverse domains, the Grounded Theory of Adolescent Creativity supports a hybrid view of creativity as both domain-general and domain-specific. A third major contribution was identification of a new form of creativity, educational creativity (ed-c), which categorises creativity for learning or achievement within the constraints of formal educational contexts. These theoretical contributions inform further research about creativity in different domains or multidisciplinary areas, and with populations engaged in formal education. However, the key contribution of this research is that it presents an original Theory and Model of Adolescent Creativity to explain the complex, multifaceted phenomenon of adolescents’ creative experiences.

Laboratory measurement of hydraulic conductivity functions of two unsaturated sandy soils during drying and wetting processes

The importance of applying unsaturated soil mechanics to geotechnical engineering design has been well understood. However, the consumption of time and the necessity for a specific laboratory testing apparatus when measuring unsaturated soil properties have limited the application of unsaturated soil mechanics theories in practice. Although methods for predicting unsaturated soil properties have been developed, the verification of these methods for a wide range of soil types is required in order to increase the confidence of practicing engineers in using these methods. In this study, a new permeameter was developed to measure the hydraulic conductivity of unsaturated soils using the steady-state method and directly measured suction (negative pore-water pressure) values. The apparatus is instrumented with two tensiometers for the direct measurement of suction during the tests. The apparatus can be used to obtain the hydraulic conductivity function of sandy soil over a low suction range (0-10 kPa). Firstly, the repeatability of the unsaturated hydraulic conductivity measurement, using the new permeameter, was verified by conducting tests on two identical sandy soil specimens and obtaining similar results. The hydraulic conductivity functions of the two sandy soils were then measured during the drying and wetting processes of the soils. A significant hysteresis was observed when the hydraulic conductivity was plotted against the suction. However, the hysteresis effects were not apparent when the conductivity was plotted against the volumetric water content. Furthermore, the measured unsaturated hydraulic conductivity functions were compared with predictions using three different predictive methods that are widely incorporated into numerical software. The results suggest that these predictive methods are capable of capturing the measured behavior with reasonable agreement.

Developing examplars for sustained integration of palliative care principles into allied health curricula

The PCC4U (Palliative Care Curriculum for Undergraduates) project aims to support the inclusion of the principles and practice of palliative care in all health professional training. While uptake rates of the project resources and curriculum initiatives is strong in medicine and nursing (86% of courses actively engaged with the project in 2012) integration of palliative care content in allied health disciplines has been less consistent. This report explores the process adopted to address this issue. In 2012 six allied health courses – representing social work, pharmacy, psychology, occupational therapy, dietetics and physiotherapy – commenced a range of tailored curriculum initiatives with the aim of informing the development of exemplars of integration of palliative care in specific disciplines. The PCC4U project provided palliative care learning materials, curriculum resources and expertise, and financial support as part of this curriculum development process. Review of the outcomes of each initiative indicates that tailored support has provided an opportunity for courses to develop palliative care curriculum content that reflects both discipline and local contexts. It has contributed six discipline specific exemplars of the integration of palliative care in allied health professional curricula and provided insights into allied health educational approaches in palliative care, particularly the use of evidence based resources. As a result project curriculum materials and activities have been expanded. These will be implemented with allied health courses through workshops, site visits and curriculum mapping initiatives in 2013 to better sustain the integration of palliative care in health professional curricula.

Conceptualizing the interplay of knowledge accumulation and integration capabilities in service innovation-based competitive strategy : a project-oriented firm context

While past knowledge-based approaches to service innovation have emphasized the role of integration of knowledge in the provisioning of solutions, these approaches fail to address complexities involved with knowledge integration in project-oriented context, specifically, how the firm’s capability to acquire new knowledge from clients and past project episodes influence the development of new service solutions. Adopting a dynamic capability framework and building on knowledge-based approaches to innovation, this paper presents a conceptual model that captures the interplay of learning capabilities and the knowledge integration capability in the service innovation-based competitive strategy. Implications to theory and directions for future research are discussed.