Exploring the implementation of a medication adherence programme by community pharmacists : a qualitative study

Background Medication adherence has been identified as an important factor for clinical success. Twenty-four Swiss community pharmacists participated in the implementation of an adherence support programme for patients with hypertension, diabetes mellitus and/or dyslipidemia. The programme combined tailored consultations with patients about medication taking (expected at an average of one intervention per month) and the delivery of each drug in an electronic monitoring system (MEMS6?). Objective To explore pharmacists' perceptions and experiences with implementation of the medication adherence programme and to clarify why only seven patients were enrolled in total. Setting Community pharmacies in French-speaking Switzerland. Method Individual in-depth interviews were audio-recorded, with 20 of the pharmacists who participated in the adherence programme. These were transcribed verbatim, coded and thematically analysed. Process quality was ensured by using an audit trail detailing the development of codes and themes; furthermore, each step in the coding and analysis was verified by a second, experienced qualitative researcher. Main outcome measure Community pharmacists' experiences and perceptions of the determining factors influencing the implementation of the adherence programme. Results Four major barriers were identified: (1) poor communication with patients resulting in insufficient promotion of the programme; (2) insufficient collaboration with physicians; (3) difficulty in integrating the programme into pharmacy organisation; and (4) insufficient pharmacist motivation. This was related to the remuneration perceived as insufficient and to the absence of clear strategic thinking about the pharmacist position in the health care system. One major facilitator of the programme's implementation was pre-existing collaboration with physicians. Conclusion A wide range of barriers was identified. The implementation of medication adherence programmes in Swiss community pharmacies would benefit from an extended training aimed at developing communication and change management skills. Individualised onsite support addressing relevant barriers would also be necessary throughout the implementation process.

Endogeneous matching in university-industry collaboration: Theory and empirical evidence from the UK

We develop a two-sided matching model to analyze collaboration between heterogeneousacademics and firms. We predict a positive assortative matching in terms of both scientificability and affinity for type of research, but negative assortative in terms of ability on one sideand affinity in the other. In addition, the most able and most applied academics and the mostable and most basic firms shall collaborate rather than stay independent. Our predictionsreceive strong support from the analysis of the teams of academics and firms that proposeresearch projects to the UK's Engineering and Physical Sciences Research Council.

Mastectomy, body deconstruction, and impact on identity: a qualitative study.

Objectives This qualitative study aims at understanding the consequences of body deconstruction through mastectomy on corporality and identity in women with breast cancer. Design Nineteen women were contacted through the hospital. All had to undergo mastectomy. Some were offered immediate breast reconstruction, others, because of cancer treatments, had no planned reconstruction. A qualitative reflexive methodological background was chosen. Method Women were invited to participate in three semi-structured interviews, one shortly before or after mastectomy, and the other interviews later in their illness courses, after surgery. All interviews were transcribed verbatim. Thematic analysis was performed. The analysis of the first interview of each woman is presented in this article. Results Mastectomy provokes a painful experience of body deconstruction. Even when immediate reconstruction is proposed, contrasted feelings and dissonance are expressed when comparing the former healthy body to the present challenged body entity. Body transformations are accompanied with experiences of mutilation, strangeness, and modify the physical, emotional social, symbolic and relational dimensions of the woman's gendered identity. Although the opportunity of breast reconstruction is seen as a possible recovery of a lost physical symmetry and body integrity, grieving the past body and integrating a new corporality leads to a painful identity crisis. Conclusion With mastectomy, the roots of the woman's identity are challenged, leading to a re-evaluation of her existential values. The consequences of mastectomy transform the woman's corporality and embodiment, and question her identity. Psychological support is discussed in the perspective of our results.

Of housing and politics : mapping political opportunities for mobilising in Bangalore, India

