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Objective: To establish research priorities which will support the development and delivery of community pharmacy initiatives for the management of skin conditions. Design: An iterative, multistage stakeholder consultation consisting of online survey, participant workshops and prioritisation meeting. Setting: All data collection took place online with participants completing a survey (delivered via the JISC Online Survey platform, between July 2021 and January 2022) and participating in online workshops and meetings (hosted on Microsoft Teams between April and July 2022). Participants: 174 community pharmacists and pharmacy staff completed the online survey. 53 participants participated in the exploratory workshops (19 community pharmacists, 4 non-pharmacist members of pharmacy staff and 30 members of the public). 4 healthcare professionals who were unable to attend a workshop participated in a one-to-one interview. 29 participants from the workshops took part in the prioritisation meeting (5 pharmacists/pharmacy staff, 1 other healthcare professional and 23 members of the public). Results: Five broad areas of potential research need were identified in the online survey: (1) identifying and diagnosing skin conditions; (2) skin conditions in skin of colour; (3) when to refer skin conditions; (4) disease-specific concerns and (5) product-specific concerns. These were explored and refined in the workshops to establish 10 potential areas for research, which will support pharmacists in managing skin conditions. These were ranked in the prioritisation meeting. Among those prioritised were topics which consider how pharmacists work with other healthcare professionals to identify and manage skin conditions. Conclusions: Survey responses and stakeholder workshops all recognised the potential for community pharmacists to play an active role in the management of common skin conditions. Future research may support this in the generation of resources for pharmacists, in encourag

Objective: To establish research priorities which will support the development and delivery of community pharmacy initiatives for the management of skin conditions. Design: An iterative, multistage stakeholder consultation consisting of online survey, participant workshops and prioritisation meeting. Setting: All data collection took place online with participants completing a survey (delivered via the JISC Online Survey platform, between July 2021 and January 2022) and participating in online workshops and meetings (hosted on Microsoft Teams between April and July 2022). Participants: 174 community pharmacists and pharmacy staff completed the online survey. 53 participants participated in the exploratory workshops (19 community pharmacists, 4 non-pharmacist members of pharmacy staff and 30 members of the public). 4 healthcare professionals who were unable to attend a workshop participated in a one-to-one interview. 29 participants from the workshops took part in the prioritisation meeting (5 pharmacists/pharmacy staff, 1 other healthcare professional and 23 members of the public). Results: Five broad areas of potential research need were identified in the online survey: (1) identifying and diagnosing skin conditions; (2) skin conditions in skin of colour; (3) when to refer skin conditions; (4) disease-specific concerns and (5) product-specific concerns. These were explored and refined in the workshops to establish 10 potential areas for research, which will support pharmacists in managing skin conditions. These were ranked in the prioritisation meeting. Among those prioritised were topics which consider how pharmacists work with other healthcare professionals to identify and manage skin conditions. Conclusions: Survey responses and stakeholder workshops all recognised the potential for community pharmacists to play an active role in the management of common skin conditions. Future research may support this in the generation of resources for pharmacists, in encourag

This research letter discusses the perspectives of community pharmacy staff on commonly encountered skin conditions and the key challenges towards enhancing their role in this area. A mixed methods online survey was created, and a total of 174 community pharmacy staff completed the survey. The results highlight the range of conditions currently encountered in community pharmacy and the breadth of challenges facing community pharmacy staff, in particular challenges surrounding providing a differential diagnosis. Community pharmacies are an integral part of the NHS and have a key role in managing skin conditions; however, in order to optimise this role, the perspectives of staff discussed in this letter need to be further explored and addressed.

This research letter discusses the perspectives of community pharmacy staff on commonly encountered skin conditions and the key challenges towards enhancing their role in this area. A mixed methods online survey was created, and a total of 174 community pharmacy staff completed the survey. The results highlight the range of conditions currently encountered in community pharmacy and the breadth of challenges facing community pharmacy staff, in particular challenges surrounding providing a differential diagnosis. Community pharmacies are an integral part of the NHS and have a key role in managing skin conditions; however, in order to optimise this role, the perspectives of staff discussed in this letter need to be further explored and addressed.

Environmental monitoring involves the quantification of microscopic cells and particles such as algae, plant cells, pollen, or fungal spores. Traditional methods using conventional microscopy require expert knowledge, are time-intensive and not wellsuited for automated high throughput. Multispectral imaging flow cytometry (MIFC) allows measurement of up to 5000 particles per second from a fluid suspension and can simultaneously capture up to 12 images of every single particle for brightfield and different spectral ranges, with up to 60x magnification. The high throughput of MIFC has high potential for increasing the amount and accuracy of environmental monitoring, such as for plant-pollinator interactions, fossil samples, air, water or food quality that currently rely on manual microscopic methods. Automated recognition of particles and cells is also possible, when MIFC is combined with deep-learning computational techniques. Furthermore, various fluorescence dyes can be used to stain specific parts of the cell to highlight physiological and chemical features including: vitality of pollen or algae, allergen content of individual pollen, surface chemical composition (carbohydrate coating) of cells, DNA- or enzyme-activity staining. Here, we outline the great potential for MIFC in environmental research for a variety of research fields and focal organisms. In addition, we provide best practice recommendations.

Transformers have become a predominant machine learning workload, they are not only the de-facto standard for natural language processing tasks, but they are also being deployed in other domains such as vision and speech recognition. Many of the transformer-based applications are real-time systems such as machine translation and web search. These real time systems often come with strict end-to-end inference latency requirements. Unfortunately, while the majority of the transformer computation comes from matrix multiplications, transformers also include several non-linear components that tend to become the bottleneck during an inference. In this work, we accelerate the inference of BERT models on the tensor streaming processor. By carefully fusing all the nonlinear components with the matrix multiplication components, we are able to efficiently utilize the on-chip matrix multiplication units resulting in a deterministic tail latency of 130 $\mu$s for a batch-1 inference through BERT-base, which is 6X faster than the current state-of-the-art.

