Community pharmacists’ understanding, attitudes, practice and perceived barriers related to providing pharmaceutical care: a questionnaire-based survey in Macao

Purpose: To explore the knowledge, attitudes, practice and perceived barriers of community pharmacists regarding provision of pharmaceutical care as well as provide recommendations on how to advance the service during the early stage of development in Macao. Methods: A questionnaire comprising 10 items was used to collect respondents’ demographic information and to evaluate their understanding of pharmaceutical care, attitude towards service provision, current practice and perceived barriers. Descriptive and comparative analysis of the results was conducted. Results: While 95 % of the participating pharmacists agreed that patients’ health was their primary responsibility, only 57 % believed that they can provide better pharmaceutical care in the future. The majority spent most of their work time counselling patients (90 %) and checking prescription (70 %). Only a small portion monitored adverse drug reaction and drug compliance (44 %), engaged in health screening or drug safety promotion (20 %) or maintained patient medication records (4 %). Insufficient communication with physicians (90 %), lack of time (79 %) and lack of physical space at the pharmacy (76 %) were considered the most significant barriers. Conclusion: A suboptimal level of pharmaceutical care is provided by pharmacists in Macao. Considering the barriers identified and integrating other country experiences, establishing an enabling atmosphere using policy and regulatory measures is the fundamental element for advancing pharmaceutical care by community pharmacists.

Um Modelo híbrido para previsão de curvas de produção de petróleo

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

The roles of community pharmacists and other pharmacy staff:public perceptions

Introduction: The focus of the community pharmacist’s (CP’s) activities continues to move away from traditional dispensing activities towards the provision of health services. Current functions of CPs cover a combination of roles including prescription matters, counselling and service provision. These expanding roles, along with raised prescription volume, have increased CP workload. Therefore, it has become commonplace to delegate certain activities to other pharmacy staff (PS). This research aimed to examine public perceptions of CPs and other PS functions. Methodology: A self-completion postal questionnaire was sent to a random sample of 9769 members of the general public in England. Participants were asked to indicate which functions they believed CPs and other PS perform. Data were imported into SPSS 22 for analysis. Results: A response rate of 15.7% (n = 1537) was achieved. The roles most commonly attributed to CPs were monitoring prescription appropriateness (90.4%, n = 1390) and counselling patients on prescribed medicines (90.4%, n = 1389). The role most commonly attributed to other PS was sales transactions (92.4%, n = 1420). Similar numbers of responders agreed that the delivery of health services was the role of both CPs and other PS (58.9%, n = 906; 57.0%, n = 876). Conclusion: Despite a move towards more service based practice, the public still primarily associate the CP’s role with activities centred on dispensing. The provision of health services was seen to be equally carried out by CPs and other PS. As the CP’s service-based activities continue to develop, promotional activities may be required to ensure developments in CP functions are recognised by the public

Pelvic-floor-muscle-training adherence “modifiers” : a review of primary qualitative studies : 2011 ICS State-of-the-Science Seminar research paper III of IV

Aims This review aims to locate and summarize the findings of qualitative studies exploring the experience of and adherence to pelvic floor muscle training (PFMT) to recommend future directions for practice and research. Methods Primary qualitative studies were identified through a conventional subject search of electronic databases, reference-list checking, and expert contact. A core eligibility criterion was the inclusion of verbatim quotes from participants about PFMT experiences. Details of study aims, methods, and participants were extracted and tabulated. Data were inductively grouped into categories describing “modifiers” of adherence (verified by a second author) and systematically displayed with supporting illustrative quotes. Results Thirteen studies (14 study reports) were included; eight recruited only or predominantly women with urinary incontinence, three recruited postnatal women, and two included women with pelvic organ prolapse. The quality of methodological reporting varied. Six “modifiers” of adherence were described: knowledge; physical skill; feelings about PFMT; cognitive analysis, planning, and attention; prioritization; and service provision. Conclusions Individuals' experience substantial difficulties with capability (particularly knowledge and skills), motivation (especially associated with the considerable cognitive demands of PFMT), and opportunity (as external factors generate competing priorities) when adopting and maintaining a PFMT program. Expert consensus was that judicious selection and deliberate application of appropriate behavior change strategies directed to the “modifiers” of adherence identified in the review may improve PFMT outcomes. Future research is needed to explore whether the review findings are congruent with the PFMT experiences of antenatal women, men, and adults with fecal incontinence.

