The production of a framework of competences for pharmacy practice in the European Union:the PHAR-QA project

Background and objectives: The goal of the PHAR-QA (Qualityassurance in European pharmacy education and training) project isthe production of a European framework of competences for pharmacypractice. This PHAR-QA framework (www.phar-qa.eu) will beEuropean and consultative i.e. it will be used for harmonization—butwill not to replace existing national QA systems.Methods: Using the proposals for competences produced by the previousPHARMINE(Pharmacy education in Europe; www.pharmine.eu) project, together with those of other sources, the authors produced a listof 68 personal and patient care competencies. Using internet surveytools the stakeholders—European pharmacy community (universitydepartment staff and students, community, hospital and industrialpharmacists, as well as pharmacists working in clinical biology andother branches, together with representatives of chambers and associations)—were invited to rank the proposals and add comments.Results and conclusions: Pharmacology and pharmacotherapy togetherwith competences such as ‘‘supply of appropriate medicinestaking into account dose, correct formulation, concentration, administrationroute and timing’’ ranked high. Other topics such as ‘‘currentknowledge of design, synthesis, isolation, characterisation and biologicalevaluation of active substances’’ ranked lower.Implications for practice: In the short term, it is anticipated that thissurvey will stimulate a productive discussion on pharmacy educationand practice by the various stakeholders. In the long term, thisframework could serve as a European model framework of competencesfor pharmacy practice.Acknowledgements: With the support of the Lifelong Learningprogramme of the European Union: 527194-LLP-1-2012-1-BEERASMUS-EMCR. This publication reflects the views only of theauthors; the Commission cannot be held responsible for any usewhich may be made of the information contained therein.

Theory and practice in the field of foresight

Purpose – The paper aims to explore the gap between theory and practice in foresight and to give some suggestions on how to reduce it. Design/methodology/approach – Analysis of practical foresight activities and suggestions are based on a literature review, the author's own research and practice in the field of foresight and futures studies, and her participation in the work of a European project (COST A22). Findings – Two different types of practical foresight activities have developed. One of them, the practice of foresight of critical futures studies (FCFS) is an application of a theory of futures studies. The other, termed here as praxis foresight (PF), has no theoretical basis and responds directly to practical needs. At present a gap can be perceived between theory and practice. PF distinguishes itself from the practice and theory of FCFS and narrows the construction space of futures. Neither FCFS nor PF deals with content issues of the outer world. Reducing the gap depends on renewal of joint discourses and research about experience of different practical foresight activities and manageability of complex dynamics in foresight. Production and feedback of self-reflective and reflective foresight knowledge could improve theory and practice. Originality/value – Contemporary practical foresight activities are analysed and suggestions to reduce the gap are developed in the context of the linkage between theory and practice. This paper is thought provoking for futurists, foresight managers and university researchers.

Nurses' spiritual well-being: Its influence on attitudes and level of practice in providing spiritual care

The purpose of this study was to examine the relationship between the spiritual well-being of nurses and its influence on their attitudes toward providing spiritual care to patients. Two research instruments and a demographic data form were used for the survey. Using a descriptive design, tbe Spiritual Well-Being Scale, the Health Professional's Spiritual Role Scale, and the demographic data form were administered to 100 registered nurses from a large South Florida teaching hospital. The findings indicated a significantly positive correlation between the overall Spiritual Well-Being Scale and the Health Professional's Spiritual Role Scale (r = 0.52; p =.005). Significant differences were found between correlation of nurses' levels of spiritual well-being and all sociodemographic factors except for the three Age Groups and for religious affiliations. Findings have implications for how nurses should be trained in meeting patients total needs. ^

