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.

The L-31E Surface Water Rediversion Project Final Report: Implementation, Results, and Recommendations

Throughout the Biscayne Bay watershed, existing coastal wetland communities have been cut off from sheet flow for decades. With the expectation that reconnection of these wetlands to upstream water sources would alter existing hydrologic conditions and recreate a more natural sheet flow to Biscayne National Park, a demonstration project on freshwater rediversion was undertaken. The objectives of the project were to document the effects of freshwater diversion on: (a) swamp and nearshore water chemistry and hydrology; (b) soil development processes; (c) macrophyte and benthic algal community composition, structure and production; (d) abundance of epiphytic and epibenthic invertebrates; (e) zonation, production, and phenology of primary producers in the nearshore environment, and (f) exchanges of nutrients and particulates between nearshore and mangrove ecosystems.

The impact of the juvenile intervention facility on the adjudication of delinquent youth in Broward County

Considerable funds have been allocated in the area of juvenile justice in attempts to reduce and prevent the problem of juvenile delinquency. Much of these funds have been funneled to various community-level intervention programs. This dissertation reports the results of a study that examined the effects of one such program, the Juvenile Intervention Facility (JIF) in Broward County, Florida, on reducing the number of cases handled judicially by the Juvenile Court in that county. ^ Juvenile justice policy, which precipitated the creation of the JIF program, assumed that more structured and integrative efforts at the point of entry into the juvenile justice system would lead to greater diversion from the courts to much needed intervention services. By virtue of this process, the number of juveniles handled judicially by the courts was expected to decrease and future delinquent behavior would be prevented. Archival data from four fiscal years were examined, two years pre-JIF, two years post-JIF, a third-year follow-up, and a concurrent outcome measure corresponding to the first year of JIF operations. Data included all juvenile cases referred during the fiscal years defined for Broward and St. Lucie Counties, the state of Florida, and the United States. The study tested four hypotheses: (a) the JIF would reduce the number of cases handled judicially in Broward County Juvenile Court, (b) the decrease in judicially handled cases would be greater for females than for males, (c) there would be greater decreases in judicially handled cases for whites than non-whites, (d) there would be greater decreases in judicial handling for younger than older offenders. Bivariate analyses were conducted, consisting of chi square tests, to test the hypotheses. ^ Results indicate that the impact of the JIF was in the opposite direction of what was expected in that more juvenile offenders were handled judicially through juvenile court. This fact points to the possibility that the JIF has failed to provide the intended consequences of the policy. In the discussion, these “unintended” consequences are addressed in the context of juvenile justice policy creation and the competing constituencies involved in such policy development. ^

Development of prediction models for freeway incident durations using data mining techniques

The nation's freeway systems are becoming increasingly congested. A major contribution to traffic congestion on freeways is due to traffic incidents. Traffic incidents are non-recurring events such as accidents or stranded vehicles that cause a temporary roadway capacity reduction, and they can account for as much as 60 percent of all traffic congestion on freeways. One major freeway incident management strategy involves diverting traffic to avoid incident locations by relaying timely information through Intelligent Transportation Systems (ITS) devices such as dynamic message signs or real-time traveler information systems. The decision to divert traffic depends foremost on the expected duration of an incident, which is difficult to predict. In addition, the duration of an incident is affected by many contributing factors. Determining and understanding these factors can help the process of identifying and developing better strategies to reduce incident durations and alleviate traffic congestion. A number of research studies have attempted to develop models to predict incident durations, yet with limited success. ^ This dissertation research attempts to improve on this previous effort by applying data mining techniques to a comprehensive incident database maintained by the District 4 ITS Office of the Florida Department of Transportation (FDOT). Two categories of incident duration prediction models were developed: "offline" models designed for use in the performance evaluation of incident management programs, and "online" models for real-time prediction of incident duration to aid in the decision making of traffic diversion in the event of an ongoing incident. Multiple data mining analysis techniques were applied and evaluated in the research. The multiple linear regression analysis and decision tree based method were applied to develop the offline models, and the rule-based method and a tree algorithm called M5P were used to develop the online models. ^ The results show that the models in general can achieve high prediction accuracy within acceptable time intervals of the actual durations. The research also identifies some new contributing factors that have not been examined in past studies. As part of the research effort, software code was developed to implement the models in the existing software system of District 4 FDOT for actual applications. ^

