A patient perspective of pharmacist prescribing: 'crossing the specialisms-crossing the illnesses'

Background: The drive for non-medical prescribing has progressed quickly since the late 1990s and involves a range of healthcare professionals including pharmacists. As part of a commissioned research project, this qualitative element of a larger case study focused on the views of patients of pharmacist prescribers. 

Objective: The aim of this study was to explore patients' perspectives of pharmacists as prescribers. 

Methods: Three pharmacists working as independent prescribers in the clinical areas of (i) hypertension, (ii) cardiovascular/diabetes management, (iii) anticoagulation were recruited to three case studies of pharmacist prescribing in Northern Ireland. One hundred and five patients were invited to participate in focus groups after they had been prescribed for by the pharmacist. Focus groups took place between November 2010 and March 2011 (ethical/governance approvals granted) were audio taped, transcribed verbatim, read independently by two authors and analysed using constant comparative analysis. 

Results: Thirty-four patients agreed to participate across seven focus groups. Analysis revealed the emergence of one overarching theme: team approach to patient care. A number of subthemes related to the role of the pharmacist, the role of the doctor and patient benefits. There was an overwhelming lack of awareness of pharmacist prescribing. Patients discussed the importance of a multidisciplinary approach to their care and recognized limitations of the current model of prescribing. 

Conclusion: Patients were positive about pharmacist prescribing and felt that a team approach to their care was the ideal model especially when treating those with more complex conditions. Despite positive attitudes, there was a general lack of awareness of this new mode of practice.

Gaze behavior of the visually impaired during street crossing.

PURPOSE:

This study explored the gaze patterns of fully sighted and visually impaired subjects during the high-risk activity of crossing the street.

METHODS:

Gaze behavior of 12 fully sighted subjects, nine with visual impairment resulting from age-related macular degeneration and 12 with impairment resulting from glaucoma, was monitored using a portable eye tracker as they crossed at two unfamiliar intersections.

RESULTS:

All subject groups fixated primarily on vehicles and crossing elements but changed their fixation behavior as they moved from "walking to the curb" to "standing at the curb" and to "crossing the street." A comparison of where subjects fixated in the 4-second time period before crossing showed that the fully sighted who waited for the light to change fixated on the light, whereas the fully sighted who crossed early fixated primarily on vehicles. Visually impaired subjects crossing early or waiting for the light fixate primarily on vehicles.

CONCLUSIONS:

Vision status affects fixation allocation while performing the high-risk activity of street crossing. Crossing decision-making strategy corresponds to fixation behavior only for the fully sighted subjects.

Crossing the Border

Thesis (Master's)--University of Washington, 2013

Testing the effects of genetic crossing distance on embryo survival within a metapopulation of brown trout (Salmo trutta)

Predicting progeny performance from parental genetic divergence can potentially enhance the efficiency of supportive breeding programmes and facilitate risk assessment. Yet, experimental testing of the effects of breeding distance on offspring performance remains rare, especially in wild populations of vertebrates. Recent studies have demonstrated that embryos of salmonid fish are sensitive indicators of additive genetic variance for viability traits. We therefore used gametes of wild brown trout (Salmo trutta) from five genetically distinct populations of a river catchment in Switzerland, and used a full factorial design to produce over 2,000 embryos in 100 different crosses with varying genetic distances (FST range 0.005-0.035). Customized egg capsules allowed recording the survival of individual embryos until hatching under natural field conditions. Our breeding design enabled us to evaluate the role of the environment, of genetic and nongenetic parental contributions, and of interactions between these factors, on embryo viability. We found that embryo survival was strongly affected by maternal environmental (i.e. non-genetic) effects and by the microenvironment, i.e. by the location within the gravel. However, embryo survival was not predicted by population divergence, parental allelic dissimilarity, or heterozygosity, neither in the field nor under laboratory conditions. Our findings suggest that the genetic effects of inter-population hybridization within a genetically differentiated meta-population can be minor in comparison to environmental effects.

Canada/U.S. border crossing: facilitation and constraint

Abstract The aim of this research project is to draw on accounts of experiences ofborder crossing and regulation at the Canada/U.S. border at Niagara in order to illuminate the dynamics of differentiation and inequality at this site. The research is informed by claims that the world is turning into a global village due to transnational flows oftechnology, infonnation, capital and people. Much of the available literature on globalization shows that while the transfer of technology, information, and capital are enhanced, the transnational movement of people is both facilitated and constrained in complex and unequal ways. In this project, the workings of facilitation and constraint were explored through an analysis often interviews with people who had spent a substantial portion oftheir childhood (e.g. 5 years) in a Canadian border community. The interviewees were at the time ofthe research between the ages of 19 and 25. Because most ofthe respondents were 'white' Canadians of working to upper middle class status, my focus was to explore how 'whiteness' as privilege may translate into enhanced movement across borders and how 'white' people may internalize and enjoy this privilege but may often deny its reality. I was also interested in how inequality is perceived, understood, and legitimated by these relatively privileged people. My analysis ofthe ten accounts ofborder crossing and regulation suggests that differentially situated people experience border crossing differently. An important finding is that while relatively privileged border crossers perceived and often problernatized differential treatment based on external factors such as physical appearance, and especially race, most did not challenge such treatment but rather saw it as acceptable. These findings are located within newer literature that addresses the increasing securitization ofborders and migration in western societies.

Dixon crossing Niagara

The description reads "(15) Dixon crossing Niagara below the Great Cantilever Bridge, U.S.A.".

Chart outlining Port Dalhousie and Thorold Railway cost of planks, bridge, railway crossing and approaches thereto

Chart outlining Port Dalhousie and Thorold Railway cost of planks, bridge, railway crossing and approaches thereto, n.d.

Calculations regarding the bridge crossing Chippawa

Calculations regarding the bridge crossing Chippawa (1 page, penciled calculations), n.d.