Evaluation of a partnership between primary and secondary care providing an accessible Level 1 sexual health service in the community

Comprehensive testing for asymptomatic sexually transmitted infections in Northern Ireland has traditionally been provided by genitourinary medicine clinics. As patient demand for services has increased while budgets have remained limited, there has been increasing difficulty in accommodating this demand. In May 2013, the newly commissioned specialist Sexual Health service in the South Eastern Trust sought to pilot a new model of care working alongside a GP partnership of 12 practices. A training programme to enable GPs and practice nurses to deliver Level 1 sexual health care to heterosexual patients aged >16 years, in accordance with the standards of BASHH, was developed. A comprehensive care pathway and dedicated community health advisor supported this new model with close liaison between primary and secondary care. Testing for Chlamydia, gonorrhoea, HIV and syphilis was offered. The aims of the pilot were achieved, namely to provide accessible, cost-effective sexual health care within a framework of robust clinical governance. Furthermore, it uncovered a high positivity rate for Chlamydia, especially in young men attending their general practice, and demonstrated a high level of patient satisfaction. Moreover the capacity of secondary care to deliver Levels 2 and 3 services was increased.

Composition and temporal variation of the algal assemblage associated with the haplosclerid sponge Haliclona indistincta (Bowerbank)

Although interactions between seaweeds and sponges have been studied in detail, general information concerning the whole epibiontic algal assemblage associated with a sponge species is virtually non-existent. We present here the first study in which the macroalgal community associated with a sponge, Haliclona indistincta (Bowerbank), was examined in detail. In the period October 2009-September 2010, the seaweed assemblage epibiontic on H. indistincta at a site of the Irish West coast was composed of 66 algal taxa (48 red algae, 7 green algae, 11 brown algae). The red algae Gelidium spinosum and Rhodothamniella floridula were the only epibionts associated with H. indistincta for the whole annual cycle. Most of the algal epibionts were filamentous species, which colonized the surface of the sponge and did not penetrate deeply into it. The algal assemblage was most abundant and species-diverse in the period late winter-spring; multivariate analyses revealed a significant variation of the community on the temporal scale of season and sampling date (weeks to months). The results indicate that the algal communities associated with sponges may be very diverse, showing that this type of assemblage deserves further detailed studies. © 2012 Elsevier B.V.

Evaluation and Evaluating the Community Initiative "URBAN"

The relevance of the relationship between evaluation and learning is widely acknowledged; as well as the importance of this learning process to support policy decision making and to judge the value of “what was done”, “how” and “with what results”. Although the activity of evaluation is not something new, but a field of knowledge with its own theories and practices, it is important to notice that there is great variability in the tradition and cultures of evaluation between countries. This paper presents and compares different conceptual and methodological frameworks created for the assessment of the European initiative Urban II, including the one that was used by the author in the context of an academic evaluation in the city of Porto. The comparative analysis of the results leads us to the recommendation for more democratic processes of evaluation and intervention, in order to improve their quality and accountability and promote the important goal of learning with this type of experimental initiatives.

