What is the new medicines use review ‘patient survey’ attempting to capture in the context of existing patient satisfaction with pharmacy questionnaires and a new conceptual framework?

The community pharmacy service medicines use review (MUR) was introduced in 2005 ‘to improve patient knowledge, concordance and use of medicines’ through a private patient–pharmacist consultation. The MUR presents a fundamental change in community pharmacy service provision. While traditionally pharmacists are dispensers of medicines and providers of medicines advice, and patients as recipients, the MUR considers pharmacists providing consultation-type activities and patients as active participants. The MUR facilitates a two-way discussion about medicines use. Traditional patient–pharmacist behaviours transform into a new set of behaviours involving the booking of appointments, consultation processes and form completion, and the physical environment of the patient–pharmacist interaction moves from the traditional setting of the dispensary and medicines counter to a private consultation room. Thus, the new service challenges traditional identities and behaviours of the patient and the pharmacist as well as the environment in which the interaction takes place. In 2008, the UK government concluded there is at present too much emphasis on the quantity of MURs rather than on their quality.[1] A number of plans to remedy the perceived imbalance included a suggestion to reward ‘health outcomes’ achieved, with calls for a more focussed and scientific approach to the evaluation of pharmacy services using outcomes research. Specifically, the UK government set out the main principal research areas for the evaluation of pharmacy services to include ‘patient and public perceptions and satisfaction’as well as ‘impact on care and outcomes’. A limited number of ‘patient satisfaction with pharmacy services’ type questionnaires are available, of varying quality, measuring dimensions relating to pharmacists’ technical competence, behavioural impressions and general satisfaction. For example, an often cited paper by Larson[2] uses two factors to measure satisfaction, namely ‘friendly explanation’ and ‘managing therapy’; the factors are highly interrelated and the questions somewhat awkwardly phrased, but more importantly, we believe the questionnaire excludes some specific domains unique to the MUR. By conducting patient interviews with recent MUR recipients, we have been working to identify relevant concepts and develop a conceptual framework to inform item development for a Patient Reported Outcome Measure questionnaire bespoke to the MUR. We note with interest the recent launch of a multidisciplinary audit template by the Royal Pharmaceutical Society of Great Britain (RPSGB) in an attempt to review the effectiveness of MURs and improve their quality.[3] This template includes an MUR ‘patient survey’. We will discuss this ‘patient survey’ in light of our work and existing patient satisfaction with pharmacy questionnaires, outlining a new conceptual framework as a basis for measuring patient satisfaction with the MUR. Ethical approval for the study was obtained from the NHS Surrey Research Ethics Committee on 2 June 2008. References 1. Department of Health (2008). Pharmacy in England: Building on Strengths – Delivering the Future. London: HMSO. www. official-documents.gov.uk/document/cm73/7341/7341.pdf (accessed 29 September 2009). 2. Larson LN et al. Patient satisfaction with pharmaceutical care: update of a validated instrument. JAmPharmAssoc 2002; 42: 44–50. 3. Royal Pharmaceutical Society of Great Britain (2009). Pharmacy Medicines Use Review – Patient Audit. London: RPSGB. http:// qi4pd.org.uk/index.php/Medicines-Use-Review-Patient-Audit. html (accessed 29 September 2009).

"Racism in a Melting Pot...?" Trinidadian mid-life transnational migrants' views on race and colour-class on return to their homes of descent

