A framework for assessing continuing professional development activities for satisfying pharmacy revalidation requirements

The United Kingdom’s pharmacy regulator contemplated using continuing professional development (CPD) in pharmacy revalidation in 2009, simultaneously asking pharmacy professionals to demonstrate the value of their CPD by showing its relevance and impact. The idea of linking new CPD requirements with revalidation was yet to be explored. Our aim was to develop and validate a framework to guide pharmacy professionals to select CPD activities that are relevant to their work and to produce a score sheet that would make it possible to quantify the impact and relevance of CPD. METHODS: We adapted an existing risk matrix, producing a CPD framework consisting of relevance and impact matrices. Concepts underpinning the framework were refined through feedback from five pharmacist teacher-practitioners. We then asked seven pharmacists to rate the relevance of the framework’s individual elements on a 4-point scale to determine content validity. We explored views about the framework through focus groups with six and interviews with 17 participants who had used it formally in a study. RESULTS: The framework’s content validity index was 0.91. Feedback about the framework related to three themes of penetrability of the framework, usefulness to completion of CPD, and advancement of CPD records for the purpose of revalidation. DISCUSSION: The framework can help professionals better select CPD activities prospectively, and makes assessment of CPD more objective by allowing quantification, which could be helpful for revalidation. We believe the framework could potentially help other health professionals with better management of their CPD irrespective of their field of practice.

Using paleo-climate comparisons to constrain future projections in CMIP5

We present a description of the theoretical framework and "best practice" for using the paleo-climate model component of the Coupled Model Intercomparison Project (Phase 5) (CMIP5) to constrain future projections of climate using the same models. The constraints arise from measures of skill in hindcasting paleo-climate changes from the present over 3 periods: the Last Glacial Maximum (LGM) (21 thousand years before present, ka), the mid-Holocene (MH) (6 ka) and the Last Millennium (LM) (850–1850 CE). The skill measures may be used to validate robust patterns of climate change across scenarios or to distinguish between models that have differing outcomes in future scenarios. We find that the multi-model ensemble of paleo-simulations is adequate for addressing at least some of these issues. For example, selected benchmarks for the LGM and MH are correlated to the rank of future projections of precipitation/temperature or sea ice extent to indicate that models that produce the best agreement with paleoclimate information give demonstrably different future results than the rest of the models. We also find that some comparisons, for instance associated with model variability, are strongly dependent on uncertain forcing timeseries, or show time dependent behaviour, making direct inferences for the future problematic. Overall, we demonstrate that there is a strong potential for the paleo-climate simulations to help inform the future projections and urge all the modeling groups to complete this subset of the CMIP5 runs.

Glycemic Index, glycemic control and beyond

It is currently estimated that over 370 million individuals have diabetes, making diabetes a major public health issue contributing significantly to global morbidity and mortality. The steep rise in diabetes prevalence over the past decades is attributable, in a large part, to lifestyle changes, with dietary habits and behaviour significant contributors. Despite the relatively wide availability of anti-diabetic medicine, it is lifestyle approaches that still remain the cornerstone of diabetes prevention and treatment. Glycemic index (GI) is a nutritional tool, which represents the glycemic response to carbohydrate ingestion. In light of the major impact of nutrition on diabetes pathophysiology, with the rising need to combat the escalating diabetes epidemic, this review will focus on the role of GI in glycemic control, the primary target of diabetic treatment and beyond. The review will present the evidence relating GI and diabetes treatment and prevention, as well as weight loss, weight maintenance and CVD risk factors.