This paper presents Unikernel Linux (UKL), a path toward integrating unikernel optimization techniques in Linux, a general purpose operating system. UKL adds a configuration option to Linux allowing for a single, optimized process to link with the kernel directly, and run at supervisor privilege. This UKL process does not require application source code modification, only a re-link with our, slightly modified, Linux kernel and glibc. Unmodified applications show modest performance gains out of the box, and developers can further optimize applications for more significant gains (e.g. 26% throughput improvement for Redis). UKL retains support for co-running multiple user level processes capable of communicating with the UKL process using standard IPC. UKL preserves Linux's battle-tested codebase, community, and ecosystem of tools, applications, and hardware support. UKL runs both on bare-metal and virtual servers and supports multi-core execution. The changes to the Linux kernel are modest (1250 LOC)., Comment: Added more results in the evaluation section. Improved overall writing and added diagrams to explain the architecture

This dissertation aims to provide insight into the relationships between environmental factors and the organization of quartz technology in northern Manitoba by evaluating the contribution of large pegmatite quarries to quartz economies around Granville and Southern Indian Lakes. Secondary ion mass spectrometry (SIMS) quantification of trace element (Ti, Ge, U, Th) concentrations and Pb isotope ratios was used to characterize large sources of pegmatite quartz exploited by toolmakers in the Granville Lake and Lac La Ronge regions of northern Manitoba and Saskatchewan, respectively. The same technique was applied to a sample of formal quartz tools from the Churchill River Diversion Archaeological Project (CRDAP) study area in northern Manitoba. Quarry and artifact results were compared. The results of this analysis indicate: 1) characterized pegmatite quartz sources in the Granville Lake district likely played a significant role in quartz economies in the Churchill River basin of northern Manitoba, 2) toolmakers in the study area had large lithic procurement ranges, and 3) lithic resource stress contributed to the selection of technological strategies in the Churchill River basin.

This dissertation aims to provide insight into the relationships between environmental factors and the organization of quartz technology in northern Manitoba by evaluating the contribution of large pegmatite quarries to quartz economies around Granville and Southern Indian Lakes. Secondary ion mass spectrometry (SIMS) quantification of trace element (Ti, Ge, U, Th) concentrations and Pb isotope ratios was used to characterize large sources of pegmatite quartz exploited by toolmakers in the Granville Lake and Lac La Ronge regions of northern Manitoba and Saskatchewan, respectively. The same technique was applied to a sample of formal quartz tools from the Churchill River Diversion Archaeological Project (CRDAP) study area in northern Manitoba. Quarry and artifact results were compared. The results of this analysis indicate: 1) characterized pegmatite quartz sources in the Granville Lake district likely played a significant role in quartz economies in the Churchill River basin of northern Manitoba, 2) toolmakers in the study area had large lithic procurement ranges, and 3) lithic resource stress contributed to the selection of technological strategies in the Churchill River basin.

This dissertation aims to provide insight into the relationships between environmental factors and the organization of quartz technology in northern Manitoba by evaluating the contribution of large pegmatite quarries to quartz economies around Granville and Southern Indian Lakes. Secondary ion mass spectrometry (SIMS) quantification of trace element (Ti, Ge, U, Th) concentrations and Pb isotope ratios was used to characterize large sources of pegmatite quartz exploited by toolmakers in the Granville Lake and Lac La Ronge regions of northern Manitoba and Saskatchewan, respectively. The same technique was applied to a sample of formal quartz tools from the Churchill River Diversion Archaeological Project (CRDAP) study area in northern Manitoba. Quarry and artifact results were compared. The results of this analysis indicate: 1) characterized pegmatite quartz sources in the Granville Lake district likely played a significant role in quartz economies in the Churchill River basin of northern Manitoba, 2) toolmakers in the study area had large lithic procurement ranges, and 3) lithic resource stress contributed to the selection of technological strategies in the Churchill River basin.

This dissertation aims to provide insight into the relationships between environmental factors and the organization of quartz technology in northern Manitoba by evaluating the contribution of large pegmatite quarries to quartz economies around Granville and Southern Indian Lakes. Secondary ion mass spectrometry (SIMS) quantification of trace element (Ti, Ge, U, Th) concentrations and Pb isotope ratios was used to characterize large sources of pegmatite quartz exploited by toolmakers in the Granville Lake and Lac La Ronge regions of northern Manitoba and Saskatchewan, respectively. The same technique was applied to a sample of formal quartz tools from the Churchill River Diversion Archaeological Project (CRDAP) study area in northern Manitoba. Quarry and artifact results were compared. The results of this analysis indicate: 1) characterized pegmatite quartz sources in the Granville Lake district likely played a significant role in quartz economies in the Churchill River basin of northern Manitoba, 2) toolmakers in the study area had large lithic procurement ranges, and 3) lithic resource stress contributed to the selection of technological strategies in the Churchill River basin.

Portal imaging was originally developed for geometric treatment verification of photon beams used in cancer radiotherapy. More recently, portal imaging systems have been successfully used in dosimetric treatment verification applications. Many of the proposed dosimetric applications involve the accurate calculation of a predicted portal dose image, including both primary and scatter dose components emerging from the patient. This thesis presents the development of a two step model that predicts dose deposition in arbitrary portal image detectors. The algorithm requires patient computed tomographic data, source-detector distance, and knowledge of the incident photon beam fluence. The first step predicts the photon fluence entering a portal imaging detector located behind the patient. Primary fluence is obtained through simple ray tracing techniques, while scatter fluence prediction requires a library of scatter fluence kernels generated by Monte Carlo simulation. These kernels allow prediction of basic radiation transport parameters haracterizing the scattered photons, including fluence and energy. The second step of the algorithm involves a superposition of Monte Carlo-generated pencil beam kernels, describing dose deposition in a specific detector, with the predicted incident fluence of primary and scattered photons. This process is performed eparately for primary and scatter fluence at high and low spatial resolutions respectively, and yields a predicted planar dose image. This algorithm is tested on a variety of phantoms including simple slab phantoms and anthropomorphic phantoms. Other clinical parameters were varied over a wide range of interest, including 6, 18, 23 MV photon beam spectra and 10-80 cm air gap between phantom and portal imaging detector. Both low and high atomic number detectors were used to verify the algorithm, including a linear array of fluid ionization chambers and a solid state, amorphous silicon detector. Agreement between predicted and m