This paper deals with second-generation, one-and-a-half generation and ‘‘prolonged sojourner” Trinidadian transnational migrants, who have decided to ‘return’ to the birthplace of their parents. Based on 40 in-depth interviews, the paper considers both the positive and critical things that these youthful transnational migrants report about returning to, and living in, this multi-ethnic plural society and the salience of racial and colour-class stratification as part of their return migration experiences. Our qualitative analysis is based on the narratives provided by these youthful returnees, as relayed ‘‘in their own words”, presenting critical reflections on racism, racial identities and experiences as transnational Trinidadians. It is clear that it is contexts such as contemporary working environments, family and community that act as the reference points for the adaptation ‘‘back home” of this strongly middle-class cohort. We accordingly encounter a diverse, sometimes contesting set of racial issues that emerge as salient concerns for these returnees. The consensus is that matters racial remain as formidable legacies in the hierarchical stratification of Trinidadian society for a sizeable number. Many of our respondents reported the positive aspects of racial affirmation on return. But for another sub-set, the fact that multi-ethnic and multi-cultural mixing are proudly embraced in Trinidad meant that it was felt that return experiences were not overly hindered, or blighted by obstacles of race and colour-class. For these returnees, Trinidad and Tobago is seen as representing a 21st century ‘‘Melting Pot”. But for others the continued existence of racial divisions within society – between ethnic groups and among those of different skin shades – was lamented. In the views of these respondents, too much racial power is still ascribed to ‘near-whiteness’. But for the most part, the returnees felt that where race played a part in their new lives, this generally served to advantage them. However, although the situation in Trinidad appears to have been moderated by assumptions that it remains a racial ‘Melting Pot’, the analysis strongly suggests that the colour-class system of stratification is still playing an essential role, along with racial stereotyping in society at large.

Species divergence and trait convergence in experimental plant community assembly

Despite decades of research, it remains controversial whether ecological communities converge towards a common structure determined by environmental conditions irrespective of assembly history. Here, we show experimentally that the answer depends on the level of community organization considered. In a 9-year grassland experiment, we manipulated initial plant composition on abandoned arable land and subsequently allowed natural colonization. Initial compositional variation caused plant communities to remain divergent in species identities, even though these same communities converged strongly in species traits. This contrast between species divergence and trait convergence could not be explained by dispersal limitation or community neutrality alone. Our results show that the simultaneous operation of trait-based assembly rules and species-level priority effects drives community assembly, making it both deterministic and historically contingent, but at different levels of community organization.

Creating teaching and learning in Europe: promoting a new paradigm

The tides of globalization and the unsteady surges and distortions in the evolution of the European Union are causing identities and cultures to be in a state of flux. Education is used by politicians as a major lever for political and social change through micro-management, but it is a crude tool. There can, however, be opportunities within educational experience for individual learners to gain strong, reflexive, multiple identities and multiple citizenship through the engagement of their creative energies. It has been argued that the twenty-first century needs a new kind of creativity characterized by unselfishness, caring and compassion—still involving monetary wealth, but resulting in a healthy planet and healthy people. Creativity and its economically derived relation, innovation, have become `buzz words' of our times. They are often misconstrued, misunderstood and plainly misused within educational conversations. The small-scale pan-European research study upon which this article is founded discovered that more emphasis needs to be placed on creative leadership, empowering teachers and learners, reducing pupils' fear of school, balancing teaching approaches, and ensuring that the curriculum and assessment are responsive to the needs of individual learners. These factors are key to building strong educational provision that harnesses the creative potential of learners, teachers and other stakeholders, values what it is to be human and creates a foundation upon which to build strong, morally based, consistent, participative democracies.

Sustaining linguistic diversity within the global cultural economy: issues of language rights and linguistic possibilities

This paper draws on ethnographic case-study research conducted amongst a group of first and second generation immigrant children in six inner-city schools in London. It focuses on language attitudes and language choice in relation to cultural maintenance, on the one hand, and career aspirations on the other. It seeks to provide insight into some of the experiences and dilemmatic choices encountered and negotiations engaged in by transmigratory groups, how they define cultural capital, and the processes through which new meanings are shaped as part of the process of defining a space within the host society. Underlying this discussion is the assumption that alternative cultural spaces in which multiple identities and possibilities can be articulated already exist in the rich texture of everyday life amongst transmigratory groups. The argument that whilst the acquisition of 'world languages' is a key variable in accumulating cultural capital, the maintenance of linguistic diversity retains potent symbolic power in sustaining cohesive identities is a recurring theme.

