Search

Chiang Mai is home to approximately 400 diasporic Punjabis, some of whom are sixth-generation residents of Thailand. While their transnational orientation, distinct sartorial choices and cultural practices might present them as outsiders to essential Thainess, Northern Thai Punjabis transgress the national image of Thainess and subjectively consider themselves to be Northern (Lanna) Thais. At the same time, these Thai citizens avail themselves of Overseas Citizenship of India (OCI) status for privileged access to economic, cultural and educational resources in India. Based on 51 in-depth interviews and 17 focus group studies among resident Hindu, Sikh and Namdhari Sikh communities in Northern Thailand, this research explores family histories, selective transnationalism, and regional Lanna identities among these overseas Punjabis. As this article will argue, while Punjabi Thais maintain their networks and cultural connections with an historic ancestral homeland, they also cultivate forms of local cultural intimacy in ways which leapfrog the linguistic and cultural hegemony of Thai national identity. [ABSTRACT FROM AUTHOR]

Background: Locum working in healthcare organisations has benefits for individual doctors and organisations but there are concerns about the impact of locum working on continuity of care, patient safety, team function and cost. We conducted a national survey of NHS Trusts in England to explore locum work, and better understand why and where locum doctors were needed; how locum doctors were engaged, supported, perceived and managed; and any changes being made in the way locums are used. Methods: An online survey was sent to 191 NHS Trusts and 98 were returned (51%) including 66 (67%) acute hospitals, 26 (27%) mental health and six (6%) community health providers. Data was analysed using frequency tables, t-tests and correlations. Free-text responses were analysed using thematic analysis. Results: Most NHS Trusts use locums frequently and for varying lengths of time. Trusts prefer to use locums from internal locum banks but frequently rely on locum agencies. The benefits of using locums included maintaining workforce capacity and flexibility. Importantly, care provided by locums was generally viewed as the same or somewhat worse when compared to care provided by permanent doctors. The main disadvantages of using locum agencies included cost, lack of familiarity and impact on organisational development. Some respondents felt that locums could be unreliable and less likely to be invested in quality improvement. NHS Trusts were broadly unfamiliar with the national guidance from NHS England for supporting locums and there was a focus on processes like compliance checks and induction, with less focus on providing feedback and support for appraisal. Conclusions: Locum doctors provide a necessary service within NHS Trusts to maintain workforce capacity and provide patient care. There are potential issues related to the way that locums are perceived, utilised, and supported which might impact the quality of the care that they provide. Future research should consider the arrangements for locum working and the performance of locums and permanent doctors, investigating the organisation of locums in order to achieve safe and high-quality care for patients. [ABSTRACT FROM AUTHOR]

Salt sensitivity is a trait in which high dietary sodium (Na+) intake causes an increase in blood pressure (BP). We previously demonstrated that in the gut, elevated dietary Na+ causes dysbiosis. The mechanistic interplay between excess dietary Na+-induced alteration in the gut microbiome and sex differences is less understood. The goal of this study was to identify novel metabolites in sex differences and blood pressure in response to a high dietary Na+ intake. We performed stool and plasma metabolomics analysis and measured the BP of human volunteers with salt intake above or below the American Heart Association recommendations. We also performed RNA sequencing on human monocytes treated with high salt in vitro. The relationship between BP and dietary Na+ intake was different in women and men. Network analysis revealed that fatty acids as top subnetworks differentially changed with salt intake. We found that women with high dietary Na+ intake have high levels of arachidonic acid related metabolism, suggesting a role in sex differences of the blood pressure response to Na+. The exposure of monocytes to high salt in vitro upregulates the transcription of fatty acid receptors and arachidonic acid-related genes. These findings provide potentially novel insights into metabolic changes underlying gut dysbiosis and inflammation in salt sensitivity of BP. [ABSTRACT FROM AUTHOR]

Hindu gods have been worshipped alongside the Lord Buddha and traditional spirits by Thai Theravada Buddhists for hundreds of years. During the past two decades there has been a spectacular boom in new forms of worship of Ganesha, the elephant-headed god of success and remover of obstacles. At these ostensibly religious events and festivals, Thai followers wear Indian clothing and consume Indian foods. Processions incorporate Indian music ensembles and dancers for accompaniment, entertainment and ambience. Through analysis of three Ganesha-sponsoring institutions, together with interviews and ethnography among both institution owners and patrons in Chiang Mai, Thailand, this article examines the role of Indian-tagged symbolic accoutrements as part of a religious experience for Thai people today. As this article argues, while Ganesha is central to the cult, and indeed, the main event, these accoutrements serve the dual purpose of creating a visual/visceral experience of cultural tourism of Indian-ness for Thai worshippers and catering to the needs of Ganesha as an Indian god in the eyes of Thais. [ABSTRACT FROM AUTHOR]

Taking apart these steps is painstaking in every sense of the word: the ostensible crimes are the horrific events and human rights abuses committed by soldiers at the behest of the Myanmar state. MacLean argues for such a fundamental shift by calling the Myanmar state army "insurgent"; even so, the term I Tatmadaw i ("royal army") is used instead of I sit tat i , or the vernacular for "armed forces" (67). [Extracted from the article]

Simulation-based education (SBE) is recognized as an effective interprofessional teaching and learning method. Whilst there is a large volume of research evidence concerning elements of SBE there is a lack of clarity concerning foundational principles of best practice. This is important for educators wishing to utilize high-quality SBE to deliver interprofessional education. The aim of this review is to synthesize review evidence of SBE best practice in a broad range of pre-registration healthcare programs and contextualize findings in light of relevant educational theory. A systematic search of PubMed, Scopus, Medline/Ovid, British Nursing Index, and the Cochrane Library databases was undertaken in February 2020. Data extraction and quality evaluation were undertaken by two authors. Fifteen reviews were included. In addition to identifying barriers and enablers to implementation, three interdependent themes regarding SBE best practice were found: curriculum level integration and planning (curriculum level integration, the opportunity for deliberate repeated practice, distribution, and sequencing); simulation design and delivery (clearly defined learning outcomes and benchmarks, pre-brief, multiple learning strategies, interactivity and individualized learning, feedback, and debrief); and resources (facilitator competency, controlled environments). These themes broadly align with the social constructivist theory of experiential learning whereby structured opportunities to learn via concrete experience, reflective observation, abstract conceptualization, and active experimentation are provided through effective planning, design, and delivery of SBE. Interdependencies suggest that integration of SBE at curriculum-level enables planning and implementation of best practice principles which are associated with effective learning, which also inform and facilitate the availability of adequate simulation resources. [ABSTRACT FROM AUTHOR]