Portal imaging was originally developed for geometric treatment verification of photon beams used in cancer radiotherapy. More recently, portal imaging systems have been successfully used in dosimetric treatment verification applications. Many of the proposed dosimetric applications involve the accurate calculation of a predicted portal dose image, including both primary and scatter dose components emerging from the patient. This thesis presents the development of a two step model that predicts dose deposition in arbitrary portal image detectors. The algorithm requires patient computed tomographic data, source-detector distance, and knowledge of the incident photon beam fluence. The first step predicts the photon fluence entering a portal imaging detector located behind the patient. Primary fluence is obtained through simple ray tracing techniques, while scatter fluence prediction requires a library of scatter fluence kernels generated by Monte Carlo simulation. These kernels allow prediction of basic radiation transport parameters haracterizing the scattered photons, including fluence and energy. The second step of the algorithm involves a superposition of Monte Carlo-generated pencil beam kernels, describing dose deposition in a specific detector, with the predicted incident fluence of primary and scattered photons. This process is performed eparately for primary and scatter fluence at high and low spatial resolutions respectively, and yields a predicted planar dose image. This algorithm is tested on a variety of phantoms including simple slab phantoms and anthropomorphic phantoms. Other clinical parameters were varied over a wide range of interest, including 6, 18, 23 MV photon beam spectra and 10-80 cm air gap between phantom and portal imaging detector. Both low and high atomic number detectors were used to verify the algorithm, including a linear array of fluid ionization chambers and a solid state, amorphous silicon detector. Agreement between predicted and m

It was proposed that a phase separated system might be utilised to deliver a concentrated polysaccharide mucosal protective coating in gastro oesophageal reflux disease (GORD). In this context the phase behaviour of xanthan gum in combination with sodium alginate and other polymers was studied. Above a threshold concentration of alginate, aqueous mixtures of xanthan exhibited phase separation, resulting in loss of normal viscoelastic properties and the formation of a low viscosity system. The shape of the phase diagram showed behaviour typical of a segregative system, with the continuous phase composed exclusively of alginate and the disperse phase being rich in xanthan gum. Increasing alginate molecular weight reduced the threshold concentration for separation, as predicted by the Flory-Huggins theory, but changes in alginate mannuronate:guluronate ratio had no effect. Increasing ionic strength elevated the threshold concentration. Xanthan separation was elicited by other aqueous anionic polyelectrolytes, but not neutral water soluble polymers. Scleroglucan, another rigid-rod polysaccharide, was investigated as an alternative to xanthan but did not show similar separation behaviour, suggesting that the charge on the xanthan molecule is a necessary prerequisite. Reversal of phase separation by dilution across the phase boundary provided increases in viscosity. A 1% xanthan:2% alginate mixture doubled in viscosity whereas if diluted with simulated gastric fluid a seven-fold increase was seen, as a result of conversion to an alginic acid gel. This offers a mechanism for producing the desired viscosity barrier. Low viscosity polyelectrolytes, with concentrations close to the phase boundary yielded the greatest viscosity increases. In the phase separated system, the disperse phase exhibited an unusual strand-like morphology whose birefringence suggests a liquid crystalline structure. The variable size of the strands was explained in terms of kinetics of xanthan molecula

Reconfiguration of the healthcare division of labour is becoming increasingly attractive in the context of increased patient demand and resource constraints. One example is the introduction of extended roles for pharmacists to provide patients additional support to manage their medicines, while also reducing work pressures experienced by other health professionals. Understanding how such policies are framed by those delivering and receiving care has been under‐theorised. Using Goffman's frame theory, we examine one newly introduced community pharmacy service (New Medicines Service (NMS)) to illustrate how a policy intended to support patient medicine‐taking through the extended roles of pharmacists is framed and where this deviates from its proposed aims. Three themes emerged: (i) the spatial‐material artefacts; (ii) existing discursive culture and practice around medicine‐taking; and (iii) the NMS interactions that shape and govern framing and subsequent interpretation of the NMS. Our study offers an explanatory and dynamic view of the framing process with important lessons for reconfiguring medicine management policy and practice. As well as illustrating framing as being variegated, complementary or conflicting, it also shows how this plurality and fragility had consequences for patient engagement and sense‐making. The consequences for engagement and recommendations for implementing future initiatives are discussed.

Introduction: Most patient safety research has focused on specialist-care settings where there is an appreciation of the frequency and causes of medical errors, and the resulting burden of adverse events. There have, however, been few large-scale robust studies that have investigated the extent and severity of avoidable harm in primary care. To address this, we will conduct a 12-month retrospective cross-sectional study involving case note review of primary care patients. Methods and Analysis: We will conduct electronic searches of general practice (GP) clinical computer systems to identify patients with avoidable significant harm. Up to sixteen general practices from three areas of England (East Midlands, London and the North West) will be recruited based on practice size, to obtain a sample of around 100,000 patients. Our investigations will include an ‘enhanced sample’ of patients with the highest risk of avoidable significant harm. We will estimate the incidence of avoidable significant harm and express this as ‘per 100,000 patients per year’. Univariate and multivariate analysis will be conducted to identify the factors associated with avoidable significant harm. Ethics/Dissemination: The decision regarding participation by general practices in the study is entirely voluntary; the consent to participate may be withdrawn at any time. We will not seek individual patient consent for the retrospective case note review, but if patients respond to publicity about the project and say they do not wish their records to be included we will follow these instructions. We will produce a report for the Department of Health’s Policy Research Programme and several high-quality peer-reviewed publications in scientific journals. The study has been granted a favourable opinion by the East Midlands Nottingham 2 Research Ethics Committee (reference 15/EM/0411) and Confidentiality Advisory Group approval for access to medical records without consent under section 251 of the NHS Act

Community pharmacists play a growing role in the delivery of primary healthcare. This has led manyto consider the changing power of the pharmacy profession in relation to other professions and patient groups. This paper contributes to these debates through developing a Foucauldian analysis of the changing dynamics of power brought about by extended roles in medicines management and patient education. Examining the New Medicine Service, the study considers how both patient and pharmacist subjectivities are transformed as pharmacists seek to survey patient’s medicine use, diagnose non-adherence to prescribed medicines, and provide education to promote behaviour change. These extended roles in medicines management and patient education expand the ‘pharmacy gaze’ to further aspects of patient health and lifestyle, and more significantly, established a form of ‘pastoral power’ as pharmacists become responsible for shaping patients’ self-regulating subjectivities. In concert, pharmacists are themselves enrolled within a new governing regime where their identities are conditioned by corporate and policy rationalities for the modernisation of primary care.

