Making decisions about antibiotic use in the Australian primary healthcare sector

Introduction Australia is contributing to the global problem of antimicrobial resistance with one of the highest rates of antibiotic use amongst OECD countries. Data from the Australian primary healthcare sector suggests unnecessary antibiotics were prescribed for conditions that will resolve without it. If left unchecked, this will result in more resistant micro-organisms, against which antibiotics will be useless. There is a lack of understanding about what is influencing decisions to use antibiotics – what factors influences general practitioners (GPs) to prescribe antibiotics, consumers to seek antibiotics, and pharmacists to fill old antibiotic prescriptions? It is also not clear how these individuals trade-off between the possible benefits that antibiotics may provide in the immediate/short term, against the longer term societal risk of antimicrobial resistance. Method This project will investigate (a) what factors drive decisions to use antibiotics for GPs, pharmacists and consumers, and (b) how these individuals discount the future. Factors will be gleaned from published literature and from a qualitative phase using semi-structured interviews, to inform the development of Discrete Choice Experiments (DCEs). Three DCEs will be constructed – one for each group of interest – to allow investigation of which factors are more important in influencing (a) GPs to prescribe antibiotics, (b) consumers to seek antibiotics, and (c) pharmacists to fill legally valid but old or repeat prescriptions of antibiotics. Regression analysis will be conducted to understand the relative importance of these factors. A Time Trade Off exercise will be developed to investigate how these individuals discount the future, and whether GPs and pharmacists display the same extent of discounting the future, as consumers. Expected Results Findings from the DCEs will provide an insight into which factors are more important in driving decision making in antibiotic use for GPs, pharmacists and consumers. Findings from the Time Trade Off exercise will show what individuals are willing to trade for preserving the miracle of antibiotics. Conclusion The emergence of antibiotic resistance is inevitable. This research will expand on what is currently known about influencing desired behaviour change in antibiotic use, in the fight against antibiotic resistance. Real World Implications Research findings will contribute to existing national programs to bring about a reduction in inappropriate use of antibiotic in Australia. Specifically, influencing (1) how key messages and public health campaigns are crafted to increase health literacy, and (2) clinical education and empowerment of GPs and pharmacists to play a more responsive role as stewards of antibiotic use in the community.

How are falls and fear of falling associated with objectively measured physical activity in a cohort of community-dwelling older men?

BACKGROUND: Falls affect approximately one third of community-dwelling older adults each year and have serious health and social consequences. Fear of falling (FOF) (lack of confidence in maintaining balance during normal activities) affects many older adults, irrespective of whether they have actually experienced falls. Both falls and fear of falls may result in restrictions of physical activity, which in turn have health consequences. To date the relation between (i) falls and (ii) fear of falling with physical activity have not been investigated using objectively measured activity data which permits examination of different intensities of activity and sedentary behaviour. METHODS: Cross-sectional study of 1680 men aged 71-92 years recruited from primary care practices who were part of an on-going population-based cohort. Men reported falls history in previous 12 months, FOF, health status and demographic characteristics. Men wore a GT3x accelerometer over the hip for 7 days. RESULTS: Among the 12% of men who had recurrent falls, daily activity levels were lower than among non-fallers; 942 (95% CI 503, 1381) fewer steps/day, 12(95% CI 2, 22) minutes less in light activity, 10(95% CI 5, 15) minutes less in moderate to vigorous PA [MVPA] and 22(95% CI 9, 35) minutes more in sedentary behaviour. 16% (n = 254) of men reported FOF, of whom 52% (n = 133) had fallen in the past year. Physical activity deficits were even greater in the men who reported that they were fearful of falling than in men who had fallen. Men who were fearful of falling took 1766(95% CI 1391, 2142) fewer steps/day than men who were not fearful, and spent 27(95% CI 18, 36) minutes less in light PA, 18(95% CI 13, 22) minutes less in MVPA, and 45(95% CI 34, 56) minutes more in sedentary behaviour. The significant differences in activity levels between (i) fallers and non-fallers and (ii) men who were fearful of falling or not fearful, were mediated by similar variables; lower exercise self-efficacy, fewer excursions from home and more mobility difficulties. CONCLUSIONS: Falls and in particular fear of falling are important barriers to older people gaining health benefits of walking and MVPA. Future studies should assess the longitudinal associations between falls and physical activity.