Internationally, there has been substantial growth in temporary working, including in the medical profession where temporary doctors are known as locums. There is little research into the implications of temporary work in health care. In this paper, we draw upon theories concerning the sociology of the medical profession to examine the implications of locum working for the medical profession, healthcare organisations and patient safety. We focus particularly on the role of organisations in professional governance and the positioning of locums as peripheral to or outside the organisation, and the influence of intergroup relationships (in this case between permanent and locum doctors) on professional identity. Qualitative semi‐structured interviews were conducted between 2015 and 2017 in England with 79 participants including locum doctors, locum agency staff, and representatives of healthcare organisations who use locums. An abductive approach to analysis combined inductive coding with deductive, theory‐driven interpretation. Our findings suggest that locums were perceived to be inferior to permanently employed doctors in terms of quality, competency and safety and were often stigmatised, marginalised and excluded. The treatment of locums may have negative implications for collegiality, professional identity, group relations, team functioning and the way organisations deploy and treat locums may have important consequences for patient safety. [ABSTRACT FROM AUTHOR]

Objectives: Although there is much evidence to support the use of simulation‐based education (SBE) in undergraduate education of health care professionals, less attention has been paid to how SBE, viewed as a complex intervention, is implemented and becomes embedded and sustained. This paper aims to explore factors that inhibited or promoted SBE becoming normal practice in undergraduate health care professional programmes. Methods: Participants involved in the organisation, design and delivery of SBE in the north of England were recruited purposefully from higher education institutions (HEI) and National Health Service (NHS) Trusts through local networks for qualitative telephone interviews. Transcripts were analysed inductively using a hybrid approach involving simultaneous inductive open coding and deductive coding using normalisation process theory (NPT) as a theoretical lens. Findings: A total of 12 NHS staff from 11 trusts and seven individuals from four HEIs were interviewed. There was considerable variation in the approach taken to implementation across organisations, which resulted in varying degrees of embeddedness. Implementation was challenged or enabled by organisational leadership, professional buy‐in and the development and maturity of the strategic approach. Variation in understanding of the scope and pedagogical aims of SBE led to inequity between professions and organisations in investment and participation, as well as design and delivery of SBE. Conclusions: Given the complexity of SBE, best practice in implementation should be considered fundamental to the successful delivery of SBE. The findings provide an explanation of how contextual factors can support or hinder implementation to maximise potential benefits and learning outcomes; this understanding can be used to better inform development of SBE strategies and highlight potential factors needed to navigate contextual barriers so that learning outcomes can be maximised. Although "validity" is a central concept for educators, this research outlining the conversion of outcome frameworks to assessment practice illustrates that the concept can easily get lost in translation. [ABSTRACT FROM AUTHOR]

Objectives: The introduction of medical revalidation in 2012 has been a controversial and radical change to medical regulation in the UK. It involved changes to the way organizations manage medical performance, and to the relationships between doctors, their employers and the professional regulatory body. In this paper, we explore the implementation of medical revalidation, analysing the change process and its consequences for doctors and organizations. Methods: We conducted a qualitative investigation of the implementation of revalidation in 15 case study organizations in 2016–2017, collecting documents and undertaking a total of 80 interviews with medical and non-medical staff. We used Normalization Process Theory to frame and structure the analysis. Results: Revalidation reforms were largely implemented successfully within and across our case study organizations, with evidence of growing acceptance of the purpose and processes of revalidation. There was an emergent shift from securing doctors' compliance towards the use of revalidation to strengthen clinical governance, and towards evaluating revalidation processes and seeking to make them more effective. However, there was substantial variation in the implementation and impact of revalidation; it was still not fully understood by many doctors, and revalidation processes were highly reliant on a few key individuals in each organization. The changes brought about by revalidation have had consequences for the way in which doctors construct their identity and the way they relate to the organizations in which they work. Conclusion: Despite considerable early scepticism and overt opposition in the medical profession, revalidation has become gradually accepted, embedded and even valued over time. Its impact and effectiveness are still questioned by many stakeholders, and the focus of attention has now shifted towards revising and improving the way revalidation works in practice. [ABSTRACT FROM AUTHOR]

Flight attendant work, although now referred to with gender-neutral terminology, continues to be archetypically feminine. Male flight attendants are often assumed to be gay, which frequently includes an emasculated, hyper-sexualised dimension to the stereotyped minority within the female-dominated occupation. The ways in which straight men navigate this occupation and its gendered/hypersexualised connotations problematises both the notions of a gay community as well as flight attendant work as inherently or necessarily feminine. Based on ethnography amongst flight attendants who work for two international airlines, this paper considers how notions of masculinity and heteronormativity operate in a feminised occupational role and how workplace dynamics affect gendered senses of self and relations with others, including with coworkers and in the public. [ABSTRACT FROM AUTHOR]

Background: Omega-3 polyunsaturated fatty acids, specifically the fish-oil-derived eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been proposed as inflammation-resolving agents via their effects on adipose tissue.Objective: We proposed to determine the effects of EPA and DHA on human adipocyte differentiation and inflammatory activation in vitro.Methods: Primary human subcutaneous adipocytes from lean and obese subjects were treated with 100 μM EPA and/or DHA throughout differentiation (differentiation studies) or for 72 h postdifferentiation (inflammatory studies). THP-1 monocytes were added to adipocyte wells for co-culture experiments. Subcutaneous and visceral adipose explants from obese subjects were treated for 72 h with EPA and DHA. Oil Red O staining was performed on live cells. Cells were collected for mRNA analysis by quantitative polymerase chain reaction, and media were collected for protein quantification by enzyme-linked immunosorbent assay.Results: Incubation with EPA and/or DHA attenuated inflammatory response to lipopolysaccharide (LPS) and monocyte co-culture with reduction in post-LPS mRNA expression and protein levels of IL6, CCL2 and CX3CL1. Expression of inflammatory genes was also reduced in the endogenous inflammatory response in obese adipose. Both DHA and EPA reduced lipid droplet formation and lipogenic gene expression without alteration in expression of adipogenic genes or adiponectin secretion.Conclusions: EPA and DHA attenuate inflammatory activation of in vitro human adipocytes and reduce lipogenesis. [ABSTRACT FROM AUTHOR]

