The feasibility of a community pharmacy delivered in-pharmacy influenza vaccination service

Pharmacist-administered vaccination is a reality in many counties including USA, Canada, UK, Portugal, Ireland and New Zealand. In Australia the role of pharmacist administered vaccination has long been supported by the profession particularly the Pharmaceutical Society of Australia and Pharmacy Guild of Australia, however legislation prohibits this practice in each state and territory. In 2013 the only available in-pharmacy vaccination services are those delivered by an immunization nurse, nurse practitioner or general practitioner.

Effective communication during disasters: What effects community decision making & action?

Study/Objective This paper describes a program of research examining emergency messaging during the response and early recovery phases of natural disasters. The objective of this suite of studies is to develop message construction frameworks and channels that maximise community compliance with instructional messaging. The research has adopted a multi-hazard approach and considers the impact of formal emergency messages, as well as informal messages (e.g., social media posts), on community compliance. Background In recent years, media reports have consistently demonstrated highly variable community compliance to instructional messaging during natural disasters. Footage of individuals watching a tsunami approaching from the beach or being over-run by floodwaters are disturbing and indicate the need for a clearer understanding of decision making under stress. This project’s multi-hazard approach considers the time lag between knowledge of the event and desired action, as well as how factors such as message fatigue, message ambiguity, and the interplay of messaging from multiple media sources are likely to play a role in an individual’s compliance with an emergency instruction. Methods To examine effective messaging strategy, we conduct a critical analysis of the literature to develop a framework for community consultation and design experiments to test the potential for compliance improvement. Results Preliminary results indicate that there is, as yet, little published evidence on which to base decisions about emergency instructional messages to threatened communities. Conclusion The research described here will contribute improvements in emergency instructional message compliance by generating an evidence-based framework that takes into account behavioural compliance theory, the psychology of decision making under stress, and multiple channels of communication including social media.

Legal mechanisms for maximising community engagement with formal evacuation messaging: How well are these understood?

Study/Objective This program of research examines the effectiveness of legal mechanisms as motivators to maximise engagement and compliance with evacuation messages. This study is based on the understanding that the presence of legislative requirements, as well as sanctions and incentives encapsulated in law, can have a positive impact in achieving compliance. Our objective is to examine whether the current Australian legal frameworks, which incorporate evacuation during disasters, are an effective structure that is properly understood by those who enforce and those who are required to comply. Background In Australia, most jurisdictions have enacted legislation that encapsulates the power to evacuate and the ability to enforce compliance, either by the use of force or imposition of penalty. However, citizens still choose to not evacuate. Methods This program of research incorporates theoretical and doctrinal methodologies for reviewing literature and legislation in the Australia context. The aim of the research is to determine whether further clarity is required to create an understanding of the powers to evacuate, as well as greater public awareness of these powers. Results & Conclusion Legislators suggest that powers of evacuation can be ineffective if they are impractical to enforce. In Australia, there may also be confusion about from which legislative instrument the power to evacuate derives, and therefore whether there is a corresponding ability to enforce compliance through the use of force or imposition of a penalty. Equally, communities may lack awareness and understanding of the powers of agencies to enforce compliance. We seek to investigate whether this is the case, and whether even if greater awareness existed, it would act as an incentive to comply.

Community Controlled Health Services: What They Are and How They Work

This chapter provides an overview of the role of community controlled health services and health sector and the role of the nurse.

Traffic behaviour and compliance with the law in low and middle income countries: are we observing "pragmatic driving"?

A common theme in many accounts of road safety and road use in low and middle income countries is a widespread lack of compliance with traffic laws and related legislation. A key element of the success of road crash prevention strategies in high income countries has been the achievement of safer road user behaviour through compliance with traffic laws. Deterrence-based approaches such as speed cameras and random breath testing, which rely on drivers making an assessment that they are likely to be caught if they offend, have been very effective in this regard. However, the long term success of (for example) drink driving legislation has been supported by drivers adopting a moral approach to compliance rather than relying solely on the intensity of police operations. For low and middle income countries such morally based compliance is important, since levels of police resourcing are typically much lower than in Western countries. In the absence of morally based compliance, it is arguable that the patterns of behaviours observed in low and middle income countries can be described as "pragmatic driving": compliance only when there is a high chance of being detected and fined, or where a crash might occur. The potential characteristics of pragmatic driving in the macro-, meso- and micro-context of driving and the enforcement approach that could address it are outlined, with reference to the limited existing information available.