The Leg Club model in the Australian context

Leg Clubs are an innovative approach to the holistic treatment of leg ulcers. They are run in a social context by community nurses who deliver ongoing support and treatment for a wide spectrum of lower limb pathology. This article looks at how the Leg Club model has been established in Australia.

The long and winding road : health services for clients with chronic leg ulcers in the community

The prevalence of leg ulcers of is 0.12%–1.1% and >3,000 lower limb amputations are performed yearly in Australia due to non-healing leg or foot ulcers. Although evidence on leg ulcer management is available, a significant evidence-practice gap exists. To identify current leg ulcer management, a cross-sectional retrospective study was undertaken in Brisbane, Australia. A sample of 104 clients was recruited from a community specialist wound clinic and a tertiary hospital outpatient’s specialist wound clinic. All clients had an ulcer below their knee or on their foot for ≥4 weeks. Data were collected on ulcer care, health service usage and clinical history for the year prior to admission. On admission, participants reported having their ulcer for a median of 25 weeks (range 2-728 weeks); with 51% (53/104) reporting an ulcer duration of ≥24 weeks. Including the wound clinic, participants sought ulcer care from a median of 3 health care providers (range 2-7). General Practitioners provided ulcer care to 82% of participants. Nearly half (42%) had self-cared for their ulcer; 29% (30/104) received treatment by a community nurse. A gap was found between the community-based ulcer care experienced by this population and evidence-based guidelines in regards to assessment, management, advice, and referrals.

Youth off the Streets "Our Place, Walgett Youth and Young Families Project" Project Evaluation.

The Project: • YOTS is a major youth specific agency established in 1991. It is a non-denominational, non-discriminatory and not-for-profit organisation, providing a wide range of services and offering a full continuum of care. It seeks to build on the strengths and positive aspects of marginalised young people and communities. • The 'Our Place, Walgett Youth and Young Families Project' further develops an existing YOTS capacity to provide services to Aboriginal young people. • The project adopted an action-research and community development model in which YOTS worked in partnership with the Youth Sub-committee of the Walgett Interagency. • Specific goals/objectives of the program were to: Coordinate youth and young family activities in partnership with local services and the community to build self-esteem, pride, resilience, motivation and skills; Contribute to the prevention and reduction of homelessness, unstable and unsafe housing and disruptive mobility (Walgett/Redfern) in youth and young families; Increase and improve collaborative engagement between youth and family focused services; and, research, adapt and implement Australian and international best-practice homelessness prevention/reduction initiatives to contribute to new models of practice relevant to rural and regional areas. • The project centred around an out-reach model that focused on providing a safe space with relevant structured activities coordinated by YOTS youth and family workers. Through community and service provider consultation, it was proposed that local services could coordinate strategies and activities and run them, where possible, from the centre, providing ease of access in a safe and supportive context. • Specific activities included: Implementing regular meetings with the stakeholders and community representatives; Developing a Terms of Reference for YOTS presence in the Walgett community; Undertaking a community consultation prior to finalising program activities; Implementing a range of recreational activities (sports, music, arts and crafts) early on in the activity; Implementing young family support initiatives; implementing a volunteering program, including volunteer support to young families through intergenerational volunteering; running a series of Culture and Healing Camps in partnership with local Elders and other services; Running a series of Music Camps; Providing alternative education support and referrals in partnership with local schools; Researching, identifying and adapting other best-practice models.

