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Nine children represented St. Joseph's at this years Ribble Valley gymnastics competition at St. Augustine's. They had all worked hard over the past few weeks, improving their floor work and pushing themselves to get onto the vault. Twenty five teams took part in the competition, and our A team- Adam, Benedict, Ashton, Josephine and Florence were placed 7th, which is a great achievement.
As always, it was very difficult to choose who should receive the annual gymnastics trophy, since all children had made wonderful progress, and Adam and Benedict had worked consistently at a high standard for 3 years.
In the end it was Ashton who scored highly in the competition, showing the most improvement since last year. He also showed a great attitude and commitment, after initially believing he wasn't good enough to be in the team! Well done Ashton.


The legacy business model of the "general hospital" is one of the greatest contributors to the astronomical cost of healthcare. Through scientific progress (much of it developed in hospitals), sustaining innovations have turned hospitals into extraordinary venues for managing the complex medical needs of patients. However, as a result, the organizations have overshot the needs of patients with straightforward diseases that have proven treatments. This post will examine how we can reform the hospital business model to ensure patients receive the right care in the proper venue for a fair price.
The claims that big tech will disrupt healthcare are often met with justifiable skepticism. We have heard repeatedly over the past several years that these companies do not fully understand the industry and how to operate effectively within it. Additionally, we have seen many organizations claim "disruption" in their pitch decks, while very few make it past a proof of concept. How can a company that makes search engines or smartphones think they have any clue how to drive change in this complex ecosystem?
Medicare for All is an idea stemming from a simple principle, everyone in the US should have access to the healthcare they need. This is certainly an admirable position that I undoubtedly support. However, I do not believe Medicare for All to be the panacea that many supporters claim, or even a moderate solution to the high cost nature of our system today. The reason is equally as simple: prices.
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As I prepare to write a post diving deep into Medicare for All, I did some research to truly understand what the current Medicare Program costs both patients and taxpayers in the US. As someone with multiple grandparents on Medicare, I found this research helpful as we discussed their plan options. I hope this can help others as they consider the right option for their needs.
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This needs to be said. I am anti-physical abuse, before, during, and even after a marriage. It is simply thuggish, bully behavior that should not be tolerated. Besides which, you cannot put the words "gentleman" and "physical abuse" together. It is contradictory.
I took a Domestic Violence class in law school. Funny enough, it was grouped under 'Family law.' I guess that's because many instances of abuse take place within a family setting.
Back to my Domestic Violence class. One of the things we learnt was that a typical abuser has a charming personality. In public. That is, if we look at our series, he is polite, and well-groomed. In short, an attractive and very desirable man. But at home, he is a lion. In a bad way.
A man who beats a woman is a thug, an agbero, a riff-raff, an animal. He belongs in a zoo.
A typical Nigerian man believes that no woman should talk to him "anyhow." And if a woman crosses that line, he can slap her or do worse. That is total nonsense.
While I do not condone rudeness from men or women, I believe there are valid ways to make your point without physically abusing another person. A gentleman, a true gentleman would never ever hit a woman. Period. The same applies to Nigerian gentlemen.
Now, for those who say women should watch their tongues or that women somehow "bring" the abuse on themselves or somehow provoke men to abuse them, let me ask you this: If you are at work, and your boss is rude to you (male or female) and your boss treats you or talks to you "anyhow" why not slap or punch your boss? I mean, it is a means of self-expression right?
You would NEVER do that because you stand to lose something: your job. For the sake of that pay check, you will endure the insults, etc from your boss. So why would you not extend the same principle to your wife, girlfriend, fiancee, sister, mother? In short, the women in your life. Because you consider yourself to be bigger, better and more powerful than them.
The reason why a man would hit his wife at home and not react the same way to his boss (or co-workers, sometimes) is because he does not consider her his equal. He has no respect for her and does not value her as a person.
Even if you grew up witnessing your father abuse your mother, you don't have to follow in his footsteps. As an adult, you should know the difference between right and wrong.
While we can never choose the family we are born into, we can definitely choose the family we will have.
I'll stop here. My point again is this: The quintessential Nigerian gentleman would never resort to physical violence to make a point. Especially not with a woman.
Question: Is physical abuse an accepted part of Nigerian culture? Should a man physically abuse a woman (or vice-versa) under any circumstances?
I think physical abuse is accepted in not just the Nigerian culture but in Africa as a whole and in many other cultures too. In the African culture, I think this is partly because women are taught to endure and 'manage' their marriages. Divorce is rarely, if ever, an option. I think it also happens a lot more than we realise because not many people would admit that they are being abused, and most women tend to cover for their husbands. I agree with all the points you made, but I think the issue of physical violence in relationships is a lot more complex than may seem at first glance. For example, it's easy to say to a woman that is being abused to pack her bags and get out, but this might not be very easy for the woman to do, for example, if she has kids, or is fully dependent on her husband for her upkeep (unfortunately, we don't have many 'safe houses' that women can go to in such situations). There is also the emotional attachment to the relationship that is not easy to let go of. I could go on and on, but it's also worth mentioning that there is emotional abuse, which sometimes accompanies physical abuse, and also important is the fact that men do get abused too!
Abuse of any kind; physical, verbal, emotional is not acceptable. The end.
Jemima: You're right, especially on the emotional abuse. That one is more common, but doesn't get as much publicity because it goes undetected. I mean, how do you tell if a person is being emotionally abused?
Toin: Yup! That's a strong statement. Point taken!
I think here in the US, there are ways to help battered women, but in Nigeria, where does such a woman go to for help? Her parents will likely say they have no place for her. Are there even shelters for them? And then, there's the big issue of economic dependence, like you noted. If she is dependent on her husband for money, then how can she leave? I think the Church needs to step in and stop turning a blind eye or telling these women to go back home as if nothing happened.
Victor: Well said! Physical abuse should not be tolerated. But it is. I love the scripture you used. I didn't quite see it this way. "As long as it depends on you ..." Food for thought.
Thanks for the household chores suggestion. I'll definitely consider it, but I think you already know what I'm going to say. 50-50!
Nollywood Reinvented: Thank you for sharing that story here. I actually read it when it was still fresh and was just infuriated. There are times for words, and there are times for action. When a woman reports that she is being abused in her home, words alone are not enough. That is the time for action, and the Pastor did not do it. And then, she died at her husband's hands. Ridiculous!
