An examination of the role of the concept of the community within the current reorganisation of English local government

The thesis will examine the role and impact of the concept of the community within the structural reorganisation of English local government between 1992 and 1995. The methodological approach adopted within this thesis has been to compare the use, application and significance of the community with a case study of a specific local authority and its preparations for reorganisation. The authority in question was Wychavon District Council located in the County of Hereford and Worcester. The conclusions from this case study were then compared to the role and significance of the community in the reviews of other local authorities in England. This study produced two important results. These were that there was an established body of literature which argued that the community could be of value to local government and that the community should be identified by measuring individuals sense of belonging and feelings of attachment, as well as such daily activities as shopping and working (which help to stimulate these feelings). The then Conservative Government even instructed the specially appointed Commission to apply this particular interpretation of the community to their reviews, and to attempt to base any new unitary authorities upon the social and spatial area it created. The Conservative Government also gave the Commission a Community Index to assist with the identification of communities, and appointed the pollsters MORI to support the Commission with the task of identifying the emotional and more subjective senses of community. The Commission eventually came to rely entirely on the MORI polls, and whilst these polls attempted to faithfully apply the Governments interpretation of the community, they unfortunately produced small and often complex communities, which the Commission felt could not be applied to its reviews. This therefore led to the community becoming a secondary consideration to the factors of cost and efficiency. Furthermore the problematic nature of the community - that is, the production of small and complex communities - was repeated in this thesis' own survey of community identities in the District of Wychavon. In fact this authority's proposals for reorganisation were based almost entirely upon the factors of cost, size and efficiency.

Reducing medicines waste in the community

There is increasing concern at the amount and cost of prescribed medicines that are unused or wasted and then have to be disposed of. Previous studies have used health promotion and Dispose Unwanted Medicines Properly campaigns targeted at the patient to describe and quantify the annual cost of waste. The reasons patients return unused drugs to pharmacies have also been explored. The paper focuses on patient explanations for not needing medication; categorized as: over-collection in the past, self-management strategies, changes in medical condition, other changes in patient circumstances, or the repeat medicines policy at the surgery. The aim of the original study was to make a measurable change in prescribed medicines with a reduction in medicines wastage, whilst at the same time achieving improved standards of pharmaceutical care. Information on patient needs and behaviour came from consultation in the pharmacy monitoring forms and interview. The study was based on two medical practices in the West Midlands, UK, comparing an outer city and an inner city population. The participants were general practitioners, pharmacists and 350 repeat prescription patients. Prescriptions were issued for two three-month periods. The outcome was that 23.8% of the prescribed items were not dispensed, at a value of £13.1K, 58% of the medications that would be expected to be regularly supplied were collected. The study suggests that closer professional management at the point of dispensing and an understanding of patient experiences can help reduce the amount of unwanted medication collected by patients.

Information systems design for the community health services

This system is concerned with the design and implementation of a community health information system which fulfils some of the local needs of fourteen nursing and para-medical professions in a district health authority, whilst satisfying the statutory requirements of the NHS Korner steering group for those professions. A national survey of community health computer applications, documented in the form of an applications register, shows the need for such a system. A series of general requirements for an informations systems design methodology are identified, together with specific requirements for this problem situation. A number of existing methodologies are reviewed, but none of these were appropriate for this application. Some existing approaches, tools and techniques are used to define a more suitable methodology. It is unreasonable to rely on one single general methodology for all types of application development. There is a need for pragmatism, adaptation and flexibility. In this research, participation in the development stages by those who will eventually use the system was thought desirable. This was achieved by forming a representative design group. Results would seem to show a highly favourable response from users to this participation which contributed to the overall success of the system implemented. A prototype was developed for the chiropody and school nursing staff groups of Darlington health authority, and evaluations show that a significant number of the problems and objectives of those groups have been successfully addressed; the value of community health information has been increased; and information has been successfully fed back to staff and better utilised.

Pharmacist monitoring of patient health in the community

The Government has established essential principles in order to make significant improvements in the health of the people and has placed an emphasis on shifting care to the primary sening. This research has explored the potential role of the community pharmacist in health promotion in the pharmacy, and at general medical practices. The feasibility of monitoring patients' health status in the community was evaluated by intervention to assess and alter cardiovascular risk factors.68, hypertensive patients, monitored at one surgery, had a change in mean systolic blood pressure from 158.28 to 146.55 mmHg, a reduction of 7.4%, and a change in mean diastolic bood pressure from 90.91 to 84.85 mmHg, a reduction of 6.7%.120 patients, from a cohort of 449 at the major practice, with an initial serum total cholesterol of 6.0+mmol/L, experienced a change in mean value from 6.79 to 6.05 mmol/L, equivalent to a reduction of 10.9%. 86% of this patient cohort showed a decrease in cholesterol concentration. Patients, placed in a high risk category according to their coronary rank score, assessed at the first health screening, showed a consistent and significant improvement in coronary score throughout the study period of two years. High risk and intermediate risk patients showed improvements in coronary score of 52% and 14% respectively. Patients in the low risk group maintained their good coronary score. In some cases, a patient's improvement was effected in liaison with the GP, after a change or addition of medication and/or dosage.Pharmacist intervention consisted of advice on diet and lifestyle and adherence to medication regimes. It was concluded that a pharmacist can facilitate a health screening programme in the primary care setting, and provide enhanced continuity of care for the patient.