Pelvic-floor-muscle-training adherence “modifiers” : a review of primary qualitative studies : 2011 ICS State-of-the-Science Seminar research paper III of IV

Aims This review aims to locate and summarize the findings of qualitative studies exploring the experience of and adherence to pelvic floor muscle training (PFMT) to recommend future directions for practice and research. Methods Primary qualitative studies were identified through a conventional subject search of electronic databases, reference-list checking, and expert contact. A core eligibility criterion was the inclusion of verbatim quotes from participants about PFMT experiences. Details of study aims, methods, and participants were extracted and tabulated. Data were inductively grouped into categories describing “modifiers” of adherence (verified by a second author) and systematically displayed with supporting illustrative quotes. Results Thirteen studies (14 study reports) were included; eight recruited only or predominantly women with urinary incontinence, three recruited postnatal women, and two included women with pelvic organ prolapse. The quality of methodological reporting varied. Six “modifiers” of adherence were described: knowledge; physical skill; feelings about PFMT; cognitive analysis, planning, and attention; prioritization; and service provision. Conclusions Individuals' experience substantial difficulties with capability (particularly knowledge and skills), motivation (especially associated with the considerable cognitive demands of PFMT), and opportunity (as external factors generate competing priorities) when adopting and maintaining a PFMT program. Expert consensus was that judicious selection and deliberate application of appropriate behavior change strategies directed to the “modifiers” of adherence identified in the review may improve PFMT outcomes. Future research is needed to explore whether the review findings are congruent with the PFMT experiences of antenatal women, men, and adults with fecal incontinence.

The Role of B5G UAV-Aided Mobile Networks

With the advent of 5G, several novel network paradigms and technologies have been proposed to fulfil the key requirements imposed. Flexibility, efficiency and scalability, along with sustainability and convenience for expenditure have to be addressed in targeting these brand new needs. Among novel paradigms introduced in the scientific literature in recent years, a constant and increasing interest lies in the use of unmanned aerial vehicles (UAVs) as network nodes supporting the legacy terrestrial network for service provision. Their inherent features of moving nodes make them able to be deployed on-demand in real-time. Which, in practical terms, means having them acting as a base station (BS) when and where there is the highest need. This thesis investigates then the potential role of UAV-aided mobile radio networks, in order to validate the concept of adding an aerial network component and assess the system performance, from early to later stages of its deployment. This study is intended for 5G and beyond systems, to allow time for the technology to mature. Since advantages can be manyfold, the aerial network component is considered at the network layer under several aspects, from connectivity to radio resource management. A particular emphasis is given to trajectory design, because of the efficiency and flexibility it potentially adds to the infrastructure. Two different frameworks have been proposed, to take into account both a re-adaptable heuristic and an optimal solution. Moreover, diverse use cases are taken under analysis, from mobile broadband to machine and vehicular communications. The thesis aim is thus to discuss the potential and advantages of UAV-aided systems from a broad perspective. Results demonstrate that the technology has good prospects for diverse scenarios with a few arrangements.

Augmented Reality for Airport Control Tower: Analysis and Implementation of Safety Nets

With the development of new technologies, Air Traffic Control, in the nearby of the airport, switched from a purely visual control to the use of radar, sensors and so on. As the industry is switching to the so-called Industry 4.0, also in this frame, it would be possible to implement some of the new tools that can facilitate the work of Air Traffic Controllers. The European Union proposed an innovative project to help the digitalization of the European Sky by means of the Single European Sky ATM Research (SESAR) program, which is the foundation on which the Single European Sky (SES) is based, in order to improve the already existing technologies to transform Air Traffic Management in Europe. Within this frame, the Resilient Synthetic Vision for Advanced Control Tower Air Navigation Service Provision (RETINA) project, which saw the light in 2016, studied the possibility to apply new tools within the conventional control tower to reduce the air traffic controller workload, thanks to the improvements in the augmented reality technologies. After the validation of RETINA, the Digital Technologies for Tower (DTT) project was established and the solution proposed by the University of Bologna aimed, among other things, to introduce Safety Nets in a Head-Up visualization. The aim of this thesis is to analyze the Safety Nets in use within the control tower and, by developing a working concept, implement them in a Head-Up view to be tested by Air Traffic Control Operators (ATCOs). The results, coming from the technical test, show that this concept is working and it could be leading to a future implementation in a real environment, as it improves the air traffic controller working conditions also when low visibility conditions apply.