I feel like the Church has a role to play in this because Pastors and spiritual leaders are usually the ones (apart from friends and relatives) that battered men or women run to during these episodes. I'm glad Stella is helping to create awareness.


text:
Review ArticleREVIEW
A Systematic Review of Leadership Definitions, Competencies, and Assessment Methods in Pharmacy Education
Brent N. Reed, Abigail M. Klutts and T. Joseph Mattingly
Brent N. Reed
aUniversity of Maryland School of Pharmacy, Baltimore, Maryland
Abigail M. Klutts
T. Joseph Mattingly II
bEditorial Board Member, , Arlington, Virginia
Objective. To characterize leadership definitions, competencies, and assessment methods used in pharmacy education, based on a systematic review of the literature.
Findings. After undergoing title, abstract, and full-text review, 44 (10%) of 441 articles identified in the initial search were included in this report. Leadership or an aspect of leadership was defined in 37 (84%) articles, and specific leadership competencies were listed or described in 40 (91%) articles. The most common definitions of leadership involved motivating others toward the achievement of a specific goal and leading organizational change. Definitions of leadership in some articles required that individuals hold a formal leadership position whereas others did not. Only two leadership competencies were related to specific areas of knowledge. Most of the competencies identified were interpersonal and self-management skills. In terms of assessment, only one (2.3%) article assessed leadership effectiveness, and none assessed leadership development. Of the remaining 24 (55%) articles that included some type of assessment, most involved behavioral-based tools assessing individual attributes conceptually related to leadership (eg, strengths, emotional intelligence), or self-assessments regarding whether learning objectives in a leadership course had been met.
Summary. Definitions for leadership in pharmacy varied considerably, as did leadership competencies. Most conceptualizations of leadership resembled a combination of established approaches rather than being grounded in a specific theory. If leadership development is to remain a focus within accreditation standards for Doctor of Pharmacy education, a consistent framework for operationalizing it is needed.
affective domain
Leadership is a highly desired attribute among pharmacists, and some have suggested it should be considered a professional obligation.1 Recognizing its importance among Doctor of Pharmacy (PharmD) graduates, leadership is listed as a key element in Standard 4 of the 2016 Accreditation Council for Pharmacy Education (ACPE) standards ("Standards 2016").2 Specifically, Standard 4.2 requires that graduates be "able to demonstrate responsibility for creating and achieving shared goals, regardless of position." Although examples of co-curricular experiences intended to support Standard 4 are provided in the accompanying ACPE accreditation guidance document, no recommendations exist for how to operationalize leadership development, including how to define, measure, or assess it.3
A cursory review of the literature suggests that definitions of leadership in pharmacy vary considerably, as do expectations regarding the knowledge, skills, abilities, and other characteristics to be demonstrated by pharmacy leaders. Additionally, no consensus exists regarding how leadership should be measured and assessed, adding significant ambiguity to how schools of pharmacy should be evaluated on their ability to meet Standard 4.2. In fact, based on some conceptualizations of leadership, such as the trait-based approach (eg, leadership as a reflection of individual traits such as cognitive ability and motivation),4 schools could argue that students with such attributes are sought out during the admissions process and no further efforts to develop leadership are necessary. Expectedly, the extent to which leadership has become integrated into the PharmD curriculum varies. Indeed, many of the reports in the literature have consisted of extracurricular strategies (eg, involvement in professional organizations, medical mission trips) or elective didactic experiences, suggesting that leadership development may still be mostly limited to those students who already demonstrate a proclivity for leadership.5–9
Recent efforts have been made to advance our understanding of leadership in pharmacy via use of the Delphi method.10,11 The Delphi method consists of a series of structured surveys or interviews in which a panel of subject matter experts is guided to consensus by an external mediator. A 26-member Delphi approach was used to identify a set of guiding principles and associated competencies for student leadership development.10,11 Members of the panel were leadership instructors selected on the basis of attending sessions on leadership development at American Association of Colleges of Pharmacy (AACP) meetings, membership in the investigators' professional network, and the results of a query of the AACP member database. Participants were guided through three rounds of surveys, resulting in the identification of 12 guiding principles and 11 competencies (four related to knowledge, two related to personal leadership commitments, and five related to leadership skills).10,11 A major advantage of the Delphi method is that it encourages dialogue in a confidential and blinded fashion so that the discussion is not dominated by one or more voices.12 However, disadvantages include a lack of standardization (eg, size and composition of the panel, process for selecting panel members) and concerns regarding its validity and reliability.13
The purpose of our research was to complement existing efforts to conceptualize leadership in pharmacy by performing a systematic review of the literature. The primary advantage of this approach is that the totality of scholarship on a topic can be reviewed and evaluated in a systematic way, including perspectives that may be underrepresented in an expert panel. Another advantage is that a systematic review can characterize changes in a construct over time,14 which may be particularly important given the evolution of leadership theories over the last century.15
Using this structured approach, we hoped to accomplish three aims. Our first aim was to compare definitions for pharmacy leadership, including whether they differed from established leadership theories. The second was to characterize the knowledge, skills, abilities, and other characteristics (ie, competencies) expected of pharmacy leaders, which is essential to the development of instructional strategies. Although use of the term competency in reference to leadership remains controversial in personnel psychology because of the lack of a consensus definition,16 we selected it to be consistent with Standards 2016 and prior research in pharmacy education.10 Finally, we hoped to identify instruments for assessing leadership effectiveness or development, which could be used by schools of pharmacy to evaluate their leadership development efforts. For this latter purpose, we did not differentiate between assessments of leadership effectiveness vs emergence, terms which refer to an individual's effects on group performance vs his or her ability to rise to the top in an organization, respectively.17
A literature search was conducted using PubMed and SCOPUS to find English-language articles containing the terms "pharmacy," "student," and "leadership." Two of the authors completed title and abstract reviews, and a third author served as tie-breaker for each round. We determined a priori that agreement of <80% during any phase would prompt clarification of review criteria and the process would be repeated. Interrater agreement for the title and abstract screens was calculated using Cohen's kappa. All three team members participated in the full-text screen, and exclusion of any additional articles required group consensus.