Tracking rates of ecotone migration due to salt-water encroachment using fossil mollusks in coastal South Florida

We determined the rate of migration of coastal vegetation zones in response to salt-water encroachment through paleoecological analysis of mollusks in 36 sediment cores taken along transects perpendicular to the coast in a 5.5 km2 band of coastal wetlands in southeast Florida. Five vegetation zones, separated by distinct ecotones, included freshwater swamp forest, freshwater marsh, and dwarf, transitional and fringing mangrove forest. Vegetation composition, soil depth and organic matter content, porewater salinity and the contemporary mollusk community were determined at 226 sites to establish the salinity preferences of the mollusk fauna. Calibration models allowed accurate inference of salinity and vegetation type from fossil mollusk assemblages in chronologically calibrated sediments. Most sediments were shallow (20–130 cm) permitting coarse-scale temporal inferences for three zones: an upper peat layer (zone 1) representing the last 30–70 years, a mixed peat-marl layer (zone 2) representing the previous ca. 150–250 years and a basal section (zone 3) of ranging from 310 to 2990 YBP. Modern peat accretion rates averaged 3.1 mm yr)1 while subsurface marl accreted more slowly at 0.8 mm yr)1. Salinity and vegetation type for zone 1 show a steep gradient with freshwater communities being confined west of a north–south drainage canal constructed in 1960. Inferences for zone 2 (pre-drainage) suggest that freshwater marshes and associated forest units covered 90% of the area, with mangrove forests only present along the peripheral coastline. During the entire pre-drainage history, salinity in the entire area was maintained below a mean of 2 ppt and only small pockets of mangroves were present; currently, salinity averages 13.2 ppt and mangroves occupy 95% of the wetland. Over 3 km2 of freshwater wetland vegetation type have been lost from this basin due to salt-water encroachment, estimated from the mollusk-inferred migration rate of freshwater vegetation of 3.1 m yr)1 for the last 70 years (compared to 0.14 m yr)1 for the pre-drainage period). This rapid rate of encroachment is driven by sea-level rise and freshwater diversion. Plans for rehydrating these basins with freshwater will require high-magnitude re-diversion to counteract locally high rates of sea-level rise.

Salinity and Chlorophyll a as Performance Measures to Rehabilitate a Mangrove-Dominated Deltaic Coastal Region: the Ciénaga Grande de Santa Marta–Pajarales Lagoon Complex, Colombia

Salinity, water temperature, and chlorophyll a (chl-a) biomass were used as performance measures in the period 1999–2001 to evaluate the effect of a hydrological rehabilitation project in the Ciénaga Grande de Santa Marta (CGSM)–Pajarales lagoon complex, Colombia where freshwater diversions were initiated in 1995 and completed in 1998. The objective of this study was to evaluate how diversions of freshwater into previously hypersaline (>80) environments changed the spatial and temporal distribution of environmental characteristics. Following the diversion, 19 surveys and transects using a flow-through system were surveyed in the CGSM–Pajarales complex to continuously measure selected water quality parameters. Geostatistical analysis indicates that hydrology and salinity regimes and water circulation patterns in the CGSM lagoon are largely controlled by freshwater discharge from the Fundacion, Aracataca, and Sevilla Rivers. Residence times in the CGSM lagoon were similar before (15.5 ± 3.8 days) and after (14.2 ± 2.0 days) the rehabilitation project and indicated that the system is flushed regularly. In contrast, chl-a biomass was highly variable in the CGSM–Pajarales lagoon complex and not related to discharge patterns. Mean annual chl-a biomass (44–250 μg L−1) following the diversion project was similar to values recorded since the 1980s and still remains among the highest reported in coastal systems around the world owing to its unique hydrology regulated by the Magdalena River and Sierra Nevada de Santa Marta watersheds and the high teleconnection to the El Niño Southern Oscillation (ENSO). Our results confirm that the reduction in salinity in the CGSM lagoon and Pajarales complex during 1999–2000 was largely driven by high precipitation (2500 mm) induced by the ENSO–La Niña rather than by the freshwater diversions.