Regional Eligibility Criteria for the Provision of Wheelchairs Through the Northern Ireland Wheelchair Service (PDF 2.20 MB)

A Guide for wheelchair users on regional eligibility criteria for the provision of wheelchairs through the Northern Ireland Wheelchair Service

Antipsychotic polypharmacy in a regional health service: a population-based study

Background To analyse the extent and profile of outpatient regular dispensation of antipsychotics, both in combination and monotherapy, in the Barcelona Health Region (Spain), focusing on the use of clozapine and long-acting injections (LAI). Methods Antipsychotic drugs dispensed for people older than 18 and processed by the Catalan Health Service during 2007 were retrospectively reviewed. First and second generation antipsychotic drugs (FGA and SGA) from the Anatomical Therapeutic Chemical classification (ATC) code N05A (except lithium) were included. A patient selection algorithm was designed to identify prescriptions regularly dispensed. Variables included were age, gender, antipsychotic type, route of administration and number of packages dispensed. Results A total of 117,811 patients were given any antipsychotic, of whom 71,004 regularly received such drugs. Among the latter, 9,855 (13.9%) corresponded to an antipsychotic combination, 47,386 (66.7%) to monotherapy and 13,763 (19.4%) to unspecified combinations. Of the patients given antipsychotics in association, 58% were men. Olanzapine (37.1%) and oral risperidone (36.4%) were the most common dispensations. Analysis of the patients dispensed two antipsychotics (57.8%) revealed 198 different combinations, the most frequent being the association of FGA and SGA (62.0%). Clozapine was dispensed to 2.3% of patients. Of those who were receiving antipsychotics in combination, 6.6% were given clozapine, being clozapine plus amisulpride the most frequent association (22.8%). A total of 3.800 patients (5.4%) were given LAI antipsychotics, and 2.662 of these (70.1%) were in combination. Risperidone was the most widely used LAI. Conclusions The scant evidence available regarding the efficacy of combining different antipsychotics contrasts with the high number and variety of combinations prescribed to outpatients, as well as with the limited use of clozapine. Background To analyse the extent and profile of outpatient regular dispensation of antipsychotics, both in combination and monotherapy, in the Barcelona Health Region (Spain), focusing on the use of clozapine and long-acting injections (LAI). Methods Antipsychotic drugs dispensed for people older than 18 and processed by the Catalan Health Service during 2007 were retrospectively reviewed. First and second generation antipsychotic drugs (FGA and SGA) from the Anatomical Therapeutic Chemical classification (ATC) code N05A (except lithium) were included. A patient selection algorithm was designed to identify prescriptions regularly dispensed. Variables included were age, gender, antipsychotic type, route of administration and number of packages dispensed. Results A total of 117,811 patients were given any antipsychotic, of whom 71,004 regularly received such drugs. Among the latter, 9,855 (13.9%) corresponded to an antipsychotic combination, 47,386 (66.7%) to monotherapy and 13,763 (19.4%) to unspecified combinations. Of the patients given antipsychotics in association, 58% were men. Olanzapine (37.1%) and oral risperidone (36.4%) were the most common dispensations. Analysis of the patients dispensed two antipsychotics (57.8%) revealed 198 different combinations, the most frequent being the association of FGA and SGA (62.0%). Clozapine was dispensed to 2.3% of patients. Of those who were receiving antipsychotics in combination, 6.6% were given clozapine, being clozapine plus amisulpride the most frequent association (22.8%). A total of 3.800 patients (5.4%) were given LAI antipsychotics, and 2.662 of these (70.1%) were in combination. Risperidone was the most widely used LAI. Conclusions The scant evidence available regarding the efficacy of combining different antipsychotics contrasts with the high number and variety of combinations prescribed to outpatients, as well as with the limited use of clozapine.

How well do regional or national Breeding Bird Survey data predict songbird population trends at an intact boreal site?

A study to monitor boreal songbird trends was initiated in 1998 in a relatively undisturbed and remote part of the boreal forest in the Northwest Territories, Canada. Eight years of point count data were collected over the 14 years of the study, 1998-2011. Trends were estimated for 50 bird species using generalized linear mixed-effects models, with random effects to account for temporal (repeat sampling within years) and spatial (stations within stands) autocorrelation and variability associated with multiple observers. We tested whether regional and national Breeding Bird Survey (BBS) trends could, on average, predict trends in our study area. Significant increases in our study area outnumbered decreases by 12 species to 6, an opposite pattern compared to Alberta (6 versus 15, respectively) and Canada (9 versus 20). Twenty-two species with relatively precise trend estimates (precision to detect > 30% decline in 10 years; observed SE ≤ 3.7%/year) showed nonsignificant trends, similar to Alberta (24) and Canada (20). Precision-weighted trends for a sample of 19 species with both reliable trends at our site and small portions of their range covered by BBS in Canada were, on average, more negative for Alberta (1.34% per year lower) and for Canada (1.15% per year lower) relative to Fort Liard, though 95% credible intervals still contained zero. We suggest that part of the differences could be attributable to local resource pulses (insect outbreak). However, we also suggest that the tendency for BBS route coverage to disproportionately sample more southerly, developed areas in the boreal forest could result in BBS trends that are not representative of range-wide trends for species whose range is centred farther north.