Articles were included in the title screen if any reference was made to "leadership" and "pharmacy" in the title of the article or the journal in which it was published (eg, an article having been published in the American Journal of Pharmaceutical Education would satisfy the "pharmacy" criterion; thus, the title only needed to refer to "leadership" for the article to be included in the study). During the abstract screen, articles were included if they referred to "education" or "training" and at least one of the following pertaining to leadership: definitions, competencies, or assessments. Any articles without an abstract were forced into the full-text screen.
During the full-text screen, an article was excluded if it did not provide a definition or conceptualization of leadership, or if upon more detailed analysis, the article did not relate to education or training. The constructs of interest for this study (ie, definitions, competencies, and assessment methods) were also collected during the full-text screen. Given a paucity of methods for assessing leadership effectiveness or development in the full-text screen, data collection was expanded to include any assessments related to leadership, including self-reported leadership perceptions and domains conceptually related to leadership (eg, emotional intelligence).
Following data collection, leadership definitions, competencies, and assessment methods were categorized according to construct similarity based on group consensus (eg, "embracing adversity" and "taking on challenges" were considered similar and thus were grouped together as "perseverance"). Leadership assessment methods were further analyzed to determine whether validated instruments were used.
Five hundred thirty-one abstracts were identified in the initial search. Of these, 90 duplicates were removed, leaving 441 abstracts for the title screen. During this phase, the screening authors agreed on 419 of 441 titles (95.0% agreement, κ=0.80, p<.001), and the remaining 22 titles were reconciled by the third author. Three hundred seventy-six articles were deemed irrelevant to the study during the title screen, leaving 65 articles for the abstract screen. Agreement by the screening authors was achieved on 55 of 65 abstracts (84.6% agreement, κ=0.49, p<.001), and after reconciliation by the third author, an additional 12 abstracts were excluded. Of the remaining 53 articles that underwent a full-text screen, nine were excluded based on group consensus, leaving 44 articles for data extraction and analysis. These included 15 descriptions of a leadership course or program, 10 surveys, nine commentaries, three Delphi panels, three qualitative studies, three multimethod studies, and a single literature review. Many of the descriptive studies incorporated surveys (eg, pre- and post-course evaluations), but assessments of leadership perceptions or effectiveness were not their primary focus. A summary of the search strategy using the PRISMA framework is depicted in Figure 1.18
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement Flow Diagram for Search Methods
Eight definitions of leadership were extracted during the analysis (Table 1). The most common definition involved influencing, motivating, enabling, or empowering others, often to achieve a specific goal (11 articles). Two other definitions were commonly cited: the leader as an agent of change (nine articles) and the leader as an individual who receives external recognition for leadership, eg, serving in a formal position, receiving an award (nine articles). Some articles defined leadership in terms of the position held (eg, president),19,20 whereas others indicated that any position was sufficient, including involvement on a committee or task force. Demonstrating leadership without a formal title or position was the fourth most common definition (six articles); "big l" versus "little l" leadership was a common framework used to distinguish between individuals with formal leadership roles and those who lead informally.6,21 Less commonly identified definitions are provided in Table 1.
Terms Used in Published, Peer-Reviewed Articles to Define Leaders or Leadership in Pharmacya
Sixteen leadership competencies were extracted from the literature (Table 2). We classified each competency as an area of knowledge, skill or ability, or other characteristic, based on the framework commonly used in personnel psychology and in accordance with prior leadership research.22,23 Knowledge refers to technical expertise whereas skills and abilities refer to the capacity to perform tasks. Other characteristics include motivations, attitudes, values, interests, and personality traits.23
Knowledge, Skills, Abilities, and Other Characteristics of Pharmacy Leaders Identified Through a Review of Published, Peer-Reviewed Papers
Knowledge of leadership characteristics (including distinctions between leadership and management) and knowledge of the pharmacy profession were the only two areas of technical expertise identified in our analysis. Of the 10 skills and abilities identified, the most common was self-regulation (26 references), or the ability to monitor, reflect upon, and adapt one's attitudes and behaviors in response to demands (Figure 2). Persuasion, or the ability to influence the thoughts and/or behaviors of others, and strategic planning, an ability to articulate a vision and develop and/or support strategies for accomplishing it, were also common (19 and 17 references, respectively).
Bar Chart Depicting the Frequency of Pharmacy Leadership Competencies as Described in the Literature and Included in This Analysis
Four other characteristics were extracted from the literature. Team and service orientations were mentioned in similar frequencies (nine and eight references, respectively), and a learning orientation was found in four references. An ethical orientation, or the tendency to act in accordance with a set of moral and/or ethical standards, was found in only one reference.
Leadership Assessments.
As described previously, we expanded our criteria to include any instruments related to leadership, including self-reported leadership perceptions and assessments of conceptually related domains. We identified nine such methods, four of which (44%) were validated by prior research (Table 3). The most frequently used method was students' self-reported achievement of learning objectives for a leadership course or program (nine references). Another common method (six references) was CliftonStrengths (formerly known as StrengthsFinder or StrengthsQuest, Gallup; Washington, DC), a validated instrument for identifying themes of talent upon which leadership and other skills can be built.24 Most references evaluated leadership perceptions rather than competencies. Only one study evaluated leadership effectiveness; however, because of its cross-sectional design, leadership development (ie, a change in effectiveness over time) was not ascertained.25
Methods for Assessing Leadership in Published, Peer-Reviewed Articles
Despite a growing emphasis on leadership development in pharmacy, the results of this systematic review indicate that little consensus has been achieved on the definition of leadership in the profession. A similar lack of agreement was observed with regard to leadership competencies, providing little guidance to schools of pharmacy on how leaders should be developed. Not surprisingly, few validated instruments have been identified to measure leadership among pharmacy professionals. The implications of each of these findings and the challenges they pose for operationalizing leadership development in pharmacy education are discussed in further detail below.
The most common conceptualization of leadership revealed in this analysis was an individual who influences or motivates others, often in the achievement of a specific goal. However, this definition was still only used in a quarter of articles, suggesting that considerable disagreement exists. Perhaps the most notable discrepancy in our findings was the use of formal titles or positions to define leadership (seven of the nine references in which leadership was defined by external recognition), and the assertion in others (six articles) that a formal title or position was not necessary for leadership. Given that the remaining definitions of leadership involved performing specific tasks, defining leadership as the attainment of a title or position (or using it as an inclusion criterion for a study) likely restricts the range of competencies that can be captured. Indeed, with perhaps the exception of personnel management, none of the attributes we identified would require that an individual hold a position of leadership, which is consistent with at least one aspect of Standard 4.2.