The inclusion of forage mixtures in the diet of growing dairy heifers: impacts on digestion, energy utilisation, and methane emissions

Intensive farming focusing on monoculture grass species to maximise forage production has led to a reduction in the extent and diversity of species-rich grasslands. However, plant communities with higher species number (richness) are a potential strategy for more sustainable production and mitigation of greenhouse gas (GHG) emissions. Research has indicated the need to understand opportunities that forage mixtures can offer sustainable ruminant production systems. The objective of the two experiments reported here were to evaluate multiple species forage mixtures in comparison to ryegrass-dominant pasture, when conserved or grazed, on digestion, energy utilisation, N excretion, and methane emissions by growing 10–15 month old heifers. Experiment 1 was a 4 × 4 Latin square design with five week periods. Four forage treatments of: (1) ryegrass (control); permanent pasture with perennial ryegrass (Lolium perenne); (2) clover; a ryegrass:red clover (Trifolium pratense) mixture; (3) trefoil; a ryegrass:birdsfoot trefoil (Lotus corniculatus) mixture; and (4) flowers; a ryegrass:wild flower mixture of predominately sorrel (Rumex acetosa), ox-eye daisy (Leucanthemum vulgare), yarrow (Achillea millefolium), knapweed (Centaurea nigra) and ribwort plantain (Plantago lanceolata), were fed as haylages to four dairy heifers. Measurements included digestibility, N excretion, and energy utilisation (including methane emissions measured in respiration chambers). Experiment 2 used 12 different dairy heifers grazing three of the same forage treatments used to make haylage in experiment 1 (ryegrass, clover and flowers) and methane emissions were estimated using the sulphur hexafluoride (SF6) tracer technique. Distribution of ryegrass to other species (dry matter (DM) basis) was approximately 70:30 (clover), 80:20 (trefoil), and 40:60 (flowers) for experiment 1. During the first and second grazing rotations (respectively) in experiment 2, perennial ryegrass accounted for 95 and 98% of DM in ryegrass, and 84 and 52% of DM in clover, with red clover accounting for almost all of the remainder. In the flowers mixture, perennial ryegrass was 52% of the DM in the first grazing rotation and only 30% in the second, with a variety of other flower species occupying the remainder. Across both experiments, compared to the forage mixtures (clover, trefoil and flowers), ryegrass had a higher crude protein (CP) content (P < 0.001, 187 vs. 115 g kg −1 DM) and DM intake (P < 0.05, 9.0 vs. 8.1 kg day −1). Heifers in experiment 1 fed ryegrass, compared to the forage mixtures, had greater total tract digestibility (g kg −1) of DM (DMD; P < 0.008, 713 vs. 641) and CP (CPD, P < 0.001, 699 vs. 475), and used more intake energy (%) for body tissue deposition (P < 0.05, 2.6 vs. −4.9). For both experiments, heifers fed flowers differed the most compared to the ryegrass control for a number of measurements. Compared to ryegrass, flowers had 40% lower CP content (P < 0.001, 113 vs. 187 g kg −1), 18% lower DMD (P < 0.01, 585 vs. 713 g kg −1), 42% lower CPD (P < 0.001, 407 vs. 699 g kg −1), and 10% lower methane yield (P < 0.05, 22.6 vs. 25.1 g kg −1 DM intake). This study has shown inclusion of flowers in forage mixtures resulted in a lower CP concentration, digestibility and intake. These differences were due in part to sward management and maturity at harvest. Further research is needed to determine how best to exploit the potential environmental benefits of forage mixtures in sustainable ruminant production systems.

Terrestrial biosphere changes over the last 120 kyr and their impact on ocean δ 13C

A new global synthesis and biomization of long (>40 kyr) pollen-data records is presented, and used with simulations from the HadCM3 and FAMOUS climate models to analyse the dynamics of the global terrestrial biosphere and carbon storage over the last glacial–interglacial cycle. Global modelled (BIOME4) biome distributions over time generally agree well with those inferred from pollen data. The two climate models show good agreement in global net primary productivity (NPP). NPP is strongly influenced by atmospheric carbon dioxide (CO2) concentrations through CO2 fertilization. The combined effects of modelled changes in vegetation and (via a simple model) soil carbon result in a global terrestrial carbon storage at the Last Glacial Maximum that is 210–470 Pg C less than in pre-industrial time. Without the contribution from exposed glacial continental shelves the reduction would be larger, 330–960 Pg C. Other intervals of low terrestrial carbon storage include stadial intervals at 108 and 85 ka BP, and between 60 and 65 ka BP during Marine Isotope Stage 4. Terrestrial carbon storage, determined by the balance of global NPP and decomposition, influences the stable carbon isotope composition (δ13C) of seawater because terrestrial organic carbon is depleted in 13C. Using a simple carbon-isotope mass balance equation we find agreement in trends between modelled ocean δ13C based on modelled land carbon storage, and palaeo-archives of ocean δ13C, confirming that terrestrial carbon storage variations may be important drivers of ocean δ13C changes.

