GPs’ and community pharmacists’ opinions on medication management at transitions of care in Ireland

Objective. The aim of this study was to survey GPs and community pharmacists (CPs) in Ireland regarding current practices of medication management, specifically medication reconciliation, communication between health care providers and medication errors as patients transition in care.<br/>Methods. A national cross-sectional survey was distributed electronically to 2364 GPs, 311 GP Registrars and 2382 CPs. Multivariable associations comparing GPs to CPs were generated and content analysis of free text responses was undertaken.<br/>Results. There was an overall response rate of 17.7% (897 respondents—554 GPs/Registrars and 343 CPs). More than 90% of GPs and CPs were positive about the effects of medication reconciliation on medication safety and adherence. Sixty per cent of GPs reported having no formal system of medication reconciliation. Communication between GPs and CPs was identified as good/very good by &gt;90% of GPs and CPs. The majority (&gt;80%) of both groups could clearly recall prescribing errors, following a transition of care, they had witnessed in the previous 6 months. Free text content analysis corroborated the positive relationship between GPs and CPs, a frustration with secondary care communication, with many examples given of prescribing errors.<br/>Conclusions. While there is enthusiasm for the benefits of medication reconciliation there are limited formal structures in primary care to support it. Challenges in relation to systems that support inter-professional communication and reduce medication errors are features of the primary/secondary care transition. There is a need for an improved medication management system. Future research should focus on the identified barriers in implementing medication reconciliation and systems that can improve it.

Energy levels and radiative rates for transitions in Cr-like Co IV and Ni V

<p>We report calculations of energy levels and radiative rates (A-values) for transitions in Cr-like Co IV and Ni V. The quasi-relativistic Hartree-Fock (QRHF) code is adopted for calculating the data although grasp (general-purpose relativistic atomic structure package) and flexible atomic code (fac) have also been employed for comparison purposes. No radiative rates are available in the literature to compare with our results, but our calculated energies are in close agreement with those compiled by NIST for a majority of the levels. However, there are discrepancies for a few levels of up to 3%. The A-values are listed for all significantly contributing E1, E2 and M1 transitions, and the corresponding lifetimes reported, although unfortunately no previous theoretical or experimental results exist to compare with our data.</p>

Radiative rates for E1, E2, M1, and M2 transitions in S-like to F-like tungsten ions (W LIX to W LXVI)

<p>Calculations of energy levels, radiative rates and lifetimes are reported for eight ions of tungsten, i.e. S-like (W LIX) to F-like (W LXVI). A large number of levels have been considered for each ion and extensive configuration interaction has been included among a range of configurations. For the calculations, the general-purpose relativistic atomic structure package (. grasp) has been adopted, and radiative rates (as well as oscillator strengths and line strengths) are listed for all E1, E2, M1, and M2 transitions of the ions. Comparisons have been made with earlier available experimental and theoretical energies, although these are limited to only a few levels for most ions. Therefore for additional accuracy assessments, particularly for energy levels, analogous calculations have been performed with the flexible atomic code (. fac).</p>

Radiative rates for E1, E2, M1, and M2 transitions in Br-like ions with 43≤Z≤50

<p>Energies and lifetimes are reported for the eight Br-like ions with 43≤Z≤50, namely Tc IX, Ru X, Rh XI, Pd XII, Ag XIII, Cd XIV, In XV, and Sn XVI. Results are listed for the lowest 375 levels, which mostly belong to the 4s²4p⁵, 4s²4p⁴4â„“, 4s4p⁶,4s²4p⁴5â„“, 4s²4p³4d², 4s4p⁵4â„“, and 4s4p⁵5â„“ configurations. Extensive configuration interaction among 39 configurations (generating 3990 levels) has been considered and the general-purpose relativistic atomic structure package (grasp) has been adopted for the calculations. Radiative rates are listed for all E1, E2, M1, and M2 transitions involving the lowest 375 levels. Previous experimental and theoretical energies are available for only a few levels of three, namely Ru X, Rh XI and Pd XII. Differences with the measured energies are up to 4% but the present results are an improvement (by up to 0.3 Ryd) in comparison to other recently reported theoretical data. Similarly for radiative rates and lifetimes, prior results are limited to those involving only 31 levels of the 4s²4p⁵, 4s²4p⁴4d, and 4s4p⁶ configurations for the last four ions. Moreover, there are generally no discrepancies with our results, although the larger calculations reported here differ by up to two orders of magnitude for a few transitions.</p>

