An examination of the UK community pharmacist's role in facilitating patient self-management of cardiovascular disease through lifestyle behaviours

The progression of cardiovascular disease (CVD) is largely modifiable through lifestyle behaviours. UK pharmacists are contractually obliged to facilitate patient self-management of chronic conditions such as CVD. Pharmacists are easily accessible health professionals who are well placed to identify “at risk” patients through medication regimes. Research has identified varying attitudes towards and levels of involvement in pharmacist-led health promotion activity. Given the diverse and exploratory nature of the work, a pragmatic, mixed methods approach was used to explore community pharmacists’ role in facilitating patient self-management of CVD. The thesis presents four studies: a qualitative study with pharmacists; a cross sectional questionnaire of community pharmacists; a systematic review and a qualitative study with patients with CVD. The qualitative study with pharmacists gave an insight into pharmacists’ experiences of giving patients with CVD lifestyle advice and the factors underpinning commonly cited barriers to providing public health services. This informed the development of the cross-sectional questionnaire which identified the predictors of pharmacists’ intentions to give two different types of advice to facilitate patient self-management. The systematic review identified a small number of interventions to prepare pharmacists to facilitate patient lifestyle behaviour change and evaluated the theories and behaviour change techniques used in successful interventions; however due to poor study quality and poor reporting of the interventions limited conclusions about the efficacy of the interventions could reliably be drawn. Finally, the qualitative study gave an insight into the experiences of patients with CVD using community pharmacy services and their expectations of the service they receive from community pharmacists. Recommendations about changes to pharmacy policy and practice in order to support pharmacists’ provision of CVD self-management advice are made.

The Socioeconomic Background of the Divergence of Belarusian and Ukrainian Political Systems

The aim of this paper is to analyze the political, social and economic background of the divergence of Belarusian and Ukrainian transitions. We focus on Belarus in order to find explanation for questions such as why could Lukashenko remain the authoritarian leader of Belarus, while in Ukraine the position of the political elite had proved less stable and collapsed in 2004. On the theoretical framework of elite-sociology, we seek to determine whether the internal factors (as macroeconomic conditions, standard of living, the oppressive nature of the political system and the structure of the political elite) play a significant role in the operation of the domino effect. This article emphasises the determining role of immanent internal factors, thus the political stability in Belarus can be explained by the role of the suppressing political regime, the hindrance of democratic rights and the relatively good living conditions that followed the transformational recession. Whilst in Ukraine, the markedly different circumstances brought forth the success of the Orange Revolution.

Különböző beszerzői magatartásminták a magyarországi kórházak körében (Behaviour of the Hungarian hospital in their relationship with drug suppliers.)

A szerzők kutatásának célja a magyar kórházak gyógyszerbeszállítókkal kapcsolatos magatartásának jobb megértése. A szervezeti viselkedés természetéből adódóan a szerzők kutatásukat a komplexitás paradigmájára támaszkodva (Mucchielli, 2004) végezték el. Ahhoz, hogy kórházak beszerzési döntéseinek komplex eljárásait megvizsgálják, egy vegyes kutatási módszer alkalmazására volt szükség. Elméleti háttérként az üzleti kapcsolatok értékének integrált modelljét alkalmazták. A tanulmányban bemutatják egy kvantitatív és egy kvalitatív kutatás eredményeit a magyarországi kórházak és a gyógyszerbeszállítók közötti üzleti kapcsolatokban. ________________ The main goal of this research is to better understand the behaviour of the Hungarian hospital in their relationship with drug suppliers. The nature of the organisational behaviour guides the authors to conduct their research on the complexity paradigm (Mucchielli, 2004). To be able to explore the complex procedure of purchasing decisions in the hospitals, they applied a research design based on mixed method research. As a theoretical background the authors used the integrated model of business relationship value. In their paper they introduce the results of a quantitative and a qualitative research about the business relationships between hospitals and drug suppliers in Hungary.