English language teaching and educational reform in Western China: a knowledge management perspective

This study examines the impact of a large-scale UK-based teacher development programme on innovation and change in English language education in Western China within a knowledge management (KM) framework. Questionnaire data were collected from 229 returnee teachers in 15 cohorts. Follow-up interviews and focus groups were conducted with former participants, middle and senior managers, and teachers who had not participated in the UK programme. The results showed evidence of knowledge creation and amplification at individual, group and inter-organizational levels. However, the present study also identified knowledge creation potential through the more effective organization of follow-up at the national level, particularly for the returnee teachers. It is argued that the KM framework might offer a promising alternative to existing models and metaphors of Continuing Professional Development (CPD).

Climate-driven expansion of blanket bogs in Britain during the Holocene

Blanket bog occupies approximately 6 % of the area of the UK today. The Holocene expansion of this hyperoceanic biome has previously been explained as a consequence of Neolithic forest clearance. However, the present distribution of blanket bog in Great Britain can be predicted accurately with a simple model (PeatStash) based on summer temperature and moisture index thresholds, and the same model correctly predicts the highly disjunct distribution of blanket bog worldwide. This finding suggests that climate, rather than land-use history, controls blanket-bog distribution in the UK and everywhere else. We set out to test this hypothesis for blanket bogs in the UK using bioclimate envelope modelling compared with a database of peat initiation age estimates. We used both pollen-based reconstructions and climate model simulations of climate changes between the mid-Holocene (6000 yr BP, 6 ka) and modern climate to drive PeatStash and predict areas of blanket bog. We compiled data on the timing of blanket-bog initiation, based on 228 age determinations at sites where peat directly overlies mineral soil. The model predicts large areas of northern Britain would have had blanket bog by 6000 yr BP, and the area suitable for peat growth extended to the south after this time. A similar pattern is shown by the basal peat ages and new blanket bog appeared over a larger area during the late Holocene, the greatest expansion being in Ireland, Wales and southwest England, as the model predicts. The expansion was driven by a summer cooling of about 2 °C, shown by both pollen-based reconstructions and climate models. The data show early Holocene (pre-Neolithic) blanket-bog initiation at over half of the sites in the core areas of Scotland, and northern England. The temporal patterns and concurrence of the bioclimate model predictions and initiation data suggest that climate change provides a parsimonious explanation for the early Holocene distribution and later expansion of blanket bogs in the UK, and it is not necessary to invoke anthropogenic activity as a driver of this major landscape change.

Innovation and change in English teaching in the western provinces of China: the impact of overseas training

In this article we explore issues around the impact of continuing professional development (CPD) for secondary teachers of English offered by an overseas provider through the lens of participants from the Western provinces of China who completed courses at a UK university between 2003 and 2012. We start by offering an overview of English teaching in China. We then report two complementary studies of the same programme. The first aimed for breadth of understanding and involved the collection and analysis of interviews and focus groups discussions with former participants, their teaching colleagues and senior management, as well as classroom observation. The second aimed for depth and drew on data collected from a cohort of 38 teachers on one of the courses, using pre- and post-course surveys; focus group discussions at the end of the course with the whole cohort; and interviews with five of the participants both before they left the UK and again six months later. Evidence is presented for changes in teachers’ philosophies of education directly attributable to participation in the courses; for improved teacher competencies (linguistic, cultural and pedagogical) in the classroom; and for the ways in which returnees are undertaking new roles and responsibilities that exploit their new understandings. Finally, we discuss the implications of these findings for both providers and sponsors of CPD for English language teachers.