Adventures and Misfortunes in Macondo: Rehabilitation of the Cienaga Grande

We describe trajectories of selected ecological indicators used as performance measures to evaluate the success of a mangrove rehabilitation project in the Ciénaga Grande de Santa Marta (CGSM) Delta-Lagoon complex, Colombia, as result of freshwater diversions initiated in 1995. There is a significant reduction in soil and water column salinity in all sampling stations following the hydraulic reconnection of the Clarín and Aguas Negras channels to the Magdalena River. Soil intersticial water salinity (depth: 0.5 m) (7 stations) and water column salinity (0.5 m) (10 stations) values declined significantly (soil <30 g kg-1; water <10 g kg-1) from 1994 to 2000. During 1994 soil interstitial water salinity ranged from 40 g kg-1 (Rinconada) to 100 g kg-1 (KM 13), while water column salinity fluctuated between 25-35 g kg-1 for most of the sampling stations. This salinity reduction increased mangrove forest regeneration promoting a net gain of 99 km2 from 1995 to 1999. The high precipitation recorded in 1995 and 1999 caused by El Niño-La Niña (ENSO), coinciding with the channels rehabilitation, influenced rapid mangrove regeneration. The lack of economic investment in the maintenance of the diversion structures from 2001 to 2004 caused a salinity increase affecting negatively already restored vegetation. A sustainable effort from the international community and the Colombian government is needed to maintain the strategic social and economic benefits reached until 2000 in the CGSM region.

Defense Expenditure: Andean and Amazon Regions

The Andean and the amazon, comprised of Venezuela, Colombia, Bolivia, Peru and Ecuador, have recently undertaken significant modernization efforts ranging from equipment, logistics, doctrine, training, deployment and the re-definition of the roles and missions of their forces. In most cases, motivations to modernize have been internal, such as continuing operations against armed groups as in the case of Colombia and Peru, enhance border control and sovereignty enforcement, as in the case of Ecuador and Brazil or regime control in Venezuela. However, they are complemented by perceptions of external threats, including traditional intra-state conventional wars. The increased tensions between Colombia and Venezuela and Ecuador as well as the historic Peru-Chile tensions are the most salient examples. Although diplomacy –especially defence diplomacy- has worked to a good degree in creating and strengthening confidence building measures, the potential for inter-state conflict is higher in this region of the Americas. This region has seen the recent emergence of long-term modernization plans, initially in Colombia followed by Venezuela and Ecuador and probably best embodied in scope and scale by the Brazilian National Defence Plan (for its long term vision). Although it has been speculated that high allocation of funds to retirement pension systems has had an impact on delaying modernization plans, this comparative study on the allocation of pension and social funds in these particular countries concludes that there is no direct linkage between the poor funding of military modernization plans and the diversion of funds to military pension systems.

Current Status of Collectibility of Gaming-Related Credit Dollars

In her piece entitled - Current Status Of Collectability Of Gaming-Related Credit Dollars - Ruth Lisa Wenof, Graduate Student at Florida International University initially states: “Credit is an important part of incentives used to lure gamblers to gaming establishments. However, a collection problem exists in casinos retrieving gaming-related credit losses of individuals living in states where gambling is illegal. The author discusses the history of this question, citing recent cases related to Atlantic City.” This author’s article is substantially laden with legal cases associated with casinos in New Jersey; Atlantic City to be exact. The piece is specific to the segment of the gaming industry that the title suggests, and as such is written in a decidedly technical style. “Legalized casino gaming, which was approved by the citizens of New Jersey on November 8, 1976, has been used as a unique tool of urban redevelopment for Atlantic City,” Wenof says in providing some background on this ‘Jersey shore municipality. “Since Resorts International opened its casino…revenues from gambling have increased rapidly. Resorts' gross win in 1978 was $134 million,” Wenof says. “Since then, the combined gross win of the city's 11 casinos has been just shy of $7.5 billion.” The author points out that the competition for casino business is fierce and that credit dollars play an integral role in soliciting such business. “Credit plays a most important part in every casino hotel. This type of gambler is given every incentive to come to a particular hotel,” says the author. “Airplanes, limousines, suites, free meals, and beverages all become a package for the person who can sign a marker. The credit department of a casino is similar to that of a bank. A banker who loans money knows that it must be paid back or his bank will fail. This is indeed true of a casino,” Wenof warns in outlining the potential problem that this article is fundamentally designed around. In providing further background on credit essentials and possible pitfalls, Wenof affords: “…on the Casino Control Act the State Commission of Investigation recommended to the legislature that casinos should not be allowed to extend credit at all, by reason of a concern for illicit diversion of revenues, which is popularly called skimming within the industry…” Although skimming is an after-the-fact problem, and is parenthetic to loan returns, it is an important element of the collective [sic] credit scheme. “A collection problem of prime importance is if a casino can get back gaming-related credit dollars advanced by the casino to a gambler who lives in a state where gambling is illegal,” is a central factor to consider, Wenof reveals. This is a primary focus of this article. Wenof touches on the social/societal implications of gambling, and then continues the discussion by citing a host of legal cases pertaining to debt collection.

