A cross-sectional evaluation of community pharmacists’ perceptions of intermediate care and medicines management across the healthcare interface

Background Despite the importance placed on the concept of the multidisciplinary team in relation to intermediate care (IC), little is known about community pharmacists’ (CPs) involvement. 
Objective To determine CPs’ awareness of and involvement with IC services, perceptions of the transfer of patients’ medication information between healthcare settings and views of the development of a CP–IC service. 
Setting Community pharmacies in Northern Ireland. 
Methods A postal questionnaire, informed by previous qualitative work was developed and piloted. 
Main outcome measure CPs’ awareness of and involvement with IC. Results The response rate was 35.3 % (190/539). Under half (47.4 %) of CPs ‘agreed/strongly agreed’ that they understood the term ‘intermediate care’. Three quarters of respondents were either not involved or unsure if they were involved with providing services to IC. A small minority (1.2 %) of CPs reported that they received communication regarding medication changes made in hospital or IC settings ‘all of the time’. Only 9.5 and 0.5 % of respondents ‘strongly agreed’ that communication from hospital and IC, respectively, was sufficiently detailed. In total, 155 (81.6 %) CPs indicated that they would like to have greater involvement with IC services. ‘Current workload’ was ranked as the most important barrier to service development.
Conclusion It was revealed that CPs had little awareness of, or involvement with, IC. Communication of information relating to patients’ medicines between settings was perceived as insufficient, especially between IC and community pharmacy settings. CPs demonstrated willingness to be involved with IC and services aimed at bridging the communication gap between healthcare settings.

Assessing the resilience of a real-world social-ecological system: lessons from a multidisciplinary evaluation of a South African pastoral system

In the past decades, social-ecological systems (SESs) worldwide have undergone dramatic transformations with often detrimental consequences for livelihoods. Although resilience thinking offers promising conceptual frameworks to understand SES transformations, empirical resilience assessments of real-world SESs are still rare because SES complexity requires integrating knowledge, theories, and approaches from different disciplines. Taking up this challenge, we empirically assess the resilience of a South African pastoral SES to drought using various methods from natural and social sciences. In the ecological subsystem, we analyze rangelands’ ability to buffer drought effects on forage provision, using soil and vegetation indicators. In the social subsystem, we assess households’ and communities’ capacities to mitigate drought effects, applying agronomic and institutional indicators and benchmarking against practices and institutions in traditional pastoral SESs. Our results indicate that a decoupling of livelihoods from livestock-generated income was initiated by government interventions in the 1930s. In the post-apartheid phase, minimum-input strategies of herd management were adopted, leading to a recovery of rangeland vegetation due to unintentionally reduced stocking densities. Because current livelihood security is mainly based on external monetary resources (pensions, child grants, and disability grants), household resilience to drought is higher than in historical phases. Our study is one of the first to use a truly multidisciplinary resilience assessment. Conflicting results from partial assessments underline that measuring narrow indicator sets may impede a deeper understanding of SES transformations. The results also imply that the resilience of contemporary, open SESs cannot be explained by an inward-looking approach because essential connections and drivers at other scales have become relevant in the globalized world. Our study thus has helped to identify pitfalls in empirical resilience assessment and to improve the conceptualization of SES dynamics.

Supporting self-management: development and evaluation of a digital resource for adults with asthma