Radiative rates for E1, E2, M1, and M2 transitions in F-like ions with 37≤Z≤53

<p>Calculations of energy levels, radiative rates and lifetimes are reported for 17 F-like ions with 37≤Z≤53. For brevity, results are only presented among the lowest 113 levels of the 2s²2p⁵, 2s2p⁶, 2s²2p⁴3â„“, 2s2p⁵3â„“, and 2p⁶3â„“ configurations, although the calculations have been performed for up to 501 levels in each ion. The general-purpose relativistic atomic structure package (grasp) has been adopted for the calculations, and radiative rates (along with oscillator strengths and line strengths) are listed for all E1, E2, M1, and M2 transitions of the ions. Comparisons are made with earlier available experimental and theoretical energies, although these are limited to only a few levels for most ions. Therefore for additional accuracy assessments, particularly for energy levels, analogous calculations have been performed with the Flexible Atomic Code (fac), for up to 72 259 levels. Limited previous results are available for radiative rates for comparison purposes, and no large discrepancy is observed for any transition and/or ion.</p>

Benchmarking Energy Transitions: An Irish Case Study

The challenges of a low carbon energy transition have now been recognized by most nation states, each of whom have responded with differing visions, strategies and programmes, with variable veracity and effectiveness. Given the complexity of each country’s energy system (and sub-systems such as mobility, food etc), the differing sources and wealth of indigenous energy resources, the variable legacy of the fossil fuel regime and differing capacity to respond to global shifts in energy markets, it is clear that each country will respond to this challenge in very different ways. <br/>This poses difficulties for understanding the extent to which a transition may be taking hold in any territory as simple indicators such as GHG emission data or increases in renewable energy ignore the complex contexts in which transitions take place. Drawing on the results of a study, funded by the Irish Environmental Protection Agency (Characterizing and Catalyzing Transitions) and using the wider theoretical framework of socio-technological transitions, this paper will explore the challenges, virtues and constraints of attempting to ‘benchmark’ the Republic of Ireland’s transition. This will lead to wider observations on the normative nature of benchmarking and a critical review of how we conceptualize the very idea of transition. <br/>

Transitions in Contentious Behaviour in Infancy and Later Aggressive Conduct Problems

Background. Individual trajectories toward aggression originate in early infancy, before there is intent to harm. We focused on infants who were contentious, i.e., prone to engage in anger and use of physical force with other people, and examined change in levels of contentiousness between 6 and 12 months of age with reference to later aggressive conduct problems. <br/>Sample. The CCDS is a nationally representative sample of 321 firstborn children whose families were recruited from antenatal clinics in two National Health Service Trusts.<br/>Method. Mothers, fathers, and a third family member or friend who knew infants well completed the Cardiff Infant Contentiousness Scale (CICS) at 6 months, which was stable form 6 to 12 months, and validated by direct observation of infants’ use of force against peers. Primary caregivers again completed the CICS at 12 months, and up to three informants completed the Child Behaviour Check List at mean ages of 36 and 84 months. We used Latent Transition Analysis to identify different groups of infants in respect to their patterns of contentiousness from 6 to 12 months. <br/>Results<br/>Three ordered classes of contentiousness from low to high were found at 6 and 12 months. Infants exposed to greater family adversity were more likely to move into the high-contentious class from 6 to 12 months. Higher contentiousness in infancy predicted more aggressive conduct problems at 33 months and thereafter. <br/>Conclusions<br/>Infants exposed to family adversity are already at disadvantage by 6 months and likely to escalate in their anger and aggressiveness over time.<br/>

Insight into the mechanism of galactokinase: role of a critical glutamate residue and helix/coil transitions

Galactokinase, the enzyme which catalyses the first committed step in the Leloir pathway, has attracted interest due to its potential as a biocatalyst and as a possible drug target in the treatment of type I galactosemia. The mechanism of the enzyme is not fully elucidated. Molecular dynamics (MD) simulations of galactokinase with the active site residues Arg-37 and Asp-186 altered predicted that two regions (residues 174-179 and 231-240) had different dynamics as a consequence. Interestingly, the same two regions were also affected by alterations in Arg-105, Glu-174 and Arg- 228. These three residues were identified as important in catalysis in previous computational studies on human galactokinase. Alteration of Arg-105 to methionine resulted in a modest reduction in activity with little change in stability. When Arg-228 was changed to methionine, the enzyme’s interaction with both ATP and galactose was affected. This variant was significantly less stable than the wild-type protein. Changing Glu-174 to glutamine (but not to aspartate) resulted in no detectable activity and a less stable enzyme. Overall, these combined in silico and in vitro studies demonstrate the importance of a negative charge at position 174 and highlight the critical role of the dynamics in to key regions of the protein. We postulate that these regions may be critical for mediating the enzyme’s structure and function. 