Understanding space, place and leisure of women over 85 living in the community

There is an increase in the number of older adults 85 and over, who are choosing to live alone within the community. Moreover, older adults who live alone are reportedly spending an extensive amount of time alone within the home environment. In an effort to provide additional support and resources to older adults living in the community, a compliment of services are being offered through public and private organizations. These in-home supports focus on the instrumental or functional tasks of daily living, such as personal and rehabilitative care, nourishment, maintenance and upkeep of the home, as well as volunteer social visitation. However leisure resources and programs are not included among these services. Consequently, this creates a gap in leisure provision among this segment of the population. Throughout the life course, an individual's identity, role and purpose are developed and sustained through instrumental work roles in the formal and informal sector, as well as through personally meaningful leisure pastimes and experiences. Although roles shift post retirement, participation in instrumental and expressive activities can provide opportunities through which older adults are able to fulfill their need for agency (individuality and autonomy) and affiliation (social relatedness). Therefore barriers that inhibit instrumental or leisure experiences can negatively impact older adults' quality of life. This study explored the leisure lifestyles of four older adults, all of whom were over 85, lived alone within the community and were oriented to person, time and place. It became apparent that participants ordered their lives around a routine that consisted of instrumental, expressive and socially integrated tasks and activities. Moreover participants purposely chose to remain at home because their home environment facilitated freedom, choice and independence. As a result all four participants viewed their independence within the home as a critical determinant to their overall quality of life. Challenges associated with the home environment, participants' personal capacities and relationships were negotiated on a daily basis. Failure to positively adapt to these challenges inhibited meaningful engagement and personal fulfillment. Traditionally, leisure service delivery has been offered within institutions and through various community based venues. As a result leisure provision has been focused on the needs of the frail elderly who reside in institutions or the well elderly who are able to access leisure amenities within the community. However the growing number of older adults electing to live alone is on the rise. As individuals age the home becomes the preferred context for leisure experiences. If older adults are choosing to live alone, then both their instrumental and leisure needs must be addressed. As a result, it is imperative that leisure professionals extend the scope of service delivery to include home centered older adults.

Effectiveness of personal planning for residents re-entering the community during the facility initiative in Ontario

This paper reports on the relocation of people with intellectual disabilities (ID) from large-scale provincially run institutions that took place in Ontario as part of the Facility Initiative. Three case studies were examined in order to report on this process as experienced by those who lived and worked through it. Specifically, the planning process conducted by the Ministry of Community and Social Services (MCSS) to assist each person with hislher transition to community living was examined using the current standard of practice in person- centered planning approaches. Effectiveness was evaluated as the ability to apply a person-centered approach across settings and people, as well as what factors facilitated or hindered its application. Results show that, in general, the personal plans do not appear to reflect the pre-transition experience of the person. Also, the transitional planning process did not appear person-centered nor facilitate further person-centered planning in the community.

Coronary heart disease risk screening: the community pharmacy Healthy Heart Assessment Service

Objectives We examined the characteristics and CHD risks of people who accessed the free Healthy Heart Assessment (HHA) service operated by a large UK pharmacy chain from August 2004 to April 2006. Methods Associations between participants’ gender, age, and socioeconomics were explored in relation to calculated 10-year CHD risks by cross-tabulation of the data. Specific associations were tested by forming contingency tables and using Pearson chi-square (χ2). Results Data from 8,287 records were analysable; 5,377 were at low and 2,910 at moderate-to-high CHD risk. The likelihood of moderate-to-high risk for a male versus female participant was significantly higher with a relative risk ratio (RRR) 1.72 (P < 0.001). A higher percentage of those in socioeconomic categories ‘constrained by circumstances’ (RRR 1.15; P < 0.05) and ‘blue collar communities’ (RRR 1.13; P < 0.05) were assessed with moderate-to-high risk compared to those in ‘prospering suburbs’. Conclusions People from ‘hard-to-reach’ sectors of the population, men and people from less advantaged communities, accessed the HHA service and were more likely to return moderate-to-high CHD risk. Pharmacists prioritised provision of lifestyle information above the sale of a product. Our study supports the notion that pharmacies can serve as suitable environments for the delivery of similar screening services.

How was patient empowerment portrayed in information leaflets describing the community pharmacy Medicines Use Review service in the UK?

Objective The Medicines Use Review (MUR) community pharmacy service was introduced in 2005 to enhance patient empowerment but the service has not been taken up as widely as expected. We investigated the depiction of the patient–pharmacist power relationship within MUR patient information leaflets. Methods We identified 11 MUR leaflets including the official Department of Health MUR booklet and through discourse analysis examined the way language and imagery had been used to symbolise and give meaning to the MUR service, especially the portrayal of the patient–pharmacist interactions and the implied power relations. Results A variety of terminology was used to describe the MUR, a service that aimed ultimately to produce more informed patients through the information imparted by knowledgeable, skilled pharmacists. Conclusion The educational role of the MUR overshadowed the intended patient empowerment that would take place with a true concordance-centred approach. Although patient empowerment was implied, this was within the boundaries of the biomedical model with the pharmacist as the expert provider of medicines information. Practice implications If patient empowerment is to be conveyed this needs to be communicated to patients through consistent use of language and imagery that portrays the inclusivity intended.

