Medicines non-use in primary care

This study expands the current knowledge base on the nature, causes and fate of unused medicines in primary care. Three methodologies were used and participants for each element were sampled from the population of Eastern Birmingham PCT. A detailed assessment was made of medicines returned to pharmacies and GP surgeries for destruction and a postal questionnaire covering medicines use and disposal was used to patients randomly selected from the electoral roll. The content of this questionnaire was informed by qualitative data from a group interview on the subject. By use of these three methods it was possible to triangulate the data, providing a comprehensive assessment of unused medicines. Unused medicines were found to be ubiquitous in primary care and cardiovascular, diabetic and respiratory medicines are unused in substantial quantities, accounting for a considerable proportion of the total financial value of all unused medicines. Additionally, analgesic and psychoactive medicines were highlighted as being unused in sufficient quantities for concern. Anti-infective medicines also appear to be present and unused in a substantial proportion of patients’ homes. Changes to prescribed therapy and non-compliance were identified as important factors leading to the generation of unused medicines. However, a wide array of other elements influence the quantities and types of medicines that are unused including the concordancy of GP consultations and medication reviews and patient factors such as age, sex or ethnicity. Medicines were appropriately discarded by 1 in 3 patients through return to a medical or pharmaceutical establishment. Inappropriate disposal was by placing in household refuse or through grey and black water with the possibility of hoarding or diversion also being identified. No correlations wre found between the weight of unused medicines and any clinical or financial factor. The study has highlighted unused medicines to be an issue of some concern and one that requires further study.

A national roll out of an insufficiently evaluated practice : how evidence based are our end-of-life care policies?

There has been increasing international efforts to ensure that health care policies are evidence based. One area where there is a lack of ‘effectiveness’ evidence is in the use of end-of-life care pathways (EOLCP) (1). Despite the lack of evidence supporting the efficacy of the EOCLP, their use has been endorsed in the recent national palliative care strategy document in the UK (2). In addition, a publication endorsed by the Australian Government (titled: Supporting Australians to live well at the End of Life- National Palliative Care Strategy 2010) (3), recommended a national roll out of EOLCP across all sectors (primary, acute and aged care) in Australia. According to this document, it is a measure of “appropriateness” and “effectiveness” for promoting quality end-of-life care.

Elections 2.0 : reflections on the 2010 federal election and the future of Australian electoral law

This article analyses the 2010 federal election and the impact the internet and social media had on electoral law, and what this may mean for electoral law in the future. Four electoral law issues arising out of the 2010 election as a result of the internet are considered, including online enrolment, regulation of online advertising and comment, fundraising and the role of lobby groups, especially when it comes to crowdsourcing court challenges. Finally, the article offers some suggestions as to how the parliament and the courts should respond to these challenges.

Roll the dice, rational agent : should extra-curial punishment mitigate an offender's sentence?

It was rugby league State of Origin night 2008 and a group of adults had descended upon a house in Eagleby, Brisbane to have some drinks and to celebrate the game. At 11pm that evening, Shane Thomas Davidson entered the bedroom of the homeowner’s 10-year-old son, TC. Davidson approached the bed and began to massage the boy’s penis under his clothing, which caused TC to wake. Davidson stated, ‘Show me how big your willy is and I’ll show you how big mine is’. TC refused the request and after a small period of time, left the bedroom and told his father what had happened...

Politicians as experts, electoral control, and fiscal restraints

We establish an argument for fiscal restraints which is based on the idea that politicians are experts in the meaning of the credence good literature. A budget maximizing politician is better informed than the electorate about the necessary spending to ensure the states ability to provide services for the economy. Voters, being able to observe the budget but not the necessary level of spending, attenuate the government’s spending level via electoral control. A fiscal restraint limits the maximum spending a government will choose if the level of spending ensuring the politicians reelection is not sufficient to ensure the state’s ability to provide services to the economy. We determine when such a fiscal restraint improves voter welfare and discuss the role of the opposition in situations where very high levels of spending are required.

Electoral behaviour in the 2010 Australian federal election

All elections are unique, but the Australian federal election of 2010 was unusual for many reasons. It came in the wake of the unprecedented ousting of the Prime Minister who had led the Australian Labor Party to a landslide victory, after eleven years in opposition, at the previous election in 2007. In a move that to many would have been unthinkable, Kevin Rudd’s increasing unpopularity within his own parliamentary party finally took its toll and in late June he was replaced by his deputy, Julia Gillard. Thus the second unusual feature of the election was that it was contested by Australia’s first female prime minister. The third unusual feature was that the election almost saw a first-term government, with a comfortable majority, defeated. Instead it resulted in a hung parliament, for the first time since 1940, and Labor scraped back into power as a minority government, supported by three independents and the first member of the Australian Greens ever to be elected to the House of Representatives. The Coalition Liberal and National opposition parties themselves had a leader of only eight months standing, Tony Abbott, whose ascension to the position had surprised more than a few. This was the context for an investigation of voting behaviour in the 2010 election....