Study on tracheal collapsibility, compliance, and stress by considering nonlinear mechanical property of cartilage

Tracheal cartilage has been widely regarded as a linear elastic material either in experimental studies or in analytic and numerical models. However, it has been recently demonstrated that, like other fiber-oriented biological tissues, tracheal cartilage is a nonlinear material, which displays higher strength in compression than in extension. Considering the nonlinearity requires a more complex theoretical frame work and costs more to simulate. This study aims to quantify the deviation due to the simplified treatment of the tracheal cartilage as a linear material. It also evaluates the improved accuracy gained by considering the nonlinearity. Pig tracheal rings were used to exam the mechanical properties of cartilage and muscular membrane. By taking into account the asymmetric shape of tracheal cartilage, the collapse behavior of complete rings was simulated, and the compliance of airway and stress in the muscular membrane were discussed. The results obtained were compared with those assuming linear mechanical properties. The following results were found: (1) Models based on both types of material properties give a small difference in representing collapse behavior; (2) regarding compliance, the relative difference is big, ranging from 10 to 40% under negative pressure conditions; and (3) the difference in determining stress in the muscular membrane is small too: <5%. In conclusion, treating tracheal cartilage as a linear material will not cause big deviations in representing the collapse behavior, and mechanical stress in the muscular part, but it will induce a big deviation in predicting the compliance, particularly when the transmural pressure is lower than -0.5 kPa. The results obtained in this study may be useful in both understanding the collapse behavior of trachea and in evaluating the error induced by the simplification of treating the tracheal cartilage as a linear elastic material.

Impact of community-based fisheries management practices on production and species diversity in Turag-Bangshi basin floodplains in Kaliakoir, Gazipur, Bangladesh

The study was conducted to investigate the communities perception and compliance to community-based fisheries management (CBFM) in Turag-Bangshi floodplains under Kaliakoir, Gazipur District. Measures such as ban on use of the harmful fishing gears, seasonal fishing closure, halt of fry fishing, halt of dewatering of beels and the impact of establishment of sanctuaries on fish production and species diversity were introduced by MACH project. Almost all members of the communities in Turag-Bangshi MACH (Management of Aquatic Ecosystem through Community Husbandry) site welcomed the introduction and complied with the implementation of all management measures which helped stopped use of harmful fishing gears, ensured survival and breeding of brood fish in the rainy season, protected and allowed fry to grow big, restored lost and degraded fisheries and organized communities for sustainable development of the fisheries. A total of 51 species of fishes were found in Makosh beel (natural depression). Among these, small indigenous species (SIS) under Cyprinidae family (Puntius sophore) was the most dominant. Many species available in the past recorded disappeared from the Makosh beel due to loss of habitat and industrial pollution that damaged spawning and nursery grounds of fish. Introduction of some selective native endangered species (Nandus nandus, Notopterus notopterus, Ompok pabda and Labeo calbasu) by MACH in the Turag-Bangshi water bodies increased diversity of species from 82 to 95. Over a period of five years during MACH intervention, the average production remained nearly 200% higher than the baseline production of 57 kg/ha to present 207 kg/ha due to maintaining sanctuaries and the closed fishing seasons. Per capita daily fish consumption of the surrounding communities also increased by 78% (from 27 to 48 g/person/day) which is much higher than the national average fish consumption in Bangladesh. The implementation of community-based MACH project management measures substantially improved fish habitat, production, consumption and socio-economic conditions of the surrounding communities. The model can be used to improve the floodplains of Bangladesh.

