How was patient empowerment portrayed in information leaflets describing the community pharmacy Medicines Use Review service in the UK?

Objective The Medicines Use Review (MUR) community pharmacy service was introduced in 2005 to enhance patient empowerment but the service has not been taken up as widely as expected. We investigated the depiction of the patient–pharmacist power relationship within MUR patient information leaflets. Methods We identified 11 MUR leaflets including the official Department of Health MUR booklet and through discourse analysis examined the way language and imagery had been used to symbolise and give meaning to the MUR service, especially the portrayal of the patient–pharmacist interactions and the implied power relations. Results A variety of terminology was used to describe the MUR, a service that aimed ultimately to produce more informed patients through the information imparted by knowledgeable, skilled pharmacists. Conclusion The educational role of the MUR overshadowed the intended patient empowerment that would take place with a true concordance-centred approach. Although patient empowerment was implied, this was within the boundaries of the biomedical model with the pharmacist as the expert provider of medicines information. Practice implications If patient empowerment is to be conveyed this needs to be communicated to patients through consistent use of language and imagery that portrays the inclusivity intended.

How is the language of medicines use review leaflets symbolising the service?

Introduction The medicines use review (MUR), a new community pharmacy ‘service’, was launched in England and Wales to improve patients’ knowledge and use of medicines through a private, patient–pharmacist appointment. After 18 months, only 30% of pharmacies are providing MURs; at an average of 120 per annum (maximum 400 allowed).1 One reason linked to low delivery is patient recruitment.2 Our aim was to examine how the MUR is symbolised and given meaning via printed patient information, and potential implications. Method The language of 10 MUR patient leaflets, including the NHS booklet,3 and leaflets from multiples and wholesalers was evaluated by discourse analysis. Results and Discussion Before experiencing MURs, patients conceivably ‘categorise’ relationships with pharmacists based on traditional interactions.4 Yet none of the leaflets explicitly describe the MUR as ‘new’ and presuppose patients would become involved in activities outside of their pre-existing relationship with pharmacists such as appointments, self-completion of charts, and pharmacy action plans. The MUR process is described inconsistently, with interchangeable use of formal (‘review meeting‘) and informal (‘friendly’) terminology, the latter presumably to portray an intended ‘negotiation model’ of interaction.5 Assumptions exist about attitudes (‘not understanding’; ‘problems’) that might lead patients to an appointment. However, research has identified a multitude of reasons why patients choose (or not) to consult practitioners,6 and marketing of MURs should also consider other barriers. For example, it may be prudent to remove time limits to avoid implying patients might not be listened to fully, during what is for them an additional practitioner consultation.

A review of growth for construction service companies in global markets

Throughout the developed world, professional services play an increasingly important part in an economy, with many countries showing a substantial positive trade balance for services. Yet, there has been relatively little research on construction services (CS) and, in particular, how well professional service companies (PSFs) perform in the international arena. The method for collecting services export information differs to the way in which goods and products exports data are gathered because of the intangible nature of services. Organisational growth of companies aims to share risks across different regions and sectors, however, the rapidly changing business environment challenges companies with the increasing foreign ownership and changes in procurement. The complexity of today’s international construction services organisations raises two questions: how the organisations can successfully manage growth and what are their motives for international trade. The research focuses on top UK consulting engineering companies to understand their organisational strategy, their export strategy, and drivers for overseas activities. The data will feed a model of professional services exports, which can help to inform the way services export data could be collected to better reflect the industry’s performance.

Percentile growth charts for biomedical studies using a porcine model

Increasing rates of obesity and heart disease are compromising quality of life for a growing number of people. There is much research linking adult disease with the growth and development both in utero and during the first year of life. The pig is an ideal model for studying the origins of developmental programming. The objective of this paper was to construct percentile growth curves for the pig for use in biomedical studies. The body weight (BIN) of pigs was recorded from birth to 150 days of age and their crown-to-rump length was measured over the neonatal period to enable the ponderal index (Pl; kg/m(3)) to be calculated. Data were normalised and percentile curves were constructed using Cole's lambda-mu-sigma (LMS) method for BW and PI. The construction of these percentile charts for use in biomedical research will allow a more detailed and precise tracking of growth and development of individual pigs under experimental conditions.

Analysis of feeding strategies for small-scale dairy systems in central Mexico using linear programming

A limitation of small-scale dairy systems in central Mexico is that traditional feeding strategies are less effective when nutrient availability varies through the year. In the present work, a linear programming (LP) model that maximizes income over feed cost was developed, and used to evaluate two strategies: the traditional one used by the small-scale dairy producers in Michoacan State, based on fresh lucerne, maize grain and maize straw; and an alternative strategy proposed by the LIP model, based on ryegrass hay, maize silage and maize grain. Biological and economic efficiency for both strategies were evaluated. Results obtained with the traditional strategy agree with previously published work. The alternative strategy did not improve upon the performance of the traditional strategy because of low metabolizable protein content of the maize silage considered by the model. However, the Study recommends improvement of forage quality to increase the efficiency of small-scale dairy systems, rather than looking for concentrate supplementation.