The problem: Around 300 million people worldwide have asthma and prevalence is increasing. Support for optimal self-management can be effective in improving a range of outcomes and is cost effective, but is underutilised as a treatment strategy. Supporting optimum self-management using digital technology shows promise, but how best to do this is not clear. Aim: The purpose of this project was to explore the potential role of a digital intervention in promoting optimum self-management in adults with asthma. Methods: Following the MRC Guidance on the Development and Evaluation of Complex Interventions which advocates using theory, evidence, user testing and appropriate modelling and piloting, this project had 3 phases. Phase 1: Examination of the literature to inform phases 2 and 3, using systematic review methods and focussed literature searching. Phase 2: Developing the Living Well with Asthma website. A prototype (paper-based) version of the website was developed iteratively with input from a multidisciplinary expert panel, empirical evidence from the literature (from phase 1), and potential end users via focus groups (adults with asthma and practice nurses). Implementation and behaviour change theories informed this process. The paper-based designs were converted to the website through an iterative user centred process (think aloud studies with adults with asthma). Participants considered contents, layout, and navigation. Development was agile using feedback from the think aloud sessions immediately to inform design and subsequent think aloud sessions. Phase 3: A pilot randomised controlled trial over 12 weeks to evaluate the feasibility of a Phase 3 trial of Living Well with Asthma to support self-management. Primary outcomes were 1) recruitment & retention; 2) website use; 3) Asthma Control Questionnaire (ACQ) score change from baseline; 4) Mini Asthma Quality of Life (AQLQ) score change from baseline. Secondary outcomes were patient activation, adherence, lung function, fractional exhaled nitric oxide (FeNO), generic quality of life measure (EQ-5D), medication use, prescribing and health services contacts. Results: Phase1: Demonstrated that while digital interventions show promise, with some evidence of effectiveness in certain outcomes, participants were poorly characterised, telling us little about the reach of these interventions. The interventions themselves were poorly described making drawing definitive conclusions about what worked and what did not impossible. Phase 2: The literature indicated that important aspects to cover in any self-management intervention (digital or not) included: asthma action plans, regular health professional review, trigger avoidance, psychological functioning, self-monitoring, inhaler technique, and goal setting. The website asked users to aim to be symptom free. Key behaviours targeted to achieve this include: optimising medication use (including inhaler technique); attending primary care asthma reviews; using asthma action plans; increasing physical activity levels; and stopping smoking. The website had 11 sections, plus email reminders, which promoted these behaviours. Feedback during think aloud studies was mainly positive with most changes focussing on clarification of language, order of pages and usability issues mainly relating to navigation difficulties. Phase 3: To achieve our recruitment target 5383 potential participants were invited, leading to 51 participants randomised (25 to intervention group). Age range 16-78 years; 75% female; 28% from most deprived quintile. Nineteen (76%) of the intervention group used the website for an average of 23 minutes. Non-significant improvements in favour of the intervention group observed in the ACQ score (-0.36; 95% confidence interval: -0.96, 0.23; p=0.225), and mini-AQLQ scores (0.38; -0.13, 0.89; p=0.136). A significant improvement was observed in the activity limitation domain of the mini-AQLQ (0.60; 0.05 to 1.15; p = 0.034). Secondary outcomes showed increased patient activation and reduced reliance on reliever medication. There was no significant difference in the remaining secondary outcomes. There were no adverse events. Conclusion: Living Well with Asthma has been shown to be acceptable to potential end users, and has potential for effectiveness. This intervention merits further development, and subsequent evaluation in a Phase III full scale RCT.

Experimental study on the impact of using a fan coil in the evaluation of contaminant removal effectiveness of common air diffusion strategies

Indoor Air 2016 - The 14th International Conference Indoor Air Quality and Climate

Influences of change strategies to achieve organizational flexibility: a system dynamics approach.

257 p.

TRAFFIC IMPACT ANALYSIS OF SEVERAL DYNAMIC LANE MANAGEMENT STRATEGIES FOR CONGESTION MITIGATION BASED ON DTA MODEL

Persistent daily congestion has been increasing in recent years, particularly along major corridors during selected periods in the mornings and evenings. On certain segments, these roadways are often at or near capacity. However, a conventional Predefined control strategy did not fit the demands that changed over time, making it necessary to implement the various dynamical lane management strategies discussed in this thesis. Those strategies include hard shoulder running, reversible HOV lanes, dynamic tolls and variable speed limit. A mesoscopic agent-based DTA model is used to simulate different strategies and scenarios. From the analyses, all strategies aim to mitigate congestion in terms of the average speed and average density. The largest improvement can be found in hard shoulder running and reversible HOV lanes while the other two provide more stable traffic. In terms of average speed and travel time, hard shoulder running is the most congested strategy for I-270 to help relieve the traffic pressure.

