Antimicrobial prescribing in residential homes.

Objectives: Research in residential homes has been limited to date and the extent of systemic and topical antimicrobial prescribing is largely unknown. The aim of this study was to investigate antimicrobial prescribing in residential homes in Northern Ireland (NI).

Methods: Point prevalence studies (PPSs) were completed in November 2010 (PPS1) and April 2011 (PPS2) in 30 residential homes. Data were obtained from care plans, medication administration records and staff in relation to antimicrobial prescribing and facility and resident characteristics, and analysed descriptively.

Results: The point prevalence of systemic antimicrobial prescribing was 9.4% in PPS1 and 9.2% in PPS2 (range 0.0%–33.3% during both PPSs). Trimethoprim was the most commonly prescribed systemic antimicrobial and the main indication was the prevention of urinary tract infections. Almost 25% of systemic antimicrobials were prescribed at inappropriate doses. The point prevalence of topical antimicrobial prescribing was 6.4% (range 0.0%–22.2%) in PPS1 and 5.9% (range 0.0%–21.1%) in PPS2. The most commonly prescribed topical antimicrobials were chloramphenicol eye preparations in PPS1 and fusidic acid skin preparations in PPS2; treatment with these topical antimicrobials was generally prolonged. More than 25% of all systemic and 55% of all topical antimicrobials were initiated following telephone consultations as opposed to face-to-face consultations.

Conclusions: The prevalence of systemic antimicrobial prescribing in residential homes in NI is relatively high compared with care homes (particularly nursing homes) in other countries. Systemic and topical antimicrobial prescribing is not always appropriate in terms of the doses prescribed and the duration of use. It is apparent that current strategies employed in NI are insuf?cient to ensure prudent antimicrobial prescribing within this environment.

Smart meter devices and the effect of feedback on residential electricity consumption: Evidence from a natural experiment in Northern Ireland

Using a unique set of data and exploiting a large-scale natural experiment, we estimate the effect of real-time usage information on residential electricity consumption in Northern Ireland. Starting in April 2002, the utility replaced prepayment meters with advanced meters that allow the consumer to track usage in real-time. We rely on this event, account for the endogeneity of price and payment plan with consumption through a plan selection correction term, and find that the provision of information is associated with a decline in electricity consumption of 11-17%. We find that the reduction is robust to different specifications, selection-bias correction methods and subsamples of the original data. The advanced metering program delivers reasonably cost-effective reductions in carbon dioxide emissions, even under the most conservative usage reduction scenarios.

Hygrothermal Features of Laterite Dimension Stones for Sub-Saharan Residential Building Construction

The building sector is widely recognized as having a major impact on sustainable development. Both in developed and developing countries, sustainability in buildings approaches are growing. Laterite dimension stone (LDS) is a building material that was traditionally used in sub-Saharan Africa, but its technical features still need to be assessed. This article presents some results of a study focused on the characterization of LDS exploited in Burkina Faso for building purposes. The measured average thermal conductivity is 0.51  W/mK, which increases with water content and evolves with the specific gravity and with porosity. Rock mineral phases (quartz, goethite, hematite, magnetite) are cemented by kaolinite. The porosity of the material is high (30%), with macropores visible on the surface and found in the rock inner structure as well. Results from the hygrothermal monitoring of a pilot building are also presented.

Nurses' experiences providing palliative care to individuals living in rural communities aspects of the physical residential setting

Introduction: Efforts are needed to improve palliative care in rural communities, given the unique characteristics and inherent challenges with respect to working within the physical aspects of residential settings. Nurses who work in rural communities play a key role in the delivery of palliative care services. Hence, the purpose of this study was to explore nurses’ experiences of providing palliative care in rural communities, with a particular focus on the impact of the physical residential setting.

Methods: This study was grounded in a qualitative approach utilizing an exploratory descriptive design. Individual telephone interviews were conducted with 21 community nurses. Data were analyzed by thematic content analysis.

