Advance care planning in stroke: Influence of time on engagement in the process

Purpose Individuals who experience stroke have a higher likelihood of subsequent stroke events, making it imperative to plan for future medical care. In the event of a further serious health event, engaging in the process of advanced care planning (ACP) can help family members and health care professionals (HCPs) make medical decisions for individuals who have lost the capacity to do so. Few studies have explored the views and experiences of patients with stroke about discussing their wishes and preferences for future medical events, and the extent to which stroke HCPs engage in conversations around planning for such events. In this study, we sought to understand how the process of ACP unfolded between HCPs and patients post-stroke. Patients and methods Using grounded theory (GT) methodology, we engaged in direct observation of HCP and patient interactions on an acute stroke unit and two stroke rehabilitation units. Using semi-structured interviews, 14 patients and four HCPs were interviewed directly about the ACP process. Results We found that open and continual ACP conversations were not taking place, patients experienced an apparent lack of urgency to engage in ACP, and HCPs were uncomfortable initiating ACP conversations due to the sensitive nature of the topic. Conclusion In this study, we identified lack of engagement in ACP post-stroke, attributable to patient and HCP factors. This encourages us to look further into the process of ACP in order to develop open communication between the patient with stroke, their families, and stroke HCPs.

Towards adaptive management of QoS-aware service compositions - Functional architecture

Service compositions enable users to realize their complex needs as a single request. Despite intensive research, especially in the area of business processes, web services and grids, an open and valid question is still how to manage service compositions in order to satisfy both functional and non-functional requirements as well as adapt to dynamic changes. In this paper we propose an (functional) architecture for adaptive management of QoS-aware service compositions. Comparing to the other existing architectures this one offers two major advantages. Firstly, this architecture supports various execution strategies based on dynamic selection and negotiation of services included in a service composition, contracting based on service level agreements, service enactment with flexible support for exception handling, monitoring of service level objectives, and profiling of execution data. Secondly, the architecture is built on the basis of well know existing standards to communicate and exchange data, which significantly reduces effort to integrate existing solutions and tools from different vendors. A first prototype of this architecture has been implemented within an EU-funded Adaptive Service Grid project. © 2006 Springer-Verlag.

Improved shear design rules of cold-formed steel beams

Light gauge cold-formed steel sections have been developed as more economical building solutions to the alternative heavier hot-rolled sections in the commercial and residential markets. Cold-formed lipped channel beams (LCB), LiteSteel beams (LSB) and triangular hollow flange beams (THFB) are commonly used as flexural members such as floor joists and bearers while rectangular hollow flange beams (RHFB) are used in small scale housing developments through to large building structures. However, their shear capacities are determined based on conservative design rules. For the shear design of cold-formed steel beams, their elastic shear buckling strength and the potential post-buckling strength must be determined accurately. Hence experimental and numerical studies were conducted to investigate the shear behaviour and strength of LCBs, LSBs, THFBs and RHFBs. Improved shear design rules including the direct strength method (DSM) based design equations were developed to determine the ultimate shear capacities of these open and hollow flange steel beams. An improved equation for the higher elastic shear buckling coefficient of cold-formed steel beams was proposed based on finite element analysis results and included in the design equations. A new post-buckling coefficient was also introduced in the design equations to include the available post-buckling strength of cold-formed steel beams. This paper presents the details of this study on cold-formed steel beams subject to shear, and the results. It proposes generalised and improved shear design rules that can be used for any type of cold-formed steel beam.

Burning questions: Exploring the impact of a natural disaster on community pharmacies

Background The past decade has seen a rapid change in the climate system with an increased risk of extreme weather events. On and following the 3rd of January 2013, Tasmania experienced three catastrophic bushfires, which led to the evacuation of several communities, the loss of many properties, and a financial cost of approximately AUD$80 million. Objective To explore the impacts of the 2012/2013 Tasmanian bushfires on community pharmacies. Method Qualitative research methods were undertaken, employing semi-structured telephone interviews with a purposive sample of seven Tasmanian pharmacists. The interviews were recorded and transcribed, and two different methods were used to analyse the text. The first method utilised Leximancer® text analytics software to provide a birds-eye view of the conceptual structure of the text. The second method involved manual, open and axial coding, conducted independently by the two researchers for inter-rater reliability, to identify key themes in the discourse. Results Two main themes were identified - ‘people’ and ‘supply’ - from which six key concepts were derived. The six concepts were ‘patients’, ‘pharmacists’, ‘local doctor’, ‘pharmacy operations’, ‘disaster management planning’, and ‘emergency supply regulation’. Conclusion This study identified challenges faced by community pharmacists during Tasmanian bushfires. Interviewees highlighted the need for both the Tasmanian State Government and the Australian Federal Government to recognise the important primary care role that community pharmacists play during natural disasters, and therefore involve pharmacists in disaster management planning. They called for greater support and guidance for community pharmacists from regulatory and other government bodies during these events. Their comments highlighted the need for a review of Tasmania’s 3-day emergency supply regulation that allows pharmacists to provide a three-day supply of a patient’s medication without a doctor’s prescription in an emergency situation.

Arguing the archive: Reconceptualising the NFSA in a time of austerity

This paper examines key issues emerging from the July 2014 Where We Are Heading sessions conducted between The National Film and Sound Archive (NFSA) CEO Michael Loebenstein, industry stakeholders and members of the public seeking to engage with the future direction of the NFSA. Analysis of transcripts from these public meetings reveal significant conceptual and programmatic gaps exist between what the NFSA has done in the past, how it “self-actualises” in terms of a national collection and what it can practically and effectively achieve in the near future. These significant challenges to the historical function of the Archive occur at a time of pronounced economic austerity for public cultural institutions and expanding, digitally driven curatorial responsibilities. Tensions exist between the need for the NFSA to increase revenue while preserving the function of an open and accessible Archive. Three key areas of challenge are addressed - digitisation, funding and the need for the NFSA to connect more broadly and more deeply with Australian society. The latter area is identified as crucial as the NFSA continues to articulate and actively promote the public value of the Archive through renewed program and outreach efforts.

DIY/DIWO media architecture: The InstaBooth

Building on previous discourse regarding the ability of media architecture to be more open and accessible for the purposes of community engagement (Caldwell & Foth, 2014), this chapter explores a particular case study that was designed, constructed and implemented with the intention of allowing city users to participate in the development and creation of media architecture, the InstaBooth. In this chapter, we first explore DIY (do it yourself) and DIWO (do it with others) phenomena to examine what motivates the DIY cultures, communities, and practices. Secondly, in this chapter, we define and discuss our implementation of a DIY / DIWO media architecture example, the InstaBooth. The InstaBooth project pro-vides an opportunity to question the effectiveness of a DIY driven media architec-ture artefact to see to what extent it impacts on the experience of its users and for what benefit.