Forage production and nutrient availability in small-scale dairy systems in central Mexico using linear programming and partial budgeting

Small-scale dairy systems play an important role in the Mexican dairy sector and farm planning activities related to resource allocation have a significant impact on the profitability of such enterprises. Linear programming is a technique widely used for planning and ration formulation, and partial budgeting is a technique for assessing the impact of changes on the profitability of an enterprise. This study used both methods to optimise land use for forage production and nutrient availability, and to evaluate the economic impact of such changes in small-scale Mexican dairy systems. The model showed satisfactory performance when optimal solutions were compared with the traditional strategy. The strategy using fresh ryegrass, maize silage and oat hay, and the strategy using a combination of alfalfa hay, maize silage, fresh ryegrass and oat hay appeared attractive options for providing a better nutrient supply and maintaining a higher stocking rate throughout the year than the traditional strategy.

The remote distractor effect in saccade programming: channel interactions and lateral inhibition

We explored the dependency of the saccadic remote distractor effect (RDE) on the spatial frequency content of target and distractor Gabor patches. A robust RDE was obtained with low-medium spatial frequency distractors, regardless of the spatial frequency of the tat-get. High spatial frequency distractors interfered to a similar extent when the target was of the same spatial frequency. We developed a quantitative model based on lateral inhibition within an oculomotor decision unit. This lateral inhibition mechanism cannot account for the interaction observed between target and distractor spatial frequency, pointing to the existence of channel interactions at an earlier level. (C) 2004 Elsevier Ltd. All rights reserved.

Modelling requirements of supplier selection for benchmarking service provision

Supplier selection has a great impact on supply chain management. The quality of supplier selection also affects profitability of organisations which work in the supply chain. As suppliers can provide variety of services and customers demand higher quality of service provision, the organisation is facing challenges for making the right choice of supplier for the right needs. The existing methods for supplier selection, such as data envelopment analysis (DEA) and analytical hierarchy process (AHP) can automatically perform selection of competitive suppliers and further decide winning supplier(s). However, these methods are not capable of determining the right selection criteria which should be derived from the business strategy. An ontology model described in this paper integrates the strengths of DEA and AHP with new mechanisms which ensure the right supplier to be selected by the right criteria for the right customer's needs.

An EPN-based method for web service composition

Web service composition can be facilitated by an automatic process which consists of rules, conditions and actions. This research has adapted ElementaryPetri Net (EPN) to analyze and model the web services and their composition. This paper describes a set of techniques for representing transition rules, algorithm and workflow that web service composition can be automatically carried out.

Solving optimal control problems with state constraints using nonlinear programming and simulation tools

This paper illustrates how nonlinear programming and simulation tools, which are available in packages such as MATLAB and SIMULINK, can easily be used to solve optimal control problems with state- and/or input-dependent inequality constraints. The method presented is illustrated with a model of a single-link manipulator. The method is suitable to be taught to advanced undergraduate and Master's level students in control engineering.

An ECOOP web portal for visualising and comparing distributed coastal oceanography model and in situ data

As part of a large European coastal operational oceanography project (ECOOP), we have developed a web portal for the display and comparison of model and in situ marine data. The distributed model and in situ datasets are accessed via an Open Geospatial Consortium Web Map Service (WMS) and Web Feature Service (WFS) respectively. These services were developed independently and readily integrated for the purposes of the ECOOP project, illustrating the ease of interoperability resulting from adherence to international standards. The key feature of the portal is the ability to display co-plotted timeseries of the in situ and model data and the quantification of misfits between the two. By using standards-based web technology we allow the user to quickly and easily explore over twenty model data feeds and compare these with dozens of in situ data feeds without being concerned with the low level details of differing file formats or the physical location of the data. Scientific and operational benefits to this work include model validation, quality control of observations, data assimilation and decision support in near real time. In these areas it is essential to be able to bring different data streams together from often disparate locations.