Nonlinear dynamics and chaos simulation system analysis for improved design

Small errors proved catastrophic. Our purpose to remark that a very small cause which escapes our notice determined a considerable effect that we cannot fail to see, and then we say that the effect is due to chance. Small differences in the initial conditions produce very great ones in the final phenomena. A small error in the former will produce an enormous error in the latter. When dealing with any kind of electrical device specification, it is important to note that there exists a pair of test conditions that define a test: the forcing function and the limit. Forcing functions define the external operating constraints placed upon the device tested. The actual test defines how well the device responds to these constraints. Forcing inputs to threshold for example, represents the most difficult testing because this put those inputs as close as possible to the actual switching critical points and guarantees that the device will meet the Input-Output specifications. ^ Prediction becomes impossible by classical analytical analysis bounded by Newton and Euclides. We have found that non linear dynamics characteristics is the natural state of being in all circuits and devices. Opportunities exist for effective error detection in a nonlinear dynamics and chaos environment. ^ Nowadays there are a set of linear limits established around every aspect of a digital or analog circuits out of which devices are consider bad after failing the test. Deterministic chaos circuit is a fact not a possibility as it has been revived by our Ph.D. research. In practice for linear standard informational methodologies, this chaotic data product is usually undesirable and we are educated to be interested in obtaining a more regular stream of output data. ^ This Ph.D. research explored the possibilities of taking the foundation of a very well known simulation and modeling methodology, introducing nonlinear dynamics and chaos precepts, to produce a new error detector instrument able to put together streams of data scattered in space and time. Therefore, mastering deterministic chaos and changing the bad reputation of chaotic data as a potential risk for practical system status determination. ^

Use of conjoint analysis to examine beliefs related to the practice of early literacy instruction

The purpose of the study was to examine the relationship between teacher beliefs and actual classroom practice in early literacy instruction. Conjoint analysis was used to measure teachers' beliefs on four early literacy factors—phonological awareness, print awareness, graphophonic awareness, and structural awareness. A collective case study format was then used to measure the correspondence of teachers' beliefs with their actual classroom practice. ^ Ninety Project READS participants were given twelve cards in an orthogonal experimental design describing students that either met or did not meet criteria on the four early literacy factors. Conjoint measurements of whether the student is an efficient reader were taken. These measurements provided relative importance scores for each respondent. Based on the relative important scores, four teachers were chosen to participate in a collective case study. ^ The conjoint results enabled the clustering of teachers into four distinct groups, each aligned with one of the four early literacy factors. K-means cluster analysis of the relative importance measurements showed commonalities among the ninety respondents' beliefs. The collective case study results were mixed. Implications for researchers and practitioners include the use of conjoint analysis in measuring teacher beliefs on the four early literacy factors. Further, the understanding of teacher preferences on these beliefs may assist in the development of curriculum design and therefore increase educational effectiveness. Finally, comparisons between teachers' beliefs on the four early literacy factors and actual instructional practices may facilitate teacher self-reflection thus encouraging positive teacher change. ^

The practice and use of picuristes (lay injectionists) among Haitian immigrants in Miami -Dade County, Florida

This exploratory study examined use of picuristes among Haitian immigrants in Miami-Dade County, Florida. It describes how this health-seeking behavior is socially constructed among Haitian immigrants in terms of benefits. (b) risks, (c) sex, (d) gender, (e) acculturation proxies, and (f) transnational influences. It is conducted within the frameworks of Symbolic Interactionism, the Health Belief Model and the Explanatory Model of Illness. ^ Purposive sampling and a mixed-method design were used to obtain semistructured interviews of 10 picuristes and 25 users. The same methods were employed to select survey respondents so as to obtain a descriptive estimate of picuriste use and covariates of picuriste use within the sample. ATLAS.ti 5.0 and SPSS 14.0 were used to analyze the data. ^ The findings indicate an interconnection of elements from Vodou, traditional Haitian health beliefs and picuriste practice and use. ^ Rekonnèt, a relationship based on a history of trust with individuals related by blood or who share close personal and social ties was identified as a sufficient and necessary reason for picuriste practice and use. ^ Benefits reported are that the picuriste injections directly impact the blood, and that they represent affordable and convenient access to health care. Risks include rashes, abscesses and fevers. The reuse of injection equipment, routine injection of antibiotics and unknown substances and the improper discard of syringes and needles were reported, implying unrecognized risks of preventable infectious disease. No participant described a process that adheres to established international standards for safe injections. ^ There is no clear evidence that biological sex, gender, length of time in U.S. or language of interview influence picuriste practice or use. Transnational ties facilitate transport of substances from Haiti and the practice and use of picuristes locally. ^ Recommendation by a relative or trusted friend and believing that the benefits of picures outweigh risks were covariates of picuriste use. ^ This study highlights values and priorities of Haitian immigrants seeking healthcare, and cultural forces that shape their decisions about wellness and treatment. Future studies should test the application of Symbolic Interactionism to picuriste use in larger epidemiological studies that examine picuriste use in relation to health status.^

An Audit and Feedback Intervention for Reducing Antibiotic Prescribing in General Dental Practice : The RAPiD Cluster Randomised Controlled Trial

Funding: This study was conducted as part of the TRiaDS programme of implementation research which is funded by NHS Education for Scotland (NES). The Health Services Research Unit which is funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates supported the study. The funder had no influence over the design, conduct, analysis and write up of the study.

