Training on the use of a bespoke continuing professional development framework improves the quality of CPD records

BACKGROUND: Using continuing professional development (CPD) as part of the revalidation of pharmacy professionals has been proposed in the UK but not implemented. We developed a CPD Outcomes Framework (‘the framework’) for scoring CPD records, where the score range was -100 to +150 based on demonstrable relevance and impact of the CPD on practice. OBJECTIVE: This exploratory study aimed to test the outcome of training people to use the framework, through distance-learning material (active intervention), by comparing CPD scores before and after training. SETTING: Pharmacy professionals were recruited in the UK in Reading, Banbury, Southampton, Kingston-upon-Thames and Guildford in 2009. METHOD: We conducted a randomised, double-blinded, parallel-group, before and after study. The control group simply received information on new CPD requirements through the post; the active intervention group also received the framework and associated training. Altogether 48 participants (25 control, 23 active) completed the study. All participants submitted CPD records to the research team before and after receiving the posted resources. The records (n=226) were scored blindly by the researchers using the framework. A subgroup of CPD records (n=96) submitted first (before-stage) and rewritten (after-stage) were analysed separately. MAIN OUTCOME MEASURE: Scores for CPD records received before and after distributing group-dependent material through the post. RESULTS: Using a linear-regression model both analyses found an increase in CPD scores in favour of the active intervention group. For the complete set of records, the effect was a mean difference of 9.9 (95% CI = 0.4 to 19.3), p-value = 0.04. For the subgroup of rewritten records, the effect was a mean difference of 17.3 (95% CI = 5.6 to 28.9), p-value = 0.0048. CONCLUSION: The intervention improved participants’ CPD behaviour. Training pharmacy professionals to use the framework resulted in better CPD activities and CPD records, potentially helpful for revalidation of pharmacy professionals. IMPACT: • Using a bespoke Continuing Professional Development outcomes framework improves the value of pharmacy professionals’ CPD activities and CPD records, with the potential to improve patient care. • The CPD outcomes framework could be helpful to pharmacy professionals internationally who want to improve the quality of their CPD activities and CPD records. • Regulators and officials across Europe and beyond can assess the suitability of the CPD outcomes framework for use in pharmacy CPD and revalidation in their own setting.

Production of milk foams by steam injection: the effects of steam pressure and nozzle design

Foam properties depend on the physico-chemical characteristics of the continuous phase, the method of production and process conditions employed; however the preparation of barista-style milk foams in coffee shops by injection of steam uses milk as its main ingredient which limits the control of foam properties by changing the biochemical characteristics of the continuous phase. Therefore, the control of process conditions and nozzle design are the only ways available to produce foams with diverse properties. Milk foams were produced employing different steam pressures (100-280 kPa gauge) and nozzle designs (ejector, plunging-jet and confined-jet nozzles). The foamability of milk, and the stability, bubble size and texture of the foams were investigated. Variations in steam pressure and nozzle design changed the hydrodynamic conditions during foam production, resulting in foams having a range of properties. Steam pressure influenced foam characteristics, although the net effect depended on the nozzle design used. These results suggest that, in addition to the physicochemical determinants of milk, the foam properties can also be controlled by changing the steam pressure and nozzle design.

The timing of anthropogenic emergence in simulated climate extremes

Determining the time of emergence of climates altered from their natural state by anthropogenic influences can help inform the development of adaptation and mitigation strategies to climate change. Previous studies have examined the time of emergence of climate averages. However, at the global scale, the emergence of changes in extreme events, which have the greatest societal impacts, has not been investigated before. Based on state-of-the-art climate models, we show that temperature extremes generally emerge slightly later from their quasi-natural climate state than seasonal means, due to greater variability in extremes. Nevertheless, according to model evidence, both hot and cold extremes have already emerged across many areas. Remarkably, even precipitation extremes that have very large variability are projected to emerge in the coming decades in Northern Hemisphere winters associated with a wettening trend. Based on our findings we expect local temperature and precipitation extremes to already differ significantly from their previous quasi-natural state at many locations or to do so in the near future. Our findings have implications for climate impacts and detection and attribution studies assessing observed changes in regional climate extremes by showing whether they will likely find a fingerprint of anthropogenic climate change.