Young people with intellectual disabilities attending mainstream and segregated schooling: perceived stigma, social comparison and future aspirations

Mainstream schooling is a key policy in the promotion of social inclusion of young people with learning disabilities. Yet there is limited evidence about the school experience of young people about to leave mainstream as compared with segregated education, and how it impacts on their relative view of self and future aspirations. Sixty young people with mild to moderate intellectual disabilities in their final year of secondary school participated in this study. Twenty-eight individuals came from mainstream schools and 32 attended segregated school. They completed a series of self-report measures on perceptions of stigma, social comparison to a more disabled and non-disabled peer and the likelihood involved in attaining their future goals. The majority of participants from both groups reported experiencing stigmatized treatment in the local area where they lived. The mainstream group reported significant additional stigma at school. In terms of social comparisons, both groups compared themselves positively with a more disabled peer and with a non-disabled peer. While the mainstream pupils had more ambitious work-related aspirations, both groups felt it equally likely that they would attain their future goals. Although the participants from segregated schools came from significantly more deprived areas and had lower scores on tests of cognitive functioning, neither of these factors appeared to have an impact on their experience of stigma, social comparisons or future aspirations. Irrespective of schooling environment, the young people appeared to be able to cope with the threats to their identities and retained a sense of optimism about their future. Nevertheless, negative treatment reported by the children was a serious source of concern and there is a need for schools to promote the emotional well-being of pupils with intellectual disabilities.

The loss of Normandy and the invention of Terre Normannorum, 1204

The conquest of Normandy by Philip Augustus of France effectively ended the ‘Anglo-Norman’ realm created in 1066, forcing cross-Channel landholders to choose between their English and their Norman estates. The best source for the resulting tenurial upheaval in England is the Rotulus de valore terrarum Normannorum, a list of seized properties and their former holders, and this article seeks to expand our understanding of the impact of the loss of Normandy through a detailed analysis of this document. First, it demonstrates that the compilation of the roll can be divided into two distinct stages, the first containing valuations taken before royal justices in June 1204 and enrolled before the end of July, and the second consisting of returns to orders for the valuation of particular properties issued during the summer and autumn, as part of the process by which these estates were committed to new holders. Second, study of the roll and other documentary sources permits a better understanding of the order for the seizure of the lands of those who had remained in Normandy, the text of which does not survive. This establishes that this royal order was issued in late May 1204 and, further, that it enjoined the temporary seizure rather than the permanent confiscation of these lands. Moreover, the seizure was not retrospective and covers a specific window of time in 1204. On the one hand, this means that the roll is far from a comprehensive record of terre Normannorum. On the other hand, it is possible to correlate the identities of those Anglo-Norman landholders whose English estates were seized with the military progress of the French king through the duchy in May and June and thus shed new light on the campaign of 1204. Third, the article considers the initial management of the seized estates and highlights the fact that, when making arrangements for the these lands, John was primarily concerned to maintain his freedom of manoeuvre, since he was not prepared to accept that Normandy had been lost for good.