Results: Nurses described the characteristics of working in a rural community and how it influences their perception of their role, highlighting the strong sense of community that exists but how system changes over the past decade have changed the way they provide care. They also described the key role that they play, which was often termed a ‘jack of all trades’, but focused on providing emotional, physical, and spiritual care while trying to manage many challenges related to transitioning and working with other healthcare providers. Finally, nurses described how the challenges of working within the physical constraints of a rural residential setting impeded their care provision to clients who are dying in the community, specifically related to the long distances that they travel while dealing with bad weather.

Utilising a computer game as a therapeutic intervention for youth in residential care: Some preliminary findings on use and acceptability

Mental illness is common amongst young people living in residential care, many of whom are reluctant to avail of therapeutic help. The potential value of computer games as therapeutic tools for these young people has received very little attention, despite indications of their potential for promoting engagement in therapeutic work and improving mental health outcomes. This study aimed to fill this research gap through the development, introduction, and preliminary evaluation of a therapeutic intervention in group care settings. The intervention incorporated a commercially available computer game (The SIMS Life Stories™) and emotion regulation skill coaching. Qualified residential social workers were trained to deliver it to young people in three children's homes in Northern Ireland, where therapeutic approaches to social work had been introduced. The research was framed as an exploratory case study which aimed to determine the acceptability and potential therapeutic value of this intervention. The evidence suggests that computer-game based interventions of this type may have value as therapeutic tools in group care settings and deserve further development and empirical investigation to determine their effectiveness in improving mental health outcomes.

Enhanced AIMD based decentralized residential charging of EVs

Moving from combustion engine to electric vehicle (EV)-based transport is recognized as having a major role to play in reducing pollution, combating climate change and improving energy security. However, the introduction of EVs poses major challenges for power system operation. With increasing penetration of EVs, uncontrolled coincident charging may overload the grid and substantially increase peak power requirements. Developing smart grid technologies and appropriate charging strategies to support the role out of EVs is therefore a high priority. In this paper, we investigate the effectiveness of distributed additive increase and multiplicative decrease (AIMD) charging algorithms, as proposed by Stu¨dli et al. in 2012, at mitigating the impact of domestic charging of EVs on low-voltage distribution networks. In particular, a number of enhancements to the basic AIMD implementation are introduced to enable local power system infrastructure and voltage level constraints to be taken into account and to reduce peak power requirements. The enhanced AIMD EV charging strategies are evaluated using power system simulations for a typical low-voltage residential feeder network in Ireland. Results show that by using the proposed AIMD-based smart charging algorithms, 50% EV penetration can be accommodated, compared with only 10% with uncontrolled charging, without exceeding network infrastructure constraints.

Spatial allocation of material flow analysis in residential developments: a case study of Kildare County, Ireland

Studies of urban metabolism provide important insights for environmental management of cities, but are not widely used in planning practice due to a mismatch of data scale and coverage. This paper introduces the Spatial Allocation of Material Flow Analysis (SAMFA) model as a potential decision support tool aimed as a contribution to overcome some of these difficulties and describes its pilot use at the county level in the Republic of Ireland. The results suggest that SAMFA is capable of identifying hotspots of higher material and energy use to support targeted planning initiatives, while its ability to visualise different policy scenarios supports more effective multi-stakeholder engagement. The paper evaluates this pilot use and sets out how this model can act as an analytical platform for the industrial ecology–spatial planning nexus.

Residential electrical vehicle charging strategies: the good, the bad and the ugly

In recent years, a wide variety of centralised and decentralised algorithms have been proposed for residential charging of electric vehicles (EVs). In this paper, we present a mathematical framework which casts the EV charging scenarios addressed by these algorithms as optimisation problems having either temporal or instantaneous optimisation objectives with respect to the different actors in the power system. Using this framework and a realistic distribution network simulation testbed, we provide a comparative evaluation of a range of different residential EV charging strategies, highlighting in each case positive and negative characteristics.