A study of the role of the community pharmacist in responding to symptons

Factors affecting the current role of the community pharmacist in responding to symptoms are investigated. Communication and collaboration with general medical practitioners (GPs), and the competency of pharmacists and counter assistants to perform the role of responding to symptoms, are examined. A national survey of GPs, conducted by postal questionnaire, explores attitudes towards the role of the community pharmacist in the treatment of patients' symptoms, and towards future extension of such a role. A majority (over 90%) of respondents thought that the counter prescribing activities of the pharmacist should be maintained or increased. Doctors supported treatment of most minor illnesses by pharmacists, but there was relatively little support for the deregulation of selected Prescription Only Medicines. Three quarters of respondents were in favour of joint educational meetings for pharmacists and doctors. Most GPs (85%) expressed support for a formal referral route from pharmacists to doctors, using a "notification card". A pilot study of the use of a notification card was conducted . Two thirds of the patients who were advised to see their doctor by the pharmacist subsequently did so. In most cases , the GP rated the patients' symptoms " significant" and the card "helpful". Pharmacists' and counter assistants' competency in responding to symptoms was assessed by a programme of pharmacy visits, where previously-defined symptoms were presented. Some pharmacists' questioning skills were found to be inadequate, and their knowledge not sufficiently current. Counter assistants asked fewer and less appropriate questions than did pharmacists, and assistants ' knowledge base was shown to be inadequate. Recommendations are made in relation to the education and training of pharmacists and counter assistants in responding to symptoms .

Measuring the assessment and counselling provided with the supply of non-prescription asthma reliever medication: a simulated patient study

BACKGROUND: Over one quarter of asthma reliever medications are provided without prescription by community pharmacies in Australia. Evidence that community pharmacies provide these medications with sufficient patient assessment and medication counseling to ensure compliance with the government's Quality Use of Medicines principles is currently lacking. OBJECTIVE: To assess current practice when asthma reliever medication is provided in the community pharmacy setting and to identify factors that correlate with assessment of asthma control. METHODS: Researchers posing as patients visited a sample of Perth metropolitan community pharmacies in May 2007. During the visit, the simulated patient enacted a standardized scenario of someone with moderately controlled asthma who wished to purchase a salbutamol (albuterol) inhaler without prescription. Results of the encounter were recorded immediately after the visit. Regression analysis was performed, with medication use frequency (a marker of asthma control) as the dependent variable. RESULTS: One hundred sixty community pharmacies in the Perth metropolitan area were visited in May 2007. Pharmacists and/or pharmacy assistants provided some form of assessment in 84% of the visits. Counseling was provided to the simulated patients in 24% of the visits. Only 4 pharmacy staff members asked whether the simulated patient knew how to use the inhaler. Significant correlation was found between assessment and/or counseling of reliever use frequency and 3 independent variables: visit length (p < 0.001), number of assessment questions asked (p < 0.001), and the simulated patient who conducted the visit (p < 0.02). CONCLUSIONS: Both patient assessment and medication counseling were suboptimal compared with recommended practice when nonprescription asthma reliever medication was supplied in the community pharmacy setting. Pharmacy and pharmacist demographic variables do not appear to affect assessment of asthma control. This research indicates the need for substantial improvements in practice in order to provide reliever medication in line with Quality Use of Medication principles of ensuring safe and effective use of medication.

Study of the potential role of the community pharmacist in health promotion

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Impact of severity and type of depression on quality of life in cases identified in the community

BACKGROUND: The impact of different levels of depression severity on quality of life (QoL) is not well studied, particularly regarding ICD-10 criteria. The ICD classification of depressive episodes in three levels of severity is also controversial and the less severe category, mild, has been considered as unnecessary and not clearly distinguishable from non-clinical states. The present work aimed to test the relationship between depression severity according to ICD-10 criteria and several dimensions of functioning as assessed by Medical Outcome Study (MOS) 36-item Short Form general health survey (SF-36) at the population level. METHOD: A sample of 551 participants from the second phase of the Outcome of Depression International Network (ODIN) study (228 controls without depression and 313 persons fulfilling ICD criteria for depressive episode) was selected for a further assessment of several variables, including QoL related to physical and mental health as measured with the SF-36. RESULTS: Statistically significant differences between controls and the depression group were found in both physical and mental markers of health, regardless of the level of depression severity; however, there were very few differences in QoL between levels of depression as defined by ICD-10. Regardless of the presence of depression, disability, widowed status, being a woman and older age were associated with worse QoL in a structural equation analysis with covariates. Likewise, there were no differences according to the type of depression (single-episode versus recurrent). CONCLUSIONS: These results cast doubt on the adequacy of the current ICD classification of depression in three levels of severity.