Television and the popular: viewing from the British perspective

The academic discipline of television studies has been constituted by the claim that television is worth studying because it is popular. Yet this claim has also entailed a need to defend the subject against the triviality that is associated with the television medium because of its very popularity. This article analyses the many attempts in the later twentieth and twenty-first centuries to constitute critical discourses about television as a popular medium. It focuses on how the theoretical currents of Television Studies emerged and changed in the UK, where a disciplinary identity for the subject was founded by borrowing from related disciplines, yet argued for the specificity of the medium as an object of criticism. Eschewing technological determinism, moral pathologization and sterile debates about television's supposed effects, UK writers such as Raymond Williams addressed television as an aspect of culture. Television theory in Britain has been part of, and also separate from, the disciplinary fields of media theory, literary theory and film theory. It has focused its attention on institutions, audio-visual texts, genres, authors and viewers according to the ways that research problems and theoretical inadequacies have emerged over time. But a consistent feature has been the problem of moving from a descriptive discourse to an analytical and evaluative one, and from studies of specific texts, moments and locations of television to larger theories. By discussing some historically significant critical work about television, the article considers how academic work has constructed relationships between the different kinds of objects of study. The article argues that a fundamental tension between descriptive and politically activist discourses has confused academic writing about ›the popular‹. Television study in Britain arose not to supply graduate professionals to the television industry, nor to perfect the instrumental techniques of allied sectors such as advertising and marketing, but to analyse and critique the medium's aesthetic forms and to evaluate its role in culture. Since television cannot be made by ›the people‹, the empowerment that discourses of television theory and analysis aimed for was focused on disseminating the tools for critique. Recent developments in factual entertainment television (in Britain and elsewhere) have greatly increased the visibility of ›the people‹ in programmes, notably in docusoaps, game shows and other participative formats. This has led to renewed debates about whether such ›popular‹ programmes appropriately represent ›the people‹ and how factual entertainment that is often despised relates to genres hitherto considered to be of high quality, such as scripted drama and socially-engaged documentary television. A further aspect of this problem of evaluation is how television globalisation has been addressed, and the example that the issue has crystallised around most is the reality TV contest Big Brother. Television theory has been largely based on studying the texts, institutions and audiences of television in the Anglophone world, and thus in specific geographical contexts. The transnational contexts of popular television have been addressed as spaces of contestation, for example between Americanisation and national or regional identities. Commentators have been ambivalent about whether the discipline's role is to celebrate or critique television, and whether to do so within a national, regional or global context. In the discourses of the television industry, ›popular television‹ is a quantitative and comparative measure, and because of the overlap between the programming with the largest audiences and the scheduling of established programme types at the times of day when the largest audiences are available, it has a strong relationship with genre. The measurement of audiences and the design of schedules are carried out in predominantly national contexts, but the article refers to programmes like Big Brother that have been broadcast transnationally, and programmes that have been extensively exported, to consider in what ways they too might be called popular. Strands of work in television studies have at different times attempted to diagnose what is at stake in the most popular programme types, such as reality TV, situation comedy and drama series. This has centred on questions of how aesthetic quality might be discriminated in television programmes, and how quality relates to popularity. The interaction of the designations ›popular‹ and ›quality‹ is exemplified in the ways that critical discourse has addressed US drama series that have been widely exported around the world, and the article shows how the two critical terms are both distinct and interrelated. In this context and in the article as a whole, the aim is not to arrive at a definitive meaning for ›the popular‹ inasmuch as it designates programmes or indeed the medium of television itself. Instead the aim is to show how, in historically and geographically contingent ways, these terms and ideas have been dynamically adopted and contested in order to address a multiple and changing object of analysis.

Adapting to new challenges: extension theory and practice for the 21st century

Twenty first century challenges facing agriculture include climate change, threats to food security for a growing population and downward economic pressures on rural livelihoods. Addressing these challenges will require innovation in extension theory, policy and education, at a time when the dominance of the state in the provision of knowledge and information services to farmers and rural entrepreneurs continues to decline. This paper suggests that extension theory is catching up with and helping us to understand innovative extension practice, and therefore provides a platform for improving rural development policies and strategies. Innovation is now less likely to be spoken of as something to be passed on to farmers, than as a continuing process of creativity and adaptation that can be nurtured and sustained. Innovation systems and innovation platforms are concepts that recognise the multiple factors that lead to farmers’ developing, adapting and applying new ideas and the importance of linking all actors in the value chain to ensure producers can access appropriate information and advice for decision making at all stages in the production process. Concepts of social learning, group development and solidarity, social capital, collective action and empowerment all help to explain and therefore to apply more effectively group extension approaches in building confidence and sustaining innovation. A challenge facing educators is to ensure the curricula for aspiring extension professionals in our higher education institutions are regularly reviewed and keep up with current and future developments in theory, policy and practice.