Quelles sont les conditions pour l'émergence d'une mobilisation sociale en faveur du logement convenable dans la métropole de Bangalore (Inde)? Cette question, qui est au coeur de cette thèse, est particulièrement pertinente dans le contexte d'une ville où 1,7 million de personnes, soit un cinquième de la population, vit dans des bidonvilles. L'absence d'un mouvement mettant en cause l'échec des politiques publiques du logement est intéressante dans la mesure où l'Inde a hérité un système de gouvernance colonial et d'une tradition de mouvements sociaux. Pour répondre à ce questionnement, un cadre théorique issu de la littérature sur les mouvements sociaux est développé. Il s'articule autour des liens entre les opportunités politiques au niveau macro et les répertoires d'action des organisations de mouvement social (OMS) au niveau méso, de la tension entre la formalité de la loi et des politiques publiques et l'informalité des circuits d'échange, de la corruption et du clientélisme, et enfin, se focalise sur les systèmes de discours de caste et de la citoyenneté et de leur concrétisation dans des systèmes d'organisations et de réseaux sociaux. Ce cadre théorique permet d'étudier empiriquement la question à travers quatre OMS dans la ville de Bangalore. Les résultats mettent en avant l'existence de mécanismes complexes. Les opportunités politiques formelles n'étant ouvertes que sur le plan rhétorique, elles ne peuvent être véritablement utilisées que par des moyens légaux ou contentieux, ce qui nécessite des compétences sociales dont la plupart des habitants des bidonvilles sont dépourvus. L'inadéquation entre les ressources à disposition pour les logements sociaux et les besoins très importants des pauvres, donne un poids politique considérable aux acteurs en charge de l'attribution de ces ressources rares. Cet état de fait a des répercussions sur la politique électorale. Les habitants des bidonvilles représentant un poids électoral important, ils sont mobilisés à travers de pratiques clientélistes. La corruption et le clientélisme se nourrissent mutuellement pour maintenir une certaine dépendance des habitants. Les OMS qui développent un répertoire discursif remettant en cause le système de caste et qui encouragent une conscience citoyenne, se sont avérées les plus durables pour résister à la cooptation des forces politiques. Cette recherche empirique met en lumière l'inadéquation entre les prescriptions formelles dans le domaine de la gouvernance des besoins humains, tels que le logement, et les pratiques réelles sur le terrain. Cette recherche appelle à réfléchir au-delà de la diffusion du discours sur la « bonne gouvernance » vers des formes de « gouvernance vernaculaire » qui prendrait au sérieux l'informalité en développant une compréhension des avantages à court terme pour les personnes marginalisées dans la ville et les effets à long terme sur la pratique démocratique. - What are the conditions for the emergence of a social movement on the issue of adequate housing in the metropolitan city of Bangalore (India)? This question is at the heart of this dissertation and is particularly pertinent against the background that an estimated 1.7 million or about 20% of the city's population lives in slums. The absence of a movement addressing the failure of public housing policy despite India having inherited colonial systems of governance and traditions of movement is noteworthy. Answers are sought within a theoretical framework stemming from social movement theories that incorporates three linkages articulating around: Macro-level political opportunities and meso-level action repertoires of social movement organisations (SMOs), tensions between the formality of law, policy and the informality of exchange circuits of corruption and clientelism and finally around systems of discourses of caste and citizenship and their instantiation in concrete systems of social organisations and networks. This thesis is empirically investigated through a qualitative case study research design involving four sampled social movement organisations. The results bring complex mechanisms to the fore. Formal political opportunities are only rhetorically open and have to be cracked through legal weaponry or contentious escalation, which requires considerable social skills that slum-dwellers often lack. The inadequacy between the few housing resources and the vast number of slum-dwellers transform housing benefits and urban service provisions into political currency. Such a state of affairs has serious repercussions on conditions for mobilisation. They become imbricated with electoral logic, in which slum-dwellers represent large vote-banks and where corruption and clientelism feed each other to maintain a certain dependency of the poor. SMOs deploying a discursive repertoire that questioned the caste system and encouraged a pursuit of citizenship proved to be the most sustainable to resist co-option from political forces. This empirical investigation brings to light the mismatch between the formal prescriptions in the domain of the governance of basic human needs such as housing and the real practices on the ground. This research calls to reflect beyond the inadequacy of the diffused « good governance » discourse towards forms of « vernacular governance » that take informality seriously in understanding the short-term benefits for the marginalised in the city and the long-term effects on democratic practice.

When nightclub security agents assault clients more insight through a qualitative approach.

Between 2007 and 2009, aggressions by security agents of nightclubs on clients increased from 6% to 10% among community violence situations encountered at the Violence Medical Unit (VMU) at the Lausanne University Hospital in Switzerland. Most victims were young men who had been drinking alcohol before the assault. About one quarter (25.7%) presented with one or several fractures, all of them in the head area. (For more details, refer to the previous article "When nightclub security agents assault clients" published in 2012(1).) Following this first study, we performed a second qualitative study in order to bring more information about the context and highlight victims' behaviors and experiences. Four themes emerged: how the assault began; the assault itself; third-party involvement; and the psychological state of victims when they consulted the VMU. The findings of this second study complemented the statistical results of the first study by showing under what circumstances security agents of nightclubs respond with physical violence to situations they consider a threat to security. Furthermore, the study described consequences for the victims that could be quite serious. Our findings support the need for nightclubs to improve selection and training of security staff.

