Gender and Clinical Pharmacy: The Career of an Occupational Ideology*

Cet article étudie le concept selon lequel, dans une profession en mutation, la pharmacie en l'occurrence, les femmes sont les principales personnes à transmettre les valeurs liées à la pharmacie clinique - une idéologic professionnelle prétendument instaurée afin de redonner sa place à la pharmacie dans la hiérarchie des professions. Si on constate la force des convictions des membres de la profession à l'endroit de la pharmacie clinique, on observe également que les femmes ne sont pas les premières à les dèfendre. Ni la socialisation des rapports entre les sexes ni une formation particulière en pharmacie n'ont rendu les femmes mieux disposées que les hommes à l'egard de la pharmacie clinique. Les divergences - et elles sont très importantes - au sein de la profession au sujet de la pharmacie clinique se font sentir selon les différents cadres de travail des pharmaciens et selon l'année d'obtention de leur permis d'exercice. Ce sont plus les lieux de travail que les rapports entre les sexes qui permettent de prévoir les attitudes à l'égard de la pharmacie clinique. Il semble done peu probable que le fait d'équilibrer le nombre d'hommes et de femmes dans un milieu de travail soit de nature à le faire évoluer. Quelle que soit, au départ, la conception des pharmaciennes à l'égard de leur profession, elle influe peu sur leur rapport à la pharmacie clinique. This paper explores the idea that in a changing profession, women are the principal value carriers of clinical pharmacy—an occupational ideology professedly developed to restore pharmacy's precarious standing in the occupational hierarchy. While the investigation uncovers considerable evidence for the vitality of clinical pharmacy beliefs among practitioners, women were not at the forefront of this trend. Neither general gender socialization nor specific pharmacy training has rendered females more sympathetic to clinical pharmacy than males. Differences within the pharmacy community regarding clinical pharmacy—and they are quite considerable— emanate from the varied work settings that practitioners occupy and their year of licensure. Attitudes to clinical pharmacy are better predicted by workplace than by gender. On the basis of our findings, it seems unlikely that balancing the number of men and women in an occupation or work organization will, in and of itself, change it. Whatever distinctive prior orientations to work that female pharmacists may hold, they have little impact upon how they think about clinical pharmacy.     

Time series forecasting with neural networks: a comparative study using the air line data

This case-study fits a variety of neural network (NN) models to the well-known air line data and compares the resulting forecasts with those obtained from the Box–Jenkins and Holt–Winters methods. Many potential problems in fitting NN models were revealed such as the possibility that the fitting routine may not converge or may converge to a local minimum. Moreover it was found that an NN model which fits well may give poor out-of-sample forecasts. Thus we think it is unwise to apply NN models blindly in 'black box' mode as has sometimes been suggested. Rather, the wise analyst needs to use traditional modelling skills to select a good NN model, e.g. to select appropriate lagged variables as the 'inputs'. The Bayesian information criterion is preferred to Akaike's information criterion for comparing different models. Methods of examining the response surface implied by an NN model are examined and compared with the results of alternative nonparametric procedures using generalized additive models and projection pursuit regression. The latter imposes less structure on the model and is arguably easier to understand.     

Using GIS in Risk Analysis: A Case Study of Hazardous Waste Transport

This paper provides an illustration of how a geographic information system (GIS) can be used in risk analysis. It focuses on liquid hazardous waste transport and utilizes records archived by the London Waste Regulatory Authority. This data source provides information on the origin and destination of each waste stream, but not the route followed during transport. A GIS was therefore employed to predict the paths used, taking into account different routing criteria and characteristics of the available road network. Details were also assembled on population distribution and ground-water vulnerability, thus providing a basis for evaluating the potential consequences of a waste spillage during transport. Four routing scenarios were implemented to identify sections of road which consistently saw heavy traffic. These simulations also highlighted that some interventions could lead to risk tradeoffs rather than hazard mitigation. Many parts of the research would not have been possible without a GIS, and the study demonstrates the considerable potential of such software in environmental risk assessment and management.     