The Role of the Everglades Mangrove Ecotone Region (EMER) in Regulating Nutrient Cycling and Wetland Productivity in South Florida

The authors summarize the main findings of the Florida Coastal Everglades Long-Term Ecological Research (FCE-LTER) program in the EMER, within the context of the Comprehensive Everglades Restoration Plan (CERP), to understand how regional processes, mediated by water flow, control population and ecosystem dynamics across the EMER landscape. Tree canopies with maximum height <3 m cover 49% of the EMER, particularly in the SE region. These scrub/dwarf mangroves are the result of a combination of low soil phosphorus (P < 59 μg P g dw−1) in the calcareous marl substrate and long hydroperiod. Phosphorus limits the EMER and its freshwater watersheds due to the lack of terrigenous sediment input and the phosphorus-limited nature of the freshwater Everglades. Reduced freshwater delivery over the past 50 years, combined with Everglades compartmentalization and a 10 cm rise in coastal sea level, has led to the landward transgression (1.5 km in 54 years) of the mangrove ecotone. Seasonal variation in freshwater input strongly controls the temporal variation of nitrogen and P exports (99%) from the Everglades to Florida Bay. Rapid changes in nutrient availability and vegetation distribution during the last 50 years show that future ecosystem restoration actions and land use decisions can exert a major influence, similar to sea level rise over the short term, on nutrient cycling and wetland productivity in the EMER.

Acclimatization of the tropical reef coral Acropora millepora to hyperthermal stress

The demise of reef-building corals potentially lies on the horizon, given ongoing climate change amid other anthropogenic environmental stressors. If corals cannot acclimatize or adapt to changing conditions, dramatic declines in the extent and health of the living reefs are expected within the next half century. The primary and proximal global threat to corals is climate change. Reef-building corals are dependent upon a nutritional symbiosis with photosynthetic dinoflagellates belonging to the group Symbiodinium. . The symbiosis between the cnidarian host and algal partner is a stress-sensitive relationship; temperatures just 1°C above normal thermal maxima can result in the breakdown of the symbiosis, resulting in coral bleaching (the loss of Symbiodinium and/or associated photopigments) and ultimately, colony death. As ocean temperatures continue to rise, corals will either acclimatize or adapt to changing conditions, or will perish. By experimentally preconditioning the coral Acropora millepora via sublethal heat treatment, the coral acquired thermal tolerance, resisting bleaching during subsequent hyperthermal stress. The complex nature of the coral holobiont translates to multiple possible explanations for acclimatization: acquired thermal tolerance could potentially originate from the host itself, the Symbiodinium, or from the bacterial community associated with the coral. By examining the type of in hospite Symbiodinium and the bacterial community prior acclimation and after thermal challenge, it is shown that short-term acclimatization is not due to a distinct change in the dinoflagellate or prokaryote community. Though the microbial partnerships remain without considerable flux in preconditioned corals, the host transcriptome is dynamic. One dominant pattern was the apparent tuning of gene expression observed between preconditioned and non-preconditioned treatments, showing a modulated transcriptomic response to stress. Additionally several genes were upregulated in association with thermal tolerance, including antiapoptotic genes, lectins, and oxidative stress response genes. Upstream of two of these thermal tolerance genes, inhibitor of NFκB and mannose-binding lectin, DNA polymorphisms were identified which vary significantly between the northern and southern Great Barrier Reef. The impact of these mutations in putative promoter regions remains to be seen, but variation across thermally-disparate geography serves to generate hypotheses regarding the role of regulatory element evolution in a coral adaptation context.

An alkalic volcanic suite of the Labrador Trough, Labrador

The Nimish Subgroup igneous suite is a linear belt of volcanic and plutonic rocks in the Dyke Lake area of the southern Labrador Trough. The volcanics are interbedded with the sediments of the Wishart and Sokoman Formations of the Aphebian aged, Knob Lake Group. The sokoman Formation forms a time stratigraphic horizon that separates the lower Petitsikapau Lake Formation from the upper Astray Lake formation of the Nimish Subgroup. The occurrence of these volcanics within the Knob Lake Group is unique relative to Labrador Trough stratigraphy, as elsewhere the Knob Lake Group is a dominantly sedimentary succession and volcanics are restricted to the younger Doublet Group. Stratigraphic relationships between the Nimish Subgroup and the Sokoman formation indicate contemporaneous volcanic, clastic and chemical sedimentary activity. The internal stratigraphy of the Sokoman Formation exhibits a three-fold subdivision that is broadly correlatable with similar subdivisions in the Schefferville "main ore zone", 30 miles to the northwest. A detailed facies and paleogeographic model relating the volcanic activity to iron formation deposition in the Dyke Lake is presented. The rocks of the Dyke Lake area have been affected by lower greenschist facies metamorphism during the Hudsonian orogenic event, circa 1735 my. Geochemical evidence indicates that the igneous rocks of the Nimish Subgroup have been metasomatized with large degrees of mobility in Na₂O, K₂O, CaO, MgO, SiO₂, FeO and Fe₂O₃ suspected. The "immobile trace elements", Ti, Zr, Nb, Y and Ga imply that the Nimish lavas are a mildly alkaline suite that has an alkali basalt-trachyandesite-comendite differentiation scheme. The rare earth element, REE, geochemistry of the Nimish Subgroup is supportive of the alkaline nature of the volcanics and has been used to model the fractional crystallization petrogenesis involved in the two volcanic cycles. The geological, geochemical and geophysical evidence indicates that the Nimish Subgroup lavas are possibly a rift facies, alkaline suite related to the tensional tectonic regime that preceeded the extrusion of voluminous tholeiitic lavas of the Doublet Group.