Does the subject content of the pharmacy degree course influence the community pharmacist’s views on competencies for practice?

Do community pharmacists coming from different educational backgrounds rank the importance of competences for practice differently-or is the way in which they see their profession more influenced by practice than university education? A survey was carried out on 68 competences for pharmacy practice in seven countries with different pharmacy education systems in terms of the relative importance of the subject areas chemical and medicinal sciences. Community pharmacists were asked to rank the competences in terms of relative importance for practice; competences were divided into personal and patient-care competences. The ranking was very similar in the seven countries suggesting that evaluation of competences for practice is based more on professional experience than on prior university education. There were some differences for instance in research-related competences and these may be influenced, by education.

Interaction of the parasitic angiosperm {\it Cassytha filiformis\/} L. (Lauraceae) with the exotic {\it Schinus terebinthifolius\/} Raddi (Anacardiaceae) in southern Florida

Brazilian pepper (Schinus terebinthifolius) is an exotic shrub or small tree that has become well established as an invasive and highly competitive species through much of southern Florida. Love vine (Cassytha filiformis), a native parasitic plant, was noted parasitizing Brazilian pepper, apparently affecting its health. The objective of this study was to investigate the nature of this parasitic interaction in southern Florida. Brazilian pepper populations were studied to determine whether parasitism by love vine may affect growth and reproduction. Anatomical studies of love vine parasitizing Brazilian pepper determined physical aspects of the parasitic interaction at the cell and tissue level. Physiological aspects of this interaction were investigated to help describe love vine resource acquisition as a parasite on host Brazilian pepper plants, and as an autotrophic plant. An investigation of ecological aspects of this parasitic interaction was done to determine whether physical or biological aspects of habitats may contribute to love vine parasitism on Brazilian pepper. These studies indicated that: (1) parasitism by love vine significantly decreased growth and reproduction of Brazilian pepper plants; (2) anatomical and physiological investigations indicated that love vine was primarily a xylem parasite on Brazilian pepper, but that some assimilated carbon nutrients may also be acquired from the host; (3) love vine is autotrophic (i.e., hemiparasitic), but is totally dependent on its host for necessary resources; (4) the occurrence of love vine parasitism on Brazilian pepper is mediated by physical characters of the biological community. ^

Supplemental instruction, study habits, and the community college student

The purpose of this study was to demonstrate if the academic assistance program Supplemental Instruction (SI) facilitates the acquisition of effective study behaviors through strategies that transcend simple double-exposure to the course material. Its advocates claim it increases academic achievement using learner-centered knowledge and acquisition of effective study behaviors. SI sessions are specifically related to particular courses that students are taking. Sessions are facilitated by the SI leader who has taken the subject matter course in the past. Students review the content of the previous subject matter class using collaborative learning strategies coordinated by a SI leader. In addition, the SI leader models appropriate study behaviors in his or her interactions with the students. ^ An instructor at a large Florida community college who taught five classes of an Anatomy & Physiology I course (traditionally supported by SI) was identified. Two of the classes were randomly selected to participate in SI activities, and two classes were random chosen to participate in alternate, computer-based activities that dealt with the course content, but did not include work in developing students' study behaviors. These treatments were carried out over the course of an entire semester. Participation was mandatory. ^ Data were collected on two variables. Academic achievement in anatomy and physiology content was measured both pre- and post-treatment using an instructor developed examination. Student study behaviors were measured using pre- and post-treatment administration of the Study Behavior Inventory, a valid and reliable instrument that provides scores on three categories of study behaviors: (a) Academic self-efficacy, (b) Preparation for routine academic tasks, and (c) Preparation for long range academic tasks. Measures obtained at the end of the semester of treatment revealed no significant differences between the SI and alternative treatment groups in post-treatment achievement test score and the post-treatment scores on the three study behaviors categories when adjusted for pre-treatment scores. ^ These results suggest that the development of appropriate study behaviors requires more time than SI, as it is now implemented, can provide. In addition, results indicate that improved academic achievement may be attained through any number of means that include repeated exposure to course material. ^