Cone-beam computerized tomographic, radiographic, and histologic evaluation of periapical repair in dogs` post-endodontic treatment

Objective. To evaluate the periapical repair after root canal treatment in the teeth of dogs using CT and conventional radiography and to compare these findings with the gold standard microscopic evaluation. Study design. The animals were divided into three groups according to endodontic treatment performed: Group 1, single-visit endodontic treatment in teeth without apical periodontitis; Group 2, single-visit endodontic treatment in teeth with apical periodontitis; and Group 3, endodontic treatment in teeth with apical periodontitis using calcium hydroxide as a root canal dressing. Group 4 consisted of teeth with apical periodontitis not submitted to root canal treatment and Group 5 consisted of healthy teeth without periapical disease. Radiographic, tomographic, and microscopic evaluations were performed by blind examiners. At 180 days experimental time, CT and radiographic measurements of periapical disease were compared with the gold standard microscopic measurement using intraclass correlation coefficient. Intergroup comparisons considering different methods of periapical lesions measurement or different clinical protocols of root canal treatment were performed by Kruskal Wallis test followed by Dunn. Integrity of lamina dura, presence of radiolucent areas, and presence of root resorption were analyzed by Fisher`s exact test. Results. There was discontinuity of the lamina dura and CPD in all teeth from Groups 2, 3, and 4 evaluated by tomography and radiography 45 days after CPD induction. Radiographically, 180 days after root canal treatment, there was no periapical lesion in teeth from Groups 1 and 3, different from groups 2 and 4 (p < .05). The highest reduction in the CPD size was observed on Group 3 (p < .05). According to the tomographic results, there was decrease of the size of the CPD on Group 3 but not on Groups 2 or 4. However, in all groups the periapical lesions presented larger mesio-distal extension if compared with radiography, both 45 days after CPD induction and 180 days after root canal treatment. At 180 days, CT measurements were closely related to microscopic results (ICC = 0.95) differently from radiographic evaluation (ICC = 0.86). Conclusion. CT Scan evaluation of periapical repair following root canal treatment provided similar information than that obtained by microscopic analysis, whereas radiographic evaluation underestimated the size do periapical lesion. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108:796-805)

CPDs and 6-4PPs play different roles in UV-induced cell death in normal and NER-deficient human cells

Ultraviolet (UV) light generates two major DNA lesions: cyclobutane pyrimidine dimers (CPDs) and pyrimidine-(6-4)-pyrimidone photoproducts (6-4PPs), but the specific participation of these two lesions in the deleterious effects of UV is a longstanding question. In order to discriminate the precise role of unrepaired CPDs and 6-4PPs in UV-induced responses triggering cell death, human fibroblasts were transduced by recombinant adenoviruses carrying the CPD-photolyase or 6-4PP-photolyase cDNAs. Both photolyases were able to prevent UV-induced apoptosis in cells deficient for nucleotide excision repair (NER) to a similar extent, while in NER-proficient cells UV-induced apoptosis was prevented only by CPD-photolyase, with no effects observed when 6-4PPs were removed by the specific photolyase. These results strongly suggest that both CPDs and 6-4PPs contribute to UV-induced apoptosis in NER-deficient cells, while in NER-proficient cells, CPDs are the only lesions responsible for UV-killing, probably due to the rapid repair of 6-4PPs by NER. As a consequence, the difference in skin photosensitivity, including carcinogenesis, of most of the xeroderma pigmentosum patients and of normal people is probably not only a quantitative aspect, but depends on the type of DNA damage induced by sunlight and its rate of repair. (c) 2007 Elsevier B.V. All rights reserved.