One of our aims was to compare conceptualizations of leadership in pharmacy to established leadership theories. With the exception of definitions that involved medication use and patient care (6.8% of articles analyzed), most resembled a blend of existing leadership frameworks but few were grounded in a specific theory. Many of the conceptualizations most closely resembled transformational leadership, which is characterized by understanding followers' motivations and empowering them to achieve an aspirational goal.26 Transformational leadership is one of the most popular contemporary approaches to leadership, likely because of its characterization of leadership as a process, its emphasis on leader-follower relationships, and its association with positive work-related outcomes for both individuals (eg, job attitudes) and organizations (eg, performance).15,26,27 We did not find any specific references to the four-factor model of transformational leadership originally articulated by Bass and Avolio (ie, idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration), but other transformational approaches were evident in the reports we reviewed, such as the practices of exemplary leadership proposed by Kouzes and Posner.26,28
Although charisma (often used interchangeably with "idealized influence") is considered a fundamental feature of transformational leadership, it was not mentioned in any of the articles we analyzed. This finding was consistent with an overall lack of focus on the role that individual traits (eg, personality, cognitive ability) can play in leadership effectiveness, a point we discuss in further detail later in the manuscript. The need for charisma is one of the most commonly cited drawbacks of the transformational approach, as it implies that leadership is less accessible to individuals who lack it.26 Defining leadership according to the transformational approach also presents a challenge to the idea of leadership as a professional obligation, which may also explain the absence of a focus on charisma (among other traits) in the articles we reviewed in this analysis.
Transformational leadership may also be partially reflected in definitions that referred to serving as an agent of change, a term popularized in John Kotter's book on business leadership, Leading Change.29 Kotter's eight-step process for leading change borrows from a variety of established leadership and motivational theories, including leader-member exchange ("build the guiding coalition") and goal theory ("generate short-term wins"). Although Kotter's change framework was originally applied to business leadership, it has since been used in a variety of organizations, likely because of its greater practicality compared to some of the leadership theories upon which it is based. The latter may also explain the relatively high number of references to change leadership in our analysis.
Other established models of leadership observed in our analysis included servant leadership and authentic leadership. Service was mentioned in only four articles (9.1%), but this may reflect an expectation that all pharmacy professionals, and not just leaders, heed a call to service (as reflected in the Oath of a Pharmacist). Consequently, service may not be an appropriate metric of leadership in pharmacy, especially as quantifying acts of service (eg, number of health fairs attended) may not reflect underlying constructs of interest (eg, altruism). Leading by example was mentioned in two articles and represents an important component of authentic leadership in which leaders connect with their followers through mutual trust.15
As we alluded to previously, an aspect of leadership that was notably absent in our analysis was the role of individual traits and, in particular, personality. Early trait-based approaches to leadership were largely abandoned in favor of situational and contextual models but have gained renewed interest as our taxonomical understanding of personality has improved.15,30 Based on the five-factor model of personality, meta-analytic research has suggested at least a moderate correlation between personality and leadership (r=0.48), with extraversion being the trait that best predicts leadership emergence and effectiveness across studies.30 These findings have important implications for the operationalization of leadership development in pharmacy, and they raise questions as to whether leadership should be considered a professional obligation of all graduates. Instead, there may be specific competencies (which are often but not exclusively attributed to leaders) that should serve as targets of development efforts at schools of pharmacy.
In terms of the competencies identified in this analysis, only two were specific areas of knowledge: knowledge of leadership characteristics and of the pharmacy profession (eg, history, societal mission). Knowledge of leadership characteristics was also identified as a competency in prior work and was defined as being able to describe the skills, behaviors, and styles of effective leaders.10 However, given the varying and sometimes discrepant conceptualizations of leadership (including those identified in our own analysis), it is unclear how learners should be held accountable for this. An alternative approach could be to encourage students to critically appraise various leadership frameworks and examine the evidence (or lack thereof) connecting certain attributes to leadership effectiveness, and how these are influenced by factors such as culture (eg, Eastern vs Western perspectives) and organizational context. For instructors interested in such a strategy, a set of guiding principles was recently published.31
Although knowledge of the pharmacy profession was also identified as a key area of expertise, little additional detail was typically provided. Indeed, the relationship between an interest in pharmacy history and leadership was the subject of only one cross-sectional survey.32 Conversely, most leadership frameworks place a focus on understanding organizational culture,15 and perhaps leaders in pharmacy must understand both their own organization as well as the profession in which it operates.
Most of the competencies (62.5%) we identified were skills and abilities, which we believe adds considerable value to the literature on leadership in pharmacy. Only a handful of skills have been identified in prior research, and some of these may be challenging to teach and assess in the earlier parts of the pharmacy curriculum.10,11 For example, "collaborate with others" is an important competency to expect of pharmacy graduates, but it requires that learners demonstrate an array of fundamental interpersonal skills, including social insight, relationship-building, and communication. Consequently, we believe that the additional specificity provided in this analysis complements existing work by identifying areas that could serve as targets of further instruction.
In terms of interpersonal skills, social insight was most commonly referred to as emotional intelligence, and several instruments were used to measure this skill.33–35 Although Standards 2016 allude to social and emotional learning (SEL) (eg, self-awareness), the emphasis placed on higher-order constructs such as professionalism, patient advocacy, and cultural sensitivity implies that students are expected to have already developed many foundational SEL skills (eg, self-efficacy, empathy, appreciation for diversity) prior to enrolling in pharmacy school. However, exposure to SEL training varies considerably in primary and secondary educational settings despite evidence that it improves problem-solving and decision-making skills, and increases prosocial behavior.36 Variability in the development of SEL skills may therefore explain why social insight was seen as a distinguishing feature of leaders and may represent a potential target for training.
Relationship-building was often mentioned in the context of professional networking, but an emphasis was placed on both the quantity and quality of relationships, and how the latter helps leaders achieve organizational goals. The fact that strong communication skills were seen as a distinguishing feature of leaders was unsurprising, but these were not restricted to a specific medium. Indeed, leaders were seen as individuals who demonstrated skill in both speaking and written communications.