Globalizing the Sculptural Landscapes of the Sarapis and Isis Cults in Hellenistic and Roman Greece

“Globalizing the Sculptural Landscape of Isis and Sarapis Cults in Roman Greece,” asks questions of cross-cultural exchange and viewership of sculptural assemblages set up in sanctuaries to the Egyptian gods. Focusing on cognitive dissonance, cultural imagining, and manipulations of time and space, I theorize ancient globalization as a set of loosely related processes that shifted a community's connections with place. My case studies range from the 3rd century BCE to the 2nd century CE, including sanctuaries at Rhodes, Thessaloniki, Dion, Marathon, Gortyna, and Delos. At these sites, devotees combined mainstream Greco-Roman sculptures, Egyptian imports, and locally produced imitations of Egyptian artifacts. In the last case, local sculptors represented Egyptian subjects with Greco-Roman naturalistic styles, creating an exoticized visual ideal that had both local and global resonance. My dissertation argues that the sculptural assemblages set up in Egyptian sanctuaries allowed each community to construct complex narratives about the nature of the Egyptian gods. Further, these images participated in a form of globalization that motivated local communities to adopt foreign gods and reinterpret them to suit local needs.

I begin my dissertation by examining how Isis and Sarapis were represented in Greece. My first chapter focuses on single statues of Egyptian gods, describing their iconographies and stylistic tendencies through examples from Corinth and Gortyna. By comparing Greek examples with images of Sarapis, Isis, and Harpokrates from around the Mediterranean, I demonstrate that Greek communities relied on globally available visual tropes rather than creating site or region-specific interpretations. In the next section, I examine what other sources viewers drew upon to inform their experiences of Egyptian sculpture. In Chapter 3, I survey the textual evidence for Isiac cult practice in Greece as a way to reconstruct devotees’ expectations of sculptures in sanctuary contexts. At the core of this analysis are Apuleius’ Metamorphoses and Plutarch’s De Iside et Osiride, which offer a Greek perspective on the cult’s theology. These literary works rely on a tradition of aretalogical inscriptions—long hymns produced from roughly the late 4th century B.C.E. into the 4th century C.E. that describe the expansive syncretistic powers of Isis, Sarapis, and Harpokrates. This chapter argues that the textual evidence suggests that devotees may have expected their images to be especially miraculous and likely to intervene on their behalf, particularly when involved in ritual activity inside the sanctuary.

In the final two chapters, I consider sculptural programs and ritual activity in concert with sanctuary architecture. My fourth chapter focuses on sanctuaries where large amounts of sculpture were found in underground water crypts: Thessaloniki and Rhodes. These groups of statues can be connected to a particular sanctuary space, but their precise display contexts are not known. By reading these images together, I argue that local communities used these globally available images to construct new interpretations of these gods, ones that explored the complex intersections of Egyptian, Greek, and Roman identities in a globalized Mediterranean. My final chapter explores the Egyptian sanctuary at Marathon, a site where exceptional preservation allows us to study how viewers would have experienced images in architectural space. Using the Isiac visuality established in Chapter 3, I reconstruct the viewer's experience, arguing that the patron, Herodes Atticus, intended his viewer to inform his experience with the complex theology of Middle Platonism and prevailing elite attitudes about Roman imperialism.

