Community pharmacy dispensing of prescription medicine sample packs: Changing the business of medicine initiation?

Prescription medicine samples (or starter packs) are provided by pharmaceutical manufacturers to prescribing doctors as one component in the suite of marketing products used to convince them to prescribe a particular medicine [1,2]. Samples are generally newer, more expensive treatment options still covered by patent [3,4]. Safe, effective, judicious and appropriate medicine use (quality use of medicines) [5] could be enhanced by involving community pharmacists in the dispensing of starter packs. Doctors who use samples show a trend towards prescribing more expensive medicines overall [6] and also prescribe more medicines [7]. Cardiovascular health and mental health are Australian National Health Priority Areas [8] and account for approximately 30% and 17%, respectively, of annual government Pharmaceutical Benefits System (PBS) in 2006 [9]. The PBS is Australia's universal prescription subsidy scheme [9]. Antihypertensives were a major contributor to the estimated 80 000 medicine-related hospital admissions in Australia in 1999 [10] and also internationally [11,12]. The aim of this study was to pilot an alternative model for supply of free sample or starter packs of prescription medicines and ascertain if it is a viable model in daily practice.

Reproducibility of subjective appetite ratings and ad libitum test meal energy intake in overweight and obese males

Background To determine whether changes in appetite and energy intake (EI) can be detected and play a role in the effectiveness of interventions, it is necessary to identify their variability under normal conditions. We assessed the reproducibility of subjective appetite ratings and ad libitum test meal EI after a standardised pre-load in overweight and obese males. Methods Fifteen overweight and obese males (BMI 30.3 ± 4.9 kg/m2, aged 34.9 ± 10.6 years) completed two identical test days, 7 days apart. Participants were provided with a standardised fixed breakfast (1676 kJ) and 5 h later an ad libitum pasta lunch. An electronic appetite rating system was used to assess subjective ratings before and after the fixed breakfast, and periodically during the postprandial period. EI was assessed at the ad libitum lunch meal. Sample size estimates for paired design studies were calculated. Results Appetite ratings demonstrated a consistent oscillating pattern between test days, and were more reproducible for mean postprandial than fasting ratings. The correlation between ad libitum EI on the two test days was r = 0.78 (P < 0.01). Using a paired design and a power of 0.8, a minimum of 12 participants would be needed to detect a 10 mm change in 5 h postprandial mean ratings and 17 to detect a 500 kJ difference in ad libitum EI. Conclusion Intra-individual variability of appetite and ad libitum test meal EI in overweight and obese males is comparable to previous reports in normal weight adults. Sample size requirements for studies vary depending on the parameter of interest and sensitivity needed.

Transformerless PV inverters - recent test results and a discussion of DC current injection and safety issues

With the variety of PV inverter types and the number of transformerless PV inverters on the Australian market increasing, we revisit some of the issues associated with these topologies. A recent electric shock incident in Queensland (luckily without serious outcome) associated with a transformerless PV system, highlights the need for earthing PV array structures and PV module frames to prevent capacitive leakage currents causing electric shock. The presented test results of the relevant voltages associated with leakage currents of five transformerless PV inverters stress this requirement, which is currently being addressed by both the Clean Energy Council and Standards Australia. DC current injection tests were performed on the same five inverters and were used to develop preliminary recommendations for a more meaningful DC current test procedure for AS4777 Part 2. The test circuit, methodology and results are presented and discussed. A notable temperature dependency of DC current injections with three of the five inverters suggests that DC current injection should be tested at high and low internal inverter temperatures whereas the power dependency noted only for one inverter does not seem to justify recommendations for a (rather involved) standard test procedure at different power levels.

Reliability in the Parameterization of the Functional Reach Test in Elderly Stroke Patients: A Pilot Study

BACKGROUND: Postural instability is one of the major complications found in stroke survivors. Parameterising the functional reach test (FRT) could be useful in clinical practice and basic research. OBJECTIVES: To analyse the reliability, sensitivity, and specificity in the FRT parameterisation using inertial sensors for recording kinematic variables in patients who have suffered a stroke. DESIGN: Cross-sectional study. While performing FRT, two inertial sensors were placed on the patient's back (lumbar and trunk). PARTICIPANTS: Five subjects over 65 who suffer from a stroke. MEASUREMENTS: FRT measures, lumbosacral/thoracic maximum angular displacement, maximum time of lumbosacral/thoracic angular displacement, time return initial position, and total time. Speed and acceleration of the movements were calculated indirectly. RESULTS: FRT measure is  12.75±2.06 cm. Intrasubject reliability values range from 0.829 (time to return initial position (lumbar sensor)) to 0.891 (lumbosacral maximum angular displacement). Intersubject reliability values range from 0.821 (time to return initial position (lumbar sensor)) to 0.883 (lumbosacral maximum angular displacement). FRT's reliability was 0.987 (0.983-0.992) and 0.983 (0.979-0.989) intersubject and intrasubject, respectively. CONCLUSION: The main conclusion could be that the inertial sensors are a tool with excellent reliability and validity in the parameterization of the FRT in people who have had a stroke.