Tracking the Effects of Salt Water Encroachment on South Florida Coastal Ecotones Using Mollusks

Many coastal wetland communities of south Florida have been cut off from freshwater sheet flow for decades and are migrating landward due to salt-water encroachment. A paleoecological study using mollusks was conducted to assess the rates and effects of salt-water encroachment due to freshwater diversion and sea level rise on coastal wetland basins in Biscayne National Park. Modem mollusk distributions taken from 226 surface sites were used to determine local habitat affinities which were applied to infer past environments from mollusk distributions found in soil cores. Mollusks species compositions were found to be strongly correlated to habitat and salinity, providing reliable predictions. Wetland soils were cored to bedrock at 36locations. Mollusks were abundant throughout the cores and 15 of the 20 most abundant taxa served as bioindicators of salinity and habitat. Historic accounts coupled with mollusk based inference models indicate (1) increasing salinity levels along the coast and encroaching into the interior with mangroves communities currently migrating westward, (2) replacement of a mixed graminoid-mangrove zone by a dense monoculture of dwarf mangroves, and (3) a confinement of freshwater and freshwater graminoid marsh to landward areas between urban developments and drainage canals.

A Review of the Effects of Altered Hydrology and Salinity on Vertebrate Fauna and Their Habitats in Northeastern Florida Bay

Estuarine productivity is highly dependent on the freshwater sources of the estuary. In Florida Bay, Taylor Slough was historically the main source of fresh water. Beginning in about 1960, and culminating with the completion of the South Dade Conveyance System in 1984, water management practice began to change the quantity and distribution of flow from Taylor Slough into Northeastern Florida Bay. These practices altered salinity and hydrologic parameters that had measurable negative impacts on vertebrate fauna and their habitats. Here, I review those impacts from published and unpublished literature and anecdotal observations. Almost all vertebrates covered in this review have shown some form of population decline since 1984; most of the studies implicate declines in food resources as the main stressor on their populations. My conclusion is that the diversion of fresh water resulted in an ecological cascade starting with hydrologic stresses on primary then secondary producers culminating in population declines at the top of the food web.

Everglades Ridge, Slough, and Tree Island Mosaics: Year 2 Annual Report

Status and history of the Ridge-Slough Mosaic The Florida Everglades is a large subtropical wetland with diverse hydrologic, edaphic, and vegetative characteristics. Historically, a significant portion of this system was a slow moving river originating from the Kissimmee River floodplain, flowing into the vast but shallow Lake Okeechobee, and draining south-southwest over extensive peatlands into Florida Bay (McVoy 2011). Human-induced alterations to the hydrologic regime, including reduction, stabilization, and impoundment of water flow through diversion and compartmentalization of water via canals and levees have degraded pre-drainage vegetation patterns and microtopographic structure (Davis and Ogden 1994, Ogden 2005, McVoy 2011). The Everglades peatland emerged 5,000 years ago with the stabilization of sea level at approximately current elevations (Loveless 1959, Gleason and Stone 1994). This, combined with subtropical rainfalls, allowed a vast mass of water to slowly flow over a limestone bedrock platform 160 km long and 50 km wide at a near uniform descent totaling about 6 m, ultimately reaching Florida Bay (Stephens 1956, Gleason and Stone 1994, McVoy 2011). Vegetation quickly colonized the area, and peat, in the absence of adequate respiration, accumulated on the limestone bedrock to a depth of 3-3.7 m (Gleason and Stone 1994, McVoy et al. 2011). The “River of Grass” referenced by Douglas (1947) alludes to the dually intertwined processes of the historic riverine nature of the Everglades and the vast sawgrass (Cladium jamaicense) communities that have dominated the landscape for about the last 1,000 years (Bernhardt and Willard 2009).