A Bayesian approach for multi-model downscaling: Seasonal forecasting of regional rainfall and river flows in South America

This study addresses three issues: spatial downscaling, calibration, and combination of seasonal predictions produced by different coupled ocean-atmosphere climate models. It examines the feasibility Of using a Bayesian procedure for producing combined, well-calibrated downscaled seasonal rainfall forecasts for two regions in South America and river flow forecasts for the Parana river in the south of Brazil and the Tocantins river in the north of Brazil. These forecasts are important for national electricity generation management and planning. A Bayesian procedure, referred to here as forecast assimilation, is used to combine and calibrate the rainfall predictions produced by three climate models. Forecast assimilation is able to improve the skill of 3-month lead November-December-January multi-model rainfall predictions over the two South American regions. Improvements are noted in forecast seasonal mean values and uncertainty estimates. River flow forecasts are less skilful than rainfall forecasts. This is partially because natural river flow is a derived quantity that is sensitive to hydrological as well as meteorological processes, and to human intervention in the form of reservoir management.

Daily Calls Volume Forecasting

A massive amount has been written about forecasting but few articles are written about the development of time series models of call volumes for emergency services. In this study, we use different techniques for forecasting and make the comparison of the techniques for the call volume of the emergency service Rescue 1122 Lahore, Pakistan. For the purpose of this study data is taken from emergency calls of Rescue 1122 from 1st January 2008 to 31 December 2009 and 731 observations are used. Our goal is to develop a simple model that could be used for forecasting the daily call volume. Two different approaches are used for forecasting the daily call volume Box and Jenkins (ARIMA) methodology and Smoothing methodology. We generate the models for forecasting of call volume and present a comparison of the two different techniques.

Forecasting auto ownership and mode choice for U.S. metropolitan areas. Volume II: model equations. Final report.

Transportation Department, Office of University Research, Washington, D.C.

A simple regional-scale model for forecasting sorghum yield across North-Eastern Australia

Sorghum is the main dryland summer crop in NE Australia and a number of agricultural businesses would benefit from an ability to forecast production likelihood at regional scale. In this study we sought to develop a simple agro-climatic modelling approach for predicting shire (statistical local area) sorghum yield. Actual shire yield data, available for the period 1983-1997 from the Australian Bureau of Statistics, were used to train the model. Shire yield was related to a water stress index (SI) that was derived from the agro-climatic model. The model involved a simple fallow and crop water balance that was driven by climate data available at recording stations within each shire. Parameters defining the soil water holding capacity, maximum number of sowings (MXNS) in any year, planting rainfall requirement, and critical period for stress during the crop cycle were optimised as part of the model fitting procedure. Cross-validated correlations (CVR) ranged from 0.5 to 0.9 at shire scale. When aggregated to regional and national scales, 78-84% of the annual variation in sorghum yield was explained. The model was used to examine trends in sorghum productivity and the approach to using it in an operational forecasting system was outlined. (c) 2005 Elsevier B.V. All rights reserved.

Dental set-vice provision in private general practice for an insured population in New South Wales, Australia

Objective To determine patterns of dental set-vices provided to a cohort of the insured population 18 years and over, in private general practice in New South Wales, Australia. Basic research design A cohort study using the person-years method and Poisson regression for analysis. Setting Data were derived from claims records submitted by members of a health insurance fund (Government Employees Health Fund-GEHF) for rebates during the study period 1 January 1992-31 December 1995. Participants There were 133,467 members aged 18 years and over from New South Wales. Main outcome measures To determine, by age group, for those members who used private general practice and made a claim (referred to as 'patients') the annual number of visits, total number of services received per year and number of services received at a visit, Results The mean number of visits per patient was 2.4 per year with patients under 45 years making fewer visits than the 45-54 age group reference category. Mean number of services utilised per patient-year was 5.9, with services provided increasing from 3.5 for the 18-24-year-old group, reaching a plateau of approximately 6.2 for those aged 45 years or more. The number of services received per visit was 2.4 and there were no differences by age. Service mix was dominated by restorative (35%), diagnostic (27%), and preventive services (18%); with age specific variations observed. Conclusions Age was found to be an important determinant in the use of dental services, independent of membership duration and gender.