Throughout my dissertation, I diverge from traditional approaches to culture change that center on the concepts of Romanization and identity. In order to access local experiences of globalization, I examine viewership on a micro-scale. I argue that viewers brought their concerns about culture change into dialogue with elements of cult, social status, art, and text to create new interpretations of Roman sculpture sensitive to the challenges of a highly connected Mediterranean world. In turn, these transcultural perspectives motivated Isiac devotees to create assemblages that combined elements from multiple cultures. These expansive attitudes also inspired Isiac devotees to commission exoticized images that brought together disparate cultures and styles in an eclectic manner that mirrored the haphazard way that travel brought change to the Mediterranean world. My dissertation thus offers a more theoretically rigorous way of modeling culture change in antiquity that recognizes local communities’ agency in producing their cultural landscapes, reconciling some of the problems of scale that have plagued earlier approaches to provincial Roman art.

These case studies demonstrate that cultural anxieties played a key role in how viewers experienced artistic imagery in the Hellenistic and Roman Mediterranean. This dissertation thus offers a new component in our understanding of ancient visuality, and, in turn, a better way to analyze how local communities dealt with the rise of connectivity and globalization.

Knowing The Way: Scriptural Imagination and the Acts of the Apostles

In this dissertation, I offer a pedagogical proposal for learning the Christian Scriptures guided by respect for the nature of the reader and the integrity of the biblical text. Christian educators have profitably developed recent theoretical interest in the body’s role in human meaning with regard to worship and praxis methodologies, but the implications of this research for communal study of the biblical text merit further development. I make the case for adopting scriptural imagination as the goal of pedagogically constructed encounters with the Christian Scriptures. The argument proceeds through a series of questions addressing both sides of the text/reader encounter.

Chapter one considers the question “what is the nature of the reader and, subsequently, the shape of the reader’s ways of knowing?” This investigation into recent literature on the body’s involvement in human knowing includes related epistemological shifts with Christian education. On the basis of this survey, imagination emerges as a compelling designator of an incorporative, constructive creaturely capacity that gives rise to a way of being in the world. Teachers of Scripture who intend to participate in Christian formation should account for the imagination’s centrality for all knowing. After briefly situating this proposal within a theological account of creatureliness, I make the initial case for Scriptural imagination as a pedagogical aim.

Imagination as creaturely capacity addresses the first guiding value, but does this proposal also respect the integrity and nature of the biblical text, and specifically of biblical narratives? In response, in chapter two I take up the Acts of the Apostles as a potential test case and exemplar for the dynamics pertinent to the formation of imagination. Drawing on secondary literature on the genre and literary features of Acts, I conclude that Acts coheres with this project’s explicit interest in imagination as a central component of the process of Christian formation in relationship to the Scriptures.

Chapters three and four each take up a pericope from Acts to assess whether the theoretical perspectives developed in prior chapters generate any interpretive payoff. In each of these chapters, a particular story within Acts functions as a test case for readings of biblical narratives guided by a concern for scriptural imagination. Each of these chapters begins with further theoretical development of some element of imaginal formation. Chapter three provides a theoretical account of practices as they relate to imagination, bringing that theory into conversation with Peter’s engagement in hospitality practices with Cornelius in Acts 10:1-11:18. Chapter four discusses the formative power of narratives, with implications for the analysis of Paul’s shipwreck in Acts 27:1-28:16.

In the final chapter, I offer a two-part constructive pedagogical proposal for reading scriptural narratives in Christian communities. First, I suggest adopting resonance above relevance as the goal of pedagogically constructed encounters with the Scriptures. Second, I offer three ways of reading with the body, including the physical, ecclesial, and social bodies that shape all learning. I conclude by identifying the importance of scriptural imagination for Christian formation and witness in the twenty-first century.