Two specific types of communication identified in our analysis were persuasion and negotiation, a finding consistent with transformational approaches to leadership. Although the two are conceptually related, negotiation typically involves compromise solutions that may benefit and harm all parties involved. Given the growing emphasis on shared decision-making among the members of interprofessional teams and between teams and patients, negotiating skills may represent an area from which all trainees could benefit. Coursework in communication has been shown to improve negotiating skills and shared decision-making in other health disciplines, and could represent an area of opportunity in pharmacy education.37
In addition to an emphasis on interpersonal relationships, another common theme to emerge from our analysis was self-management, reflected in the competencies of self-regulation, perseverance, and decision-making. In particular, self-regulation skills were alluded to in 26 references (59.1%). Self-awareness is a key element of Standard 4, and reflective learning has been posited as a strategy for promoting personal and professional growth.2,3 Similar to the ambiguity encountered in clinical practice, reflective learning may also help leaders deal with the uncertainties of organizational leadership.38
Reflective learning has also been posited as a strategy for building perseverance (sometimes referred to as resilience or "grit"), which was another competency identified in our analysis. We categorized perseverance as an ability rather than a trait based on research suggesting that it can be developed over time.39 Importantly, most of the research supporting this assertion is derived from children and adolescents, and studies in pharmacy education have failed to show a consistent relationship with academic performance.39 Conversely, these findings could also reflect a ceiling effect caused by the many barriers to professional school that may eliminate individuals with lower levels of perseverance. To our knowledge, no studies have compared the relative level of resilience or grit among student pharmacists to the general population, and studies in other health disciplines have yielded mixed results.40-42 It is therefore unclear whether opportunities exist to further improve this attribute among pharmacy trainees. A more detailed discussion of resiliency and grit among health professional students has been published previously within the Journal.39
Decision-making reflects skills in both critical thinking and judgement, and a clear distinction between these two attributes was not apparent in the literature we analyzed. Formal strategies such as strengths, weaknesses, opportunities, and threats (SWOT) analyses may assist students in learning how to identify key considerations when making decisions. Because few decisions facing leaders (or clinicians) are zero-sum, emphasis should also be placed on helping students deal with uncertainty and managing the consequences (both beneficial and adverse) of their decisions. Such strategies would also assist students in developing strategic planning skills, which was also a common theme in our analysis. Although efforts to grow strategic planning skills were usually limited to envisioning exercises, combining these with training in decision-making may help students understand how ideas can be translated into actionable initiatives.
Finally, only one of the competencies in our analysis resembled an attribute mostly associated with positional leadership, which we broadly labeled as personnel management. We used this label to refer to one's ability to align individuals with the roles for which they are best suited based on an assessment of their attributes (eg, strengths and weaknesses). Although the power to make this type of decision is usually limited to positional leaders, aligning team members with the roles to which they are best suited could also be accomplished by informal leaders. Doing so would require several of the skills mentioned previously (eg, social insight).
The lack of assessments for gauging leadership is one of the most important findings of this research, and it has important implications for schools of pharmacy given the emphasis on leadership in Standards 2016. If students are expected to demonstrate leadership upon graduation and few instruments exist for measuring it, how programs can be held accountable for meeting Standard 4 is unclear.
A lack of leadership instruments may reflect ambiguity in leadership definitions and the competencies that should be expected of pharmacy leaders. Because many of the conceptualizations of leadership in pharmacy already resemble established paradigms and few competencies were unique to pharmacy, time may be better spent adapting existing tools. Similar efforts have been successful with other affective domains, such as the adaptation of the Jefferson Scale of Empathy for use with student pharmacists.43 Conversely, if a pharmacy-centric instrument is desired, a collection of best practices for developing valid and reliable assessments of leadership has been published.44
Importantly, efforts to identify instruments for assessing leadership should clarify whether the intent is to measure leadership emergence or effectiveness. Leadership emergence measures the ability for an individual to rise to the top of an organization but does not necessarily correlate with leadership effectiveness (ie, the leader's impact on organizational performance). Moreover, although emergence can be shaped by many of the competencies identified in this analysis, it is also subject to influence by organizational politics and reputation management rather than leadership skill.30 Conversely, leadership effectiveness is more challenging to assess, as fewer opportunities exist to measure it given the relatively brief duration of pharmacy school and limited opportunities to serve in a leadership capacity.
We identified a number of gaps and opportunities for future research (Table 4). Several gaps have been discussed in detail above, such as the use of leadership self-perceptions as a surrogate for leader effectiveness and the assessment of individual domains rather than leadership as a whole. The remaining gaps identified in this analysis were methodological in nature. Most of the references we analyzed were descriptions of leadership development programs, but formal analyses of performance were not conducted. Nine studies involved observational or correlational analyses, a methodological limitation common to leadership research in other areas.15,30 For studies that assessed a specific aspect of leadership, many did not use a validated instrument, or authors did not describe the validity of the instrument used. Finally, many references were editorials or commentaries on leadership; we hope the gaps identified in this analysis will serve as an impetus for more original research to answer these important questions.
Gaps Identified in the Literature Regarding Leadership in Pharmacy and Opportunities for Future Research
As illustrated in this systematic review of the literature, leadership is a complex, multidimensional construct representing a diverse set of underlying competencies that differ considerably based on the approach selected. Because these competencies vary and leadership is at least in part determined by personality and other traits (eg, charisma, extraversion), it may not be reasonable or fair to suggest that leadership be a professional obligation of all pharmacists. Furthermore, the dearth of evidence demonstrating that leadership can be developed at schools of pharmacy suggests it may also be an unreasonable accreditation standard. Consequently, we recommend that ACPE revisit its use in future versions of the standards. If leadership is to remain an expectation of all pharmacy graduates, additional guidance should be provided regarding the desired framework, as the current description ("creating and achieving shared goals") only captures a fraction of the competencies identified in this and prior analyses. Based on the current guidance, simply being an effective team member may be a sufficient standard for all graduates to meet.
Several of our recommendations for the Academy relate to leadership research. First, because few of the competencies identified in this analysis seemed specific to pharmacy, future research should be grounded in established leadership theory. Most articles derived leadership definitions and other variables from a variety of models, making it difficult to discern whether improvements in specific skills or behaviors can be theoretically associated with the individual or organizational outcomes observed in prior leadership research. Second, future research should involve the assessment of leadership effectiveness (eg, follower perceptions, impact on organizational performance) and development (ie, changes in effectiveness over time such as before and after an intervention). Third, validated instruments should be used whenever available, or validation research should be performed prior to the use of any newly developed instruments.