In 1935, two Burmese filmmakers traveled to Tokyo with the intention of acquiring the latest sound recording equipment and training in sound-on-film production. In addition to these stated goals, in Japan they co-produced the feature film Japan Yin Thwe/Nippon Musume, 'Japanese Darling.' The film depicts daring young Burmese aviators and a budding romance with a Japanese woman. The active harnessing of the symbolic capital of aviation - the ideological notion of airmindedness - through the mimetic capacities of cinema, could be seen as a prescient example of Pan-Asianism, predating Daitoa Kyoeiken 'Greater East-Asia Co-Prosperity Sphere' propaganda. The film's explicit encouragement of Burmese techno-nationalism offers a compelling contrast to other examples of anti-colonial nationalism, which emphasize notions of ethnic history and Buddhist morality and concerns of religious decline in the face of foreign imperialism. However, a comprehensive analysis of the film industry and commercial aviation in Japan in the 1930s reveals a structural impetus for this collaboration, arguably overshadowing ideological motivations and results. [ABSTRACT FROM AUTHOR]

The first ionization constants of phosphoric acid and acetic acid have been measured in H2O and D2O from T = 373 K to T = 573 K and p = 11.5 and 20 MPa to yield accurate values of the deuterium isotope effect. Sequential conductivity measurements using a unique high-precision flow-through AC conductance instrument were made on dilute (m ≤ 10–2 mol·kg−1) aqueous solutions of phosphoric acid, acetic acid, potassium dihydrogenphosphate, sodium acetate, potassium hydroxide, sodium hydroxide, hydrochloric acid, potassium chloride and sodium chloride in light and heavy water under the same experimental conditions (temperature, pressure, flow-rate), so that systematic experimental errors between the two solvents would cancel. The experimental molar conductivities of potassium dihydrogenphosphate, sodium acetate, hydrochloric acid, and the corresponding chloride salts were used to calculate the molar conductivities for the fully dissociated acids [λ(D+), λ(D2PO4−) and λ(CH3COO−)]. Together with the molar conductivities measured for partially ionized acids, Λ(D3PO4) and Λ(CH3COOD), these yielded values for the degree of dissociation, α, and the ionization constants, pKa1. The iterative process was repeated at each temperature in both H2O and D2O where the Fuoss-Hsia-Fernández-Prini ("FHFP") and the Quint-Viallard ("QV") equations were used to correct for ionic strength. The resulting values of pKa1 for phosphoric acid in H2O agree with those reported from conductivity studies by previous works over the entire temperature range and with low temperature potentiometric studies to within the combined experimental uncertainties. The results for pKa1 above 298.15 K in D2O are the first to be reported in the literature. The new values for pKa(CH3COOD) yield more accurate values for the deuterium isotope effect on the ionization constant of acetic acid than those reported in our previous work (Erickson et al. in J. Phys. Chem. B. 123:9503–9506, 2019). The single-ion limiting conductivities for dihydrogenphosphate and acetate in D2O, λ(D2PO4−) and λ(CH3COO−), were found to be the same as those in H2O once corrected for viscosity effects, confirming previous observations for other ions. [ABSTRACT FROM AUTHOR]

The Second World War indelibly transformed the political landscape of Southeast Asia. Few people in Myanmar’s Shan State today have any direct memories of the Japanese occupation and Allied bombing campaigns in the area. Therefore, folklore offers an important connection to the historical events and cultural geographies of war. Based on ethnography among Shan villagers carried out in 2015, this article discusses folklore regarding two specific aerial bombing incidents between the towns of Kyaukme and Hsipaw, Shan State. According to these narratives, local spiritual powers influenced the effects of either the bombs or the airplanes themselves. Through analysis of the stories, we learn of the capacity for local spiritual powers to extend their domain to the air, which, in turn offers a new way to understand airmindedness as a relationship with aviation technology and aerial geographies of war. In addition to articulating a Buddhist and spiritual framework for airmindedness, these stories also mobilize physical evidence not only to confirm their truth, but also to encourage Buddhist notions of morality in the future. [ABSTRACT FROM AUTHOR]

Ongoing political changes, diasporic mobilities and new communication modalities present anthropologists with novel challenges for conducting ethnographic field work. As both configurations of and expectations for varied forms of social identity change, so too has the notion of the native, what Arjun Appadurai once called the technical preserve of anthropologists. Through reflection on contemporary field work experiences in Kazakhstan, the Philippines and South Korea, this set of papers considers how changing political and cultural regimes, diasporic mobilities and social media also tag the native anthropologist, a concept which can be to the advantage of the researcher, but also can create new problems and complexities for research. [ABSTRACT FROM AUTHOR]

Background: Medical revalidation is the process by which all licensed doctors are legally required to demonstrate that they are up to date and fit to practise in order to maintain their licence. Revalidation was introduced in the United Kingdom (UK) in 2012, constituting significant change in the regulation of doctors. The governing body, the General Medical Council (GMC), envisages that revalidation will improve patient care and safety. This potential however is, in part, dependent upon how successfully revalidation is embedded into routine practice. The aim of this study was to use Normalisation Process Theory (NPT) to explore issues contributing to or impeding the implementation of revalidation in practice.Methods: We conducted seventy-one interviews with sixty UK policymakers and senior leaders at different points during the development and implementation of revalidation: in 2011 (n = 31), 2013 (n = 26) and 2015 (n = 14). We selected interviewees using purposeful sampling. NPT was used as a framework to enable systematic analysis across the interview sets.Results: Initial lack of consensus over revalidation's purpose, and scepticism about its value, decreased over time as participants recognised the benefits it brought to their practice (coherence category of NPT). Though acceptance increased across time, revalidation was not seen as a legitimate part of their role by all doctors. Key individuals, notably the Responsible Officer (RO), were vital for the successful implementation of revalidation in organisations (cognitive participation category). The ease with which revalidation could be integrated into working practices varied greatly depending on the type of role a doctor held and the organisation they work for and the provision of resources was a significant variable in this (collective action category). Formal evaluation of revalidation in organisations was lacking but informal evaluation was taking place. Revalidation had not yet reached the stage where feedback was being used for improvement (reflexive monitoring category).Conclusions: Requiring all organisations to use the same revalidation model made revalidation easy to integrate into existing work for some but problematic for others. In order for revalidation to be fully embedded and successful, impeding factors, such as a lack of resources, need to be addressed. [ABSTRACT FROM AUTHOR]