Characterization and evaluation of the impact of feed management on the effluents of Nile tilapia (Oreochromis niloticus) culture

O objetivo deste trabalho foi avaliar o efeito da utilização de diferentes manejos alimentares: alimento natural, ração peletizada, extrusada ou farelada, sobre a qualidade da água dos efluentes gerados em uma criação de tilápia do Nilo (Oreochromis niloticus). O experimento foi desenvolvido durante 19 semanas em doze viveiros de 300 m², com renovação contínua de água, povoados com juvenis machos de tilápia do Nilo na densidade de 1,7 peixes m-2. As rações isoproteícas (30% de proteína bruta) e isoenergéticas (3.000kcal de energia digestível) foram fornecidas duas vezes ao dia. Quanto ao tratamento alimento natural, foi utilizado esterco de galinha poedeira. Semanalmente, foram aferidos na água de abastecimento e nos efluentes, temperatura, oxigênio dissolvido, pH, fósforo total, nitrogênio total, clorofila a e material em suspensão. de maneira geral, houve piora na qualidade da água dos efluentes de todos os tratamentos estudados, em comparação a água de abastecimento, evidenciando o impacto ambiental desta atividade produtiva, podendo levar a eutrofização dos corpos d'água receptores.

Evaluation of confidence-driven cost aggregation strategies

In this thesis I describe eight new stereo matching algorithms that perform the cost-aggregation step using a guided filter with a confidence map as guidance image, and share the structure of a linear stereo matching algorithm. The results of the execution of the proposed algorithms on four pictures from the Middlebury dataset are shown as well. Finally, based on these results, a ranking of the proposed algorithms is presented.

Evaluation of the risk factors contributing to the African swine fever occurrence in Sardinia, Italy

This study assesses the relation between hypothesized risk factors and African swine fever virus (ASFV) distribution in Sardinia (Italy) after the beginning of the eradication program in 1993, using a Bayesian multivariable logistic regression mixed model. Results indicate that the probability of ASFV occurrence in Sardinia was associated to particular socio-cultural, productive and economical factors found in the region, particularly to large number of confined (i.e., closed) farms (most of them backyard), high road density, high mean altitude, large number of open fattening farms, and large number of pigs per commune. Conversely, large proportion of open farms with at least one census and large proportion of open farms per commune, were found to be protective factors for ASFV. Results suggest that basic preventive and control strategies, such as yearly census or registration of the pigs per farm and better control of the public lands where pigs are usually raised, together with endanced effords of outreach and communication with pig producers should help in the success of the eradication program for ASF in the Island. Methods and results presented here will inform decision making to better control and eradicate ASF in Sardinia and in all those areas with similar management and epidemiological conditions.