Effects of moisture content on resilient properties of recycled concrete aggregates (RCAs)

In pavement design, resilient modulus of a pavement material is one of the key design parameters. Resilient modulus of a granular pavement material can be measured using repeated load Triaxial (RLT) test or estimated using empirical models. For conventional granular pavement materials, a significant amount of resilient modulus data and empirical models to estimate this key design parameter are available. However, RCA is a relatively new granular pavement material and therefore no such data or empirical models are available. In this study, a number of RLT tests were conducted on RCA sample to investigate the effects of moisture content on its resilient modulus (Mr). It was observed that the resilient modulus of RCA increased with a number of loading cycles but decreased as the moisture content was increased. Further, using RLT test results, empirical models to estimate the resilient modulus of RCA were enhanced and validated.

A novel ambiguity acceptance test threshold determination method with controllable failure rate

Ambiguity validation as an important procedure of integer ambiguity resolution is to test the correctness of the fixed integer ambiguity of phase measurements before being used for positioning computation. Most existing investigations on ambiguity validation focus on test statistic. How to determine the threshold more reasonably is less understood, although it is one of the most important topics in ambiguity validation. Currently, there are two threshold determination methods in the ambiguity validation procedure: the empirical approach and the fixed failure rate (FF-) approach. The empirical approach is simple but lacks of theoretical basis. The fixed failure rate approach has a rigorous probability theory basis, but it employs a more complicated procedure. This paper focuses on how to determine the threshold easily and reasonably. Both FF-ratio test and FF-difference test are investigated in this research and the extensive simulation results show that the FF-difference test can achieve comparable or even better performance than the well-known FF-ratio test. Another benefit of adopting the FF-difference test is that its threshold can be expressed as a function of integer least-squares (ILS) success rate with specified failure rate tolerance. Thus, a new threshold determination method named threshold function for the FF-difference test is proposed. The threshold function method preserves the fixed failure rate characteristic and is also easy-to-apply. The performance of the threshold function is validated with simulated data. The validation results show that with the threshold function method, the impact of the modelling error on the failure rate is less than 0.08%. Overall, the threshold function for the FF-difference test is a very promising threshold validation method and it makes the FF-approach applicable for the real-time GNSS positioning applications.

Towards coordinated multirobot missions for lunar sample collection in an unknown environment

In this paper, the recent results of the space project IMPERA are presented. The goal of IMPERA is the development of a multirobot planning and plan execution architecture with a focus on a lunar sample collection scenario in an unknown environment. We describe the implementation and verification of different modules that are integrated into a distributed system architecture. The modules include a mission planning approach for a multirobot system and modules for task and skill execution within a lunar use-case scenario. The skills needed for the test scenario include cooperative exploration and mapping strategies for an unknown environment, the localization and classification of sample containers using a novel approach of semantic perception, and the skill of transporting sample containers to a collection point using a mobile manipulation robot. Additionally, we present our approach of a reliable communication framework that can deal with communication loss during the mission. Several modules are tested within several experiments in the domain of planning and plan execution, communication, coordinated exploration, perception, and object transportation. An overall system integration is tested on a mission scenario experiment using three robots.

A follow up sample of first time drink driving offenders : how many drink drive post offence?

Background Drink driving remains an important issue to address in terms of health and injury prevention even though research shows that over time there has been a steady decline in drink driving. This has been attributed to the introduction of countermeasures such as random breath testing (RBT), changing community attitudes and norms leading to less acceptance of the behaviour and, to a lesser degree, the implementation of programs designed to deter offenders from engaging in drink driving. Most of the research to date has focused on the hard core offenders - those with high blood alcohol content at the time of arrest, and those who have more than one offence. Aims There has been little research on differences within the first offender population or on factors contributing to second offences. This research aims to fill the gap by reporting on those factors in a sample of offenders. Methods This paper reports on a study that involved interviewing 198 first offenders in court and following up this group 6-8 months post offence. Of these original participants, 101 offenders were able to be followed up, with 88 included in this paper on the basis that they had driven a vehicle since the offence. Results Interestingly, while the rate of reported apprehended second offences was low in that time frame (3%), a surprising number of offenders reported that they had driven under the influence at a much higher rate (27%). That is a large proportion of first offenders were willing to risk the much larger penalties associated with a second offence in order to engage in drink driving. Discussion and conclusions Key characteristics of this follow up group are examined to inform the development of a evidence based brief intervention program that targets first time offenders with the goal of decreasing the rate of repeat drink driving.