A final consideration for the Academy is the role that teams, particularly interprofessional teams, should play in trainees' conceptualizations of leadership. Leadership is often taught in the context of vertical power dynamics but a growing emphasis on team-based work has contributed to a flattening of organizational structures across industries, and health care is no exception.15 Conversely, despite the assertion by a number of organizations that leadership of the interprofessional health care team should not be limited to physicians,45,46 traditional hierarchies remain the norm at many institutions. Consequently, trainees of all health disciplines may be better served by learning about leadership in an interprofessional context rather than the vestigial hierarchies of the past.
The primary methodologic strength of this study is that the authors attempted to extract all relevant literature on leadership in pharmacy rather than approach the research question with a preconceived leadership framework. We believe this permitted us to capture a greater diversity of leadership definitions, competencies, and assessment strategies. Other methodologic strengths included the use of multiple screeners, blinded reviews and ratings at each stage of the process, and a high threshold of agreement for study inclusion. Although one of the advantages of a systematic review is to identify changes over time, such a change was not clearly discernible in our research. We attribute this to the fact that 90% of articles were published in the last decade. Several attempts have been made to achieve consensus on leadership and related competencies during this period; thus, an important follow-up to this research would be to determine whether this resulted in coalescence in the literature.
Several limitations warrant further discussion. First, our focus on pharmacy-specific literature was intentional but may have excluded valuable publications in other health professions that could inform the design of instructional strategies in pharmacy education. Second, we did not exclude commentaries, descriptions of leadership courses or programs, or committee reports, which may have led to an overrepresentation of opinions rather than the results of rigorous investigation. We attempted to adjust for this by restricting our analysis to peer-reviewed manuscripts to ensure that commentary was at least evaluated by a journal editor and/or independent reviewer. A third limitation was that we grouped items into domains using a grounded theory approach in which text within the analyzed publications served as the basis for each category. All three authors reviewed and reached full agreement on the final themes; however, another set of researchers may have generated slightly different categories. Fourth, we considered an assessment method or instrument to be validated based on whether it had been tested or validated in any population rather than specifically among student pharmacists. This more lenient definition of validity may lead to misclassification bias, as the instruments we considered to be valid may not have been tested in a sample representative of the target population. A final limitation of our research is that we reported the frequency with which each construct was mentioned, ie, the number of publications in which it was found. Having done so may lead readers to the misinterpretation that more frequently mentioned definitions or competences are more important than those receiving less attention in the literature. This is further compounded by the fact that some individuals contributed to multiple publications and, in at least one instance, multiple publications originated from the same scholarly effort.10,11 Consequently, we caution the reader against making judgements regarding relative value, as we chose this straightforward, descriptive approach to limit the subjective determinations of the research team.
Despite an emphasis on leadership in Standards 2016, considerable ambiguity exists regarding the conceptualizations of leadership in pharmacy and the competencies that should be expected of pharmacists upon graduation. Furthermore, the lack of instruments for measuring and assessing leadership make it unclear how schools of pharmacy should operationalize leadership development and thus be held accountable for meeting Standard 4.2. Altogether, these findings suggest that leadership, as currently described in Standards 2016, should be critically re-evaluated by ACPE when determining the next set of standards. Fortunately, should leadership remain an area of emphasis in the future, many conceptualizations of the construct in the pharmacy literature resemble established paradigms, suggesting that existing tools and instructional strategies could be adapted for use in pharmacy education. Studies to evaluate these strategies should serve as the subject of future research.
Received January 16, 2019.
© 2019 American Association of Colleges of Pharmacy
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text:
Harlequins sign former Bath hooker Jack Walker
by Matthew Wood Wednesday 7 July 2021
Jack Walker has made 86 appearances for Bath Rugby
Bath Rugby confirm squad for 2021/22 season
England call-up Bath lock Josh McNally to squad for summer series Tests
Match Centre: Bath Rugby 30-24 Northampton Saints
Bath Rugby, Gallagher Premiership
Premiership champions Harlequins have confirmed the signing of hooker Jack Walker ahead of the 2021/22 season.
Walker joined Bath Rugby from Championship Yorkshire Carnegie ahead of the 2016/17 season and went on to make his debut for the club in the European Challenge Cup. The 25-year-old has gone on to make 86 appearances for the club before making an exit when his contract expired at the end of the 2020/21 season.
Walker also captained the England Under 20 side during the 2016 Six Nations and Junior Rugby World Cup.
"Harlequins are going in an exciting direction at the moment, and I'm thrilled to be able to join them in their journey," he told the club's official website.
"Having spoken to some of the coaches and people involved with the team, I know this is a side with real potential to build something big.
"There's a great balance to the squad and I'm looking forward to playing my part and contributing to what's to come.
"Quins are a team with real history and are one of the first names you think of when you think of English rugby.
"To join a champions team as well-known as Quins is something I'm proud of, and I can't wait to get my first chance at running out in the Quarters."
Match Centre: Bath Rugby 7-64 Leinster Rugby


the second examiner is from another local university and the third examiner is from a suitable foreign university (usually from Commonwealth countries). Specific undergraduate courses, especially writing-intensive courses or courses taken by upperclassmen, may also require one or more extensive written assignments referred to variously as theses, essays, or papers. The Final Oral Defense will be open to the University community. Also involves submission of dissertation.
Students may request, in writing, an extension of one year over the listed time limits. We have also arranged for the University Bookstore to stock the following books on technical writing in computer science: Writing for Computer Science: The Art of Effective Communication, Justin Zobel, Springer Verlag, 175 pages. Second, since the thesis supervisor (and the other members of the advisory committee) will normally have reviewed the thesis extensively before recommending the student proceed to the defense, such an outcome would be regarded as a major failure not only on the part of the. Students who fail one option cannot use the alternative option for graduation. Pearce, Lynne (2005) How to Examine a Thesis, McGraw-Hill International,. Just upload your work, and youre ready to go! At the University of Oxford, for instance, any member of the University may attend a DPhil viva (the University's regulations require that details of the examination and its time and place be published formally in advance) provided he or she attends in full academic dress. Requests of more than one year over the time limit must be approved by the College.