What is wrong with the global support facility for small-scale mining?

The World Bank, United Nations and UK Department for International Development (DfID) have spearheaded a recent global drive to regularize artisanal and small-scale mining (ASM), and provide assistance to its predominantly impoverished participants. To date, millions of dollars have been pledged toward the design of industry-specific policies and regulations; implementation of mechanized equipment; extension; and the launch of alternative livelihood (AL) programmes aimed at diversifying local economies. Much of this funding, however, has failed to facilitate marked improvements, and in many cases, has exacerbated problems. This paper argues that a poor understanding of artisanal, mine-community dynamics and operators’ needs has, in a number of cases, led to the design and implementation of inappropriate industry support schemes and interventions. The discussion focuses upon experiences from sub-Saharan Africa, where ASM is in the most rudimentary of states.

Describing Earth system simulations with the Metafor CIM

The Metafor project has developed a common information model (CIM) using the ISO19100 series for- malism to describe numerical experiments carried out by the Earth system modelling community, the models they use, and the simulations that result. Here we describe the mechanism by which the CIM was developed, and its key properties. We introduce the conceptual and application ver- sions and the controlled vocabularies developed in the con- text of supporting the fifth Coupled Model Intercomparison Project (CMIP5). We describe how the CIM has been used in experiments to describe model coupling properties and de- scribe the near term expected evolution of the CIM.

Evaluation of modelled regional water balance using lake status data: a comparison of 6ka simulations with the NCAR CCM

Variations in lake area and depth reflect climatically induced changes in the water balance of overflowing as well as closed lakes. A new global data base of lake status has been assembled, and is used to compare two simulations for 6 ka (6000 yr ago) made with successive R15 versions of the NCAR Community Climate Model (CCM). Simulated water balance was expressed as anomalies of annual precipitation minus evaporation (P-E); observed water balance as anomalies of lake status. Comparisons were made visually, by comparing regional averages, and by a statistic that compares the signs of simulated P-E anomalies (smoothly interpolated to the lake sites) with the status anomalies. Both CCM0 and CCM1 showed enhanced Northern-Hemisphere monsoons at 6 ka. Both underestimated the effect, but CCM1 fitted the spatial patterns better. In the northern mid- and high-latitudes the two versions differed more, and fitted the data less satisfactorily. CCM1 performed better than CCM0 in North America and central Eurasia, but not in Europe. Both models (especially CCM0) simulated excessive aridity in interior Eurasia. The models were systematically wrong in the southern mid-latitudes. Problems may have been caused by inadequate treatment of changes in sea-surface conditions in both models. Palaeolake status data will continue to provide a benchmark for the evaluation of modelling improvements.

Care in the community? Interpretations of a fractured goat bone from Neolithic Jarmo, Iraq

A case study of a goat metatarsal exhibiting a complex diaphyseal fracture from Pottery Neolithic Jarmo in the Central Zagros region of the eastern Fertile Crescent is here described and analysed. The Central Zagros is one of the areas with the earliest evidence for goat domestication. The significance of the pathology may be viewed within the context of domestic goat ecology in the landscape of Jarmo, potentially impacting browsing behaviour (goats raise themselves on their hind limbs to browse) and movement with the herd in the landscape (the terrain around Jarmo is very steep in places, which would be difficult for an animal to navigate on three legs). In the light of this, possible levels of care that the Neolithic human community may have afforded this animal are discussed – from a situation where therapeutic intervention may have occurred, to one of stall confinement of the animal to allow the pathology to heal, to a position of simple awareness of the condition – and how this impacts on our understanding of changes in attitudes towards animals through the process of domestication.

