A qualitative study of community pharmacists’ awareness of and involvement with intermediate care facilities

Rationale, aims and objectives: Intermediate care (IC) describes a range of services targeted at older people, aimed at preventing unnecessary hospitalisation, promoting faster recovery and maximising independence. The introduction of IC has created a new interface between primary and secondary care. Older people are known to be at an increased risk of medication-related problems when transferring between healthcare settings and pharmacists are often not included as part of IC multidisciplinary teams. This study aimed to explore community pharmacists’ (CPs) awareness of IC services and to investigate their views of and attitudes towards the medicines management aspects of such services, including the transfer of medication information.

Method: Semi-structured interviews were conducted, recorded, transcribed verbatim and analysed using a constant comparative approach with CPs practising in the vicinity of IC facilities in Northern Ireland, UK.

Results: Interviews were conducted with 16 CPs. Three themes were identified and named ‘left out of the loop’, ‘chasing things up’ and ‘closing the loop’. CPs felt that they were often ‘left out of the loop’ with regards to both their involvement with local IC services and communication across the healthcare interfaces. As a result, CPs resorted to ‘chasing things up’ as they had to proactively try to obtain information relating to patients’ medications. CPs viewed themselves as ideally placed to facilitate medicines management across the healthcare interfaces (i.e., ‘closing the loop’), but several barriers to potential services were identified.

Conclusion: CPs have limited involvement with IC services. There is a need for improvement of effective communication of patients’ medication information between secondary care, IC and community pharmacy. Increasing CP involvement may contribute to improving continuity of care across such healthcare interfaces, thereby increasing the person-centeredness of service provision.

Knowledge Exchange, Spatial Analysis & Healthy Urban Environments (KESUE): Project Report

The Knowledge Exchange, Spatial Analysis and Healthy Urban Environments (KESUE) project has extended work previously undertaken by a QUB team of inter-disciplinary researchers engaged with the Physical Activity in the Regeneration of Connswater (PARC) project (Tully et al, 2013). The PARC project focussed on parts of East Belfast to assess the health impact of the Connswater Community Greenway. The KESUE project has aimed to extend some of the tools used initially in East Belfast so that they have data coverage of all of Belfast and Derry-Londonderry. The purpose of this has been to enable the development of evidence and policy tools that link features of the built environment with physical activity in these two cities. The project has used this data to help shape policy decisions in areas such as physical activity, park management, public transport and planning.

Working with a range of local partners who part-funded the project (City Councils in Belfast and Derry-Londonderry, Public Health Agency, Belfast Healthy Cities and Department of Regional Development), this project has mapped all the footpaths in the two cities (covering 37% of the NI population) and employed this to develop evidence used in strategies related to healthy urban planning. Using Geographic Information Systems (GIS), the footpath network has been used as a basis for a wide range of policy-relevant analyses including pedestrian accessibility to public facilities, site options for new infrastructure and assessing how vulnerable groups can access services such as pharmacies. Key outputs have been Accessibility Atlases and maps showing how walkability of the built environment varies across the two cities.

In addition to generating this useful data, the project included intense engagement with potential users of the research, which has led to its continued uptake in a number of policies and strategies, creating a virtuous circle of research, implementation and feedback. The project has proved so valuable to Belfast City Council that they have now taken on one of the researchers to continue the work in-house.

Evolving national park models: The emergence of an economic imperative and its effect on the contested nature of the 'national' park concept in Northern Ireland.

National park models have evolved in tandem with the emergence of a multifunctional countryside. Sustainable development has been added to the traditional twin aims of conservation and recreation. This is typified by recent national park designations, such as the Cairngorms National Park in Scotland. A proposed Mournes national park in Northern Ireland has evolved a stage further with a model of national park to deliver national economic goals envisaged by government. This seeks to commodify the natural landscape. This paper compares Cairngorm and Mourne stakeholders’ views on the principal features of both models: park aims, management structures and planning functions. While Cairngorm stakeholders were largely positive from the outset, the model of national park introduced is not without criticism. Conversely, Mourne stakeholders have adopted an anti-national park stance. Nevertheless, the model of national park proposed possessing a strong economic imperative, an absence of the Sandford Principle as a means to manage likely conflicts, and lacking any planning powers in its own right, may still be insufficient to bring about widespread support for a Mourne national park. Such a model is also likely to accelerate the degradation of the Mourne landscape. Competing national identities (British and Irish) provide an additional dimension to the national park debate in Northern Ireland. Deep ideological cleavages are capable of derailing the introduction of a national park irrespective of the model proposed. In Northern Ireland the national park debate is not only about reconciling environmental and economic interests but also political and ethno-national differences.

