Teaching and assessment of prescribing medicines : how does pharmacy perform?

BACKGROUND Prescribing is a complex task, requiring specific knowledge and skills combined with effective, context-specific clinical reasoning. Prescribing errors can result in significant morbidity and mortality. For all professions with prescribing rights, a clear need exists to ensure students graduate with a well-defined set of prescribing skills, which will contribute to competent prescribing. AIM To describe the methods employed to teach and assess the principles of effective prescribing across five non-medical professions at Queensland University of Technology. METHOD The NPS National Prescribing Competencies Framework (PCF) was used as the prescribing standard. A curriculum mapping exercise was undertaken to determine how well the PCF was addressed across the disciplines of paramedic science, pharmacy, podiatry, nurse practitioner and optometry. Identified gaps in teaching and/or assessment were noted. RESULTS Prescribing skills and knowledge are taught and assessed using a range of methods across disciplines. A multi-modal approach is employed by all disciplines. The Pharmacy discipline uses more tutorial sessions to teach prescribing principles and relies less on case studies and clinical appraisal to assess prescribing when compared to other disciplines. Within the pharmacy discipline approximately 90% of the PCF competencies are taught and assessed. This compares favourably with the other disciplines. CONCLUSION Further work is required to establish a practical, effective approach to the assessment of prescribing competence especially between the university and clinical settings. Effective and reliable assessment of prescribing undertaken by students in diverse settings remains challenging.

Ergonomic assessment of hospital bed moving using DHM Siemens JACK

While the indirect and direct cost of occupational musculoskeletal disorders (MSD) causes a significant burden on the health system, lower back pain (LBP) is associated with a significant portion of MSD. In Australia, the highest prevalence of MSD exists for health care workers, such as nurses. The digital human model (DHM) Siemens JACK was used to investigate if hospital bed pushing, a simple task and hazard that is commonly associated with LBP, can be simulated and ergonomically assessed in a virtual environment. It was found that while JACK has implemented a range of common physical work assessment methods, the simulation of dynamic bed pushing remains a challenge due to the complex interface between the floor and wheels, which can only be insufficiently modelle

Deathbed instructions and the assessment of capacity: A practical perspective

The assessment of capacity in the context of wills and advance care planning is a challenging task for modern practitioners with the increase in mentally disabling conditions, such as acquired brain injury. This challenge is only heightened in the situation where the assessment occurs at the client’s deathbed as there are the added elements of urgency, and emotional upheaval at the impending death of a loved one. This situation poses a minefield of problems a legal practitioner should be aware of, involving not only the assessment process but also potential professional liability issues. This presentation will address the practical considerations a legal professional should take into account when in this situation. We will focus on two discrete situations and the issues arising from them: first, where there has been an acquired brain injury and legal capacity is in question; and second, where a spinal injury has occurred which does not affect capacity, rather results in the inability to use conventional forms of communication to communicate his/her instructions. We will examine these case studies with a view to proposing a best practice model for legal practitioners when assessing capacity in this context.

Towards Ecologically Sustainable Management of the Torres Strait Prawn Fishery. CRC Torres Strait Task T1.5 – Final Report

This publication, which is the final report to the Torres Strait Cooperative Research Centre, provides an overview of all the research that was conducted as part of the Torres Strait CRC Task 1.5 - Towards Ecologically Sustainable Management of the Torres Strait Prawn Fishery The objectives of the task were: To develop cost-effective protocols to monitor and quantify the bycatch and environmental impacts of commercial prawn trawling. To monitor the status of target species using both fishery dependent and fishery independent data. To develop biological reference points for target species and undertake management strategy evaluation, in particular a risk assessment of fishing at various levels of fishing mortality. This report focuses on the second component of objective 1 and details a comparative analysis of bycatch samples collected from areas of the Torres Strait that were both closed and open to prawn trawl fishing. The report also reviews the research conducted in relation to objectives 2 and 3 which are detailed in a separate report, Stock Assessment of the Torres Strait Tiger Prawn Fishery (Penaeus esculentus).

Modeling Efficient Classification as a Process of Confidence Assessment and Delegation