As founder and owner, Lisa is excited to be able to announce the creation and launch of her new online venture, BabiesAndMuchMore.com; this new retail marketplace offers parents a new place to find a wide range of products for the nursery, feeling supplies and more, and a portion of the proceeds is donated to charities fighting child abuse. More information can be found on the website's blog, BabiesAndMoreBlog.com.
Masury, OH -- (ReleaseWire) -- 09/20/2018 -- Lisa is proud to announce the launch of her new website venture, https://BabiesAndMuchMore.com. The online store offers new parents and caregivers a one-stop shop for all of their baby accessories at a price that won't break the bank. Shoppers looking for products for the nursery will appreciate the huge selection of furniture, including cribs, bassinets and playards, as well as accessories like mobiles, bedding, sleeping clothes and more. Feeding time is a whole lot easier with the right supplies, which is exactly what customers will find on the website, including nursing and breast pump accessories, highchairs, bowls, sippy cups and so much more.
BabiesAndMuchMore.com was launched in April 2018 with the vision of a store that not only offers parents and caregivers a place to find high-quality products for infants but also gives them the opportunity to give back to those in need. Lisa was inspired by the birth of her own grandson to offer supplies to new parents and a portion of her proceeds to charitable organizations that fight child abuse. Customers shopping the website can feel great about both the quality of the purchase and their donation to a worthy cause.
All of the products on BabiesAndMuchMore.com are carefully selected for their usefulness, their quality and their durability, so that customers can rest assured that they will last for years to come. As the website continues to grow and mature, new products will become available, including more clothing options for boys and girls, safety equipment like baby gates and baby-proofing accessories and even seasonal apparel and décor.
In conjunction with the main website, Lisa is also launching a blog at https://BabiesAndMoreBlog.com. The posts on the blog will help parents to make purchasing choices by offering product reviews as well as additional product details.
BabiesAndMuchMore.com is owned and operated by Lisa, a grandmother and entrepreneur.


which bases i can get token for technical unit?
And so far the Gen II units have not had the Training Tokens available via Training Bases..
The only time they have been available is during the Special Event in which that unit was introduced in.
I'm not sure when they plan to make them available like the Gen I units tokens.
They will be given out during this next Invasion event.
easy fix.....Don't play it! and the ones who wish to can. I intend to do it (without coin), Now that was easy. Lets move on to the next negative comment please.
Today is the first day of the rest of your life. Make it count!
I have done pretty well in the past invasions and havent coined at all during any of them.Been in top 600 twice and top 300 once.
What has happened to this once great game.


Ashurst and Oentoeng Suria & Partners (OSP) are acting for PT Indonesia Asahan Aluminium (Persero) (Inalum), an Indonesian state owned company, as lead counsel in Inalum's landmark acquisition of a 51.2% majority stake in the Grasberg mine from leading mining companies Freeport-McMoRan and Rio Tinto. The Grasberg mine, located in Papua, Indonesia, is the world's largest gold mine and second largest copper mine. After the transaction, Inalum's stake in the Grasberg mine increased from 9.36% to 51.2%, giving Indonesia majority interest in the mine.
Valued at US$3.85 billion, the transfer of a majority interest in the mine from Freeport-McMoRan and Rio Tinto to Inalum represents one of the most significant and complex M&A transactions in the region this year and Indonesia's largest ever divestment by a foreign resources company. The divestment involved a transfer of a 40% participating interest from Rio Tinto, issuance of new shares in PT Freeport Indonesia, merger filings in five different jurisdictions and a USD4 billion worth of fund raising. The Grasberg mine is a key strategic asset to the Indonesian government and the transaction symbolises the government's continued efforts to gain control of its national assets. The divestment is a significant victory for the people of the Republic of Indonesia and also the largest acquisition by an Indonesian state-owned enterprise.
Partners Simon Brown and Ratih (Ipop) Nawangsari led the Ashurst/OSP team, advising on the international law and Indonesian law aspects respectively.


text:
Q: Splitting time data to fit a timeline of time interval of 0.2 seconds So I have a table with two columns - Time A, and Time B.

I need to plot the time difference from A to B on a timeline of 5 seconds which has an interval of 0.2 seconds, which looks like 0, 0.2, 0.4, 0.6...., 5 seconds.
For every interval of the timeline which matches the difference from A to B, it will register a hit of "1". The expected outcome is like this,

How can I automate this on Excel? Or how to translate this action in Python?
Thank you so much for your help!

redpajama_set_name: RedPajamaStackExchange


Rise Above by Shanell Alyssa It's hard out here for a music consumer. Mainstream media is constantly polluting the airwaves with rubbish which is deteriorating the industry with reckless abandon at an alarming rate. Luckily the universe has given us Acoustic/Neo-Soul artist Shanell Alyssa. In a world where the smog of lackluster music stifles us like acid rain on a muggy day, her music is a much needed breath of fresh air.
Shanell's latest EP Rise Above is so necessary to have. It's a five cut opus that rejuvenates the soul with its relative content and harmonious sound. It kind of reminds me of India.Arie's early work. Soulful stings, skillful writing, and Shanell's solid voice pick up where Arie left off as the bright rays of acoustic soul cuts through the mire clogging the airwaves. All of the featured songs are air-tight, but the standout record is the EP's title track. Silky smooth guitar licks share the spotlight with a light bed of percussion and Shanell belts out powerful lyrics. This is an excellent song man… absolutely excellent.
So stop subjecting yourself to what the mass-communication companies force on you. Show your support by copping the EP (it's only $5) and keep up with all things Shanell Alyssa by following her on Twitter.


but they shall speak with the enemies in the gate. I just finished reading a post from Deep Roots at Home. I must admit that Jacqueline is one of my favorite authors in the blogging world. I met her in person at a home school convention and she is every bit as sweet as she seems in her blog! I am very thankful that I had the opportunity to meet her and hope I will see her again in the future! Her post The Childfree Life is wonderful! My heart breaks for women who can not have children or whose family has been limited for reasons beyond their control. But I think it is a message that has been lost, even in most of our churches. I am not passing judgment, just passing on a wonderful post!
I have several hair clips that I love! They are Flexi Clips from Lilla Rose! Not only are they beautiful, but also quick and easy to use! I find that the clips do not pull and grab my hair like regular "clam-claw" clips do and hold much better!