Radiographic Findings Among Children Hospitalized With Severe Community-Acquired Pneumonia

Background: Community-acquired pneumonia (CAP) is a leading cause of childhood death. There are few published reports of radiographic findings among children with severe CAP. Objective: To describe chest X-ray (CXR) findings and assess association between these radiographic findings and pneumococcal isolation in children with severe CAP. Methods: A prospective, multicenter, observational study was conducted in 12 centers in Argentina, Brazil, and the Dominican Republic. Children aged 3-59 months, hospitalized with severe pneumonia, were included. On admission, blood and pleural effusion cultures were performed. Streptococcus pneumoniae was identified according to standard procedures in the respective national reference laboratory. Chest X-rays were taken on admission and read before the culture results were reported. Results: Out of 2,536 enrolled patients, 283 (11.2%) had S. pneumoniae isolated, in 181 cases (7.1%) from blood. The follow radiographic patterns were observed: alveolar infiltrate (75.2%), pleural effusion (15.6%), and interstitial infiltrate (9.2%). Overall, pleural effusion was associated with pneumococcal isolation and pneumococcal bacteremia (P < 0.001). Infiltrates were unilateral (78.7%) or bilateral (21.3%), right-sided (76%) or left-sided (24%), in the lower lobe (53.6%) or the upper lobe (46.4%). Multivariate analysis including patients with affection of only one lobe showed that upper lobe affection and pleural effusion were associated with pneumococcal isolation (OR 1.8, 95% CI, 1.3-2.7; OR 11.0, 95% CI, 4.6-26.8, respectively) and with pneumococcal bacteremia (OR 1.7, 95% CI, 1.2-2.6; OR 3.1, 95% CI, 1.2-8.0, respectively). Conclusions: Three-quarters of the patients studied had alveolar infiltrates. Upper lobe compromising and pleural effusion were associated with pneumococcal invasive disease. Pediatr Pulmonol. 2010; 45:1009-1013. (C) 2010 Wiley-Liss, Inc.

Counter-terrorism across the policing continuum

Over the past two decades private and hybrid forms of policing have grown considerably in Australia. As a result, governments have begun to recognize the role played by non-state police agencies and personnel in the provision of public order and safety, further extending and legitimizing non-state policing. In addition, the private ownership of critical infrastructure and 'communal spaces' has led to a central role for non-state police in the area of 'high policing' counter-terrorism. In response to changes to the auspices and providers of policing, state police were beginning to explore new ways of working with private and hybrid forms of policing, with the emergence of a new type of experiment in policing partnerships, the Police-Private Security Committee (POLSEC). This paper examines these trends and implications for ongoing developments in Australian policing.

Policing in the 'communal spaces' of major event venues

The recent re-conceptualization of 'mass private property' as one form of 'communal spaces' raises a series of questions concerning policing and security in these domains. This paper applies the concept of 'communal spaces' to an analysis of policing in 'major event venues.' We assess the character of policing in these communal spaces by drawing upon interviews conducted with policing—private and public—personnel operating in major event venues. The paper identifies different perspectives on the nature of policing in these communal spaces and tension between public and private police personnel concerning their respective roles and responsibilities. We conclude by raising issues concerning the implications for the 'public good' in policing at major event venues.

The role of the print media in informing the community about safety in public hospitals in Victoria, Australia: the case of `golden staph`

Objective. In this article the authors explore how the print media contribute to information and education of the community on issues of safety and quality in the health services, since this is an important avenue of such information and education for many members of the community. Study design. The authors undertook a qualitative study of a random sample of articles in the Australian print press between 1996 and 2004 where ‘golden staph’ was presented as a major issue of risk to the safety of consumers of health services. The content of each article was examined with reference to several criteria including title, the source of the article, and the metaphorical language employed by the journalist.
Results. Results show that while the articles are substantially accurate as sources of information on concrete events, they do not serve as sources of education on issues of safety, typically apportioning blame and serving to maintain the status quo.
Conclusion. The authors conclude that print media are not a good source of community education in areas of safety and quality and do not assist members of the community to participate in addressing issues of safety in health services.