In visual object detection and recognition, classifiers have two interesting characteristics: accuracy and speed. Accuracy depends on the complexity of the image features and classifier decision surfaces. Speed depends on the hardware and the computational effort required to use the features and decision surfaces. When attempts to increase accuracy lead to increases in complexity and effort, it is necessary to ask how much are we willing to pay for increased accuracy. For example, if increased computational effort implies quickly diminishing returns in accuracy, then those designing inexpensive surveillance applications cannot aim for maximum accuracy at any cost. It becomes necessary to find trade-offs between accuracy and effort. We study efficient classification of images depicting real-world objects and scenes. Classification is efficient when a classifier can be controlled so that the desired trade-off between accuracy and effort (speed) is achieved and unnecessary computations are avoided on a per input basis. A framework is proposed for understanding and modeling efficient classification of images. Classification is modeled as a tree-like process. In designing the framework, it is important to recognize what is essential and to avoid structures that are narrow in applicability. Earlier frameworks are lacking in this regard. The overall contribution is two-fold. First, the framework is presented, subjected to experiments, and shown to be satisfactory. Second, certain unconventional approaches are experimented with. This allows the separation of the essential from the conventional. To determine if the framework is satisfactory, three categories of questions are identified: trade-off optimization, classifier tree organization, and rules for delegation and confidence modeling. Questions and problems related to each category are addressed and empirical results are presented. For example, related to trade-off optimization, we address the problem of computational bottlenecks that limit the range of trade-offs. We also ask if accuracy versus effort trade-offs can be controlled after training. For another example, regarding classifier tree organization, we first consider the task of organizing a tree in a problem-specific manner. We then ask if problem-specific organization is necessary.

Self Assessment-Based Decision Making for Multiagent Cooperative Search

This paper addresses a search problem with multiple limited capability search agents in a partially connected dynamical networked environment under different information structures. A self assessment-based decision-making scheme for multiple agents is proposed that uses a modified negotiation scheme with low communication overheads. The scheme has attractive features of fast decision-making and scalability to large number of agents without increasing the complexity of the algorithm. Two models of the self assessment schemes are developed to study the effect of increase in information exchange during decision-making. Some analytical results on the maximum number of self assessment cycles, effect of increasing communication range, completeness of the algorithm, lower bound and upper bound on the search time are also obtained. The performance of the various self assessment schemes in terms of total uncertainty reduction in the search region, using different information structures is studied. It is shown that the communication requirement for self assessment scheme is almost half of the negotiation schemes and its performance is close to the optimal solution. Comparisons with different sequential search schemes are also carried out. Note to Practitioners-In the futuristic military and civilian applications such as search and rescue, surveillance, patrol, oil spill, etc., a swarm of UAVs can be deployed to carry out the mission for information collection. These UAVs have limited sensor and communication ranges. In order to enhance the performance of the mission and to complete the mission quickly, cooperation between UAVs is important. Designing cooperative search strategies for multiple UAVs with these constraints is a difficult task. Apart from this, another requirement in the hostile territory is to minimize communication while making decisions. This adds further complexity to the decision-making algorithms. In this paper, a self-assessment-based decision-making scheme, for multiple UAVs performing a search mission, is proposed. The agents make their decisions based on the information acquired through their sensors and by cooperation with neighbors. The complexity of the decision-making scheme is very low. It can arrive at decisions fast with low communication overheads, while accommodating various information structures used for increasing the fidelity of the uncertainty maps. Theoretical results proving completeness of the algorithm and the lower and upper bounds on the search time are also provided.

Genetic Algorithm for Damage Assessment

Genetic Algorithms (GAs) are recognized as an alternative class of computational model, which mimic natural evolution to solve problems in a wide domain including machine learning, music generation, genetic synthesis etc. In the present study Genetic Algorithm has been employed to obtain damage assessment of composite structural elements. It is considered that a state of damage can be modeled as reduction in stiffness. The task is to determine the magnitude and location of damage. In a composite plate that is discretized into a set of finite elements, if a jth element is damaged, the GA based technique will predict the reduction in Ex and Ey and the location j. The fact that the natural frequency decreases with decrease in stiffness is made use of in the method. The natural frequency of any two modes of the damaged plates for the assumed damage parameters is facilitated by the use of Eigen sensitivity analysis. The Eigen value sensitivities are the derivatives of the Eigen values with respect to certain design parameters. If ωiu is the natural frequency of the ith mode of the undamaged plate and ωid is that of the damaged plate, with δωi as the difference between the two, while δωk is a similar difference in the kth mode, R is defined as the ratio of the two. For a random selection of Ex,Ey and j, a ratio Ri is obtained. A proper combination of Ex,Ey and j which makes Ri−R=0 is obtained by Genetic Algorithm.

Challenges in vulnerability assessment of forests under climate change

Forest-management goals in the context of climate change are to reduce the adverse impact of climate change on biodiversity, ecosystem services and carbon stocks. For developing an effective adaptation strategy, knowledge on nature and sources of vulnerability of forests is necessary to conserve or enhance carbon sinks. However, assessing the vulnerability of forest ecosystems is a challenging task, as the mechanisms that determine vulnerability cannot be observed directly. In this article, we list the challenges in forest vulnerability assessments and propose an assessment of inherent vulnerability by using process-based indicators under the current climate. We also suggest periodic assessment of vulnerability, which is necessary to review adaptation strategies for the management of forests and forest carbon stocks.