In spite of the radical changes brought in by new communication technologies, bicycle messengers are still integral to many urban economies throughout the world. While all messengers creatively navigate through dense, hostile traffic on the streets, women face additional challenges in this male-dominated occupation. They not only confront gendered expectations, difficulties, and harassment from co-workers and the public, but also experience struggles to access restrooms during their workday. This is an overlooked – but crucial – corporeal challenge of bike messengering: how, when, and where to excrete while on the job. The issue of restroom access is compounded by instances of gendered policing, based on a stereotype that a bike messenger is an aggressive male. Drawing from ethnographic research in two North American cities and additional interview material, this article will first offer an overview of the job and then examine how women messengers work in this male-dominated occupational world. Next, it will consider inequities of toilet access, gate keeping and belonging, and how messengers are excluded from office restroom facilities. Finally, it will examine rationale for, as well as the geographic strategies that women messengers employ during their workdays in order to excrete in (relative) peace. [ABSTRACT FROM PUBLISHER]

Dietary consumption of long-chain omega-3 polyunsaturated fatty acids (n-3 PUFA) may protect against cardiometabolic disease through modulation of systemic and adipose inflammation. However, it is often difficult to detect the subtle effects of n-3 PUFA on inflammatory biomarkers in traditional intervention studies. We aimed to identify novel n-3 PUFA modulated gene expression using unbiased adipose transcriptomics during evoked endotoxemia in a clinical trial of n-3 PUFA supplementation. We analyzed adipose gene expression using RNA sequencing in the fenofibrate and omega-3 fatty acid modulation of endotoxemia (FFAME) trial of healthy individuals at three timepoints: before and after n-3 PUFA supplementation (n=8; 3600mg/day EPA/DHA) for 6weeks compared with placebo (n=6), as well as during a subsequent evoked inflammatory challenge (lipopolysaccharide 0.6ng/kg i.v.). As expected, supplementation with n-3 PUFA vs. placebo alone had only modest effects on adipose tissue gene expression, e.g., increased expression of immediate early response IER2. In contrast, the transcriptomic response to evoked endotoxemia was significantly modified by n-3 PUFA supplementation, with several genes demonstrating significant n-3 PUFA gene-nutrient interactions, e.g., enhanced transcriptional responses in specific immune genes IER5L, HES1, IL1RN, CCL18, IL1RN, IL7R, IL8, CCL3 and others. These data highlight potential mechanisms whereby n-3 PUFA consumption may enhance the immune response to an inflammatory challenge. In conclusion, unbiased transcriptomics during evoked inflammation reveals novel immune modulating functions of n-3 PUFA nutritional intervention in a dynamic pathophysiological setting. [ABSTRACT FROM AUTHOR]

This article traces the revenue category and legal concept of the Waste Land in Burma/ Myanmar from its original application by the British colonial apparatus in the nineteenth century, to its later use in tandem with Burma Army counterinsurgent tactics starting in the 1960s, and finally to the 2012 land laws and current issues in international investment. This adaptation of colonial ideas about territorialization in the context of an ongoing civil war offers a new angle for understanding the relationship between military tactics and the political economy of conflict and counterinsurgent strategies which crucially depended on giving local militias-both government and nongovernment-high degrees of autonomy. The recent government changes, including the more civilian representation in parliament and its shift to engage with Western economies, raise questions regarding the future of the military, as well as local autonomy and the rural peasantry's access to land. As increasing numbers of international investors are poised to enter the Myanmar market, this article will revisit notions of land use and appropriation, and finally the role of the army and its changing relationship with Waste Lands. [ABSTRACT FROM AUTHOR]

The author examines the context and experiences of Shan migrants from Burma regarding men who work in male host clubs in Chiang Mai, northern Thailand. While Shan commercial sex workers in Thailand often have cultural understandings of gender and sexual categories in the Shan and Burmese context, their direct experience in performing sexuality takes place in Thailand, and is economically mediated. This study seeks to answer two questions. First, to what extent do migrant Shans ascribe specific sexual and gender comportment to Thai cultural practices? Second, how might engagement with a gay commercial sex industry affect how these Shan men remember and relate to gender and sexual categories back in the Shan state in Burma? As ethnographic evidence shows, Shan male sex workers are able to adapt to certain cultural aspects of Thai ke [gay] identity, but they posit their own masculinity against former familiar categories of sexuality and gender. [ABSTRACT FROM AUTHOR]

Much of what is written about airports is from the perspective of a visionary architect, or from the experience of the cosmopolitan traveller. Airport workers, aside from their intimate knowledge of the airport space, know something about terminals that their designers and itinerant occupants do not: how they are haunted. In Yangon, Myanmar and Bangkok, Thailand, airport workers exchange occupational ghost lore regarding sightings, motives and histories of spirits within aviation. They also make use of hybrid Buddhist practices to ward off danger from airport spaces, and to make their own future travels safe and propitious. In addition to challenging the notion of the airport as the ‘non-place’, this paper demonstrates that ecumenical practices and hauntings crucially frame techno-modernity, uniting local and transregional culture with the global semantic legibility of the logistic superstructure of passenger aviation. [ABSTRACT FROM PUBLISHER]

Objectives: This study sought to identify loci for coronary artery calcification (CAC) in patients with chronic kidney disease (CKD). Background: CKD is associated with increased CAC and subsequent coronary heart disease (CHD), but the mechanisms remain poorly defined. Genetic studies of CAC in CKD may provide a useful strategy for identifying novel pathways in CHD. Methods: We performed a candidate gene study (∼2,100 genes; ∼50,000 single nucleotide polymorphisms [SNPs]) of CAC within the CRIC (Chronic Renal Insufficiency Cohort) study (N = 1,509; 57% European, 43% African ancestry). SNPs with preliminary evidence of association with CAC in CRIC were examined for association with CAC in the PennCAC (Penn Coronary Artery Calcification) (N = 2,560) and AFCS (Amish Family Calcification Study) (N = 784) samples. SNPs with suggestive replication were further analyzed for association with myocardial infarction (MI) in the PROMIS (Pakistan Risk of Myocardial Infarction Study) (N = 14,885). Results: Of 268 SNPs reaching p < 5 × 10−4 for CAC in CRIC, 28 SNPs in 23 loci had nominal support (p < 0.05 and in same direction) for CAC in PennCAC or AFCS. Besides chr9p21 and COL4A1, known loci for CHD, these included SNPs having reported genome-wide association study association with hypertension (e.g., ATP2B1). In PROMIS, 4 of the 23 suggestive CAC loci (chr9p21, COL4A1, ATP2B1, and ABCA4) had significant associations with MI, consistent with their direction of effect on CAC. Conclusions: We identified several loci associated with CAC in CKD that also relate to MI in a general population sample. CKD imparts a high risk of CHD and may provide a useful setting for discovery of novel CHD genes and pathways. [Copyright &y& Elsevier]