Geochemistry of the Japan Trench sediments at DSDP Legs 56-57 Holes

The main objective of this investigation was to study distribution of main chemical constituents and several minor elements in sediment sections drilled during DSDP Legs 56 and 57 in the Japan Trench, in order to infer geochemical features of different lithologic types of sediments, and to find out how the geochemistry is associated with major lithologic constituents, such as terrigenous detrital matter, clay, volcanic ash, and biogenic particles. The geochemical data may help to indicate the nature of the sediments and to interpret sedimentation processes. The analyzed samples seem to be representative of most lithologic units, sub-units, and sediment types drilled at all sites on both legs, except for some shallow-water deposits at Sites 438 and 439. We analyzed bulk-sediment composition by X-ray fluorescence (Kuzmina and Turanskaya) and routine wet-chemical methods (Mikhailov); amorphous SiO2, extracted in a boiling sodium carbonate solution (Analythical Laboratory, P. P. Shirshov Institute of Oceanology); Cr, Zn, Cu, Ni, Co, and Al by atomic absorption (Gordeev); and Sn, Pb, Zn, Cu, Ni, Co, Cr, V, B, and Ag by quantitative spectrographic analyses in both bulk samples and granulometric fractions (Mikhailov). In addition, Fe, Ti, Mn, and CaCO3 have been determined in selected samples by routine wet-chemical methods (Analytical Laboratory, P. P. Shirshov Institute of Oceanology). Murdmaa was responsible for interpretation of the results.

Geochemical measurements of the Tasmanian Gateway from ODP Hole 189-1172A

Tectonic changes that produced a deep Tasmanian Gateway between Australia and Antarctica are widely invoked as the major mechanism for Antarctic cryosphere growth and Antarctic Circumpolar Current (ACC) development during the Eocene/Oligocene (E/O) transition (34-33 Ma). Ocean Drilling Program (ODP) Leg 189 recovered near-continuous marine sedimentary records across the E/O transition interval at four sites around Tasmania. These records are largely barren of calcareous microfossils but contain a rich record of siliceous- and organic-walled marine microfossils. In this study we integrate micropaleontological, sedimentological, geochemical, and paleomagnetic data from Site 1172 (East Tasman Plateau) to identify four distinct phases (A-D) in the E/O Tasmanian Gateway deepening that are correlative among ODP Leg 189 sites. Phase A, prior to 35.5 Ma: minor initial deepening characterized by a shallow marine prodeltaic setting with initial condensation episodes. Phase B, 35.5-33.5 Ma: increased deepening marked by the onset of major glauconitic deposition and inception of energetic bottom-water currents. Phase C, 33.5-30.2 Ma: further deepening to bathyal depths, with episodic erosion by increasingly energetic bottom-water currents. Phase D, <30.2 Ma: establishment of stable, open-ocean, warm-temperate, oligotrophic settings characterized by siliceous-carbonate ooze deposition. Our combined evidence indicates that this early Oligocene Tasmanian Gateway deepening initially produced an eastward flow of relatively warm surface waters from the Australo-Antarctic Gulf into the southwestern Pacific Ocean. This "proto-Leeuwin" current fundamentally differs from previous regional reconstructions of eastward flowing cool water (e.g., a "proto-ACC") during the early Oligocene and thereby represents an important new constraint for reconstructing regional- to global-scale dynamics for this major global change event.

Annotated record of the detailed examination of Mn deposits from DSDP Site, Leg 4 (Cores 4-27-1 and 4-27A-1)

The northern margin of the Demerara Abyssal Plain is bordered by a low ESE-WNW trending rise known as the Barracuda Ridge. North of South America, the eastern margin of the Demerara Abyssal Plain is formed by the Barbados Ridge. An extensive sedimentary section of the Barbados Ridge is exposed on the island of Barbados and consists of a series of radiolarian to planktonic foraminiferal and calcareous nannofossil biogenic sediments interlayered with ash beds. To determine the nature of the sediments and "basement," Site 27 was selected on the northern margin of the Demerara Abyssal Plain, south of the Barracuda Ridge.

The Significance of the Disputed Territory in Bechuanaland 1887-1893

British Imperial policy in Southern Africa in the last three decades of the nineteenth century oscillated between two extremes. It began in the early 1870's with Lord Kimberley's attempt to effect confederation as a means of devolving Imperial responsibility and expenditure. It ended in 1899 with Britain's active intervention against the Boers. For most of the remaining years of those decades a middle course was adopted while the British Government struggled to reconcile its diverse political interests. Strategy, supremacy, economy, humanitarianism, and recognition of colonial aspirations were all at one time or another, in varying degrees, motivating forces behind Imperial policy. Many historians have pointed out how incompatible many of these ends were and how the attempt to pursue them all at once almost inevitably ended in at least one of them being sacrificed on the way. This study focusses on a relatively minor problem over a period of about seven years. It attempts to show how the British Government tried to reconcile, in this case, the predominant motives of economy and supremacy. The problem of the Disputed Territory now seems like a small fish in a big ocean because non the great hopes and fears that it raised were ever realized. But the anticlimactic nature of the outcome of events should not be allowed to conceal two important points: first, that the problem loomed large at the time in the eyes of the Imperial Government; and second, that in the case of its policy towards the Disputed Territory, the Government gained a greater degree of success in trying to reconcile seemingly incompatible ends than it did in many other instances.