Emergetic evaluation of cattle rearing in a montado farm

O Montado, em Portugal, é um complexo sistema silvopastoril de uso da terra, tipicamente Mediterrânico, com diversos estratos de vegetação, incluindo sobreiro e azinheira em várias densidades, onde é frequente a criação de gado. Esta actividade pecuária beneficia das pastagens no sob-coberto, de algumas espécies arbustivas e também das bolotas que caem do coberto arbóreo, contribuindo para evitar a invasão da pastagem por matos. No entanto, dependendo da sua gestão, este gado pode comprometer a regeneração do sistema. Nos últimos 20 anos, os subsídios no âmbito da Política Agrícola Comum da União Europeia têm promovido a criação de gado bovino em detrimento de outras espécies e raças mais leves, bem como a intensificação desta produção. Esta intensificação pode impossibilitar a regeneração natural das árvores ameaçando o equilíbrio do Montado. Por esta razão é necessária uma avaliação focada na criação de gado bovino e nos seus impactos sobre o sistema. O objectivo deste estudo foi obter uma melhor compreensão do funcionamento de uma exploração silvopastoril num sistema de Montado, através da aplicação do Método de Avaliação Emergética e do cálculo de índices emergéticos. Pretende-se assim compreender a melhor forma de o gerir, bem como conceber estratégias que maximizem o fluxo de emergia na exploração. Uma comparação deste método com a avaliação económica permitiu perceber em que aspectos esta pode ser complementada pelo método da avaliação emergética. O método da avaliação emergética permite a avaliação de sistemas multifuncionais complexos à escala de uma exploração individual, fornecendo informação extra em relação à avaliação económica como a renovabilidade dos inputs do sistema, ou a quantidade de fluxos livres da natureza que é valorada por preços de mercado. Este método permite a integração das emternalidades e das externalidades à contabilização económica, transformando uma avaliação tendencialmente separada do seu sistema mais vasto, numa avaliação de um sistema em conexão com aqueles mais vastos nos quais se integra; Abstract: The Montado, in Portugal, is a complex silvo-pastoral system of land use, typically Mediterranean, with different strata of vegetation, including cork and holm oaks in various densities, and where cattle rearing is common. This stockfarm benefits from the herbaceous layer under the trees, as well as from some species in the shrub layer, and also from the acorns faling down from the tree cover, while contributing to prevent the invasion of pastures by shrubs. Nevertheless, depending on its management, livestock can affect the system regeneration. Over the past 20 years, subsidies of the European Union's common agricultural policy have promoted the cattle rearing at expense of other lighter species and breeds, as well as its intensification. This intensification may impair the natural regeneration of trees threatening the balance of the Montado. Therefore an assessment focused on cattle and their impact on the system is required. The purpose of this study was to obtain a better understanding of the functioning of a silvo-pastoral farm in a Montado system, by applying the emergy evaluation method and through the calculation of emergy indices. It is intended to understand the best way to manage and design strategies that maximize the emergy flow on the farm. A comparison of this method with the economic evaluation allowed to realize in what aspects it can be complemented by the emergy evaluation method. The emergy evaluation method alows the assessment of complex multi-functional systems at the scale of an individual farm, providing extra information in relation to economic avaluation as the renewability of the inputs to a system and the amount of free flows of nature that is valued by market prices. This method allows the integration of the emternalities and the externalities to the economic accounting, transforming an evaluation tended separated from its wider system, in an evaluation of a system in connection with the larger ones on which it is incorporated.

Modelling and Optimization of Energy Management Strategies for Hybrid Vehicles

In the last decades the automotive sector has seen a technological revolution, due mainly to the more restrictive regulation, the newly introduced technologies and, as last, to the poor resources of fossil fuels remaining on Earth. Promising solution in vehicles’ propulsion are represented by alternative architectures and energy sources, for example fuel-cells and pure electric vehicles. The automotive transition to new and green vehicles is passing through the development of hybrid vehicles, that usually combine positive aspects of each technology. To fully exploit the powerful of hybrid vehicles, however, it is important to manage the powertrain’s degrees of freedom in the smartest way possible, otherwise hybridization would be worthless. To this aim, this dissertation is focused on the development of energy management strategies and predictive control functions. Such algorithms have the goal of increasing the powertrain overall efficiency and contextually increasing the driver safety. Such control algorithms have been applied to an axle-split Plug-in Hybrid Electric Vehicle with a complex architecture that allows more than one driving modes, including the pure electric one. The different energy management strategies investigated are mainly three: the vehicle baseline heuristic controller, in the following mentioned as rule-based controller, a sub-optimal controller that can include also predictive functionalities, referred to as Equivalent Consumption Minimization Strategy, and a vehicle global optimum control technique, called Dynamic Programming, also including the high-voltage battery thermal management. During this project, different modelling approaches have been applied to the powertrain, including Hardware-in-the-loop, and diverse powertrain high-level controllers have been developed and implemented, increasing at each step their complexity. It has been proven the potential of using sophisticated powertrain control techniques, and that the gainable benefits in terms of fuel economy are largely influenced by the chose energy management strategy, even considering the powerful vehicle investigated.