Background: Epidermal growth factor receptor (EGFR) gene mutations identify patients with non-small cell lung cancer (NSCLC) who have a high likelihood of benefiting from treatment with anti-EGFR tyrosine kinase inhibitors. Sanger sequencing is widely used for mutation detection but can be technically challenging, resulting in longer turn-around-time, with limited sensitivity for low levels of mutations. This manuscript details the technical performance verification studies and external clinical reproducibility studies of the cobas EGFR Mutation Test, a rapid multiplex real-time PCR assay designed to detect 41 mutations in exons 18, 19, 20 and 21. Methods: The assay's limit of detection was determined using 25 formalin-fixed paraffin-embedded tissue (FFPET)-derived and plasmid DNA blends. Assay performance for a panel of 201 specimens was compared against Sanger sequencing with resolution of discordant specimens by quantitative massively parallel pyrosequencing (MPP). Internal and external reproducibility was assessed using specimens tested in duplicate by different operators, using different reagent lots, instruments and at different sites. The effects on the performance of the cobas EGFR test of endogenous substances and nine therapeutic drugs were evaluated in ten FFPET specimens. Other tests included an evaluation of the effects of necrosis, micro-organisms and homologous DNA sequences on assay performance, and the inclusivity of the assay for less frequent mutations. Results: A >95% hit rate was obtained in blends with >5% mutant alleles, as determined by MPP analysis, at a total DNA input of 150 ng. The overall percent agreement between Sanger sequencing and the cobas test was 96.7% (negative percent agreement 97.5%; positive percent agreement 95.8%). Assay repeatability was 98% when tested with two operators, instruments, and reagent lots. In the external reproducibility study, the agreement was > 99% across all sites, all operators and all reagent lots for 11/12 tumors tested. Test performance was not compromised by endogenous substances, therapeutic drugs, necrosis up to 85%, and common micro-organisms. All of the assessed less common mutations except one (exon 19 deletion mutation 2236_2248 > AGAC) were detected at a similar DNA input level as that for the corresponding predominant mutation. Conclusion: The cobas EGFR Mutation Test is a sensitive, accurate, rapid, and reproducible assay. [ABSTRACT FROM AUTHOR]

Copy thachin, or Burmese cover songs of international hits, dominates the popular music scene in contemporary Burma/Myanmar. These songs in Burmese often retain melodic and stylistic patterns with international popular hits, but have lyrics rewritten by Burmese poets with varying degrees of fidelity to their original meaning. As I will argue, because of its explicit transience,copy thachinconstitutes a mimetic transcription device whereby Burmese poets and musicians can engage an international other, but do so in a way that points to—yet does not always reveal—the global character of popular music. [ABSTRACT FROM PUBLISHER]

Recent advances in RNA sequencing (RNA-Seq) have enabled the discovery of novel transcriptomic variations that are not possible with traditional microarray-based methods. Tissue and cell specific transcriptome changes during pathophysiological stress in disease cases versus controls and in response to therapies are of particular interest to investigators studying cardiometabolic diseases. Thus, knowledge on the relationships between sequencing depth and detection of transcriptomic variation is needed for designing RNA-Seq experiments and for interpreting results of analyses. Using deeply sequenced Illumina HiSeq 2000 101 bp paired-end RNA-Seq data derived from adipose of a healthy individual before and after systemic administration of endotoxin (LPS), we investigated the sequencing depths needed for studies of gene expression and alternative splicing (AS). In order to detect expressed genes and AS events, we found that ∼100 to 150 million (M) filtered reads were needed. However, the requirement on sequencing depth for the detection of LPS modulated differential expression (DE) and differential alternative splicing (DAS) was much higher. To detect 80% of events, ∼300 M filtered reads were needed for DE analysis whereas at least 400 M filtered reads were necessary for detecting DAS. Although the majority of expressed genes and AS events can be detected with modest sequencing depths (∼100 M filtered reads), the estimated gene expression levels and exon/intron inclusion levels were less accurate. We report the first study that evaluates the relationship between RNA-Seq depth and the ability to detect DE and DAS in human adipose. Our results suggest that a much higher sequencing depth is needed to reliably identify DAS events than for DE genes. [ABSTRACT FROM AUTHOR]

Background: Race- and gender-variation in innate immunity may contribute to demographic differences in inflammatory and cardiometabolic disease; yet their influence on dynamic responses during inflammatory stress is poorly understood. Our objective was to examine race and gender influence on the response to experimental endotoxemia. Methods: The Genetics of Evoked Responses to Niacin and Endotoxemia (GENE) study was designed to investigate regulation of inflammatory and metabolic responses during low-grade endotoxemia (LPS 1 ng/kg intravenously) in healthy individuals (median age 24, IQR=7) of European (EA; n=193, 47% female) and African ancestry (AA; n=101, 59% female). Results: Baseline clinical, metabolic, and inflammatory biomarkers by race and gender were consistent with epidemiological literature; pre-LPS cytokines (e.g. median (IQR) IL-6, 2.7 (2) vs.2.1 (2) pg/ml, P=0.001) were higher in AA than EA. In contrast, acute cytokine responses during endotoxemia were lower in AA than EA (e.g. median (IQR) peak IL-1RA, 30 (38) vs.43 (45) ng/ml P=0.002) as was the induction of hepatic acute-phase proteins (e.g. median (IQR) peak CRP 12.9 (9) vs.17.4 (12) mg/L P=0.005). Further, baseline levels of cytokines were only weakly correlated with peak inflammatory responses (all rs <0.2) both in AA and in EA. There were less pronounced and less consistent differences in the response by gender, with males having a higher AUC for CRP response compared to females (median (IQR) AUC: 185 (112) vs. 155 (118), P=0.02). Conclusions: We observed lower levels of evoked inflammation in response to endotoxin in AA compared with EA, despite similar or higher baseline levels of inflammatory markers in AA. Our data also suggest that levels of inflammatory biomarkers measured in epidemiological settings might not predict the degree of acute stress-response or risk of diseases characterized by activation of innate immunity. Trial registration: FDA clinicaltrials.gov registration number NCT00953667 [ABSTRACT FROM AUTHOR]