Background: Community pharmacies are increasingly commissioned to deliver new, complex health interventions in response to the growing demands on family doctors and secondary health care services. Little is known about how these complex interventions are being accommodated and translated into the community pharmacy setting and whether their aims and objectives are realized in practice. The New Medicine Service (NMS) is a complex medicine management intervention that aims to support patients’ adherence to newly prescribed medicines for a long-term condition. Objective: This study explores the recent implementation of the NMS in community pharmacies across England. It also seeks to understand how the service is becoming manifest in practice and what lessons can be learned for future service implementation. Methods: Structured, organizational ethnographic observations and in situ workplace interviews with pharmacists and support staff were undertaken within 23 English community pharmacies. Additionally, one-toone, semi-structured interviews were carried out with 47 community pharmacists and 11 general practitioners (GPs). Observational and interview data were transcribed and analysed thematically and guided by Damschroder’s consolidated framework for implementation research. Results: The NMS workload had been implemented and absorbed into pharmacists’ daily routines alongside existing responsibilities with no extra resources and little evidence of reduction in other responsibilities. Pharmacists were pragmatic, simplifying, and adapting the NMS to facilitate its delivery and using discretion to circumvent perceived non-essential paperwork. Pharmacist understanding of the NMS was found to impact on what they believed should be achieved from the service. Despite pharmacists holding positive views about the value of the NMS, not all were convinced of its perceived benefits and necessity, with reports that many consultations did not identify any problems with the patients’

Studies of error rates in community pharmacies have reported error rates of between 0.014% and 3.3% per item dispensed. This suggests up to 36 million items per year may contain errors in England. In addition, literature shows that patient satisfaction with services is directly related to waiting times. There is a need for a method to model pharmacy efficiency balancing safety and waiting times, ensuring that the reliability of the dispensing process is not compromised. In this paper a Coloured Petri Net (CPN) approach is proposed for analysing reliability and efficiency of community pharmacy. A pharmacy team work to complete dispensing and non-dispensing tasks, where non-dispensing tasks require staff to be temporarily removed from the dispensing process. The proposed approach is useful to investigate what affects the error rates and long waiting times, and provides modelling-based evidence to decision makers, looking to optimise staffing levels and improve the reliability of dispensing.

Objective: In 2014 The School of Pharmacy at the University of Nottingham needed to deliver individual research methods supervision by a small number of academic staff to a large number of final year students. There are limited opportunities for students to gain patient facing experience on this course. The learning initiative was designed to meet these needs. Design: Dissertation students were offered a unique opportunity to participate in a large scale community pharmacy research project. Eighty-two students collected standardised data from patients across 36 pharmacies in the Greater Nottingham area. Local data collection supervision was provided by the local community pharmacists at the data collection sites. Academic supervision was provided to students using a hub and spoke model with ‘hub’ supervision provided by two members of staff offering broad methodological support to the cohort. This was further supported by local supervisors providing individualised ‘spoke’ support to students. Students were able to examine and report on their local results. The data generated overall provides a mass dataset for further examination by academics. An independent evaluation of stakeholder experience was undertaken. Assessment: Students were assessed by a poster presentation and written report summarising one segment of local analysis. Conclusion: Academics saw the hub and spoke model of supervision as innovative and a positive and efficient use of their time. All participating stakeholders feel that students benefit from the timely development of their transferable skills for their professional career; skills cited as requirements for pharmacy education by the GPhC (2011).

Objective: To design and deliver a synoptic experiential learning experience drawing on leadership and management skills coupled with clinical problem solving in a high fidelity simulation. To provide undergraduates with a mentor employed to support and coach groups and individuals to learn, practise and develop their leadership and team working skills. Design: Pharmacy Leadership and Management (PLM) is a module which provides an experiential learning simulation drawing on leadership and management skills coupled with clinical problem solving. Teams of six students run their own primary care based pharmacy business competing against each other, based on a successful model currently run by the GIMMICS consortia of universities across Europe. Working with the university graduate school, a job description and person specification was developed. Mentors were appointed, using a robust application and interview process. A bespoke leadership and management training programme was co-developed between the Pharmacy and Graduate schools. The mentors supported student-led group sessions, coaching them to reflect on performance, develop solutions and change initiatives. The performance mentors were able to monitor the progress of their clients and stimulate interventions to improve their performance. Assessment: Students are required to reflect on their team working and its development during the simulation via their reflective portfolios. Conclusion: In this paper, we will present the development of the mentors and the impact they had on student learning. Qualitative interviews are currently being conducted to determine the impact of the mentor role on recent graduates and their development as future leaders.

Objective: To design and deliver a synoptic experiential learning experience drawing on leadership and management skills coupled with clinical problem solving in a high fidelity simulation. Our vision is to produce world leading pharmacists by providing them with diverse opportunities to demonstrate and expand their knowledge, skills and behaviours and prepare them for the changing healthcare landscape of the future. Design: Pharmacy Leadership and Management (PLM) is based on the successful GIMMICS consortia blueprint. Development was informed by stakeholder events with local and national health commissioners, professionals, experts, patients and academic staff. Teams of six final-year students run their own primary care-based pharmacy business competing against four others over four blocks of three days through the year. Simulated patients and academics deliver approximately 180 acute scenarios over the module to each team, comprising face-to-face, telephone and email queries. Teams also have longer term challenges including development new services and tendering for contracts. The curriculum covers all areas of practice including communication with patients and professionals, business and people development, medicines supply, clinical practice, governance and patient safety and health promotion and public health. Assessment: Assessment uses a multi-format approach of OSCE for skills, reflective portfolio for longer term and attitudinal attributes and an online assessment for knowledge based elements. Conclusion: In this paper, we will present the development of this educational experience and describe our implementation and operationalisation of this highly complex module.

Background: Pharmacy Leadership and Management is a 12-day, final-year synoptic experiential learning simulation. Student teams of six run a primary care-based pharmacy business and are presented with approximately 180 scenarios and over 400 medicines-based exercises. This module is based on the successful model created by the GIMMICS consortia of universities. Aims: To evaluate the acceptability and perceived usefulness to students and their future employment. Method: An online 82-item questionnaire was sent to all 221 students on the module comprising open and closed questions about their module experiences. Two reminders were sent. Analysis consisted of frequency counts and percentages. Results: Sixty-five percent of students completed the survey (n=143). Ninety-two percent said the module challenged them (n=132/143). Eighty-nine percent said it made them more confident talking to patients (n=127/143); 84% reported that their team-working skills improved as the module progressed (n=110/131). Eighty nine percent of students stated that they thought the module consolidated their learning across the degree (n=117/131). Despite the nature of the module, over half felt that the business skills would not be useful to their future career (55%, n=71/131). Conclusion: This new module has assisted students to develop themselves by challenging them and assisting to consolidate their team-working skills. Despite the importance of understanding business and management, students still appear to lack appreciation of this topic, perhaps due to lack of practice exposure in the course. This is the first year the module has run and we will be following up with the now recent graduates to evaluate the module impact on the next stages of their career.