Defective transcription/repair factor IN recruitment to specific UV lesions in trichothiodystrophy syndrome

Most trichothiodystrophy (TTD) patients present mutations in the xeroderma pigmentosum D (XPD) gene, coding for a subunit of the transcription/repair factor IIH (TFHH) complex involved in nucleotide excision repair (NER) and transcription. After UV irradiation, most TTD/XPD patients are more severely affected in the NER of cyclobutane pyrimidine dimers (CPD) than of 6-4-photoproducts (6-4PP). The reasons for this differential DNA repair defect are unknown. Here we report the first study of NER in response to CPDs or 6-4PPs separately analyzed in primary fibroblasts. This was done by using heterologous photorepair; recombinant adenovirus vectors carrying photolyases enzymes that repair CPD or 64PP specifically by using the energy of light were introduced in different cell lines. The data presented here reveal that some mutations affect the recruitment of TFHH specifically to CPDs, but not to 6-4PPs. This deficiency is further confirmed by the inability of TTD/XPD cells to recruit, specifically for CPDs, NER factors that arrive in a TFIIH-dependent manner later in the NER pathway. For 6-4PPs, we show that TFHH complexes carrying an NH2-terminal XPD mutated protein are also deficient in recruitment of NER proteins downstream of TFUH. Treatment with the histone deacetylase inhibitor trichostatin A allows the recovery of TFHH recruitment to CPDs in the studied TTD cells and, for COOH-terminal XPD mutations, increases the repair synthesis and survival after UV, suggesting that this defect can be partially related with accessibility of DNA damage in closed chromatin regions.

Efficacy of high intensity diode laser as an adjunct to non-surgical periodontal treatment: a randomized controlled trial

The high intensity diode laser has been studied in periodontics for the reduction of subgingival bacteria in non-surgical treatment. Our study evaluated the bacterial effect as well as changes in periodontal clinical parameters promoted by root scaling and planing associated with this wavelength. Twenty-seven patients randomly assigned in two groups underwent root scaling and planing on the tested sites, and only the experimental group received the diode laser irradiation. Among the clinical parameters studied, the clinical probing depth (CPD) and the clinical attachment level (CAL) resulted in significant enhancement in the control group when compared with the experimental group (P = 0.014 and P = 0.039, respectively). The results were similar for both groups regarding the plaque index (PI) and bleeding on probing (BP). No significant difference in the microbiological parameters was observed between the control and experimental groups. It was possible to conclude that the high power diode laser adjunct to the non-surgical periodontal treatment did not promote additional effects to the conventional periodontal treatment.

Algoritmos para o posicionamento de células em circuitos VLSI

Este trabalho faz uma análise ampla sobre os algoritmos de posicionamento. Diversos são extraídos da literatura e de publicações recentes de posicionamento. Eles foram implementados para uma comparação mais precisa. Novos métodos são propostos, com resultados promissores. A maior parte dos algoritmos, ao contrário do que costuma encontrar-se na literatura, é explicada com detalhes de implementação, de forma que não fiquem questões em aberto. Isto só possível pela forte base de implementação por trás deste texto. O algorítmo de Fidduccia Mateyeses, por exemplo, é um algorítmo complexo e por isto foi explicado com detalhes de implementação. Assim como uma revisão de técnicas conhecidas e publicadas, este trabalho oferece algumas inovações no fluxo de posicionamento. Propõe-se um novo algorítimo para posicionamento inicial, bem como uma variação inédita do Cluster Growth que mostrta ótimos resultados. É apresentada uma série de evoluções ao algorítmo de Simulated Annealling: cálculo automático de temperatura inicial, funções de perturbação gulosas (direcionadas a força), combinação de funções de perturbação atingindo melhores resultados (em torno de 20%), otimização no cálculo de tamanho dos fios (avaliação das redes modificadas e aproveitamento de cálculos anteriores, com ganhos em torno de 45%). Todas estas modificações propiciam uma maior velocidade e convergência do método de Simulated Annealling. É mostrado que os algorítmos construtivos (incluindo o posicionador do Tropic, baseado em quadratura com Terminal Propagation) apresentam um resultado pior que o Simulated Annealling em termos de qualidade de posicionamento às custas de um longo tempo de CPD. Porém, o uso de técnicas propostas neste trabalho, em conjunto com outras técnicas propostas em outros trabalhos (como o trabalho de Lixin Su) podem acelerar o SA, de forma que a relação qualidade/tempo aumente.