Background: In order to achieve Millennium Development Goals 4, 5 and 6, it is essential to address adolescents' health. Objective: To estimate the additional resources required to scale up adolescent friendly health service interventions with the objective to reduce mortality and morbidity among individuals aged 10 to 19 years in 74 low- and middle- income countries. Methods: A costing model was developed to estimate the financial resources needed to scale-up delivery of a set of interventions including contraception, maternity care, management of sexually transmitted infections, HIV testing and counseling, safe abortion services, HIV harm reduction, HIV care and treatment and care of injuries due to intimate partner physical and sexual violence. Financial costs were estimated for each intervention, country and year using a bottom-up ingredients approach, defining costs at different levels of delivery (i.e., community, health centre, and hospital level). Programme activity costs to improve quality of care were also estimated, including activities undertaken at national-, district- and facility level in order to improve adolescents' use of health services (i.e., to render health services adolescent friendly). Results: Costs of achieving universal coverage are estimated at an additional US$ 15.41 billion for the period 2011-2015, increasing from US$ 1.86 billion in 2011 to US$ 4,31 billion in 2015. This corresponds to approximately US$ 1.02 per adolescent in 2011, increasing to 4.70 in 2015. On average, for all 74 countries, an annual additional expenditure per capita ranging from of US$ 0.38 in 2011 to US$ 0.82 in 2015, would be required to support the scale-up of key adolescent friendly health services. Conclusion: The estimated costs show a substantial investment gap and are indicative of the additional investments required to scale up health service delivery to adolescents towards universal coverage by 2015. [ABSTRACT FROM AUTHOR]

Objectives: This study sought to examine the role of lipoprotein-associated phospholipase A2 (Lp-PLA2/PLA2G7) in human inflammation and coronary atherosclerosis. Background: Lp-PLA2 has emerged as a potential therapeutic target in coronary heart disease. Data supporting Lp-PLA2 are indirect and confounded by species differences; whether Lp-PLA2 is causal in coronary heart disease remains in question. Methods: We examined inflammatory regulation of Lp-PLA2 during experimental endotoxemia in humans, probed the source of Lp-PLA2 in human leukocytes under inflammatory conditions, and assessed the relationship of variation in PLA2G7, the gene encoding Lp-PLA2, with coronary artery calcification. Results: In contrast to circulating tumor necrosis factor-alpha and C-reactive protein, blood and monocyte Lp-PLA2 messenger ribonucleic acid decreased transiently, and plasma Lp-PLA2 mass declined modestly during endotoxemia. In vitro, Lp-PLA2 expression increased dramatically during human monocyte to macrophage differentiation and further in inflammatory macrophages and foamlike cells. Despite only a marginal association of single nucleotide polymorphisms in PLA2G7 with Lp-PLA2 activity or mass, numerous PLA2G7 single nucleotide polymorphisms were associated with coronary artery calcification. In contrast, several single nucleotide polymorphisms in CRP were significantly associated with plasma C-reactive protein levels but had no relation with coronary artery calcification. Conclusions: Circulating Lp-PLA2 did not increase during acute phase response in humans, whereas inflammatory macrophages and foam cells, but not circulating monocytes, are major leukocyte sources of Lp-PLA2. Common genetic variation in PLA2G7 is associated with subclinical coronary atherosclerosis. These data link Lp-PLA2 to atherosclerosis in humans while highlighting the challenge in using circulating Lp-PLA2 as a biomarker of Lp-PLA2 actions in the vasculature. [Copyright &y& Elsevier]

Abstract: Objective: Omega-3 polyunsaturated fatty acids (n-3 PUFA) may protect against the development of cardiovascular disease (CVD). Genotype at key genes such as nitric oxide synthase (NOS3) may determine responsiveness to fatty acids. Gene–nutrient interactions may be important in modulating the development of CVD, particularly in high-risk individuals with the metabolic syndrome (MetS). Methods: Biomarkers of CVD risk, plasma fatty acid composition, and NOS3 single nucleotide polymorphism (SNP) genotype (rs11771443, rs1800783, rs1800779, rs1799983, rs3918227, and rs743507) were determined in 450 individuals with the MetS from the LIPGENE dietary intervention cohort. The effect of dietary fat modification for 12 weeks on metabolic indices of the MetS was determined to understand potential NOS3 gene–nutrient interactions. Results: Several markers of inflammation and dyslipidaemia were significantly different between the genotype groups. A significant gene–nutrient interaction was observed between the NOS3 rs1799983 SNP and plasma n-3 PUFA status on plasma triacylglycerol (TAG) concentrations. Minor allele carriers (AC+AA) showed an inverse association with significantly higher plasma TAG concentrations in those with low plasma n-3 PUFA status and vice versa but the major allele homozygotes (CC) did not. Following n-3 PUFA supplementation, plasma TAG concentrations of minor allele carriers of rs1799983 were considerably more responsive to changes in plasma n-3 PUFA, than major allele homozygotes. Conclusions: Carriers of the minor allele at rs1799983 in NOS3 have plasma TAG concentrations which are more responsive to n-3 PUFA. This suggests that these individuals might show greater beneficial effects of n-3 PUFA consumption to reduce plasma TAG concentrations. [ABSTRACT FROM AUTHOR]

Eastern forms of meditation have been widely studied for their effectiveness in stress management (Walsh and Shapiro American Psychologist 61:227–239, ). Yet few empirical studies have been conducted on the health effects of Judeo-Christian contemplative prayer practices. This study contributes to research in this underdeveloped area by exploring the outcome of a contemporary form of Christian meditation called Centering Prayer (Keating ) on everyday stress and on Christians’ approach to communicating with God. The impact of 10 weekly 2-hour group sessions and individual practice of Centering Prayer 2-times daily by 15 Roman Catholic congregants was hypothesized to decrease participants’ stress and increase their collaborative relationship with God (Pargament et al. Journal for the Scientific Study of Religion 27:90–104, ). Pre-post quantitative and qualitative data on Centering Prayer versus comparison groups supported the hypothesis. [ABSTRACT FROM AUTHOR]