Background The review was carried out review prior to evaluating and to inform our research on the clinical pharmacists in general practices pilot, a world leading initiative to improve health care delivery in England. Around 500 pharmacists are already working in general practice as part of the pilot, launched in July 2015 Objectives The review attempts to explain the how “clinical pharmacists in general practices” is being implemented, what works well, what does not work so well and everything in-between. Methods This realist review was conducted to the RAMESES standards. Studies were identified by searching three databases, Medline, Embase and Scopus. Additional papers were gathered from reference lists, Google searches and via the find similar citations feature. Results A total of 83 papers and articles were initially identified from Medline (19), Embase (31) and Scopus (32). With close reading, the final review consisted of of 43 papers relating to 38 studies. Most of the research was undertaken in the field of pharmacy practice and over half of the studies investigated the perspectives of different stakeholders using questionnaires or qualitative methods. Conclusion The pharmacist in general practices initiative is still at an early stage of implementation, further research and more in-depth findings are still required. However, from this small number of studies, the common barriers and facilitators to the implementation can be identified. The review also lists mechanisms that will be needed to ensure the effective implementation of this initiative.

Reconfiguration of the healthcare division of labour is becoming increasingly attractive in the context of increased patient demand and resource constraints. One example is the introduction of extended roles for pharmacists to provide patients additional support to manage their medicines, while also reducing work pressures experienced by other health professionals. Understanding how such policies are framed by those delivering and receiving care has been under‐theorised. Using Goffman's frame theory, we examine one newly introduced community pharmacy service (New Medicines Service (NMS)) to illustrate how a policy intended to support patient medicine‐taking through the extended roles of pharmacists is framed and where this deviates from its proposed aims. Three themes emerged: (i) the spatial‐material artefacts; (ii) existing discursive culture and practice around medicine‐taking; and (iii) the NMS interactions that shape and govern framing and subsequent interpretation of the NMS. Our study offers an explanatory and dynamic view of the framing process with important lessons for reconfiguring medicine management policy and practice. As well as illustrating framing as being variegated, complementary or conflicting, it also shows how this plurality and fragility had consequences for patient engagement and sense‐making. The consequences for engagement and recommendations for implementing future initiatives are discussed.

Background: Antimicrobial resistance is a worldwide concern to reserve the effectiveness of antibiotics in therapy. The irrational use of antibiotics is one of the factors contributing to antimicrobial resistance. In depth exploration of the public’s attitudes towards the use of antibiotics for treating the common cold will improve understanding of the factors that cause the indiscriminate use of antibiotics; and could have an impact on antimicrobial resistance. Method: Semi-structured interviews were conducted with individuals recruited from public places, within governorate of Muscat, Oman. The interviews explored public perceptions about self care of minor ailments. The data was analysed by applying the principles of constructivist grounded theory. Results: Twenty-one participants were interviewed. Emerging themes included attitude to medicines in general, comprising specifically the use of antibiotics. Some participants indicated that it was necessary to take antibiotics for conditions associated with fever or severe sore throats. They believed that fever and inflammation is always a sign of bacterial infection that requires antibiotics. Participants did not understand the concept of bacterial resistance but thought that overuse of antibiotics affected their immunity to colds and sore throats. Access to antibiotics for treating the common cold is highly influenced by physicians’ prescribing behaviours, and there was a clear variance percieved between the private and public primary health sectors with regards to antibiotic prescribing practice. Conclusion: Due to misunderstanding, people believe that antibiotics are needed to treat colds and sore throats. These findings suggest there is a need for educational intervention and better enforcement of regulations in Oman.

Background: Identifying risk is an important facet of a safety practice in an organization. To identify risk, all components within a system of operation should be considered. In clinical safety practice, a team of people, technologies, procedures and protocols, management structure and environment have been identified as key components in a system of operation. Objectives: To explore risks in relation to prescription dispensing in community pharmacies by taking into account relationships between key components that relate to the dispensing process. Methods: Fifteen community pharmacies in England with varied characteristics were identified, and data were collected using non-participant observations, shadowing and interviews. Approximately 360 hours of observations and 38 interviews were conducted by the team. Observation field notes from each pharmacy were written into case studies. Overall, 52,500 words from 15 case studies and interview transcripts were analyzed using thematic and line-by-line analyses. Validation techniques included multiple data collectors co-authoring each case study for consensus, review of case studies by members of the wider team including academic and practicing community pharmacists, and patient safety experts and two presentations (internally and externally) to review and discuss findings. Results: Risks identified were related to relationships between people and other key components in dispensing. This included how different levels of staff communicated internally and externally, followed procedures, interacted with technical systems, worked with management, and engaged with the environment. In a dispensing journey, the following categories were identified which show how risks are inextricably linked through relationships between human components and other key components: 1) dispensing with divided attention; 2) dispensing under pressure; 3) dispensing in a restricted space or environment; and, 4) managing external influences. Conclusio

Objectives: To compare prevalence and types of dispensing errors and pharmacists’ labelling enhancements, for prescriptions transmitted electronically versus paper prescriptions. Design: Naturalistic stepped wedge study. Setting: 15 English community pharmacies. Intervention: Electronic transmission of prescriptions between prescriber and pharmacy. Main outcome measures: Prevalence of labelling errors, content errors and labelling enhancements (beneficial additions to the instructions), as identified by researchers visiting each pharmacy. Results: Overall, we identified labelling errors in 5.4% of 16 357 dispensed items, and content errors in 1.4%; enhancements were made for 13.6%. Pharmacists also edited the label for a further 21.9% of electronically transmitted items. Electronically transmitted prescriptions had a higher prevalence of labelling errors (7.4% of 3733 items) than other prescriptions (4.8% of 12 624); OR 1.46 (95% CI 1.21 to 1.76). There was no difference for content errors or enhancements. The increase in labelling errors was mainly accounted for by errors (mainly at one pharmacy) involving omission of the indication, where specified by the prescriber, from the label. A sensitivity analysis in which these cases (n=158) were not considered errors revealed no remaining difference between prescription types. Conclusions: We identified a higher prevalence of labelling errors for items transmitted electronically, but this was predominantly accounted for by local practice in a single pharmacy, independent of prescription type. Community pharmacists made labelling enhancements to about one in seven dispensed items, whether electronically transmitted or not. Community pharmacists, prescribers, professional bodies and software providers should work together to agree how items should be dispensed and labelled to best reap the benefits of electronically transmitted prescriptions. Community pharmacists need to ensure their computer systems are promptly updated