Complementing SBIRT for Alcohol Misuse with SBIRT for Trauma: A Feasibility Study

Reducing alcohol misuse is a priority for U.S. health officials considering that misuse of alcohol is a leading preventable cause of morbidity and mortality. Consequently, health centers are integrating Screening, Brief Intervention, and Referral to Treatment (SBIRT) for alcohol misuse within usual care. Although SBIRT is well validated among general patient samples, results have not generalized to drinkers with probable alcohol use disorder; moreover, little is known about the efficacy of SBIRT with patients who are of low-income or ethnic or racial minority status. Members of these groups are of particular concern because they are at risk to experience trauma, potentially in concert with alcohol misuse. Therefore, translational approaches to delivering SBIRT particularly with these groups of interest might be needed to meet the Grand Challenge of reducing alcohol misuse. Accordingly, this study combined SBIRT with a model designed to address psychological trauma: T-SBIRT. With a sample of 112 adults, most of whom were African American or Latino/a, authors analyzed multiple indicators of feasibility. Results indicated that T-SBIRT is suitable for and acceptable to patients accessing community-based health services, and T-SBIRT can promote high referral acceptance rates to specialty treatment, particularly among patients with probable alcohol use disorder.     

Re-distributed manufacturing and the food-water-energy nexus: opportunities and challenges

Abstract

Addressing the intersection of two important emerging research areas, re-distributed manufacturing (RDM) and the food-energy-water (FEW) nexus, this work combines insights from engineering, business and policy perspectives and explores opportunities and challenges towards a more localized and sustainable food system. Analysis centred on two specific food products, namely bread and tomato paste reveals that the feasibility and potential of RDM vary with the type of food product and the supply chain (SC) components. Physically, energy efficiency, water consumption and reduction of waste and carbon footprint may be affected by scale and location of production activities and potentials of industrial symbiosis. From the business perspective, novel products, new markets and new business models are expected in order for food RDM to penetrate within the established food industry. Studies on policies, through the lens of public procurement, call for solid evidence of envisioned environmental, social and economic benefits of a more localized food system. An initial integrated framework is proposed for understanding and assessing food RDM and the FEW nexus.     

Working for Patients? The Right Approach?

This paper is a slightly revised version of a Memorandum requested by the House of Commons Social Services Select Committee to assist the Committee in its analysis of the White Paper Working for Patients (Cm 555). It was submitted to the Committee on 28 February 1989. The paper follows up the authors'earlier study of the reform of the NHS (Barr, Glennerster and Le Grand, 1988), prepared at the request of the Select Committee prior to the publication of the White Paper.
The success or failure of the White Paper depends crucially on the precise details of the way in which its proposals are implemented. The Working Papers, although providing some more information as to how the White Paper's proposals will be implemented, do not in the main address the issues that concern us here.
Given the inescapable tension between cost and quality, quality control will be absolutely critical if the incentives to economize on the use of resources are not on occasion to lead to unacceptable reductions in quality — reductions which might well apply differentially by socioeconomic group.     

Group psychotherapy with pathological gamblers

This paper reviews some of the group therapy techniques utilized in the authors' work with pathological gamblers. These conceptual tools ranged from rational-emotive psychotherapy to Zen philosophy which provided a background and foundation for working with pathological gamblers. Many therapeutic and antitherapeutic beliefs and behaviors of gamblers are discussed including narcissism, manipulative behavior, and rejection of Gamblers Anonymous. Each technique, behavior or belief discussed is explained in terms of how each affects the group process and how each is managed in group therapy.This paper represents a discourse on the group treatment of pathological gamblers primarily from the experiences of Julian Ingersoll Taber, Ph.D. who was the coordinator of the Gambling Treatment Program at the Cleveland Veterans Administration Medical Center for seven years. Dr. Taber is currently Chief of the Addictive Disorders Treatment Program at the Veterans Administration Medical Center in Reno, Nevada. Martin Paul Chaplin, Ph.D., who is specializing in the treatment of addiction, assisted in the theoretical and editorial aspects of this article. He worked under the aegis of Dr. Taber as an intern at the Gambling Treatment Program and currently has a position at Community Mental Health Services of Medina in Ohio.