Estimating link-dependent origin-destination matrices from sample trajectories and traffic counts

In transport networks, Origin-Destination matrices (ODM) are classically estimated from road traffic counts whereas recent technologies grant also access to sample car trajectories. One example is the deployment in cities of Bluetooth scanners that measure the trajectories of Bluetooth equipped cars. Exploiting such sample trajectory information, the classical ODM estimation problem is here extended into a link-dependent ODM (LODM) one. This much larger size estimation problem is formulated here in a variational form as an inverse problem. We develop a convex optimization resolution algorithm that incorporates network constraints. We study the result of the proposed algorithm on simulated network traffic.

Comparison of Body Composition Assessment Methods in Breast Cancer Survivors

Purpose/Objectives: To examine and compare the reliability of four body composition methods commonly used in assessing breast cancer survivors. Design: Cross-sectional. Setting: A rehabilitation facility at a university-based comprehensive cancer center in the southeastern United States. Sample: 14 breast cancer survivors aged 40-71 years. Methods: Body fat (BF) percentage was estimated via bioelectric impedance analysis (BIA), air displacement plethysmography (ADP), and skinfold thickness (SKF) using both three- and seven-site algorithms, where reliability of the methods was evaluated by conducting two tests for each method (test 1 and test 2), one immediately after the other. An analysis of variance was used to compare the results of BF percentage among the four methods. Intraclass correlation coefficient (ICC) was used to test the reliability of each method. Main Research Variable: BF percentage. Findings: Significant differences in BF percentage were observed between BIA and all other methods (three-site SKF, p < 0.001; seven-site SKF, p < 0.001; ADP, p = 0.002). No significant differences (p > 0.05) in BF percentage between three-site SKF, seven-site SKF, and ADP were observed. ICCs between test 1 and test 2 for each method were BIA = 1, ADP = 0.98, three-site SKF = 0.99, and seven-site SKF = 0.94. Conclusions: ADP and both SKF methods produce similar estimates of BF percentage in all participants, whereas BIA overestimated BF percentage relative to the other measures. Caution is recommended when using BIA as the body composition method for breast cancer survivors who have completed treatment but are still undergoing adjuvant hormonal therapy. Implications for Nursing: Measurements of body composition can be implemented very easily as part of usual care and should serve as an objective outcome measure for interventions designed to promote healthy behaviors among breast cancer survivors. - See more at: https://onf.ons.org/onf/38/4/comparison-body-composition-assessment-methods-breast-cancer-survivors#sthash.5djfTS1Q.dpuf

Chirp-spread-spectrum-based real time location system for construction safety management: A case study

Observing the working procedure of construction workers is an effective means of maintaining the safety performance of a construction project. It is also difficult to achieve due to a high worker-to-safety-officer ratio. There is an imminent need for the development of a tool to assist in the real-time monitoring of workers, in order to reduce the number of construction accidents. The development and application of a real time locating system (RTLS) based on the Chirp Spread Spectrum (CSS) technique is described in this paper for tracking the real-time position of workers on construction sites. Experiments and tests were carried out both on- and off-site to verify the accuracy of static and dynamic targets by the system, indicating an average error of within one metre. Experiments were also carried out to verify the ability of the system to identify workers’ unsafe behaviours. Wireless data transfer was used to simplify the deployment of the system. The system was deployed in a public residential construction project and proved to be quick and simple to use. The cost of the developed system is also reported to be reasonable (around 1800USD) in this study and is much cheaper than the cost of other RTLS. In addition, the CCS technique is shown to provide an economical solution with reasonable accuracy compared with other positioning systems, such as ultra wideband. The study verifies the potential of the CCS technique to provide an effective and economical aid in the improvement of safety management in the construction industry.

Higher-intensity exercise results in more sustainable improvements for VO2peak for breast and prostate cancer survivors