Development of predictive energy management strategies for hybrid electric vehicles supported by connectivity

Nowadays, the spreading of the air pollution crisis enhanced by greenhouse gases emission is leading to the worsening of the global warming. In this context, the transportation sector plays a vital role, since it is responsible for a large part of carbon dioxide production. In order to address these issues, the present thesis deals with the development of advanced control strategies for the energy efficiency optimization of plug-in hybrid electric vehicles (PHEVs), supported by the prediction of future working conditions of the powertrain. In particular, a Dynamic Programming algorithm has been developed for the combined optimization of vehicle energy and battery thermal management. At this aim, the battery temperature and the battery cooling circuit control signal have been considered as an additional state and control variables, respectively. Moreover, an adaptive equivalent consumption minimization strategy (A-ECMS) has been modified to handle zero-emission zones, where engine propulsion is not allowed. Navigation data represent an essential element in the achievement of these tasks. With this aim, a novel simulation and testing environment has been developed during the PhD research activity, as an effective tool to retrieve routing information from map service providers via vehicle-to-everything connectivity. Comparisons between the developed and the reference strategies are made, as well, in order to assess their impact on the vehicle energy consumption. All the activities presented in this doctoral dissertation have been carried out at the Green Mobility Research Lab} (GMRL), a research center resulting from the partnership between the University of Bologna and FEV Italia s.r.l., which represents the industrial partner of the research project.

Development of Optimal Energy Management Strategies for a Hybrid Boat

The present work proposes different approaches to extend the mathematical methods of supervisory energy management used in terrestrial environments to the maritime sector, that diverges in constraints, variables and disturbances. The aim is to find the optimal real-time solution that includes the minimization of a defined track time, while maintaining the classical energetic approach. Starting from analyzing and modelling the powertrain and boat dynamics, the energy economy problem formulation is done, following the mathematical principles behind the optimal control theory. Then, an adaptation aimed in finding a winning strategy for the Monaco Energy Boat Challenge endurance trial is performed via ECMS and A-ECMS control strategies, which lead to a more accurate knowledge of energy sources and boat’s behaviour. The simulations show that the algorithm accomplishes fuel economy and time optimization targets, but the latter adds huge tuning and calculation complexity. In order to assess a practical implementation on real hardware, the knowledge of the previous approaches has been translated into a rule-based algorithm, that let it be run on an embedded CPU. Finally, the algorithm has been tuned and tested in a real-world race scenario, showing promising results.

Evaluation of a 2D multileader training system for improving sustainability and precision orchard management applications in italian apple orchards

The presented study aimed to evaluate the productive and physiological behavior of a 2D multileader apple training systems in the Italian environment both investigating the possibility to increase yield and precision crop load management resolution. Another objective was to find valuable thinning thresholds guaranteeing high yields and matching fruit market requirements. The thesis consists in three studies carried out in a Pink Lady®- Rosy Glow apple orchard trained as a planar multileader training system (double guyot). Fruiting leaders (uprights) dimension, crop load, fruit quality, flower and physiological (leaf gas exchanges and fruit growth rate) data were collected and analysed. The obtained results found that uprights present dependence among each other and as well as a mutual support during fruit development. However, individual upright fruit load and upright’s fruit load distribution on the tree (~ plant crop load) seems to define both upright independence from the other, and single upright crop load effects on the final fruit quality production. Correlations between fruit load and harvest fruit size were found and thanks to that valuable thinning thresholds, based on different vegetative parameters, were obtained. Moreover, it comes out that an upright’s fruit load random distribution presents a widening of those thinning thresholds, keeping un-altered fruit quality. For this reason, uprights resulted a partially physiologically-dependent plant unit. Therefore, if considered and managed as independent, then no major problems on final fruit quality and production occurred. This partly confirmed the possibility to shift crop load management to single upright. The finding of the presented studies together with the benefits coming from multileader planar training systems suggest a high potentiality of the 2D multileader training systems to increase apple production sustainability and profitability for Italian apple orchard, while easing the advent of automation in fruit production.