An LDA and probability-based classifier for the diagnosis of Alzheimer's Disease from structural MRI

In this paper a custom classification algorithm based on linear discriminant analysis and probability-based weights is implemented and applied to the hippocampus measurements of structural magnetic resonance images from healthy subjects and Alzheimer’s Disease sufferers; and then attempts to diagnose them as accurately as possible. The classifier works by classifying each measurement of a hippocampal volume as healthy controlsized or Alzheimer’s Disease-sized, these new features are then weighted and used to classify the subject as a healthy control or suffering from Alzheimer’s Disease. The preliminary results obtained reach an accuracy of 85.8% and this is a similar accuracy to state-of-the-art methods such as a Naive Bayes classifier and a Support Vector Machine. An advantage of the method proposed in this paper over the aforementioned state of the art classifiers is the descriptive ability of the classifications it produces. The descriptive model can be of great help to aid a doctor in the diagnosis of Alzheimer’s Disease, or even further the understand of how Alzheimer’s Disease affects the hippocampus.

A Genetic Algorithm for the selection of structural MRI features for classification of Mild Cognitive Impairment and Alzheimer's Disease

This work investigates the problem of feature selection in neuroimaging features from structural MRI brain images for the classification of subjects as healthy controls, suffering from Mild Cognitive Impairment or Alzheimer’s Disease. A Genetic Algorithm wrapper method for feature selection is adopted in conjunction with a Support Vector Machine classifier. In very large feature sets, feature selection is found to be redundant as the accuracy is often worsened when compared to an Support Vector Machine with no feature selection. However, when just the hippocampal subfields are used, feature selection shows a significant improvement of the classification accuracy. Three-class Support Vector Machines and two-class Support Vector Machines combined with weighted voting are also compared with the former and found more useful. The highest accuracy achieved at classifying the test data was 65.5% using a genetic algorithm for feature selection with a three-class Support Vector Machine classifier.

A reappraisal of Baskerville's Greek types

Ιn the eighteenth century the printing of Greek texts continued to be central to scholarship and discourse. The typography of Greek texts could be characterised as a continuation of French models from the sixteenth century, with a gradual dilution of the complexity of ligatures and abbreviations, mostly through printers in the Low Countries. In Britain, Greek printing was dominated by the university presses, which reproduced conservatively the continental models – exemplified by Oxford's Fell types, which were Dutch adaptations of earlier French models. Hindsight allows us to identify a meaningful development in the Greek types cut by Alexander Wilson for the Foulis Press in Glasgow, but we can argue that in the middle of the eighteenth century Baskerville was considering Greek printing the typographic environment was ripe for a new style of Greek types. The opportunity to cut the types for a New Testament (in an twin edition that included a generous octavo and a large quarto version) would seem perfect for showcasing Baskerville's capacity for innovation. His Greek type maintained the cursive ductus of earlier models, but abandoned complex ligatures and any hint of scribal flourish. He homogenised the modulation of the letter strokes and the treatment of terminals, and normalised the horizontal alignments of all letters. Although the strokes are in some letters too delicate, the narrow set of the style composes a consistent, uniform texture that is a clean break from contemporaneous models. The argument is made that this is the first Greek typeface that can be described as fully typographic in the context of the technology of the time. It sets a pattern that was to be followed, without acknowledgement, by Richard Porson nearly a century and a half later. The typeface received little praise by typographic historians, and was condemned by Victor Scholderer in his retrospective of Greek typography. A survey of typeface reviews in the surrounding decades establishes that the commentators were mostly reproducing the views of an arbitrary typographic orthodoxy, for which only types with direct references to Renaissance models were acceptable. In these comments we detect a bias against someone considered an arriviste in the scholarly printing establishment, as well as a conservative attitude to typographic innovation.