Within the popular music scene of Chiang Mai, Northern Thailand, a handful of restaurants feature live bluegrass bands, with musicians often dressed in U.S. western-style cowboy attire. By intermingling English-language songs with Lanna (Northern Thai) popular songs performed in the style of Appalachian bluegrass music, they use their illusion of the cowboy myth to point to notions of an authentic Lanna past. However, in their borrowing of this international code, they affirm established (Central) Thai boundaries of ethnonational gatekeeping. [ Lanna, Thailand, cowboys, music, nostalgia, bluegrass, identity] [ABSTRACT FROM AUTHOR]

Based on an ethnography of a Shan Buddhist novice ordination in a community of former Shan insurgents and their affiliates, this article discusses the ways in which social conditions push the signification of the ritual beyond the expectations of its orthodox intent. As I argue, it is in the ritual's juxtaposition of sober merit-making with rock music revelry that creates a kind of syncopation which gives the event greater force and social meaning in the social milieu of marginalized Shan people, pushed back by two larger nation-states. [ABSTRACT FROM AUTHOR]

The article informs that intestinal molecules during pregnancy in mice may protect offspring from metabolic disease. It mentions that maternal diet and consequent gut microbiota– derived propionate protects against future obesity and metabolic dysregulation in offspring. It also mentions that mechanisms linking maternal metabolic status during pregnancy to cardiometabolic disease risk in offspring remain elusive.

We examined the influence of sociometric status and the interactive effects of sociometric status and causal information on peers’ initial impressions of an unfamiliar child with autism. Children ( N = 576) enrolled in regular education completed sociometric nominations and responded to videotapes of a child portraying autistic behavior. In contrast to sociometrically average and rejected children, neglected children reported more negative attitudes toward the child with autism and less willingness to engage in academic activities with him. Popular children did not differ from other sociometric groups on self-reported attitudes and behavioral intentions toward the child with autism. We predicted that popular children would be the most responsive to causal information about autism; however, rejected children reported more willingness to engage in activities with the child with autism in the presence of explanatory information when compared to other sociometric groups. [ABSTRACT FROM AUTHOR]

Authors examined the combined effects of descriptive and explanatory information on peers’ perceptions and behavioral intentions toward an unfamiliar child with autism. Children (N=576; M age=10.06 years) were randomly assigned to view two videotapes of a boy engaging in typical and autistic behaviors receiving either descriptive (AUT-D) or descriptive and explanatory information (AUT-D+E). Children responded to measures of attitudes (Adjective Checklist) and behavioral intentions (Shared Activities Questionnaire). Children rated the typical boy more favorably than the boy showing autistic symptoms. When compared to descriptive information alone, the combination of descriptive and explanatory information resulted in improved third- and fourth-graders’ but not fifth-graders’ attitudes toward the child with autism. Combined information improved behavioral intentions across grades; however, girls (vs. boys) were more responsive to information as evidenced by differences in academic intentions. The combination of descriptive and explanatory information about autism appears to have a positive effect on children’s attitudes and behavioral intentions. Implications of the findings are briefly discussed as well as study limitations and recommendations for future research. [Copyright &y& Elsevier]

A fiber optic microsphere-based oligonucleotide array Is described that employs the sequence of the ollgonucleotide probe attached to each microsphere as positional identifiers. Each microsphere serves as an immobilized array feature, functionalized with a unique single-stranded oligonucleotide sequence and randomly distributed into an array of microwells. To determine the sequences attached to individual microspheres, a series of fluorescently labeled combinatorial-pooled oligonucleotide target solutions was designed. Each combinatorial decoding solution is intended to identify the nucleotide at a particular position on every microsphere in the array. The combinatorial target solutions were synthesized by linking the four possible nucleotides at each position to four different fluorescent reporter dyes. As such, when the solutions were hybridized to the array, one of four possible fluorescent responses was generated for each position on a microsphere probe sequence. Adjusting the stringency of hybridization enabled single-base mismatch discrimination, and the signal with the highest intensity corresponded to the perfect nucleotide match. By consecutively exposing the array to a series of combinatorial decoding pool solutions, it was possible to simultaneously determine the sequence of every randomly positioned oligonucleotide-functionalized microsphere in the array. Once mapped, the microsphere array can be used for any typical genomic microarray experiment. [ABSTRACT FROM AUTHOR]

Examines the development of a high-density fiber-optic DNA microarray sensor. Observation of multiple DNA sequences; Random distribution of DNA probe-functionalized microspheres; Use of an optical encoding scheme and custom-built imaging system to register microspheres; Visualization of hybridization using fluorescent-labeled DNA targets.

We have developed a randomly ordered fiber-optic gene array for rapid, parallel detection of unlabeled DNA targets with surface immobilized molecular beacons (MB) that undergo a conformational change accompanied by a fluorescence change in the presence of a complementary DNA target. Microarrays are prepared by randomly distributing MB-functionalized 3-μm diameter microspheres in an array of wells etched in a 500-μm diameter optical imaging fiber. Using several MBs, each designed to recognize a different target, we demonstrate the selective detection of genomic cystic fibrosis related targets. Positional registration and fluorescence response monitoring of the microspheres was performed using an optical encoding scheme and an imaging fluorescence smicroscope system. [ABSTRACT FROM AUTHOR]

Young people's sexual and reproductive health (SRH) continues to be a major challenge in low and middle-income countries, with implications for public health now and in the future. Fortunately there is a growing array of evidence-based interventions, and commitments from governments, development partners and donors, to support programmes that aim to improve young people's SRH. However, in some situations, the technical assistance that governments feel that they need to strengthen and implement national policies and strategies, to move from words to action, is not available. The WHO Adolescent and Youth Sexual and Reproductive Health and Rights (AYSRHR) Technical Assistance (TA) Coordination Mechanism was initiated to help fill this technical assistance gap; to respond to TA requests from ministries of health in ways that are timely, efficient, effective and contribute to strengthening capacity. This paper describes the process of developing the Technical Assistance Coordination Mechanism (TA Mechanism) and the outcomes, experiences and lessons learned after three years of working. It triangulates the findings from a preliminary review of the literature and discussions with selected key informants; the outcomes from a series of structured review meetings; and the documented processes and results of the technical assistance provided to countries. The lessons learned focus on three aspects of the TA Mechanism. How it was conceptualized and designed: through listening to people who provide and receive AYSRHR TA and by reviewing and synthesizing past experiences of TA provision. What the TA Mechanism has achieved: a standardized process for TA provision, at different stages for a range of AYSRHR issues in ten countries in three geographic regions. And what worked well and what did not: which common challenges was the TA Mechanism able to address and which ones persisted despite efforts to avoid or resolve them. The paper ends with the implications of the lessons learned for future action. [ABSTRACT FROM AUTHOR]

Presents a lifespan study of students who graduated in 1946-1955 from Yellow Springs, Ohio-based Antioch College's liberal arts cooperative education program. Career histories; College co-op experiences; Discussion in terms of Bandura's (1986) self-efficacy theory and Wagner and Sternberg's (1985) theory of practical intelligence.

