Aeration of the lung and the transition to air-breathing at birth is fundamental to mammalian life and initiates major changes in cardiopulmonary physiology. However, the dynamics of this process and the factors involved are largely unknown, because it has not been possible to observe or measure lung aeration on a breath-by-breath basis. We have used the high contrast and spatial resolution of phase contrast X-ray imaging to study lung aeration at birth in spontaneously breathing neonatal rabbits. As the liquid-filled fetal lungs provide little absorption or phase contrast, they are not visible and only become visible as they aerate, allowing a detailed examination of this process. Pups were imaged live from birth to determine the timing and spatial pattern of lung aeration, and relative levels of lung aeration were measured from the images using a power spectral analysis. We report the first detailed observations and measurements of lung aeration, demonstrating its dependence on inspiratory activity and body position; dependent regions aerated at much slower rates. The air/liquid interface moved toward the distal airways only during inspiration, with little proximal movement during expiration, indicating that trans-pulmonary pressures play an important role in airway liquid clearance at birth. Using these imaging techniques, the dynamics of lung aeration and the critical role it plays in regulating the physiological changes at birth can be fully explored.

Background: Pharmacists are viewed as highly trained yet underutilised and there is growing support to extend the role of the pharmacist within the primary health care sector. The integration of a pharmacist into a general practice medical centre is not a new concept however is a novel approach in Australia and evidence supporting this role is currently limited. This study aimed to describe the opinions of local stakeholders in South-East Queensland on the integration of a pharmacist into the Australian general practice environment. Methods: A sample of general practitioners, health care consumers, pharmacists and practice managers in SouthEast Queensland were invited to participate in focus groups or semi-structured interviews. Seeding questions common to all sessions were used to facilitate discussion. Sessions were audio recorded and transcribed verbatim. Leximancer software was used to qualitatively analyse responses. Results: A total of 58 participants took part in five focus groups and eighteen semi-structured interviews. Concepts relating to six themes based on the seeding questions were identified. These included positively viewed roles such as medication reviews and prescribing, negatively viewed roles such as dispensing and diagnosing, barriers to pharmacist integration such as medical culture and remuneration, facilitators to pharmacist integration such as remuneration and training, benefits of integration such as access to the patient's medical file, and potential funding models. Conclusions: These findings and future research may aid the development of a new model of integrated primary health care services involving pharmacist practitioners.

High quality real-time imaging of lungs in vivo presents considerable challenges. We demonstrate here that phase contrast x-ray imaging is capable of dynamically imaging the lungs. It retains many of the advantages of simple x-ray imaging, whilst also being able to map weakly absorbing soft tissues based on refractive index differences. Preliminary results reported herein show that this novel imaging technique can identify and locate airway liquid and allows lung aeration in newborn rabbit pups to be dynamically visualized.

The primary drug related problem reported in the practice pharmacist phase was Additional therapy required as compared to Precautions in the external pharmacist phase. The practice pharmacist most frequently recommended to add drug with Additional monitoring recommended most often in the external pharmacists. During the practice pharmacist phase 71 % of recommendations were implemented and was significantly higher than the external pharmacist phase with 53 % of recommendations implemented (p < 0.0001). Two of the 23 drug related problem domains differed significantly when comparing medication reviews conducted in the patient's home to those conducted in the medical centre.

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The results from this trial show that the integration of a pharmacist into the general practice team was associated with an increase in the timeliness and completion rate of medication reviews.

ARTICLEFull text free online at nps.org.au/australianprescriberThe practice pharmacist: a natural fit in the general practice team SUMMARYThere is evidence that pharmacist integration into the general practice team may improve clinical and non-clinical outcomes.The roles of the practice pharmacist can be considered under three categories -patient-directed roles, clinician-directed roles and system-or practice-directed roles.The integration of pharmacists into the general practice team would reduce fragmentation of patient care and medication misadventure.If practice pharmacist services are to be flexible to suit the heterogeneity of general practices, a flexible funding model is needed. The evidenceThe majority of the current evidence examining an integrated model of pharmacist and GP care is positive. A recent systematic review and metaanalysis of pharmacist-delivered services in general practice included 38 studies. Of these, 25 reported positive effects on at least one primary outcome measure and 13 demonstrated no effect. 10Interventions usually involved medication review, with or without other activities delivered with the GP such as education, medication monitoring and adjusting therapy. Four clinical markers were used to assess the effect of interventions -blood pressure, glycosylated haemoglobin, cholesterol, and the Framingham Risk Score. Results of the metaanalysis favoured the pharmacist intervention with significant improvements observed in all clinical markers compared to the control groups. Positive effects were more likely to be seen with pharmacistdelivered multifaceted interventions in conjunction with follow-up of patients compared to interventions that delivered a service in isolation. There was limited or no effect on outcomes related to quality of life, patient satisfaction, symptoms, and use of health service.Individual studies have shown improvements in other outcomes including:• identification and reduction of medicine-related problems • patient adherence to medicines • process measures such as timeliness • appropriateness of prescribing • reduction in total number of medications. 11-16

Anatomical visualization of airspace-containing organs in intact small animals has been limited by the resolution and contrast available from current imaging methods such as X-ray, micro-computed tomography and magnetic resonance imaging. Determining structural relationships and detailed anatomy has therefore relied on suitable fixation, sectioning and histological processing. More complex and informative analyses such as orthogonal views of an organ and three-dimensional structure visualizations have required different animals and image sets, laboriously processed to gather this complementary structural information. Precise three-dimensional anatomical views have always been difficult to achieve in small animals. Here we report the ability of phase-contrast synchrotron X-ray imaging to provide detailed two-and three-dimensional visualization of airspace organ structures in intact animals. Using sub-micrometre square pixel charge-coupled device array detectors, the structure and anatomy of hard and soft tissues, and of airspaces, is readily available using phase-contrast synchrotron X-ray imaging. Moreover, software-controlled volume-reconstructions of tomographic images not only provide unsurpassed image clarity and detail, but also selectable anatomical views that cannot be obtained with established histological techniques. The morphology and structure of nasal and lung airways and the middle ear are illustrated in intact mice, using two-and three-dimensional representations. The utility of phase-contrast synchrotron X-ray imaging for noninvasively localizing objects implanted within airspaces, and the detection of gas bubbles transiting live airways, are other novel features of this visualization methodology. The coupling of phase-contrast synchrotron X-ray imaging technology with software-based reconstruction techniques holds promise for novel and high-resolution non-invasive examination of airspace anatomy in small animal models.