Validation of the FALL3D ash dispersion model using observations of the 2010 Eyjafjallajökull volcanic ash clouds

During April-May 2010 volcanic ash clouds from the Icelandic Eyjafjallajökull volcano reached Europe causing an unprecedented disruption of the EUR/NAT region airspace. Civil aviation authorities banned all flight operations because of the threat posed by volcanic ash to modern turbine aircraft. New quantitative airborne ash mass concentration thresholds, still under discussion, were adopted for discerning regions contaminated by ash. This has implications for ash dispersal models routinely used to forecast the evolution of ash clouds. In this new context, quantitative model validation and assessment of the accuracies of current state-of-the-art models is of paramount importance. The passage of volcanic ash clouds over central Europe, a territory hosting a dense network of meteorological and air quality observatories, generated a quantity of observations unusual for volcanic clouds. From the ground, the cloud was observed by aerosol lidars, lidar ceilometers, sun photometers, other remote-sensing instru- ments and in-situ collectors. From the air, sondes and multiple aircraft measurements also took extremely valuable in-situ and remote-sensing measurements. These measurements constitute an excellent database for model validation. Here we validate the FALL3D ash dispersal model by comparing model results with ground and airplane-based measurements obtained during the initial 14e23 April 2010 Eyjafjallajökull explosive phase. We run the model at high spatial resolution using as input hourly- averaged observed heights of the eruption column and the total grain size distribution reconstructed from field observations. Model results are then compared against remote ground-based and in-situ aircraft-based measurements, including lidar ceilometers from the German Meteorological Service, aerosol lidars and sun photometers from EARLINET and AERONET networks, and flight missions of the German DLR Falcon aircraft. We find good quantitative agreement, with an error similar to the spread in the observations (however depending on the method used to estimate mass eruption rate) for both airborne and ground mass concentration. Such verification results help us understand and constrain the accuracy and reliability of ash transport models and it is of enormous relevance for designing future operational mitigation strategies at Volcanic Ash Advisory Centers.

Where Does All the Knowledge Go in Small Knowledge-intensive Professional Service Firms?

Small knowledge-intensive professional service firms are becoming increasingly important agents of innovation in construction. There is thus an urgent need to better understand the nature and process of innovation in such firms. First, this paper presents a review of the relevant literature. It is concluded that this literature is often not appropriate for SKIPSFs, as it neglects the critical role of knowledge and knowledge workers in innovation within SKIPSFs. Second, a knowledge-based innovation model is presented as a holistic, system-oriented framework to better investigate how the SKIPSFs create, manage and exploit innovation. This model is to be tested with case study research.

Exploring unanticipated consequences of strategy amongst stakeholder segments: the case of a European Revenue Service

This article applies FIMIX-PLS segmentation methodology to detect and explore unanticipated reactions to organisational strategy among stakeholder segments. For many large organisations today, the tendency to apply a “one-size-fits-all” strategy to members of a stakeholder population, commonly driven by a desire for simplicity, efficiency and fairness, may actually result in unanticipated consequences amongst specific subgroups within the target population. This study argues that it is critical for organisations to understand the varying and potentially harmful effects of strategic actions across differing, and previously unidentified, segments within a stakeholder population. The case of a European revenue service that currently focuses its strategic actions on building trust and compliant behaviour amongst taxpayers is used as the context for this study. FIMIX-PLS analysis is applied to a sample of 501 individual taxpayers, while a novel PLS-based approach for assessing measurement model invariance that can be applied to both reflective and formative measures is also introduced for the purpose of multi-group comparisons. The findings suggest that individual taxpayers can be split into two equal-sized segments with highly differentiated characteristics and reactions to organisational strategy and communications. Compliant behaviour in the first segment (n = 223), labelled “relationships centred on trust,” is mainly driven through positive service experiences and judgements of competence, while judgements of benevolence lead to the unanticipated reaction of increasing distrust among this group. Conversely, compliant behaviour in the second segment (n = 278), labelled “relationships centred on distrust,” is driven by the reduction of fear and scepticism towards the revenue service, which is achieved through signalling benevolence, reduced enforcement and the lower incidence of negative stories. In this segment, the use of enforcement has the unanticipated and counterproductive effect of ultimately reducing compliant behaviour.

Classed femininity, performativity, and camp in British structured reality programming

This article explores the representations and tonal qualities of British “structured reality” programming. Focusing on The Only Way Is Essex and Made in Chelsea, it investigates their glocalizing of the model established by MTV’s Laguna Beach and The Hills. It argues that while they blur boundaries between docusoap, drama, and soap opera, the British programs also recognize and foreground issues of construction for their reality TV-literate youth audience. It suggests the programs play a key role in their respective channel identities and the ideologies of British youth television, connecting to larger issues of class, gender, and taste. This is articulated through their regional and classed femininities, with the article exploring how the programs draw on classed ideologies surrounding “natural” and “excessive” femininities and of the role of this in their engagement with construction and camp play. This play contributes to the tonal shift offered by the British programs, mixing the melodrama of the MTV programs with a knowing, at times comic edge that can tip into mockery. In doing so, the programs offer their audience a combination of performative self-awareness and emotional realism that situates them clearly within British youth television