Towards a Mourne National Park?Emergent prospects and pitfalls fromarticulating needs in a local context

This paper examines the prospects for sustainable rural tourism within a rural development paradigm. Specifically, an adaptive management approach is proposed as a means of understanding and accommodating the different goals and interests that exist within multi-functional rural areas. This model allows priorities to change in line with particular situations while remaining sensitive to economic, environmental, social and cultural impacts. The proposed Mourne National Park in Northern Ireland, also designated an Area of Outstanding Natural Beauty (AONB), forms the backdrop for this study. Through a critique of a consultation process that was undertaken with the community the question is posed: can a sustainable rural tourism approach achieve meaningful community engagement and thereby reflect the needs of the community? Central to the analysis are the power differentials between the various partners participating in this model of governance. The conclusions consider implications for rural communities, revealing how trusting and meaningful relationships are central to facilitating collaboration, cooperation and adaptation.

Factors influencing the output of rural cataract surgical facilities in China: the SHARP study

Purpose: To identify factors associated prospectively with increased cataract surgical rate (CSR) in rural Chinese hospitals.

Methods: Annual cataract surgical output was obtained at baseline and 24 months later from operating room records at 42 rural, county-level hospitals. Total local CSR (cases/million population/y), and proportion of CSR from hospital and local competitors were calculated from government records. Hospital administrators completed questionnaires providing demographic and professional information, and annual clinic and outreach screening volume. Independent cataract surgeons provided clinical information and videotapes of cases for grading by two masked experts using the Ophthalmology Surgical Competency Assessment Rubric (OSCAR). Uncorrected vision was recorded for 10 consecutive cataract cases at each facility, and 10 randomly-identified patients completed hospital satisfaction questionnaires. Total value of international nongovernmental development organization (INGDO) investment in the previous three years and demographic information on hospital catchment areas were obtained. Main outcome was 2-year percentage change in hospital CSR.

Results: Among the 42 hospitals (median catchment population 530,000, median hospital CSR 643), 78.6% (33/42) were receiving INGDO support. Median change in hospital CSR (interquartile range) was 33.3% (-6.25%, 72.3%). Predictors of greater increase in CSR included higher INGDO investment (P = 0.02, simple model), reducing patient dissatisfaction (P = 0.03, simple model), and more outreach patient screening (P = 0.002, simple and multiple model).

Conclusions: Outreach cataract screening was the strongest predictor of increased surgical output. Government and INGDO investment in screening may be most likely to enhance output of county hospitals, a major goal of China's Blindness Prevention Plan.

Social Ecological Constraints to Park Use in Communities with Quality Access

Evidence correlates physical activity, psychological restoration, and social health to proximity to parks and sites of recreation. The purpose of this study was to identify perceived constraints to park use in low-income communities facing significant health disparities, with access to underutilized parks. We used a series of focus groups with families, teens, and older adults in neighborhoods with similar demographic distribution and access to parks over 125 acres in size. Constraints to park use varied across age groups as well as across social ecological levels, with perceived constraints to individuals, user groups, communities, and society. Policies and interventions aimed at increasing park use must specifically address barriers across social ecological levels to be successful.

Internationalising the Social Work Curriculum: A Working Toolkit for Higher Education Facilities

This toolkit was collated by social work academics at Queen’s University Belfast (QUB), United Kingdom in collaboration with social work educators nationally and internationally who are committed to the internationalisation of the social work curriculum. The information and examples contained in this document offer a practical guide for the development and evaluation of international opportunities for students and academics. The resources were designed with diverse educational settings in mind for the enhancement of social work learning and teaching.