Characterization of N-acylhomoserine lactone-degrading bacteria associated with the Zingiber officinale (ginger) rhizosphere: Co-existence of quorum quenching and quorum sensing in Acinetobacter and Burkholderia

Background Cell-to-cell communication (quorum sensing (QS)) co-ordinates bacterial behaviour at a population level. Consequently the behaviour of a natural multi-species community is likely to depend at least in part on co-existing QS and quorum quenching (QQ) activities. Here we sought to discover novelN-acylhomoserine lactone (AHL)-dependent QS and QQ strains by investigating a bacterial community associated with the rhizosphere of ginger (Zingiber officinale) growing in the Malaysian rainforest. Results By using a basal growth medium containing N-(3-oxohexanoyl)homoserine lactone (3-oxo-C6-HSL) as the sole source of carbon and nitrogen, the ginger rhizosphere associated bacteria were enriched for strains with AHL-degrading capabilities. Three isolates belonging to the generaAcinetobacter (GG2), Burkholderia (GG4) and Klebsiella (Se14) were identified and selected for further study. Strains GG2 and Se14 exhibited the broadest spectrum of AHL-degrading activities via lactonolysis while GG4 reduced 3-oxo-AHLs to the corresponding 3-hydroxy compounds. In GG2 and GG4, QQ was found to co-exist with AHL-dependent QS and GG2 was shown to inactivate both self-generated and exogenously supplied AHLs. GG2, GG4 and Se14 were each able to attenuate virulence factor production in both human and plant pathogens. Conclusions Collectively our data show that ginger rhizosphere bacteria which make and degrade a wide range of AHLs are likely to play a collective role in determining the QS-dependent phenotype of a polymicrobial community.

Interaction of the parasitic angiosperm cassytha filiformis L. (Lauraceae) with the exotic schinus terebinthifolius RADDI (Anacardiaceae) in southern Florida

Brazilian pepper (Schinus terebinthifolius) is an exotic shrub or small tree that has become well established as an invasive and highly competitive species through much of southern Florida. Love vine (Cassytha filiformis), a native parasitic plant, was noted parasitizing Brazilian pepper, apparently affecting its health. The objective of this study was to investigate the nature of this parasitic interaction in southern Florida. Brazilian pepper populations were studied to determine whether parasitism by love vine may affect growth and reproduction. Anatomical studies of love vine parasitizing Brazilian pepper determined physical aspects of the parasitic interaction at the cell and tissue level. Physiological aspects of this interaction were investigated to help describe love vine resource acquisition as a parasite on host Brazilian pepper plants, and as an autotrophic plant. An investigation of ecological aspects of this parasitic interaction was done to determine whether physical or biological aspects of habitats may contribute to love vine parasitism on Brazilian pepper. These studies indicated that: 1) parasitism by love vine significantly decreased growth and reproduction of Brazilian pepper plants; 2) anatomical and physiological investigations indicated that love vine was primarily a xylem parasite on Brazilian pepper, but that some assimilated carbon nutrients may also be acquired from the host; 3) love vine is autotrophic (i. e., hemiparasitic), but is totally dependent on its host for necessary resources; 4) the occurrence of love vine parasitism on Brazilian pepper is mediated by physical characters of the biological community.

Collectively coping with contact: The role of intragroup support in dealing with the challenges of intergroup mixing in residential contexts

The social identity approach to stress has shown how intragroup support processes shape individuals' responses to stress across health care, workplace, and community settings. However, the issue of how these 'social cure' processes can help cope with the stress of intergroup contact has yet to be explored. This is particularly important given the pivotal role of intergroup threat and anxiety in the experience of contact as well as the effect of contact on extending the boundaries of group inclusion. This study applies this perspective to a real-life instance of residential contact in a divided society. Semi-structured interviews with 14 Catholic and 13 Protestant new residents of increasingly mixed areas of Belfast city, Northern Ireland, were thematically analysed. Results highlight that transitioning to mixed communities was fraught with intergroup anxiety, especially for those coming from 'single identity' areas. Help from existing residents, especially when offered by members of other religious denominations, signalled a 'mixed community ethos' to new residents, which facilitated adopting and sharing this identity. This shared identity then enabled them to deal with unexpected intergroup threats and provided resilience to future sectarian division. New residents who did not adopt this shared identity remained isolated, fearful, and prone to negative contact.

Physical characterization of TNOs with the James Webb Space Telescope

Studies of the physical properties of trans-Neptunian objects (TNOs) are a powerful probe into the processes of planetesimal formation and solar system evolution. James Webb Space Telescope (JWST) will provide unique new capabilities for such studies. Here, we outline where the capabilities of JWST open new avenues of investigation, potentially valuable observations and surveys, and conclude with a discussion of community actions that may serve to enhance the eventual science return of JWST's TNO observations.