Empirical studies of cloud effects on UV radiation: A review

The interest in solar ultraviolet (UV) radiation from the scientific community and the general population has risen significantly in recent years because of the link between increased UV levels at the Earth's surface and depletion of ozone in the stratosphere. As a consequence of recent research, UV radiation climatologies have been developed, and effects of some atmospheric constituents (such as ozone or aerosols) have been studied broadly. Correspondingly, there are well-established relationships between, for example, total ozone column and UV radiation levels at the Earth's surface. Effects of clouds, however, are not so well described, given the intrinsic difficulties in properly describing cloud characteristics. Nevertheless, the effect of clouds cannot be neglected, and the variability that clouds induce on UV radiation is particularly significant when short timescales are involved. In this review we show, summarize, and compare several works that deal with the effect of clouds on UV radiation. Specifically, works reviewed here approach the issue from the empirical point of view: Some relationship between measured UV radiation in cloudy conditions and cloud-related information is given in each work. Basically, there are two groups of methods: techniques that are based on observations of cloudiness (either from human observers or by using devices such as sky cameras) and techniques that use measurements of broadband solar radiation as a surrogate for cloud observations. Some techniques combine both types of information. Comparison of results from different works is addressed through using the cloud modification factor (CMF) defined as the ratio between measured UV radiation in a cloudy sky and calculated radiation for a cloudless sky. Typical CMF values for overcast skies range from 0.3 to 0.7, depending both on cloud type and characteristics. Despite this large dispersion of values corresponding to the same cloud cover, it is clear that the cloud effect on UV radiation is 15–45% lower than the cloud effect on total solar radiation. The cloud effect is usually a reducing effect, but a significant number of works report an enhancement effect (that is increased UV radiation levels at the surface) due to the presence of clouds. The review concludes with some recommendations for future studies aimed to further analyze the cloud effects on UV radiation

Does Direct Democracy Matters for Political Parties : An Empirical Test in the Swiss Cantons

According to most political scientists and commentators, direct democracy seems to weaken political parties. Our empirical analysis in the 26 Swiss cantons shows that this thesis in its general form cannot be maintained. Political parties in cantons with extensive use of referendums and initiatives are not in all respects weaker than parties in cantons with little use of direct democratic means of participation. On the contrary, direct democracy goes together with more professional and formalized party organizations. Use of direct democracy is associated with more fragmented and volatile party systems, and with greater support for small parties, but causal interpretations of these relationships are difficult.

Existential values transformation in all organ transplantation : a qualitative prospective study

The aim of this qualitative study was to analyze psychological concerns in wait-listed patients T1 and six months after transplantation T2. Semi-structured interviews were conducted and qualitative analysis performed. T1 Kidney patients maintained apparent normality, building emotional protection, and a fatalist attitude. Liver patients set physical limits, reevaluation of life values was reported. Lung patients developed physical and psychological self-protection. Modified life values, fatalism and spirituality were mentioned. Heart patients husbanded ressources and self-protection. Modified life values, fatalist attitude were reported. T2 Kidney patients described new life perspectives and increase of empathy. Liver patients underlined positive identity and life values modifications. Lack of respect of life values generated anger. Heart and lung patients set their existential priorities and underlined increase in spirituality, greater openness and more closeness to significant ones. Lack of respect of human values induced negative feelings. TX comes with physical benefits, but also with positive existential values transformations and a humanistic, altruistic attitude.

Eliminació d'artefactes en EGG mitjançant l'ús de la Multivariate Empirical Mode Decomposition

La tècnica de l’electroencefalograma (EEG) és una de les tècniques més utilitzades per estudiar el cervell. En aquesta tècnica s’enregistren els senyals elèctrics que es produeixen en el còrtex humà a través d’elèctrodes col•locats al cap. Aquesta tècnica, però, presenta algunes limitacions a l’hora de realitzar els enregistraments, la principal limitació es coneix com a artefactes, que són senyals indesitjats que es mesclen amb els senyals EEG. L’objectiu d’aquest treball de final de màster és presentar tres nous mètodes de neteja d’artefactes que poden ser aplicats en EEG. Aquests estan basats en l’aplicació de la Multivariate Empirical Mode Decomposition, que és una nova tècnica utilitzada per al processament de senyal. Els mètodes de neteja proposats s’apliquen a dades EEG simulades que contenen artefactes (pestanyeigs), i un cop s’han aplicat els procediments de neteja es comparen amb dades EEG que no tenen pestanyeigs, per comprovar quina millora presenten. Posteriorment, dos dels tres mètodes de neteja proposats s’apliquen sobre dades EEG reals. Les conclusions que s’han extret del treball són que dos dels nous procediments de neteja proposats es poden utilitzar per realitzar el preprocessament de dades reals per eliminar pestanyeigs.