A Comparative Assessment of Hand Preference in Captive Red Howler Monkeys, Alouatta seniculus and Yellow-Breasted Capuchin Monkeys, Sapajus xanthosternos

There are two major theories that attempt to explain hand preference in non-human primates-the `task complexity' theory and the `postural origins' theory. In the present study, we proposed a third hypothesis to explain the evolutionary origin of hand preference in non-human primates, stating that it could have evolved owing to structural and functional adaptations to feeding, which we refer to as the `niche structure' hypothesis. We attempted to explore this hypothesis by comparing hand preference across species that differ in the feeding ecology and niche structure: red howler monkeys, Alouatta seniculus and yellow-breasted capuchin monkeys, Sapajus xanthosternos. The red howler monkeys used the mouth to obtain food more frequently than the yellow-breasted capuchin monkeys. The red howler monkeys almost never reached for food presented on the opposite side of a wire mesh or inside a portable container, whereas the yellow-breasted capuchin monkeys reached for food presented in all four spatial arrangements (scattered, on the opposite side of a wire mesh, inside a suspended container, and inside a portable container). In contrast to the red howler monkeys that almost never acquired bipedal and clinging posture, the yellow-breasted capuchin monkeys acquired all five body postures (sitting, bipedal, tripedal, clinging, and hanging). Although there was no difference between the proportion of the red howler monkeys and the yellow-breasted capuchin monkeys that preferentially used one hand, the yellow-breasted capuchin monkeys exhibited an overall weaker hand preference than the red howler monkeys. Differences in hand preference diminished with the increasing complexity of the reaching-for-food tasks, i.e., the relatively more complex tasks were perceived as equally complex by both the red howler monkeys and the yellow-breasted capuchin monkeys. These findings suggest that species-specific differences in feeding ecology and niche structure can influence the perception of the complexity of the task and, consequently, hand preference.

Rapid recreation assessment: a tool to assess visitor use and associated impacts at coastal and marine protected areas

As more people discover coastal and marine protected areas as destinations for leisure-time pursuits, the task of managing coastal resources while providing opportunities for high quality visitor experiences becomes more challenging. Many human impacts occur at these sites; some are caused by recreation and leisure activities on-site, and others by activities such as agriculture, aquaculture, or residential and economic development in surrounding areas. Coastal management professionals are continually looking for effective ways to prevent or mitigate negative impacts of visitor use. (PDF contains 8 pages) Most coastal and marine protected area managers are challenged with balancing two competing goals—protection of natural and cultural resources and provision of opportunities for public use. In most cases, some level of compromise between the goals is necessary, where one goal constrains or “outweighs” the other. Often there is a lack of clear agreement about the priority of these competing goals. Consequently, while natural resource decisions should ultimately be science-based and objective, such decisions are frequently made under uncertainty, relying heavily upon professional judgment. These decisions are subject to a complex array of formal and informal drivers and constraints—data availability, timing, legal mandate, political will, diverse public opinion, and physical, human, and social capital. This paper highlights assessment, monitoring, and planning approaches useful to gauge existing resource and social conditions, determine feasibility of management actions, and record decision process steps to enhance defensibility. Examples are presented from pilot efforts conducted at the Rookery Bay National Estuarine Research Reserve (NERR) and Ten Thousand Islands National Wildlife Refuge (NWR) in South Florida.

An integrated assessment of the continued spread and potential impacts of the colonial ascidian, Didemnum sp. A, in U.S. waters