Étude exploratoire des transitions de milieux de vie en communauté des personnes présentant une déficience intellectuelle

Cette étude exploratoire dresse un portrait des transitions de milieux de vie (MDV) dans des Centres de réadaptation en déficience intellectuelle et en troubles envahissants du développement (CRDITED) de la grande région de Montréal. Elle permet d’identifier 1) les pratiques de transition de MDV des intervenants pivots en CRDITED, 2) les critères de succès de la transition de MDV et les moyens de les évaluer selon les personnes présentant une déficience intellectuelle et les intervenants pivots et 3) l’écart entre les pratiques souhaitées et les pratiques actuelles à partir du point de vue des deux types de participants. Des personnes présentant une déficience intellectuelle (N = 9) et des intervenants pivots (N = 19) se sont exprimés sur leurs expériences de transition de MDV en participant à des entretiens de groupe. Une analyse qualitative de contenu a permis d’identifier une typologie des expériences de transition de MDV du point de vue des intervenants pivots. Un seul type de transition de MDV parmi les cinq identifiés, le type préparée, offre des conditions favorisant la réalisation de la transition dans des conditions satisfaisantes pour les intervenants pivots. Les autres types de transitions (types dernière minute, explosive, clé en main et salle d’attente) offrent peu d’occasions pour la personne présentant une déficience intellectuelle de s’impliquer dans le processus de transition. Les propos des intervenants pivots permettent d’identifier les caractéristiques d’une transition de MDV qu’ils jugent idéale (type comme si c’était moi). Les types de transitions sont comparés entre eux sur deux axes, soit sur l’axe représentant un continuum d’implication de la personne présentant une déficience intellectuelle dans sa propre transition et sur l’axe identifiant les grandes étapes de réalisation de la transition. Les résultats permettent de déceler un écart important entre les transitions actuellement effectuées et les politiques, intentions et engagements de l’offre de service auprès de cette clientèle, notamment au regard de l’implication de la personne présentant une déficience intellectuelle dans les décisions relatives à sa transition de MDV. L’étude permet aussi d’identifier trois dimensions importantes de l’évaluation du succès de la transition selon les perspectives des personnes présentant une déficience intellectuelle et des intervenants pivots. Les dimensions identifiées sont : bien-être psychologique et comportement, santé physique et collaboration. Les propos des intervenants pivots permettent de constater qu’il existe parfois un paradoxe entre leurs perceptions du succès de la transition de MDV et celles des personnes présentant une déficience intellectuelle. L’interprétation des résultats a permis d’élaborer des recommandations afin de favoriser de meilleures pratiques de transition.

The economic crisis as a game changer? Exploring the role of social construction in sustainability transitions

Continuing economic turbulence has fuelled debates about social and political reform as much as it has stimulated actions and initiatives aimed at a more fundamental transition of dominant economic systems. This paper takes a transition perspective to explore, from a Western European viewpoint, how the economic crisis is actually viewed through a variety of interpretations and responded to through a range of practices. We argue that framing societal phenomena such as the economic crisis as "symptoms of transition" through alternative narratives and actions can give rise to the potential for (seemingly) short-term pressures to become game changers. Game changers are then defined as the combination of: specific events, the subsequent or parallel framing of events in systemic terms by engaged societal actors, and (eventually) the emergence of (diverse) alternative narratives and practices (in response to the systemic framing of events). Game changers, when understood in these terms, help to orient, legitimize, guide, and accelerate deep changes in society. We conclude that such dynamics in which game changers gain momentum might also come to play a critical role in transitions. Therefore, we argue for developing a better understanding of and methodologies to further study the coevolutionary dynamics associated with game changers, as well as exploring the implications for governance.