Purpose/Objectives: To examine peak volume of oxygen consumption (VO2peak) changes after a high- or low-intensity exercise intervention.
 Design: Experimental trial comparing two randomized intervention groups with control. 
 Setting: An exercise clinic at a university in Australia.
 Sample: 87 prostate cancer survivors (aged 47–80 years) and 72 breast cancer survivors (aged 34–76 years).
 Methods: Participants enrolled in an eight-week exercise intervention (n = 84) or control (n = 75) group. Intervention participants were randomized to low-intensity (n = 44, 60%–65% VO2peak, 50%–65% of one repetition maximum [1RM]) or high-intensity (n = 40, 75%–80% VO2peak, 65%–80% 1RM) exercise groups. Participants in the control group continued usual routines. All participants were assessed at weeks 1 and 10. The intervention groups were reassessed four months postintervention for sustainability. 
 Main Research Variables: VO2peak and self-reported physical activity.
 Findings: Intervention groups improved VO2peak similarly (p = 0.083), and both more than controls (p < 0.001). The high-intensity group maintained VO2peak at follow-up, whereas the low-intensity group regressed (p = 0.021). The low-intensity group minimally changed from baseline to follow-up by 0.5 ml/kg per minute, whereas the high-intensity group significantly improved by 2.2 ml/kg per minute (p = 0.01). Intervention groups always reported similar physical activity levels. 
 Conclusions: Higher-intensity exercise provided more sustainable cardiorespiratory benefits than lower-intensity exercise.
 Implications for Nursing: Survivors need guidance on exercise intensity, because a high volume of low-intensity exercise may not provide sustained health benefits.

Comparison of kinematic variables obtained by inertial sensors among stroke survivors and healthy older adults in the Functional Reach Test: cross-sectional study

Background Balance dysfunction is one of the most common problems in people who suffer stroke. To parameterize functional tests standardized by inertial sensors have been promoted in applied medicine. The aim of this study was to compare the kinematic variables of the Functional Reach Test (FRT) obtained by two inertial sensors placed on the trunk and lumbar region between stroke survivors (SS) and healthy older adults (HOA) and to analyze the reliability of the kinematic measurements obtained. Methods Cross-sectional study. Five SS and five HOA over 65. A descriptive analysis of the average range as well as all kinematic variables recorded was developed. The intrasubject and intersubject reliability of the measured variables was directly calculated. Results In the same intervals, the angular displacement was greater in the HOA group; however, they were completed at similar times for both groups, and HOA conducted the test at a higher speed and greater acceleration in each of the intervals. The SS values were higher than HOA values in the maximum and minimum acceleration in the trunk and in the lumbar region. Conclusions The SS show less functional reach, a narrower, slower and less accelerated movement during the FRT execution, but with higher peaks of acceleration and speed when they are compared with HOA.

Medically-attended respiratory illnesses amongst pregnant women in Brisbane, Australia

There are limited community-based data on the burden of influenza and influenza-like illnesses during pregnancy to inform disease surveillance and control. We aimed to determine the incidence of medically-attended respiratory illnesses (MARI) in pregnant women and the proportion of women who are tested for respiratory pathogens at these visits. We conducted a nested retrospective cohort study of a non-random sample of women aged ≥18 years who had a live birth in maternity units in Brisbane, Queensland, from March 2012 to October 2014. The primary outcomes were self-reported doctor visits for MARI and laboratory investigations for respiratory pathogens. Descriptive analyses were performed. Among 1202 participants, 222 (18.5%, 95%CI 16.3%-20.7%) self-reported MARI during their pregnancy. Of those with an MARI, 20.3% (45/222) self-reported a laboratory test was performed. We were able to confirm with health service providers that 46.7% (21/45) of tests were undertaken, responses from providers were not received for the remainder. Whilst one in five women in this population reported a MARI in pregnancy, only 3.7% (45/1202) reported a clinical specimen had been arranged at the consultation and the ability to validate that self-report was problematic. As the focus on maternal immunisation increases, ascertainment of the aetiological agent causing MARI in this population will be required and efficient and reliable methods for obtaining those data at the community level need to be established.

Public use and perceptions of emergency departments: A population survey

Objectives To inform demand management strategies aimed at reducing congestion in EDs by: (i) identifying public use of EDs, decision-making and reasons; and (ii) measuring acceptance of alternative care models. Methods A cross-sectional telephone survey of a random sample of Queensland population aged 18 years or older residing in a dwelling unit in Queensland that could be contacted on a land-based telephone service was conducted. One person per household was selected according to a predetermined algorithm to ensure sex and regional balance were interviewed. The main outcome measures were: ED use, attitudes towards ED staff and services, and alternative models of care. Results The final sample included a total of 1256 respondents (response rate = 40.3%). Twenty-one per cent attended EDs in the preceding 12 months. The decision to attend was made by patients (51%), health and medical professionals (31%), and others (18%). The main reasons included perceived severity of the illness (47%), unavailability of alternative services (26%) and better care (11%). Most respondents agreed with more flexible care models of service delivery including incentives for general practitioners (90%), private health insurance coverage for ED use (89%), and enhanced roles for paramedics and nurses. Conclusions Main reason for attending ED is perceived severity of illness, followed by lack of alternative care. The majority of both consumers and the public are in favour of more flexible care models. However, further research is necessary to detail those alternatives and to test and validate their effectiveness.