Focuses on a study which examined the role of drama in laying the foundations for critical thinking in the reading process. Intervention drama program that was used in the study; Descriptions of literacy events offered by the researchers; Conclusion.

Reports the sequence analysis of the dnrR2 locus in Streptomyces peucetius, which contains two divergently transcribed open reading frames, dnrN and dnrO. DNA sequencing; Southern analysis; Mutagenesis of aspartate of dnrN; Nucleotide sequence accession number.

Background: A national policy focus in England to address general practice workforce issues has led to a commitment to employ significant numbers of non-general practitioner (GP) roles to redistribute workload. This paper focuses on two such roles: the care navigation (CN) and social prescribing link worker (SPLW) roles, which both aim to introduce 'active signposting' into primary care, to direct patients to the right professional/services at the right time and free up GP time. There is a lack of research exploring staff views of how these roles are being planned and operationalised into general practice and how signposting is being integrated into primary care. Methods: The design uses in-depth qualitative methods to explore a wide range of stakeholder staff views. We generated a purposive sample of 34 respondents who took part in 17 semi-structured interviews and one focus group (service leads, role holders and host general practice staff). We analysed data using a Template Analysis approach. Results: Three key themes highlight the challenges of operationalising signposting into general practice: 1) role perception – signposting was made challenging by the way both roles were perceived by others (e.g. among the public, patients and general practice staff) and highlighted inherent tensions in the expressed aims of the policy of active signposting; 2) role preparedness – a lack of training meant that some receptionist staff felt unprepared to take on the CN role as expected and raised patient safety issues; for SPLW staff, training affected the consistency of service offer across an area; 3) integration and co-ordination of roles – a lack of planning and co-ordination across components of the health and care system challenged the success of integrating signposting into general practice. Conclusions: This study provides new insights from staff stakeholder perspectives into the challenges of integrating signposting into general practice, and highlights key factors affecting the success of signposting in practice. Clarity of role purpose and remit (including resolving tensions inherent the dual aims of 'active signposting'), appropriate training and skill development for role holders and adequate communication and engagement between stakeholders/partnership working across services, are required to enable successful integration of signposting into general practice. [ABSTRACT FROM AUTHOR]

Background: Temporary doctors, known as locums, are a key component of the medical workforce in the NHS but evidence on differences in quality and safety between locum and permanent doctors is limited. We aimed to examine differences in the clinical practice, and prescribing safety for locum and permanent doctors working in primary care in England. Methods: We accessed electronic health care records (EHRs) for 3.5 million patients from the CPRD GOLD database with linkage to Hospital Episode Statistics from 1st April 2010 to 31st March 2022. We used multi-level mixed effects logistic regression to compare consultations with locum and permanent GPs for several patient outcomes including general practice revisits; prescribing of antibiotics; strong opioids; hypnotics; A&E visits; emergency hospital admissions; admissions for ambulatory care sensitive conditions; test ordering; referrals; and prescribing safety indicators while controlling for patient and practice characteristics. Results: Consultations with locum GPs were 22% more likely to involve a prescription for an antibiotic (OR = 1.22 (1.21 to 1.22)), 8% more likely to involve a prescription for a strong opioid (OR = 1.08 (1.06 to 1.09)), 4% more likely to be followed by an A&E visit on the same day (OR = 1.04 (1.01 to 1.08)) and 5% more likely to be followed by an A&E visit within 1 to 7 days (OR = 1.05 (1.02 to 1.08)). Consultations with a locum were 12% less likely to lead to a practice revisit within 7 days (OR = 0.88 (0.87 to 0.88)), 4% less likely to involve a prescription for a hypnotic (OR = 0.96 (0.94 to 0.98)), 15% less likely to involve a referral (OR = 0.85 (0.84 to 0.86)) and 19% less likely to involve a test (OR = 0.81 (0.80 to 0.82)). We found no evidence that emergency admissions, ACSC admissions and eight out of the eleven prescribing safety indicators were different if patients were seen by a locum or a permanent GP. Conclusions: Despite existing concerns, the clinical practice and performance of locum GPs did not appear to be systematically different from that of permanent GPs. The practice and performance of both locum and permanent GPs is likely shaped by the organisational setting and systems within which they work. [ABSTRACT FROM AUTHOR]

Background: Transition between care settings is a time of high risk for preventable medication errors. Poor communication about medication changes on discharge from hospital can result in adverse drug events and medicines-related readmissions. Refer-to-Pharmacy is a novel electronic referral system that allows hospital pharmacy staff to refer patients from their bedside to their community pharmacist for post-hospital discharge medication support. The aim of this study was to examine factors that promoted or inhibited the implementation of Refer-to-Pharmacy in hospital and community settings.Methods: Twenty six interviews with hospital pharmacists (n = 11), hospital technicians (n = 10), and community pharmacists (n = 5) using Normalisation Process Theory (NPT) as the underpinning conceptual framework for data collection and analysis.Results: Using NPT to understand the implementation of the technology revealed that the participants unanimously agreed that the scheme was potentially beneficial for patients and was more efficient than previous systems (coherence). Leadership and initiation of the scheme was more achievable in the contained hospital environment, while initiation was slower to progress in the community pharmacy settings (cognitive participation). Hospital pharmacists and technicians worked flexibly together to deliver the scheme, and community pharmacists reported better communication with General Practitioners (GPs) about changes to patients' medication (collective action). However, participants reported being unaware of how the scheme impacted patients, meaning they were unable to evaluate the effectiveness of scheme (reflexive monitoring).Conclusion: The Refer-to-Pharmacy scheme was perceived by participants as having important benefits for patients, reduced the possibility for human error, and was more efficient than previous ways of working. However, initiation of the scheme was more achievable in the single site of the hospital in comparison to disparate community pharmacy organisations. Community and hospital pharmacists and organisational leaders will need to work individually and collectively if Refer-to-Pharmacy is to become more widely embedded across health settings. [ABSTRACT FROM AUTHOR]