Aims: To evaluate the ability of electronic patient medication record (ePMR) systems used in community pharmacies in England to detect and alert users about clinical hazards, errors and other safety problems. Methods: Between September 2012 and November 2012, direct on-site observational data about the performance of ePMR systems were collected from nine sites. Twenty-eight scenarios were developed by consensus agreement between a general practitioner and two community pharmacists. Each scenario was entered into the ePMR system, and the results obtained from the assessment of six unique systems in nine sites, in terms of the presence or absence of an alert, were recorded onto a prespecified form. Results: None of the systems produced the correct responses for all of the 28 scenarios tested. Only two systems provided an alert to penicillin sensitivity. No dose or frequency check was observed when processing a prescription for methotrexate. One system did not warn about nonsuitability of aspirin prescribed to a child of 14 years of age. In another system, it was not possible to record a patient's pregnancy status. None of the six systems provided any warning for diclofenac overdose, high initiation dose of morphine sulfate or significant dose increase. Only one of the systems did not produce any spurious alerts. Conclusions: The performance of the ePMR systems tested was variable and suboptimal. The findings suggest the need for minimum specifications and standards for ePMR systems to ensure consistency of performance.

Background: The New Medicine Service (NMS) was introduced to community pharmacies in England in October 2011. The NMS aims to improve adherence to new medicines in patients with selected long term conditions. The service consists of two follow-up consultations within 1 month in addition to usual care. Objectives: This study explored community pharmacist and superintendent pharmacist views and experiences of the NMS in the 5 weeks prior to its implementation to identify potential facilitators and barriers to its success. The study also investigated participant experiences of the introduction and provision of existing pharmacy services in order to contrast with the implementation of the NMS. Methods: This study consisted of four focus groups with a total of 15 community pharmacists representing locums and employees of small, medium and large chain pharmacies. In addition, 5 semi-structured interviews were conducted with superintendent pharmacists representing independent, small chain, supermarket and large multiple pharmacies. Data were audio-recorded, transcribed verbatim and thematically analyzed. Results: Both pharmacists and superintendent pharmacists were positive about the NMS and identified potential benefits for patients and the pharmacy profession. Awareness of the service was high, however, some confusion between the NMS and changes to Medicine Use Reviews was evident in all focus groups due to their similarity and coincidental implementation. This confusion was not observed in the interviews with superintendent pharmacists. Participants identified pharmacists' positive attitude, the similarity to current practice and the self-accreditation procedure as potential facilitators to service implementation. Potential barriers identified included a perceived lack of interest and awareness by GPs of the service, and the payment structure. Participants were concerned about the speed of implementation, and the absence of some materials needed prior to the start of th

Background: The payment structure for the New Medicine Service (NMS) in England is based on the assumption that 0.5% of prescription items dispensed in community pharmacies are eligible for the service. This assumption is based on a theoretical calculation. This study aimed to find out the actual proportion of prescription items eligible for the NMS dispensed in community pharmacies in order to compare this with the theoretical assumption. The study also aimed to investigate whether the proportion of prescription items eligible for the NMS is affected by pharmacies’ proximity to GP practices. Methods: The study collected data from eight pharmacies in Nottingham belonging to the same large chain of pharmacies. Pharmacies were grouped by distance from the nearest GP practice and sampled to reflect the distribution by distance of all pharmacies in Nottingham. Data on one thousand consecutive prescription items were collected from each pharmacy and the number of NMS eligible items recorded. All NHS prescriptions were included in the sample. Data were analysed and proportions calculated with 95% confidence intervals used to compare the study results against the theoretical figure of 0.5% of prescription items being eligible for the NMS. Results: A total of 8005 prescription items were collected (a minimum of 1000 items per pharmacy) of which 17 items were eligible to receive the service. The study found that 0.25% (95% confidence intervals: 0.14% to 0.36%) of prescription items were eligible for the NMS which differs significantly from the theoretical assumption of 0.5%. The opportunity rate for the service was lower, 0.21% (95% confidence intervals: 0.10% to 0.32%) of items, as some items eligible for the NMS did not translate into opportunities to offer the service. Of all the prescription items collected in the pharmacies, 28% were collected by patient representatives. Conclusions: The results of this study show that the proportion of items eligible for the NMS dispen

Background: The English community pharmacy New Medicine Service (NMS) significantly increases patient adherence to medicines, compared with normal practice. We examined the cost-effectiveness of NMS compared with normal practice by combining adherence improvement and intervention costs with the effect of increased adherence on patient outcomes and healthcare costs. Methods: We developed Markov models for diseases targeted by the NMS (hypertension, type 2 diabetes, chronic obstructive pulmonary disease, asthma and antiplatelet regimens) to assess the impact of patients’ non-adherence. Clinical event probability, treatment pathway, resource-use and costs were extracted from literature and costing tariffs. Incremental costs and outcomes associated with each disease were incorporated additively into a composite probabilistic model and combined with adherence rates and intervention costs from the trial. Costs per extra quality-adjusted-life-year(QALY) were calculated from the perspective of NHS England, using a lifetime horizon. Results: NMS generated a mean of 0.05 (95%CI: 0.00, 0.13) more QALYs per patient, at a mean reduced cost of -£144 (95%CI: -769, 73). The NMS dominates normal practice with probability of 0.78 (ICER: - £3166 per QALY). NMS has a 96.7% probability of cost-effectiveness compared with normal practice at a willingness-to-pay of £20000 per QALY. Sensitivity analysis demonstrated that targeting each disease with NMS has a probability over 0.90 of cost-effectiveness compared with normal practice at a willingness-to-pay of £20000 per QALY. Conclusions: Our study suggests that the New Medicine Service increased patient medicine adherence compared with normal practice, which translated into increased health gain at reduced overall cost.