Engineering the surface of a sugarcane roller mill roll for grip and durability

Roller mills are typically used to crush sugarcane to express the juice from which sugar is manufactured. The mill rolls need to provide sufficient grip to ensure minimal sliding of the sugarcane along the roll surface. The rolls are subject to pressures up to 55 MPa from the sugarcane bagasse (as the sugarcane is called after first being crushed between a pair of rolls). The insoluble component of sugarcane includes typically 10% ash that largely originates from soil that is harvested with the cane. The sugarcane juice is acidic with pH typically between 5.0 and 5.5. As a result of ash and juice, the mill rolls are subjected to a range of abrasive and corrosive wear mechanisms. Solutions to provide grip and resist wear involve the selection of an appropriate roll shell material and compatible hard facing to provide the desired grip and wear characteristics. This paper reviews the various solutions that have been adopted for grip and durability for mill rolls and highlights the advantages and disadvantages of each method.

The disenfranchisement of prisoners : Roach v Electoral Commissioner & Anor - modernity v feudalism

David Brown takes a road trip to Canberra for the Roach fixture at the High Court where modernity is attempting a fight-back against the resurrection of civil death. With echoes of Hunter S Thompson as rugby league follower, the author recounts a trip to Canberra to observe a case in which Vickie Lee Roach, an Indigenous woman prisoner, challenged (successfully as it later turns out) the Howard government's 2006 legislation disenfranchising all serving prisoners.

Ship Motion Control : Course Keeping and Roll Stabilisation Using Rudder and Fins

Motion control systems have a significant impact on the performance of ships and marine structures allowing them to perform tasks in severe sea states and during long periods of time. Ships are designed to operate with adequate reliability and economy, and in order to achieve this, it is essential to control the motion. For each type of ship and operation performed (transit, landing a helicopter, fishing, deploying and recovering loads, etc.), there are not only desired motion settings, but also limits on the acceptable (undesired) motion induced by the environment. The task of a ship motion control system is therefore to act on the ship so it follows the desired motion as closely as possible. This book provides an introduction to the field of ship motion control by studying the control system designs for course-keeping autopilots with rudder roll stabilisation and integrated rudder-fin roll stabilisation. These particular designs provide a good overview of the difficulties encountered by designers of ship motion control systems and, therefore, serve well as an example driven introduction to the field. The idea of combining the control design of autopilots with that of fin roll stabilisers, and the idea of using rudder induced roll motion as a sole source of roll stabilisation seems to have emerged in the late 1960s. Since that time, these control designs have been the subject of continuous and ongoing research. This ongoing interest is a consequence of the significant bearing that the control strategy has on the performance and the issues associated with control system design. The challenges of these designs lie in devising a control strategy to address the following issues: underactuation, disturbance rejection with a non minimum phase system, input and output constraints, model uncertainty, and large unmeasured stochastic disturbances. To date, the majority of the work reported in the literature has focused strongly on some of the design issues whereas the remaining issues have been addressed using ad hoc approaches. This has provided an additional motivation for revisiting these control designs and looking at the benefits of applying a contemporary design framework, which can potentially address the majority of the design issues.

Rudder Roll Stabilisation of Ships

In this chapter, we present a case study of control system design for rudderbased stabilisers of ships using RHC. The rudder’s main function is to correct the heading of a ship; however, depending on the type of ship, the rudder may also be used to produce, or correct, roll motion. Rudder roll stabilisation consists of using rudder-induced roll motion to reduce the roll motion induced by waves. When this technique is employed, an automatic control system is necessary to provide the rudder command based on measurements of ship motion. The RHC formulation provides a unified framework to address many of the difficulties associated with this control system design problem.

Ship roll damping control

The technical feasibility of roll motion control devices has been amply demonstrated for over 100 years. Performance, however, can still fall short of expectations because of difficulties associated with control system designs, which have proven to be far from trivial due to fundamental performance limitations and large variations of the spectral characteristics of wave-induced roll motion. This tutorial paper presents an account of the development of various ship roll motion control systems together with the challenges associated with their design. It discusses the assessment of performance and the applicability of different mathematical models, and it surveys the control methods that have been implemented and validated with full scale experiments. The paper also presents an outlook on what are believed to be potential areas of research within this topic.

A Lagrangian approach to nonlinear modeling of anti-roll tanks

This paper presents two novel nonlinear models of u-shaped anti-roll tanks for ships, and their linearizations. In addition, a third simplified nonlinear model is presented. The models are derived using Lagrangian mechanics. This formulation not only simplifies the modeling process, but also allows one to obtain models that satisfy energy-related physical properties. The proposed nonlinear models and their linearizations are validated using model-scale experimental data. Unlike other models in the literature, the nonlinear models in this paper are valid for large roll amplitudes. Even at moderate roll angles, the nonlinear models have three orders of magnitude lower mean square error relative to experimental data than the linear models.