Implementation of supply chain management theory in practice:a questionnaire survey in the United Kingdom

Purpose: The purpose of the research described in this paper is to disentangle the rhetoric from the reality in relation to supply chain management (SCM) adoption in practice. There is significant evidence of a divergence between theory and practice in the field of SCM. Research Approach: The authors’ review of the extant SCM literature highlighted a lack of replication studies in SCM, leading to the concept of refined replication being developed. The authors conducted a refined replication of the work of Sweeney et al. (2015) where a new SCM definitional construct – the Four Fundamentals – was proposed. The work presented in this article refines the previous study but adopts the same three-phase approach: focussed interviews, a questionnaire survey, and focus groups. This article covers the second phase of the refined replication study and describes an integrated research design of a questionnaire research to be undertaken in Britain. Findings and Originality: The article presents an integrated research design of a questionnaire research with emphases on the refined replication of previous work of Sweeney et al. (2015) carried out in Ireland and adapting it to the British context. Research Impact: The authors introduce the concept of refined replication in SCM research. This allows previous research to be built upon in order to test understanding of SCM theory and its practical implementation - based on the Four Fundamentals construct - among SCM professionals in Britain. Practical Impact: The article presents the integrated research design of a questionnaire research that may be used in similar studies.

Home birth in Ireland 1993-1997: a review of community midwifery practice

To date little is known about the practices of domiciliary midwives and the outcomes of home birth in Ireland. The purpose of this review is to provide some background information on the situation for women seeking a home birth and to document the outcomes of home births in Ireland between 1993 -1997. Design: Descriptive analysis of prospective data collected from domiciliary midwives regarding women who requested a home birth between 1993 and 1997. Participants: The questionnaire was distributed to 15 domiciliary midwives; this included all the domiciliary midwives known to the authors to be practising in Ireland at that time. Findings: During this period, 585 women planned to give birth in their home with the assistance of midwives, 500 women achieved this. The spontaneous vaginal delivery rate for women who commenced their labour at home was 96.9% (n = 554). These women gave birth without medications or other interventions. 544 (93%) of the women breastfed their babies and 538 (92%) were still breastfeeding at 6 weeks. This is the first review of domiciliary midwifery practice in Ireland in recent years. They obtained data from 11 independent midwives on 585 women who planned home births. Findings showed high rates of spontaneous vaginal delivery and breastfeeding. There were 500 babies born at home with three perinatal deaths, including one undiagnosed breech delivery, one infant with abnormal lungs on post-mortem and one infant with Potter's Syndrome who was stillborn.

Behavioral Perspectives on Organizational Change: Practice Adoption, Product Culling, and Technological Search

This dissertation explores the complex process of organizational change, applying a behavioral lens to understand change in processes, products, and search behaviors. Chapter 1 examines new practice adoption, exploring factors that predict the extent to which routines are adopted “as designed” within the organization. Using medical record data obtained from the hospital’s Electronic Health Record (EHR) system I develop a novel measure of the “gap” between routine “as designed” and routine “as realized.” I link this to a survey administered to the hospital’s professional staff following the adoption of a new EHR system and find that beliefs about the expected impact of the change shape fidelity of the adopted practice to its design. This relationship is more pronounced in care units with experienced professionals and less pronounced when the care unit includes departmental leadership. This research offers new insights into the determinants of routine change in organizations, in particular suggesting the beliefs held by rank-and-file members of an organization are critical in new routine adoption. Chapter 2 explores changes to products, specifically examining culling behaviors in the mobile device industry. Using a panel of quarterly mobile device sales in Germany from 2004-2009, this chapter suggests that the organization’s response to performance feedback is conditional upon the degree to which decisions are centralized. While much of the research on product exit has pointed to economic drivers or prior experience, these central finding of this chapter—that performance below aspirations decreases the rate of phase-out—suggests that firms seek local solutions when doing poorly, which is consistent with behavioral explanations of organizational action. Chapter 3 uses a novel text analysis approach to examine how the allocation of attention within organizational subunits shapes adaptation in the form of search behaviors in Motorola from 1974-1997. It develops a theory that links organizational attention to search, and the results suggest a trade-off between both attentional specialization and coupling on search scope and depth. Specifically, specialized unit attention to a more narrow set of problems increases search scope but reduces search depth; increased attentional coupling also increases search scope at the cost of depth. This novel approach and these findings help clarify extant research on the behavioral outcomes of attention allocation, which have offered mixed results.