Arquiteturas eficientes para sensoriamento espectral e classificação automática de modulações usando características cicloestacionárias

The increasing demand for high performance wireless communication systems has shown the inefficiency of the current model of fixed allocation of the radio spectrum. In this context, cognitive radio appears as a more efficient alternative, by providing opportunistic spectrum access, with the maximum bandwidth possible. To ensure these requirements, it is necessary that the transmitter identify opportunities for transmission and the receiver recognizes the parameters defined for the communication signal. The techniques that use cyclostationary analysis can be applied to problems in either spectrum sensing and modulation classification, even in low signal-to-noise ratio (SNR) environments. However, despite the robustness, one of the main disadvantages of cyclostationarity is the high computational cost for calculating its functions. This work proposes efficient architectures for obtaining cyclostationary features to be employed in either spectrum sensing and automatic modulation classification (AMC). In the context of spectrum sensing, a parallelized algorithm for extracting cyclostationary features of communication signals is presented. The performance of this features extractor parallelization is evaluated by speedup and parallel eficiency metrics. The architecture for spectrum sensing is analyzed for several configuration of false alarm probability, SNR levels and observation time for BPSK and QPSK modulations. In the context of AMC, the reduced alpha-profile is proposed as as a cyclostationary signature calculated for a reduced cyclic frequencies set. This signature is validated by a modulation classification architecture based on pattern matching. The architecture for AMC is investigated for correct classification rates of AM, BPSK, QPSK, MSK and FSK modulations, considering several scenarios of observation length and SNR levels. The numerical results of performance obtained in this work show the eficiency of the proposed architectures

Continuous peritoneal dialysis compared with daily hemodialysis in patients with acute kidney injury

Background: In some parts of the world, peritoneal dialysis is widely used for renal replacement therapy (RRT) in acute kidney injury (AKI), despite concerns about its inadequacy. It has been replaced in recent years by hemodialysis and, most recently, by continuous venovenous therapies. We performed a prospective study to determine the effect of continuous peritoneal dialysis (CPD), as compared with daily hemodialysis (dHD), on survival among patients with AKI.Methods: A total of 120 patients with acute tubular necrosis (ATN) were assigned to receive CPD or dHD in a tertiary-care university hospital. The primary endpoint was hospital survival rate; renal function recovery and metabolic, acid-base, and fluid controls were secondary endpoints.Results: of the 120 patients, 60 were treated with CPD (G1) and 60 with dHD (G2). The two groups were similar at the start of RRT with respect to age (64.2 +/- 19.8 years vs 62.5 +/- 21.2 years), sex (men: 72% vs 66%), sepsis (42% vs 47%), shock (61% vs 63%), severity of AKI [Acute Tubular Necrosis Individual Severity Score (ATNISS): 0.68 +/- 0.2 vs 0.66 +/- 0.22; Acute Physiology and Chronic Health Evaluation (APACHE) II: 26.9 +/- 8.9 vs 24.1 +/- 8.2], pre-dialysis blood urea nitrogen [BUN (116.4 +/- 33.6 mg/dL vs 112.6 +/- 36.8 mg/dL)], and creatinine (5.85 +/- 1.9 mg/dL vs 5.95 +/- 1.4 mg/dL). In G1, weekly delivered Kt/V was 3.59 +/- 0.61, and in G2, it was 4.76 +/- 0.65 (p < 0.01). The two groups were similar in metabolic and acid-base control (after 4 sessions, BUN < 55 mg/dL: 46 +/- 18.7 mg/dL vs 52 +/- 18.2 mg/dL; pH: 7.41 vs 7.38; bicarbonate: 22.8 +/- 8.9 mEq/L vs 22.2 +/- 7.1 mEq/L). Duration of therapy was longer in G2 (5.5 days vs 7.5 days; p = 0.02). Despite the delivery of different dialysis methods and doses, the survival rate did not differ between the groups (58% in G1 vs 52% in G2), and recovery of renal function was similar (28% vs 26%).Conclusion: High doses of CPD provided appropriate metabolic and pH control, with a rate of survival and recovery of renal function similar to that seen with dHD. Therefore, CPD can be considered an alternative to other forms of RRT in AKI.