An approach to multi-fidelity optimization of aeroengine compression systems

The aerodynamic design of turbomachinery presents the design optimisation community with a number of exquisite challenges. Chief among these are the size of the design space and the extent of discontinuity therein. This discontinuity can serve to limit the full exploitation of high-fidelity computational fluid dynamics (CFD): such codes require detailed geometric information often available only sometime after the basic configuration of the machine has been set by other means. The premise of this paper is that it should be possible to produce higher performing designs in less time by exploiting multi-fidelity techniques to effectively harness CFD earlier in the design process, specifically by facilitating its participation in configuration selection. The adopted strategy of local multi-fidelity correction, generated on demand, combined with a global search algorithm via an adaptive trust region is first tested on a modest, smooth external aerodynamic problem. Speed-up of an order of magnitude is demonstrated, comparable to established techniques applied to smooth problems. A number of enhancements aimed principally at effectively evaluating a wide range of configurations quickly is then applied to the basic strategy, and the emerging technique is tested on a generic aeroengine core compression system. A similar order of magnitude speed-up is achieved on this relatively large and highly discontinuous problem. A five-fold increase in the number of configurations assessed with CFD is observed. As the technique places constraints neither on the underlying physical modelling of the constituent analysis codes nor on first-order agreement between those codes, it has potential applicability to a range of multidisciplinary design challenges. © 2012 by Jerome Jarrett and Tiziano Ghisu.

Establishing a regional, multisite database for quality improvement and service planning in community-based palliative care and hospice.

BACKGROUND: Outpatient palliative care, an evolving delivery model, seeks to improve continuity of care across settings and to increase access to services in hospice and palliative medicine (HPM). It can provide a critical bridge between inpatient palliative care and hospice, filling the gap in community-based supportive care for patients with advanced life-limiting illness. Low capacities for data collection and quantitative research in HPM have impeded assessment of the impact of outpatient palliative care. APPROACH: In North Carolina, a regional database for community-based palliative care has been created through a unique partnership between a HPM organization and academic medical center. This database flexibly uses information technology to collect patient data, entered at the point of care (e.g., home, inpatient hospice, assisted living facility, nursing home). HPM physicians and nurse practitioners collect data; data are transferred to an academic site that assists with analyses and data management. Reports to community-based sites, based on data they provide, create a better understanding of local care quality. CURRENT STATUS: The data system was developed and implemented over a 2-year period, starting with one community-based HPM site and expanding to four. Data collection methods were collaboratively created and refined. The database continues to grow. Analyses presented herein examine data from one site and encompass 2572 visits from 970 new patients, characterizing the population, symptom profiles, and change in symptoms after intervention. CONCLUSION: A collaborative regional approach to HPM data can support evaluation and improvement of palliative care quality at the local, aggregated, and statewide levels.

Lack of cross-scale linkages reduces robustness of community-based fisheries management.

Community-based management and the establishment of marine reserves have been advocated worldwide as means to overcome overexploitation of fisheries. Yet, researchers and managers are divided regarding the effectiveness of these measures. The "tragedy of the commons" model is often accepted as a universal paradigm, which assumes that unless managed by the State or privatized, common-pool resources are inevitably overexploited due to conflicts between the self-interest of individuals and the goals of a group as a whole. Under this paradigm, the emergence and maintenance of effective community-based efforts that include cooperative risky decisions as the establishment of marine reserves could not occur. In this paper, we question these assumptions and show that outcomes of commons dilemmas can be complex and scale-dependent. We studied the evolution and effectiveness of a community-based management effort to establish, monitor, and enforce a marine reserve network in the Gulf of California, Mexico. Our findings build on social and ecological research before (1997-2001), during (2002) and after (2003-2004) the establishment of marine reserves, which included participant observation in >100 fishing trips and meetings, interviews, as well as fishery dependent and independent monitoring. We found that locally crafted and enforced harvesting rules led to a rapid increase in resource abundance. Nevertheless, news about this increase spread quickly at a regional scale, resulting in poaching from outsiders and a subsequent rapid cascading effect on fishing resources and locally-designed rule compliance. We show that cooperation for management of common-pool fisheries, in which marine reserves form a core component of the system, can emerge, evolve rapidly, and be effective at a local scale even in recently organized fisheries. Stakeholder participation in monitoring, where there is a rapid feedback of the systems response, can play a key role in reinforcing cooperation. However, without cross-scale linkages with higher levels of governance, increase of local fishery stocks may attract outsiders who, if not restricted, will overharvest and threaten local governance. Fishers and fishing communities require incentives to maintain their management efforts. Rewarding local effective management with formal cross-scale governance recognition and support can generate these incentives.