Objective: To examine the effectiveness of the New Medicine Service (NMS), a national community pharmacy service to support medicines-taking in people starting a new medicine for a long-term condition, compared with normal practice. Methods: Pragmatic patient-level parallel randomised controlled trial, in 46 community pharmacies in England. Patients 1:1 block randomisation stratified by drug/disease group within each pharmacy. 504 participants (NMS: 251) aged 14 years and over, identified in the pharmacy on presentation of a prescription for asthma/chronic obstructive pulmonary disease, hypertension, type 2 diabetes or an anticoagulant/antiplatelet agent. NMS intervention: One consultation 7–14 days after presentation of prescription followed by another 14–21 days thereafter to identify problems with treatment and provide support if needed. Controls received normal practice. Adherence, defined as missing no doses without the advice of a medical professional in the previous 7 days, was assessed through patient self-report at 10 weeks. Intention-to-treat analysis was employed, with outcome adjusted for recruiting pharmacy, NMS disease category, age, sex and medication count. Cost to the National Health Service (NHS) was collected. Results: At 10 weeks, 53 patients had withdrawn and 443 (85%) patients were contacted successfully by telephone. In the unadjusted analysis of 378 patients still taking the initial medicine, 61% (95% CI 54% to 67%) and 71% (95% CI 64% to 77%) patients were adherent in the normal practice and NMS arms, respectively (p=0.04 for difference). In the adjusted intention-to-treat analysis, the OR for increased adherence was 1.67 (95% CI 1.06 to 2.62; p=0.027) in favour of the NMS arm. There was a general trend to reduced NHS costs, albeit, statistically non-significant, for the NMS intervention: saving £21 (95% CI −£59 to £100, p=0.128) per patient. Conclusions: The NMS significantly increased the proportion of patients adhering to their new medici

Introduction: Most patient safety research has focused on specialist-care settings where there is an appreciation of the frequency and causes of medical errors, and the resulting burden of adverse events. There have, however, been few large-scale robust studies that have investigated the extent and severity of avoidable harm in primary care. To address this, we will conduct a 12-month retrospective cross-sectional study involving case note review of primary care patients. Methods and Analysis: We will conduct electronic searches of general practice (GP) clinical computer systems to identify patients with avoidable significant harm. Up to sixteen general practices from three areas of England (East Midlands, London and the North West) will be recruited based on practice size, to obtain a sample of around 100,000 patients. Our investigations will include an ‘enhanced sample’ of patients with the highest risk of avoidable significant harm. We will estimate the incidence of avoidable significant harm and express this as ‘per 100,000 patients per year’. Univariate and multivariate analysis will be conducted to identify the factors associated with avoidable significant harm. Ethics/Dissemination: The decision regarding participation by general practices in the study is entirely voluntary; the consent to participate may be withdrawn at any time. We will not seek individual patient consent for the retrospective case note review, but if patients respond to publicity about the project and say they do not wish their records to be included we will follow these instructions. We will produce a report for the Department of Health’s Policy Research Programme and several high-quality peer-reviewed publications in scientific journals. The study has been granted a favourable opinion by the East Midlands Nottingham 2 Research Ethics Committee (reference 15/EM/0411) and Confidentiality Advisory Group approval for access to medical records without consent under section 251 of the NHS Act

Background: Community pharmacies are increasingly commissioned to deliver new, complex health interventions in response to the growing demands on family doctors and secondary health care services. Little is known about how these complex interventions are being accommodated and translated into the community pharmacy setting and whether their aims and objectives are realized in practice. The New Medicine Service (NMS) is a complex medicine management intervention that aims to support patients’ adherence to newly prescribed medicines for a long-term condition. Objective: This study explores the recent implementation of the NMS in community pharmacies across England. It also seeks to understand how the service is becoming manifest in practice and what lessons can be learned for future service implementation. Methods: Structured, organizational ethnographic observations and in situ workplace interviews with pharmacists and support staff were undertaken within 23 English community pharmacies. Additionally, one-toone, semi-structured interviews were carried out with 47 community pharmacists and 11 general practitioners (GPs). Observational and interview data were transcribed and analysed thematically and guided by Damschroder’s consolidated framework for implementation research. Results: The NMS workload had been implemented and absorbed into pharmacists’ daily routines alongside existing responsibilities with no extra resources and little evidence of reduction in other responsibilities. Pharmacists were pragmatic, simplifying, and adapting the NMS to facilitate its delivery and using discretion to circumvent perceived non-essential paperwork. Pharmacist understanding of the NMS was found to impact on what they believed should be achieved from the service. Despite pharmacists holding positive views about the value of the NMS, not all were convinced of its perceived benefits and necessity, with reports that many consultations did not identify any problems with the patients’

The ability to understand and implement calculations required for molarity and dilution computations that are routinely undertaken in the laboratory are essential skills that should be possessed by all students entering an undergraduate Life Sciences degree. However, it is increasingly recognized that the majority of these students are ill equipped to reliably carry out such calculations. There are several factors that conspire against students' understanding of this topic, with the alien concept of the mole in relation to the mass of compounds and the engineering notation required when expressing the relatively small quantities typically involved being two key examples. In this report, we highlight teaching methods delivered via revision workshops to undergraduate Life Sciences students at the University of Nottingham. Workshops were designed to 1) expose student deficiencies in basic numeracy skills and remedy these deficiencies, 2) introduce molarity and dilution calculations and illustrate their workings in a step-by-step manner, and 3) allow students to appreciate the magnitude of numbers. Preworkshop to postworkshop comparisons demonstrated a considerable improvement in students' performance, which attenuated with time. The findings of our study suggest that an ability to carry out laboratory calculations cannot be assumed in students entering Life Sciences degrees in the United Kingdom but that explicit instruction in the form of workshops improves proficiency to a level of competence that allows students to prosper in the laboratory environment.

Community pharmacists play a growing role in the delivery of primary healthcare. This has led manyto consider the changing power of the pharmacy profession in relation to other professions and patient groups. This paper contributes to these debates through developing a Foucauldian analysis of the changing dynamics of power brought about by extended roles in medicines management and patient education. Examining the New Medicine Service, the study considers how both patient and pharmacist subjectivities are transformed as pharmacists seek to survey patient’s medicine use, diagnose non-adherence to prescribed medicines, and provide education to promote behaviour change. These extended roles in medicines management and patient education expand the ‘pharmacy gaze’ to further aspects of patient health and lifestyle, and more significantly, established a form of ‘pastoral power’ as pharmacists become responsible for shaping patients’ self-regulating subjectivities. In concert, pharmacists are themselves enrolled within a new governing regime where their identities are conditioned by corporate and policy rationalities for the modernisation of primary care.