Commentary on the Humble Remonstrance of the Company of Stationers 1643

A petition from the Company of Stationers to Parliament to introduce some form of legislative regulation of the press. The petition is significant in revealing the extent to which the Stationers depended upon the state to support the regulation of the book trade, as well as the nature of the various public and private interest arguments upon which they sought to base their claim. The commentary articulates the various arguments presented by the Stationers within their petition. The benefits of the legal regulation they suggested concerned not only the censorship and suppression of seditious and heretical texts, but also facilitated the advancement of learning and knowledge and the flourishing of the printing industry itself. In addition, the petition presents the figure of the ‘author' as reliant upon the benefit of his work, and that the ‘production of the Brain' was to be regarded as equivalent to any other commodity or chattel.

Building public policy on shifting sands: the case of the National Asset Management Agency

Over the last thirty years, there has been an increased demand for better management of public sector organisations (PSOs). This requires that they are answerable for the inputs that they are given but also for what they achieve with these inputs (Hood 1991; Hood 1995). It is suggested that this will improve the management of the organisation through better planning and control, and the achievement of greater accountability (Smith 1995). However, such a rational approach with clear goals and the means to measure achievement can cause difficulties for many PSOs. These difficulties include the distinctive nature of the public sector due to the political environment within which the public sector manager operates (Stewart and Walsh 1992) and the fact that PSOs will have many stakeholders, each of whom will have their own specific objectives based on their own perspective (Boyle 1995). This can
result in goal ambiguity which means that there is leeway in interpreting the results of the PSO. The National Asset Management Agency (NAMA) was set up to bring stability to the financial system by buying loans from the banks (which were in most cases, non-performing loans). The intention was to cleanse the banks of these loans so that they could return to their normal business of taking deposits and making loans. However, the legislation, also gave NAMA a wide range of other responsibilities including responsibility for facilitating credit in the economy and protecting the interests of taxpayers. In more recent times, NAMA has been given responsibility for building social housing. This wide-range of activities is a clear example of a PSO being given multiple goals which may conflict and is therefore likely to lead to goal ambiguity. This makes it very difficult to evaluate NAMA’s performance as they are attempting to meet numerous goals at the same time and also highlights the complexity of policy making in the public sector. The purpose of this paper is to examine how NAMA dealt with goal ambiguity. This will be done through a thematic analysis of its annual reports over the last five years. The paper’s will contribute to the ongoing debate about the evaluation of PSOs and the complex environment within which they operate which makes evaluation difficult as they are
answerable to multiple stakeholders who have different objectives and different criteria for measuring success.

Self-perceptions of the role of the planner

The role of the planning practitioner has received considerable attention in a diverse range of theoretical and empirical debates within the broad spectrum of planning scholarship from normative debates surrounding the planner's role in society, to more empirical investigations into the skills, attributes, and evolving nature of planning practitioners. Fundamental questions surrounding the role and purpose of planners have also entered into more mainstream discussions as the democratic nature of the planning system has been consistently undermined by allegations of misconduct, corruption, and incompetence. Despite the broad range of literature and debate which centres on the role of the planner, relatively few studies have explored the views of planning practitioners themselves, making it difficult to judge whether the ideas of planning academics are actually shared by those in the field. In this paper we seek to address this particular gap and argue that such insights are critical in determining the extent to which planning practitioners serve to challenge, maintain, or reinforce existing power imbalances in the planning system. The methodology consists of a series of qualitative interviews with twenty local authority planners working throughout the Greater Dublin Area, Ireland. The results suggest that planners' self-perceptions of their role tend to reflect traditional pluralist and managerialist perspectives. More broadly, the results suggest that the role orientations of contemporary planners are being shaped by dominant discourses in current planning ideology — namely, collaborative and participatory approaches