The Role of Home Practice Engagement in a Mindfulness-Based Intervention

Over the last three decades, there has been a precipitous rise in curiosity regarding the clinical use of mindfulness meditation for the self-management of a broad range of chronic health conditions. Despite the ever-growing body of evidence supporting the use of mindfulness-based therapies for both medical and psychological concerns, data on the active ingredients of these mind-body interventions are relatively scarce. Regular engagement in formal mindfulness practice is considered by many to be requisite for generating therapeutic change; however, previous investigations of at-home practice in MBIs have produced mixed results. The equivocal nature of these findings has been attributed to significant methodological limitations, including the lack of standardized, systematic practice monitoring tools, and a singular focus on practice time, with little attention paid to the nature and quality of one’s practice. The present study used a prospective, observational design to assess the effects of home-based practice on dispositional mindfulness, self-compassion, and psychological functioning in twenty-eight people enrolled in an MBSR or MBCT program. To address some of the aforementioned limitations, the present study collected detailed weekly accounts of participants’ home-based practice engagement, including information about practice time (i.e., frequency and duration), exercise type, perceived effort and barriers to participation, and practice quality. Hierarchical multiple regression was used to examine the relative contribution of practice time and practice quality on treatment outcomes, and to explore possible predictors of adherence to at-home practice recommendations. As anticipated, practice quality and perceived effort improved with time; however, rather unexpectedly, practice quality was not a significant predictor of treatment-related improvements in psychological health. Home practice engagement, however, was predictive of change in dispositional mindfulness, in the expected direction. Results of our secondary analyses demonstrated that employment status was predictive of home practice engagement, with those who were unemployed completing more at-home practice on average. Mindfulness self-efficacy at baseline and previous experience with meditation or other contemplative practices were independently predictive of mean practice quality. The results of this study suggest that home practice helps generate meaningful change in dispositional mindfulness, which is purportedly a key mechanism of action in mindfulness-based interventions.

Restoring phronesis and practice: marketing's forgotten p's

Purpose – The purpose of this paper is to examine the evolution of marketing’s philosophical conversation over the past 120 years, focusing on the emergent meaning of the notion that marketing should become more “scientific”. Design/methodology/approach – This paper focuses on the US academic marketing literature, primarily journal articles and books published in the first half of the 20th century. Findings – The Aristotelian distinction between techné, epistemé and phronesis provides a rich basis for framing philosophical discussion in marketing, and should supplant the art-science debate and Anderson’s distinction between science1 and science2. Prior to 1959, the marketing journals provided a forum for phronesis, though this diminished as the academic marketing community largely abandoned the inductive, contextual approach in favour of a deductive, “scientific” methodology. The Ford Foundation played an important role in effecting this change. Practical implications – The paper highlights the importance of forums where practitioners can reflect on the ethical and social implications of their practices and then work to enhance these practices for the greater social good. Social implications – Questions the value of distinctions between marketing theorists and practitioners and the consequential focus of marketing journals. Originality/value – Advances the concept of phronesis in the marketing literature and distinguishes it from epistemé, which has dominated academic marketing discourse over the past 60 years.

Education - research - practice

Through this paper we will look at links between architecture education, research and practice, using a current project as a vehicle to cover aspects of building, pilot and live project. The first aspect, the building project consists of the refurbishment and extension of a Parnell Cottage for a private client and is located near Cloyne, in East Cork, Ireland. The pilot project falls within the NEES Project, investigating the use of materials and services based on natural or recycled materials to improve the energy performance of new and existing buildings. The live project aims to hold a series of on site workshops and seminars for students of Architecture, Architects and interested parties, demonstrating the integration of the NEES best practice materials and techniques within the built project. The workshops, seminars and key project documents will be digitally recorded for dissemination through a web based publication. The small scale of the building project allowed for flexibility in the early conceptual design stages and the integration of the research and educational aspects.

