Travels in the interior districts of Africa /

Cox, Edward, "Reference guide to the literature of travel",

If the heart be young.

Mode of access: Internet.

The gentleman ragman; Johnny Thompson's story of the Emigger,

Mode of access: Internet.

"God bless you."

Mode of access: Internet.

Development of DYNAMIX Policy Mixes - Deliverable 4.2, revised version, of the DYNAMIX project

This report documents the development of the initial dynamic policy mixes that were developed for assessment in the DYNAMIX project. The policy mixes were designed within three different policy areas: overarching policy, land-use and food, and metals and other materials. The policy areas were selected to address absolute decoupling in general and, specifically, the DYNAMIX targets related to the use of virgin metals, the use of arable land and freshwater, the input of the nutrients nitrogen and phosphorus, and emissions of greenhouse gases. Each policy mix was developed within a separate author team, using a common methodological framework that utilize previous findings in the project. Specific drivers and barriers for resource use and resource efficiency are discussed in each policy area. Specific policy objectives and targets are also discussed before the actual policy mix is presented. Each policy mix includes a set of key instruments, which can be embedded in a wider set of supporting and complementary policy instruments. All key instruments are described in the report through responses to a set of predefined questions. The overarching mix includes a broad variety of key instruments. The land-use policy mix emphasizes five instruments to improve food production through, for example, revisions of already existing policy documents. It also includes three instruments to influence the food consumption and food waste. The policy mix on metals and other materials primarily aims at reducing the use of virgin metals through increased recycling, increased material efficiency and environmentally justified material substitution. To avoid simply shifting of burdens, it includes several instruments of an overarching character.

Concept maps as a tool to analyze the ideas of teacher training students regarding what to teach on human nutrition in Primary Education

Concept maps are a technique used to obtain a visual representation of a person's ideas about a concept or a set of related concepts. Specifically, in this paper, through a qualitative methodology, we analyze the concept maps proposed by 52 groups of teacher training students in order to find out the characteristics of the maps and the degree of adequacy of the contents with regard to the teaching of human nutrition in the 3rd cycle of primary education. The participants were enrolled in the Teacher Training Degree majoring in Primary Education, and the data collection was carried out through a training activity under the theme of what to teach about Science in Primary School? The results show that the maps are a useful tool for working in teacher education as they allow organizing, synthesizing, and communicating what students know. Moreover, through this work, it has been possible to see that future teachers have acceptable skills for representing the concepts/ideas in a concept map, although the level of adequacy of concepts/ideas about human nutrition and its relations is usually medium or low. These results are a wake-up call for teacher training, both initial and ongoing, because they shows the inability to change priorities as far as the selection of content is concerned.

Economic evaluations of clinical pharmacy services in Ireland, 2007-2015

Introduction The concept of this thesis was driven by stagnation within the Irish healthcare system. Multiple reports from pharmacy organisations had outlined possible future directions for the profession but progress was minimal, especially in comparison with other countries. The author’s directive was to evaluate the economic impact of a series of clinical pharmacy services (CPS) in hospital and community settings. Methods A systematic review of economic evaluations of clinical pharmacy services in hospital patients was undertaken to gain insight into recent research in the field. Eligible studies were evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS), to establish the quality, consistency and transparency of relevant research. A retrospective analysis of an internal hospital pharmacy interventions database was conducted. A method first described by Nesbit et al. was implemented to estimate the level of cost avoidance achieved. A cost-effectiveness analysis based on data from a randomised controlled trial of a pharmacist-supervised patient self-testing (PST) of warfarin therapy is presented. Outcome measure was the incremental cost associated with six months of intervention management. A similar cost-effectiveness analysis based on previously published RCT data was used to evaluate a novel structured pharmacist review of medication in older hospitalised patients. Cost-effectiveness analysis was presented in the form of an incremental cost-effectiveness ratio (ICER). An ICER is an additional cost per unit effect, in the case of this study, the cost of preventing an additional non-trivial ADR in hospital. A method described by Preaud et al. was adapted to estimate the clinical and economic benefit gained from vaccination of patients by a community pharmacist in Ireland in 2013/14. Sample demographic data was obtained from a national chain of community pharmacies and applied to overall national vaccination data. Results Systematic review identified twenty studies which were eligible for inclusion. Overall, pharmacist interventions had a positive impact on hospital budgets. Only three studies (15%) were deemed to be “good-quality” studies. No ‘novel’ clinical pharmacist intervention was identified during the course of this review. Analysis of internal hospital database identified 4,257 interventions documented on 2,147 individual patients over a 12 month period. Substantial cost avoidance of €710,000 was generated over a 1 year period from the perspective of the health care provider. Mean cost avoidance of €166 per intervention was generated. The cost of providing these interventions was €82,000. Substantial net cost-benefits of €626,279 and a cost-benefit ratio of 8.64 : 1 were generated based on this evaluation of pharmacist interventions. Results from an evaluation of a novel pharmacist-led form of warfarin management indicated indicated that on a per patient basis, PST was slightly more expensive than established anticoagulant management. On a per patient basis over a six month period, PST resulted in an incremental cost of €59.08 in comparison with routine care. Overall cost of managing a patient through pharmacist-supervised PST for a six month period is €226.45. However, for this increase in cost a clinically significant improvement in care was provided. Patients achieved a significantly higher time in therapeutic range during the PST arm in comparison with routine care, (72 ± 19.7% vs 59 ± 13.5%). Difference in overall cost was minimal and PST was the dominant strategy in some scenarios examined during sensitivity analysis. Structured pharmacist review of medication was determined to be dominant in comparison to usual pharmaceutical care. Even if the healthcare payer was unwilling to pay any money for the prevention of an ADR, the intervention strategy is still likely to be cost-effective (probability of being determined cost-effective = 0.707). Implementation of pharmacist-led influenza vaccination has resulted in substantial clinical and economic benefits to the healthcare system. The majority of patients (64.9%) who availed of this service had identifiable influenza-related risk factors. Of patients with influenza-related risk factors, age ≥65 year was the most commonly cited risk factor. Pharmacist vaccination services averted a total of 848 influenza cases across all age groups during the 2013/2014 influenza season. Due to receipt of vaccination in a pharmacy setting, 444 influenza-related GP visits were prevented. In terms of more serious influenza-associated events, 11 hospitalisations and five influenza-related deaths were averted. Costs averted were approximately €305,000. These were principally wider societal-related costs associated with lost productivity. Conclusion Overall, clinical pharmacy services are adding value to the Irish healthcare system in both hospital and community settings, but provision of additional funding for new services would enable them to offer a great deal more.