Location-routing problems of semi-obnoxious facilities: approaches and decision support

A presente tese resulta de um trabalho de investigação cujo objectivo se centrou no problema de localização-distribuição (PLD) que pretende abordar, de forma integrada, duas actividades logísticas intimamente relacionadas: a localização de equipamentos e a distribuição de produtos. O PLD, nomeadamente a sua modelação matemática, tem sido estudado na literatura, dando origem a diversas aproximações que resultam de diferentes cenários reais. Importa portanto agrupar as diferentes variantes por forma a facilitar e potenciar a sua investigação. Após fazer uma revisão e propor uma taxonomia dos modelos de localização-distribuição, este trabalho foca-se na resolução de alguns modelos considerados como mais representativos. É feita assim a análise de dois dos PLDs mais básicos (os problema capacitados com procura nos nós e nos arcos), sendo apresentadas, para ambos, propostas de resolução. Posteriormente, é abordada a localização-distribuição de serviços semiobnóxios. Este tipo de serviços, ainda que seja necessário e indispensável para o público em geral, dada a sua natureza, exerce um efeito desagradável sobre as comunidades contíguas. Assim, aos critérios tipicamente utilizados na tomada de decisão sobre a localização destes serviços (habitualmente a minimização de custo) é necessário adicionar preocupações que reflectem a manutenção da qualidade de vida das regiões que sofrem o impacto do resultado da referida decisão. A abordagem da localização-distribuição de serviços semiobnóxios requer portanto uma análise multi-objectivo. Esta análise pode ser feita com recurso a dois métodos distintos: não interactivos e interactivos. Ambos são abordados nesta tese, com novas propostas, sendo o método interactivo proposto aplicável a outros problemas de programação inteira mista multi-objectivo. Por último, é desenvolvida uma ferramenta de apoio à decisão para os problemas abordados nesta tese, sendo apresentada a metodologia adoptada e as suas principais funcionalidades. A ferramenta desenvolvida tem grandes preocupações com a interface de utilizador, visto ser direccionada para decisores que tipicamente não têm conhecimentos sobre os modelos matemáticos subjacentes a este tipo de problemas.

Initial insights on the biodiversity potential of biosolar roofs: A London Olympic Park green roof case study

Cities dominated by impervious artificial surfaces can experience myriad negative environmental impacts. Restoration of green infrastructure has been identified as a mechanism for increasing urban resilience, enabling cities to transition towards sustainable futures in the face of climate-driven change. Building rooftops represent a viable space for integrating new green infrastructure into high density urban areas. Urban rooftops also provide prime locations for photovoltaic (PV) systems. There is increasing recognition that these two technologies can be combined to deliver reciprocal benefits in terms of energy efficiency and biodiversity targets. Scarcity of scientific evaluation of the interaction between PVs and green roofs means that the potential benefits are currently poorly understood. This study documents evidence from a biodiversity monitoring study of a substantial biosolar roof installed in the Queen Elizabeth Olympic Park. Vegetation and invertebrate communities were sampled and habitat structure measured in relation to habitat niches on the roof, including PV panels. Ninety-two plant species were recorded on the roof and variation in vegetation structure associated with proximity to PV panels was identified. Almost 50% of target invertebrate species collected were designated of conservation importance. Arthropod distribution varied in relation to habitat niches on the roof. The overall aim of the MPC green roof design was to create a mosaic of habitats to enhance biodiversity, and the results of the study suggest that PV panels can contribute to niche diversity on a green roof. Further detailed study is required to fully characterise the effects of PV panel density on biodiversity.

On-line diagnostics of transformer winding insulation failures, by Park`s vector approach

This paper presents a non-invasive approach for diagnosing winding insulation failures in three-phase transformers, which is based on the on-line monitoring of the primary and secondary current Park's Vector. Experimental and simulated results demonstrate the effectiveness of the proposed technique, for detecting winding inter-turn insulation faults in operating three-phase transformers.

Incipient turn-to-turn winding fault diagnosis of power transformers by the on-load exciting current Extended Park`s Vector Approach

This paper presents the application of the on-load exciting current Extended Park's Vector Approach for diagnosing incipient turn-to-turn winding faults in operating power transformers. Experimental and simulated test results demonstrate the effectiveness of the proposed technique, which is based on the spectral analysis of the AC component of the on-load exciting current Park's Vector modulus.

Transformers on-load exciting current Park`s vector approach as a tool for winding faults diagnostics

This paper presents the development of a new approach for diagnosing the occurrence of inter-turn short-circuits in the windings of three-phase transformers, which is based on the on-line monitoring of the on-load exciting current Park's Vector patterns. Experimental and simulated results demonstrate the effectiveness of the proposed technique for detecting winding inter-turn insulation faults in operating three-phase transformers.