Bambi, who blogs at In the Nursery of the Nation, is hosting a giveaway! Why not hop over to her blog and check it out!
Today marks the last day of summer vacation! Sunday is the official start of our week with worshipping in the Lord's house and Monday is the official first day of our 2013-2014 academic school year. As much as I am ready, I feel so unprepared. But I know the Lord has called our family to home educate and through His strength we can do it.
Even though we still have at least a month of summer left, starting school always seems like the beginning of the autumn season. I believe we are the last of the families in our neighborhood to return to school, but have some home educating friends who still have a week of summer vacation left. So, unofficially, GOOD BYE SUMMER, HELLO AUTUMN!
Today Son #3 turns twenty-six! Wow! Where does the time go? He was just my little man and now he is a man with a family of his own!
Uh...that would be me! Definitely not nice! I don't think if I could even find the word nice in the dictionary. As a matter of fact, I think "that word" fell out of my dictionary.
Bad day? You bet! My fault? Probably...okay, I take all the blame. It is one of those days. The weather here is changing. We are expected to get some rain and the heat and humidity is starting to climb. I have had a headache since yesterday, my right sinus is hurting with some dizziness added to it.
The house is very much out of order and needs just a little TLC to make it right. Not a problem. Chores have been assigned and placed in chore packs. The nesters know the drill, they what to do.
I love to journal! Let's face it, I love paper and pens! I love "Back to School" days! Plenty of paper and pens for a nice price!
Hop on over to the Munck's Quiver for a giveaway! They are giving away a neat journal and some pretty pens! If you have not had a chance to visit their blog, grab yourself a cup of tea or coffee and pull up a comfy chair! I am sure you will be blessed by visiting this family!


Ashleigh Rider plays with her daughter Chloee, 9, after school in Kingston. The two were separated after Rider entered a drug rehabilitation centre. Rider's recovery from substance abuse might have been quicker had rehabilitation centres accommodated mothers with children. The proposed Kingston House of Recovery for Women and Children addresses the difficult decision faced by mothers fighting through addiction often have to make.
"I knew I wasn't making the right choices, but I was desperate to not lose my child," says Rider, 30, of Kingston, Ont. "I thought doing drugs would be better than her not being with me."
Mothers such as Rider are often faced with what Kingston physician Adam Newman calls an "impossible choice." If they do not seek treatment for their substance use, they can lose custody of their children. But to get the treatment they need in order to keep their families, they're required to leave their children for weeks at a time since most facilities aren't set up to allow families to stay together.
"If your motivation is to be a mother who's on the ball and is looking after her kids, you have to abandon your kids," says Newman, a family doctor who specializes in obstetrics and addiction medicine.
Newman and a team including doctors, nurses, social workers, and women with lived experience are proposing a solution that would be a rarity in Canada. They're looking to build a residential facility in Kingston that would allow mothers with substance-use disorders to stay with their children as they work on their recovery. Currently, the nearest residential rehabilitation centre that accommodates women and children is Portage's Mother and Child Program in Montreal, a model on which the Kingston team's project is based. Few others do the same in other parts of the country.
As Newman explains, the idea for the Kingston project arose from his team's efforts to keep babies born to opioid-dependent women with their mothers at Kingston General Hospital. Instead of whisking the babies off to the neonatal intensive-care unit immediately after birth for observation, their "rooming-in" program, implemented in 2013, offered support for mothers and infants as they were given a chance to bond, uninterrupted. Keeping the mothers and infants together resulted in better health outcomes: The number of babies requiring oral morphine therapy for their withdrawal symptoms was significantly lower, and their average hospital stay was considerably shorter.
The concept of keeping mothers and children together is not based on sentimentality, Newman says. There's evidence to suggest it can be beneficial for the women, too. Treatment for substance-use disorder is notoriously unsuccessful for women who are separated from their children, he says. "She's distracted and heartsick and guilty and missing her kid and feeling bad about the fact that she's not with them. It doesn't work."
Elizabeth Wall-Wieler, lead author of the study, say there's a need for more preventative measures to support women before they're deemed unable to take care of their children. And in cases where it's necessary for children to be taken into care, women need help to ensure the separation doesn't lead to further deterioration of their health and well-being, since that could make it harder for them to regain custody.
"There's a lot of trauma associated with losing custody of a child," she says.
Rider experienced this firsthand. After child protection services intervened in 2015, her daughter, then 6, was placed in the care of Rider's father and stepmother. Meanwhile, Rider went to a treatment centre in Whitby, Ont., more than 200 kilometres away.
Rider, who has her child's name tattooed on her forearm, recalls the pain of hearing her daughter sob, "I want you, Mommy," on the other end of the phone. She fought the urge to immediately run out of the treatment centre to find and comfort her. But she also knew that if she were to regain custody, she needed to remain in the month-long program.
Others told her that the separation was for the best; she needed time to be away from her daughter to focus on herself. But to Rider, that didn't ring true. "That doesn't happen. I'm a mother. I can't disconnect [from] that ever," she says.
Rider considers herself lucky that her daughter was in the care of family members. She knows of plenty of mothers struggling with addiction who have no one on whom to rely. She eventually regained custody after several months, and she says she is now making positive strides. But even their relatively short time apart has had lasting effects. Rider says her daughter still gets anxious about being separated from her. Had the option of staying with her daughter during treatment been available to her, Rider would have sought help long before child protection services became involved, she says. "I could have started to make changes a lot sooner."
"Unless somebody decides to make it a cause and to push it forward, it doesn't matter how worthy or useful or efficient it would be, or cost-efficient even, it won't happen," he says.


he was having a ball with the catnip beaver Kaylah got him for Christmas!
I made lemon bars! That's probably why we haven't eaten many chocolate chip cookies this week.
THAT FACE. I love that face.
Chicken salad in the making. Next time, more chicken, less apple.
Chicken salad, lemon bars, and a Palahniuk book.
Shawn said he was going out for 'a couple of' donuts. Then he came home with a box-full.
And some Girl Scout cookies.
I did it! I took a photo of breakfast before taking any bites! You guys don't understand how difficult that is.
I hope you all had an amazing week!! How about less snow this week though, no?
we have been getting a ton of snow too and it's funny how snow makes one want to bake. :) the anthro windows do look a little creepy but Im sure there is a lot of fun shopping inside.