Theory and Practice in Sustainability Science: Influence of Urban Form on the Urban Heat Island and Implications for Urban Systems

As the world population continues to grow past seven billion people and global challenges continue to persist including resource availability, biodiversity loss, climate change and human well-being, a new science is required that can address the integrated nature of these challenges and the multiple scales on which they are manifest. Sustainability science has emerged to fill this role. In the fifteen years since it was first called for in the pages of Science, it has rapidly matured, however its place in the history of science and the way it is practiced today must be continually evaluated. In Part I, two chapters address this theoretical and practical grounding. Part II transitions to the applied practice of sustainability science in addressing the urban heat island (UHI) challenge wherein the climate of urban areas are warmer than their surrounding rural environs. The UHI has become increasingly important within the study of earth sciences given the increased focus on climate change and as the balance of humans now live in urban areas.

In Chapter 2 a novel contribution to the historical context of sustainability is argued. Sustainability as a concept characterizing the relationship between humans and nature emerged in the mid to late 20th century as a response to findings used to also characterize the Anthropocene. Emerging from the human-nature relationships that came before it, evidence is provided that suggests Sustainability was enabled by technology and a reorientation of world-view and is unique in its global boundary, systematic approach and ambition for both well being and the continued availability of resources and Earth system function. Sustainability is further an ambition that has wide appeal, making it one of the first normative concepts of the Anthropocene.

Despite its widespread emergence and adoption, sustainability science continues to suffer from definitional ambiguity within the academe. In Chapter 3, a review of efforts to provide direction and structure to the science reveals a continuum of approaches anchored at either end by differing visions of how the science interfaces with practice (solutions). At one end, basic science of societally defined problems informs decisions about possible solutions and their application. At the other end, applied research directly affects the options available to decision makers. While clear from the literature, survey data further suggests that the dichotomy does not appear to be as apparent in the minds of practitioners.

In Chapter 4, the UHI is first addressed at the synoptic, mesoscale. Urban climate is the most immediate manifestation of the warming global climate for the majority of people on earth. Nearly half of those people live in small to medium sized cities, an understudied scale in urban climate research. Widespread characterization would be useful to decision makers in planning and design. Using a multi-method approach, the mesoscale UHI in the study region is characterized and the secular trend over the last sixty years evaluated. Under isolated ideal conditions the findings indicate a UHI of 5.3 ± 0.97 °C to be present in the study area, the magnitude of which is growing over time.

Although urban heat islands (UHI) are well studied, there remain no panaceas for local scale mitigation and adaptation methods, therefore continued attention to characterization of the phenomenon in urban centers of different scales around the globe is required. In Chapter 5, a local scale analysis of the canopy layer and surface UHI in a medium sized city in North Carolina, USA is conducted using multiple methods including stationary urban sensors, mobile transects and remote sensing. Focusing on the ideal conditions for UHI development during an anticyclonic summer heat event, the study observes a range of UHI intensity depending on the method of observation: 8.7 °C from the stationary urban sensors; 6.9 °C from mobile transects; and, 2.2 °C from remote sensing. Additional attention is paid to the diurnal dynamics of the UHI and its correlation with vegetation indices, dewpoint and albedo. Evapotranspiration is shown to drive dynamics in the study region.

Finally, recognizing that a bridge must be established between the physical science community studying the Urban Heat Island (UHI) effect, and the planning community and decision makers implementing urban form and development policies, Chapter 6 evaluates multiple urban form characterization methods. Methods evaluated include local climate zones (LCZ), national land cover database (NCLD) classes and urban cluster analysis (UCA) to determine their utility in describing the distribution of the UHI based on three standard observation types 1) fixed urban temperature sensors, 2) mobile transects and, 3) remote sensing. Bivariate, regression and ANOVA tests are used to conduct the analyses. Findings indicate that the NLCD classes are best correlated to the UHI intensity and distribution in the study area. Further, while the UCA method is not useful directly, the variables included in the method are predictive based on regression analysis so the potential for better model design exists. Land cover variables including albedo, impervious surface fraction and pervious surface fraction are found to dominate the distribution of the UHI in the study area regardless of observation method.

Chapter 7 provides a summary of findings, and offers a brief analysis of their implications for both the scientific discourse generally, and the study area specifically. In general, the work undertaken does not achieve the full ambition of sustainability science, additional work is required to translate findings to practice and more fully evaluate adoption. The implications for planning and development in the local region are addressed in the context of a major light-rail infrastructure project including several systems level considerations like human health and development. Finally, several avenues for future work are outlined. Within the theoretical development of sustainability science, these pathways include more robust evaluations of the theoretical and actual practice. Within the UHI context, these include development of an integrated urban form characterization model, application of study methodology in other geographic areas and at different scales, and use of novel experimental methods including distributed sensor networks and citizen science.