Efectos de la presencia social de las lenguas escolares en el desarrollo lingüístico del alumnado extranjero. Un estudio empírico en Cataluña = The Social Presence of School Languages and Their Effects on the Development of Immigrant Students’ Linguistic Proficiency. An Empirical Study in Catalonia

El estudio de las variables relacionadas con la adquisición de las lenguas escolares en contextos bilingües y multilingües ha resurgido a raíz de la incorporación de alumnado extranjero al sistema educativo español. En este sentido, y gracias a su peculiar situación sociolingüística, Cataluña se ha convertido en un observatorio perfecto para estudiar el proceso de adquisición de lenguas del alumnado extranjero. En este artículo presentamos una parte de los datos obtenidos en la evaluación del conocimiento de catalán y del castellano de 668 alumnos extranjeros de sexto de Primaria escolarizados en 57 centros de Cataluña. Con ello pretendemos estudiar los efectos de la presencia y del uso social de las lenguas escolares en el conocimiento lingüístico de este alumnado. La hipótesis principal es que el desarrollo de buenos niveles de conocimiento escrito de las lenguas escolares por parte de los alumnos extranjeros depende, en buena medida, de las oportunidades que haya en el entorno social para que ellos puedan utilizar estas lenguas en los intercambios comunicativos informales con sus compañeros o con otros adultos. Las conclusiones del trabajo señalan las relaciones existentes entre el desarrollo de habilidades lingüísticas conversacionales y el de habilidades lingüísticas cognitivo-académicas (Cummins, 1979b), en el sentido de que tanto el conocimiento escrito de catalán como el de castellano que tiene el alumnado extranjero están condicionados por el nivel de desarrollo conversacional previo en ambas lenguas. Además, apuntan a que la transferencia de habilidades lingüísticas cognitivo-académicas no se produce directamente entre el catalán y el castellano, sino que depende fundamentalmente de la presencia social que tengan estas lenguas y de sus usos informales. Así, en la medida en que un buen número de estudiantes extranjeros no desarrolla suficiente competencia lingüística conversacional ni en catalán ni en castellano, el proceso de adquisición de las lenguas escolares se alarga más allá de los seis años

To say or not to say: a qualitative study on the disclosure of their condition by human immunodeficiency virus-positive adolescents.

PURPOSE: Human immunodeficiency virus (HIV)-positive adolescents face a number of challenges in dealing with their disease, treatment, and developmental tasks. This qualitative study describes some of the reasons why, and the extent to which, adolescents may or may not disclose their condition to others. METHODS: A semistructured interview lasting 40-110 minutes was conducted with each of 29 adolescents 12-20 years old, 22 female and seven male) living in Switzerland. Interviews were tape recorded and transcribed verbatim. The analysis of the content of interviews allowed us to identify salient topics (e.g., disclosure), which were then explored in detail. RESULTS: Of 29 participants, eight had not disclosed their condition to anyone outside the family, 19 had disclosed it to good friends, and 16 had disclosed it to some teachers. Four participants had engaged in public disclosure, and six of 10 sexually active teenagers disclosed their status to their partners. The attitudes toward disclosure among younger adolescents were mostly related to those of the parents, particularly the mother. Older adolescents, engaged in their search for autonomy, tended to decide independently what to say and to whom. Although foster/adoptive parents would often encourage disclosure, biological parents, especially HIV-positive mothers, insisted on not disclosing the adolescent's status for fear of stigma. CONCLUSION: The health care team should systematically address the issue of disclosure with the adolescent and his family (or foster parents), the aim being to balance the right of the adolescent and that adolescent's family to maintain privacy against the concerns of sexual partners, as well as the adolescent's interest in divulging HIV status to relatives, school staff, and friends.

Systematic review of the empirical evidence of study publication bias and outcome reporting bias - an updated review.

BACKGROUND: The increased use of meta-analysis in systematic reviews of healthcare interventions has highlighted several types of bias that can arise during the completion of a randomised controlled trial. Study publication bias and outcome reporting bias have been recognised as a potential threat to the validity of meta-analysis and can make the readily available evidence unreliable for decision making. METHODOLOGY/PRINCIPAL FINDINGS: In this update, we review and summarise the evidence from cohort studies that have assessed study publication bias or outcome reporting bias in randomised controlled trials. Twenty studies were eligible of which four were newly identified in this update. Only two followed the cohort all the way through from protocol approval to information regarding publication of outcomes. Fifteen of the studies investigated study publication bias and five investigated outcome reporting bias. Three studies have found that statistically significant outcomes had a higher odds of being fully reported compared to non-significant outcomes (range of odds ratios: 2.2 to 4.7). In comparing trial publications to protocols, we found that 40-62% of studies had at least one primary outcome that was changed, introduced, or omitted. We decided not to undertake meta-analysis due to the differences between studies. CONCLUSIONS: This update does not change the conclusions of the review in which 16 studies were included. Direct empirical evidence for the existence of study publication bias and outcome reporting bias is shown. There is strong evidence of an association between significant results and publication; studies that report positive or significant results are more likely to be published and outcomes that are statistically significant have higher odds of being fully reported. Publications have been found to be inconsistent with their protocols. Researchers need to be aware of the problems of both types of bias and efforts should be concentrated on improving the reporting of trials.