Evaluating and optimizing oral formulations of live bacterial vaccines using a gastro-small intestine model

Gastrointestinal (GI) models that mimic physiological conditions in vitro are important tools for developing and optimizing biopharmaceutical formulations. Oral administration of live attenuated bacterial vaccines (LBV) can safely and effectively promote mucosal immunity but new formulations are required that provide controlled release of optimal numbers of viable bacterial cells, which must survive gastrointestinal transit overcoming various antimicrobial barriers. Here, we use a gastro-small intestine gut model of human GI conditions to study the survival and release kinetics of two oral LBV formulations: the licensed typhoid fever vaccine Vivotif comprising enteric coated capsules; and an experimental formulation of the model vaccine Salmonella Typhimurium SL3261 dried directly onto cast enteric polymer films and laminated to form a polymer film laminate (PFL). Neither formulation released significant numbers of viable cells when tested in the complete gastro-small intestine model. The poor performance in delivering viable cells could be attributed to a combination of acid and bile toxicity plus incomplete release of cells for Vivotif capsules, and to bile toxicity alone for PFL. To achieve effective protection from intestinal bile in addition to effective acid resistance, bile adsorbent resins were incorporated into the PFL to produce a new formulation, termed BR-PFL. Efficient and complete release of 4.4x107 live cells per dose was achieved from BR-PFL at distal intestinal pH, with release kinetics controlled by the composition of the enteric polymer film, and no loss in viability observed in any stage of the GI model. Use of this in vitro GI model thereby allowed rational design of an oral LBV formulation to maximize viable cell release.

Seasonality of westerly moisture transport in the East Asian summer monsoon and its implications for interpreting precipitation δ18O

East Asian summer monsoon (EASM) rainfall impacts the world's most populous regions. Accurate EASM rainfall prediction necessitates robust paleoclimate reconstructions from proxy data and quantitative linkage to modern climatic conditions. Many precisely dated oxygen isotope records from Chinese stalagmites have been interpreted as directly reflecting past EASM rainfall amount variability, but recent research suggests that such records instead integrate multiple hydroclimatic processes. Using a Lagrangian precipitation moisture source diagnostic, we demonstrate that EASM rainfall is primarily derived from the Indian Ocean. Conversely, Pacific Ocean moisture export peaks during winter, and the moisture uptake area does not differ significantly between summer and winter and is thus a minor contributor to monsoonal precipitation. Our results are substantiated by an accurate reproduction of summer and winter spatial rainfall distributions across China. We also correlate modern EASM rainfall oxygen isotope ratios with instrumental rainfall amount and our moisture source data. This analysis reveals that the strength of the source effect is geographically variable, and differences in atmospheric moisture transport may significantly impact the isotopic signature of EASM rainfall at the Hulu, Dongge, and Wanxiang Cave sites. These results improve our ability to isolate the rainfall amount signal in paleomonsoon reconstructions and indicate that precipitation across central and eastern China will directly respond to variability in Indian Ocean moisture supply.

Cupreines and cupreidines: an established class of bifunctional cinchona organocatalysts

Cinchona alkaloids with a free 6'-OH functionality are being increasingly used within asymmetric organocatalysis. This fascinating class of bifunctional catalyst offers a genuine alternative to the more commonly used thiourea systems and because of the different spacing between the functional groups, can control enantioselectivity where other organocatalysts have failed. In the main, this review covers the highlights from the last five years and attempts to show the diversity of reactions that these systems can control. It is hoped that chemists developing asymmetric methodologies will see the value in adding these easily accessible, but underused organocatalysts to their screens.

Climatic risks and impacts in South Asia: extremes of water scarcity and excess

This paper reviews the current knowledge of climatic risks and impacts in South Asia associated with anthropogenic warming levels of 1.5°C to 4°C above pre-industrial values in the 21st century. It is based on the World Bank Report “Turn Down the Heat, Climate Extremes, Regional Impacts and the Case for Resilience” (2013). Many of the climate change impacts in the region, which appear quite severe even with relatively modest warming of 1.5–2°C, pose significant hazards to development. For example, increased monsoon variability and loss or glacial meltwater will likely confront populations with ongoing and multiple challenges. The result is a significant risk to stable and reliable water resources for the region, with increases in peak flows potentially causing floods and dry season flow reductions threatening agriculture. Irrespective of the anticipated economic development and growth, climate projections indicate that large parts of South Asia’s growing population and especially the poor are likely to remain highly vulnerable to climate change.