Autobiographical memory, autonoetic consciousness, and identity in Asperger syndrome

Previous results from research on individuals with Asperger syndrome (AS) suggest a diminished ability for recalling episodic autobiographical memory (AM). The primary aim of this study was to explore autobiographical memory in individuals with Asperger syndrome and specifically to investigate whether memories in those with AS are characterized by fewer episodic 'remembered' events (due to a deficit in autonoetic consciousness). A further aim was to examine whether such changes in AM might also be related to changes in identity, due to the close relationship between memory and the self and to the established differences in self-referential processes in AS. Eleven adults with AS and fifteen matched comparison participants were asked to recall autobiographical memories from three lifetime periods and for each memory to give either a remember response (autonoetic consciousness) or a know response (noetic consciousness). The pattern of results shows that AS participants recalled fewer memories and that these memories were more often rated as known, compared to the comparison group. AS participants also showed differences in reported identity, generating fewer social identity statements and more abstract, trait-linked identities. The data support the view that differences in both memory and reported personal identities in AS are characterized by a lack of specificity.

Recognition of greater diversity of Bacillus species and related bacteria in human faeces

In a study looking at the culturable, aerobic Actinobacteria associated with the human gastrointestinal tract, the vast majority of isolates obtained from dried human faeces belonged to the genus Bacillus and related bacteria. A total of 124 isolates were recovered from the faeces of 10 healthy adult donors. 16S rRNA gene sequence analyses showed the majority belonged to the families Bacillaceae (n = 81) and Paenibacillaceae (n = 3), with Bacillus species isolated from all donors. Isolates tentatively identified as Bacillus clausii (n = 32) and B. licheniformis (n = 28) were recovered most frequently, with the genera Lysinibacillus, Ureibacillus, Oceanobacillus, Ornithinibacillus and Virgibacillus represented in some donors. Phenotypic data confirmed the identities of isolates belonging to well-characterized species. Representatives of the phylum Actinobacteria were recovered in much lower numbers (n = 11). Many of the bacilli exhibited antimicrobial activity against one or more strains of Clostridium difficile, C. perfringens, Listeria monocytogenes and Staphylococcus aureus, with some (n = 12) found to have no detectable cytopathic effect on HEp-2 cells. This study has revealed greater diversity within gut-associated aerobic spore-formers than previous studies, and suggests that bacilli with potential as probiotics could be isolated from the human gut.

Life histories of academics who become heads of department: socialisation, identity and career trajectory

Although the role of the academic head of department (HoD) has always been important to university management and performance, an increasing significance given to bureaucracy, academic performance and productivity, and government accountability has greatly elevated the importance of this position. Previous research and anecdotal evidence suggests that as academics move into HoD roles, usually with little or no training, they experience a problem of struggling to adequately manage key aspects of their role. It is this problem – and its manifestations – that forms the research focus of this study. Based on the research question, “What are the career trajectories of academics who become HoDs in a selected post-1992 university?” the study aimed to achieve greater understanding of why academics become HoDs, what it is like being a HoD, and how the experience influences their future career plans. The study adopts an interpretive approach, in line with social constructivism. Edited topical life history interviews were undertaken with 17 male and female HoDs, from a range of disciplines, in a post-1992 UK university. These data were analysed using coding, categorisation and theme formation techniques and developing profiles of each of the respondents. The findings from this study suggest that academics who become HoDs not only need the capacity to assume a range of personal and professional identities, but need to regularly adopt and switch between them. Whether individuals can successfully balance and manage these multiple identities, or whether they experience major conflicts and difficulties within or between them, greatly affects their experiences of being a HoD and may influence their subsequent career decisions. It is claimed that the focus, approach and analytical framework - based on the interrelationships between the concepts of socialisation, identity and career trajectory - provide a distinct and original contribution to knowledge in this area. Although the results of this study cannot be generalised, the findings may help other individuals and institutions move towards a firmer understanding of the academic who becomes HoD - in relation to theory, practice and future research.