Background: Electronic Patient Medication Record (ePMR) systems have important safety features embedded to alert users about potential clinical hazards and errors. To date, there is no synthesis of evidence about the effectiveness of these safety features and alerts at the point of pharmacy order entry. This review aims to systematically explore the literature and synthesise published evidence about the effectiveness of safety features and alerts in ePMR systems at the point of pharmacy order entry, in primary and secondary care. Methods: We searched MEDLINE, EMBASE, Inspec, International Pharmaceutical Abstracts, PsycINFO, CINHAL (earliest entry to March 2012) and reference lists of articles. Two reviewers examined the titles and abstracts, and used a hierarchical template to identify comparative design studies evaluating the effectiveness of safety features and alerts at the point of pharmacy order entry. The two reviewers independently assessed the quality of the included studies using Cochrane Collaboration’s risk of bias tool. Results: Three randomised trials and two before-after studies met our criteria. Four studies involved integrated care facilities and one was hospital-based. The studies were all from the United States (US). The five studies demonstrated statistically significant reduction in medication errors in patients with renal insufficiency, pregnant women dispensed US Food Drug and Administration (FDA) risk category D (evidence of fetal risk but therapeutic benefits can outweigh the risk) or X (evidence suggests that risk to the fetus outweighs therapeutic benefits) medication, first dispensing of inappropriate medications in patients aged 65 and above, co-dispensing of interacting drugs, and adverse drug events related to hyperkalaemia. Conclusions: This systematic review shows that the safety features of ePMR systems are effective in alerting users about potential clinical hazards and errors during pharmacy order entry. There are however, problems

Background Medication non-adherence is considered an important cause of morbidity and mortality in primary care. This study aims to determine the effectiveness, cost effectiveness and acceptability of a complex intervention delivered by community pharmacists, the New Medicine Service (NMS), compared with current practice in reducing non-adherence to, and problems with, newly prescribed medicines for chronic conditions. Methods/design Research subject group: patients aged 14 years and above presenting in a community pharmacy for a newly prescribed medicine for asthma/chronic obstructive pulmonary disease (COPD); hypertension; type 2 diabetes or anticoagulant/antiplatelet agents in two geographical regions in England. Design: parallel group patient-level pragmatic randomized controlled trial. Interventions: patients randomized to either: (i) current practice; or (ii) NMS intervention comprising pharmacist-delivered support for a newly prescribed medicine. Primary outcomes: proportion of adherent patients at six, ten and 26 weeks from the date of presenting their prescriptions at the pharmacy; cost effectiveness of the intervention versus current practice at 10 weeks and 26 weeks; in-depth qualitative understanding of the operationalization of NMS in pharmacies. Secondary outcomes: impact of NMS on: patients’ understanding of their medicines, pharmacovigilance, interprofessional and patient-professional relationships and experiences of service users and stakeholders. Economic analysis: Trial-based economic analysis (cost per extra adherent patient) and long-term modeling of costs and health effects (cost per quality-adjusted-life-year) will be conducted from the perspective of National Health Service (NHS) England, comparing NMS with current practice. Qualitative analysis: a qualitative study of NMS implementation in different community settings, how organizational influences affect NMS delivery, patterns of NMS consultations and experiences of professionals and patien

It was proposed that a phase separated system might be utilised to deliver a concentrated polysaccharide mucosal protective coating in gastro oesophageal reflux disease (GORD). In this context the phase behaviour of xanthan gum in combination with sodium alginate and other polymers was studied. Above a threshold concentration of alginate, aqueous mixtures of xanthan exhibited phase separation, resulting in loss of normal viscoelastic properties and the formation of a low viscosity system. The shape of the phase diagram showed behaviour typical of a segregative system, with the continuous phase composed exclusively of alginate and the disperse phase being rich in xanthan gum. Increasing alginate molecular weight reduced the threshold concentration for separation, as predicted by the Flory-Huggins theory, but changes in alginate mannuronate:guluronate ratio had no effect. Increasing ionic strength elevated the threshold concentration. Xanthan separation was elicited by other aqueous anionic polyelectrolytes, but not neutral water soluble polymers. Scleroglucan, another rigid-rod polysaccharide, was investigated as an alternative to xanthan but did not show similar separation behaviour, suggesting that the charge on the xanthan molecule is a necessary prerequisite. Reversal of phase separation by dilution across the phase boundary provided increases in viscosity. A 1% xanthan:2% alginate mixture doubled in viscosity whereas if diluted with simulated gastric fluid a seven-fold increase was seen, as a result of conversion to an alginic acid gel. This offers a mechanism for producing the desired viscosity barrier. Low viscosity polyelectrolytes, with concentrations close to the phase boundary yielded the greatest viscosity increases. In the phase separated system, the disperse phase exhibited an unusual strand-like morphology whose birefringence suggests a liquid crystalline structure. The variable size of the strands was explained in terms of kinetics of xanthan molecula

It was proposed that a phase separated system might be utilised to deliver a concentrated polysaccharide mucosal protective coating in gastro oesophageal reflux disease (GORD). In this context the phase behaviour of xanthan gum in combination with sodium alginate and other polymers was studied. Above a threshold concentration of alginate, aqueous mixtures of xanthan exhibited phase separation, resulting in loss of normal viscoelastic properties and the formation of a low viscosity system. The shape of the phase diagram showed behaviour typical of a segregative system, with the continuous phase composed exclusively of alginate and the disperse phase being rich in xanthan gum. Increasing alginate molecular weight reduced the threshold concentration for separation, as predicted by the Flory-Huggins theory, but changes in alginate mannuronate:guluronate ratio had no effect. Increasing ionic strength elevated the threshold concentration. Xanthan separation was elicited by other aqueous anionic polyelectrolytes, but not neutral water soluble polymers. Scleroglucan, another rigid-rod polysaccharide, was investigated as an alternative to xanthan but did not show similar separation behaviour, suggesting that the charge on the xanthan molecule is a necessary prerequisite. Reversal of phase separation by dilution across the phase boundary provided increases in viscosity. A 1% xanthan:2% alginate mixture doubled in viscosity whereas if diluted with simulated gastric fluid a seven-fold increase was seen, as a result of conversion to an alginic acid gel. This offers a mechanism for producing the desired viscosity barrier. Low viscosity polyelectrolytes, with concentrations close to the phase boundary yielded the greatest viscosity increases. In the phase separated system, the disperse phase exhibited an unusual strand-like morphology whose birefringence suggests a liquid crystalline structure. The variable size of the strands was explained in terms of kinetics of xanthan molecula

Conference presentation summarising the results of the Scaling Up PINCER intervention

An oral presentation on "Improving prescribing safety in general practices in the East Midlands through the Scaling Up PINCER intervention"