Steady-State and Transient Performance of Biodiesel-Fueled Compression-Ignition-Based Electrical Generation

This paper investigates the performance characteristics of rapeseed methyl ester, EN 14214 biodiesel, when used for electrical generation in compression ignition engines. The work was inspired by the need to replace fossil diesel fuel with a sustainable low carbon alternative while maintaining generator performance, power quality, and compliance with ISO 8528-5. A 50-kVA Perkins diesel engine generator was used to assess the impact of biodiesel with particular regard to gen-set fuel consumption, load acceptance, and associated standards. Tests were performed on the diesel gen-set for islanded and grid-connected modes of operation, hence both steady-state and transient performance were fully explored. Performance comparisons were made with conventional fossil diesel fuel, revealing minimal technical barriers for electrical generation from this sustainable, carbon benign fuel. Recommendations for improved transient performance are proposed and validated through tests.

Failure of thick-skinned stiffener runout sections loaded in uniaxial compression

Recent efforts towards the development of the next generation of large civil and military transport aircraft within the European community have provided new impetus for investigating the potential use of composite material in the primary structure. One concern in this development is the vulnerability of co-cured stiffened structures to through-thickness stresses at the skin-stiffener interfaces particularly in stiffener runout regions. These regions are an inevitable consequence of the requirement to terminate stiffeners at cutouts, rib intersections or other structural features which interrupt the stiffener load path. In this respect, thickerskinned components are more vulnerable than thin-skinned ones. This work presents an experimental and numerical study of the failure of thick-sectioned stiffener runout specimens loaded in uniaxial compression. The experiments revealed that failure was initiated at the edge of the runout and propagated across the skin-stiffener interface. High frictional forces at the edge of the runout were also deduced from a fractographic analysis and it is postulated that these forces may enhance the fracture toughness of the specimens. Finite element analysis using an efficient thick-shell element and the Virtual Crack Closure Technique was able to qualitatively predict the crack growth characteristics for each specimen

Community pharmacists and people with dementia: a cross-sectional survey exploring experiences, attitudes, and knowledge of pain and its management

Objectives
To explore community pharmacists' experiences with and attitudes towards people with dementia, and to determine the knowledge they have about pain and its management in this patient population. 

Methods
A questionnaire comprising five sections, including the Approaches to Dementia Questionnaire, was mailed, on two occasions, during February and March 2011, to all community pharmacies in Northern Ireland (n=530). 

Results
The response rate was 34.3%. A greater proportion of pharmacists provided pharmaceutical care to people with dementia living at home (91.2%) than those living in care homes (40.1%). Respondents most frequently encountered queries relating to starting and stopping medications, compliance with medication, and availability of formulation types. The mean total score for the Approaches to Dementia Questionnaire measure was 72.8, indicating a positive attitude towards people with dementia, and respondents demonstrated a strong person-centred approach towards this patient population. The majority of respondents recognised the difficulty of assessing pain in people with dementia; however, younger pharmacists (p=0.041) and pharmacists who provided pharmaceutical care to people with dementia (p=0.012) were more likely to be aware of the pain assessment tools for use in people with dementia. Pharmacists appeared uncertain about how to appropriately manage pain in people with dementia.

Conclusions
The study has revealed that community pharmacists often encounter people with dementia, especially those living in their own homes, and they have positive attitudes towards the patient population. However, training in the assessment and management of pain in people with dementia must be developed to further improve their knowledge in this area.