Didemnum sp. A is a colonial ascidian or “sea squirt” of unknown geographic origin. Colonies of Didemnum sp. A were first documented in U.S. waters in 1993 at Damariscotta River, Maine and San Francisco Bay, California. An alarming number of colonies have since been found at several locations in New England and along the West Coast of the contiguous continental United States. Originally believed to be restricted to artificial structures in nearshore habitats, such as ports and marinas, colonies of Didemnum sp. A have also been discovered on a gravel-pavement habitat on Georges Bank at depths of 40-65m. The wide distribution of Didemnum sp. A, the presence of colonies on an important offshore fishing ground, and the negative economic impacts that other species of noninidigenous ascidians have had on aquaculture operations have raised concerns about the potential impacts of Didemnum sp. A. We reviewed the available information on the biology and ecology of Didemnum sp. A and potentially closely related species to examine the environmental and socioeconomic factors that may have influenced the introduction, establishment and spread of Didemnum sp. A in U.S. waters, the potential impacts of this colonial ascidian on other organisms, aquaculture, and marine fisheries, and the possibility that it will spread to other U.S. waters. In addition, we present and discuss potential management objectives for minimizing the impacts and spread of Didemnum sp. A. Concern over the potential for Didemnum sp. A to become invasive stems from ecological traits that it shares with other invasive species, including the ability to overgrow benthic organisms, high reproductive and population growth rates, ability to spread by colony fragmentation, tolerance to a wide range of environmental conditions, apparent scarcity of predators, and the ability to survive in human dominated habitats. At relatively small spatial scales, species of Didemnum and other nonindigenous ascidians have been shown to alter the abundance and composition of benthic assemblages. In addition, the Canadian aquaculture industry has reported that heavy infestations of nonindigenous ascidians result in increased handling and processing costs. Offshore fisheries may also suffer where high densities of Didemnum sp. A may alter the access of commercially important fish species to critical spawning grounds, prey items, and refugia. Because colonial ascidian larvae remain viable for only 12–24hrs, the introduction and spread of Didemnum sp. A across large distances is thought to be predominantly human mediated; hull fouling, aquaculture, and ballast water. Recent studies suggest that colony growth rates decline when temperatures exceed 21 ºC for 7 consecutive days. Similarly, water temperatures above 8 to 10 ºC are necessary for colony growth; however, colonies can survive extended periods of time below this temperature threshold as an unidentified overwintering form. A qualitative analysis of monthly mean nearshore water temperatures suggest that new colonies of Didemnum will continue to be found in the Northeast U.S., California Current, and Gulf of Alaska LMEs. In contrast, water temperatures become less favorable for colony establishment in subarctic, subtropical, and tropical areas to the north and south of Didemnum’s current distribution in cool temperate habitats. We recommend that the Aquatic Nuisance Species Task Force serve as the central management authority to coordinate State and Federal management activities. Five objectives for a Didemnum sp. A management and control program focusing on preventing the spread of Didemnum sp. A to new areas and limiting the impacts of existing populations are discussed. Given the difficulty of eradicating large populations of Didemnum sp. A, developing strategies for limiting the access of Didemnum sp. A to transport vectors and locating newly established colonies are emphasized. (PDF contains 70 pages)

Towards a participatory integrated assessment approach for planning and managing Natura 2000 network sites

Managing protected areas implies dealing with complex social-ecological systems where multiple dimensions (social, institutional, economic and ecological) interact over time for the delivery of ecosystem services. Uni-dimensional and top-down management approaches have been unable to capture this complexity. Instead, new integrated approaches that acknowledge the diversity of social actors in the decision making process are required. In this paper we put forward a novel participatory assessment approach which integrates multiple methodologies to reflect different value articulating institutions in the case of a Natura 2000 network site in the Basque Country. It integrates within a social multi-criteria evaluation framework, both the economic values of ecosystem services through a choice experiment model and ecological values by means of a spatial bio-geographic assessment. By capturing confronting social and institutional conflicts in protected areas the participatory integrated assessment approach presented here can help decision makers for better planning and managing Natura 2000 sites.

IPCC WGII Fifth Assessment Report (AR5): Expanding the solution space for adaptation

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Remote Sensing and Field Assessment of Tsunami Effects on Coastal Pond Aquaculture in Northern Sumatra

An attempt was made to conduct spatial assessment of the pattern and extent of damage to coastal aquaculture ponds along the east coast of Aceh province in Sumatra, Indonesia, resulting from the tsunami event of 26 December 2004. High-resolution satellite imagery, i.e., SPOT-5 multispectral scenes covering the 700 km stretch of the coast, acquired before and after the tsunami, were digitally enhanced and visually interpreted to delineate pockets of aquaculture ponds that were discerned to be damaged and relatively intact. Field checks were conducted at 87 sites in the four eastern coastal districts. The results indicate that SPOT-5 multispectral imagery was minimally sufficient to detect areas of damaged and relatively intact aquaculture ponds, but the 10-m spatial resolution poses limitations to evaluating the extent of pond damage. Nevertheless, the 60 km swath of the imagery makes it reasonably affordable for large-area assessment to identify pockets of severe damage for targeting more detailed assessments. The image maps produced from a mosaic of the SPOT-5 scenes can also serve as base maps for spatial planning in the challenging task of reconstruction and rehabilitation of the disrupted livelihoods of the coastal communities.

The River Lune strategic stock assessment survey 1991 with particular reference to salmonids

In the past stock assessment surveys were generally reactive in response to a particular problem e.g. a pollution incident and as such were limited in the information they provided. A programme of strategic stock assessment would be more beneficial, providing up to date information on the status and composition of the stock. On a national level this could reveal trends in population dynamics and enable comparisons to be made between key rivers and between regions. The Stock Assessment Task Group (1991) has recommended annual strategic surveys for juvenile salmonids and triennial strategic surveys for coarse fish and non- migratory salmonids. The aim of this pilot study was to gain information on species distribution and their relative abundance within the River Lune catchment, and to compare the findings with the surveys carried out between 1981-1985. This would provide valuable information on the current status of the stock and provide an indication of the resources required to conduct such strategic surveys on other river catchments in the North West Region of the National Rivers Authority.