Southern New England Social and Community Plan 2009 - Covering Local Government Authorities: Armidale Dumaresq, Guyra, Uralla and Walcha

The Southern New England (SNE) Social and Community Plan is a guide to collaborative, integrated planning involving the three spheres of government, the community and commercial sectors. The Plan is based on social justice principles such as: • Equity - fairness in resource distribution, particularly for those most in need • Access - fairer access for everyone to the economic resources and services essential to meeting their basic needs and improving their quality of life • Rights - recognition and promotion of civil rights • Participation - better opportunities for genuine participation and consultation about decisions affecting people's lives. The Plan is also aimed at improving the accountability of decision-makers, and should help the councils, in conjunction with their communities meet the state government's social justice commitments. Preparation of a social and community plan is required at least every five years, and as with most councils, Armidale Dumaresq Council (ADC) has produced two already, one in 1999 and one in 2004, following the amalgamation of the former Armidale City and Dumaresq Shire Councils in 2000. Those Councils formerly prepared their own Plans in 1999, based on shared consultancy work on a community profile. This is the first joint Southern New England Plan, featuring Armidale Dumaresq, Walcha, Uralla and Guyra Councils. This Social Plan has aimed to identify and address the needs of the local community by: • describing who makes up the community • summarising key priority issues • assessing the effectiveness of any previous plans • recommending strategic ways for council and other government and non-government agencies to met community needs.

Socially inclusive learning in a community setting

People with mental health problems, learning difficulties and poor literacy and numeracy are at risk of social exclusion including homelessness. They are often disconnected from the Vocational Education and Training (VET) system, with few opportunities for education and employment. Academic research has demonstrated a link between literacy and numeracy and social inclusion, however, the pathways to enact this are not well understood. This report presents insights into how a community based adult literacy program in West End, Brisbane, was first established and has since evolved into a successful model of what we are calling ‘socially inclusive learning’. The research informing the report was conducted as a twelve-month study from April 2013 to April 2014 funded through a partnership involving Anglicare Southern Queensland, A Place to Belong and the School of Public Health and Social Work, Queensland University of Technology. The research was conducted by Greg Marston and Jeffrey Johnson- Abdelmalik. The aim of the study was to clarify the principles, practice and methodology of the Reading and Writing group (hereafter RAW) and identify the characteristics of RAW that support the social inclusion of the individual being provided literacy learning. The questions guiding the research included: • What are the key principles and practices of the RAW model? • How does the acquisition of literacy and numeracy skills contribute to the recovery of people with mental health and other issues? • How can the acquisition of literacy and numeracy skills support people’s social inclusion, including achieving employment and further education outcomes? A related aim of the project was to document how this community based literacy and numeracy program operates so that other organisations with an interest in addressing similar needs can learn from the model, particularly organisations that co-locate support and education and organisations that adopt a recovery approach when working with people with mental health challenges and intellectual and psychiatric disabilities. The report highlights the background to RAW, the learning philosophy of RAW, the profile of the participants in the program and the various roles and responsibilities and structure that supports the work of RAW. The report presents perspectives from the teachers, student participants and tutors on how the group is designed and the principles implemented.

Happiness online : supporting the emotions of emergent teachers in a virtual community

Extending Lash and Urry's (1994) notion of new "imagined communities" through information and communication structures, I ask the question: Are emergent teachers happy when they interact in online learning environments? This question is timely in the context of the ubiquity of online media and its pervasiveness in teachers' everyday work and lives. The research is important nationally and internationally, because the current research is contradictory. On the one hand, feelings of isolation and frustration have been cited as common emotions experienced in many online environments (Su, Bonk, Magjuka, Liu, & Lee, 2005). Yet others report that online communities encourage a sense of belonging and support (Mills, 2011). Emotions are inherently social, are central to learning and online interaction (Shen, Wang, & Shen, 2009). The presentations reports the use of e-motion blogs to explore emotional states of emergent primary teachers in an online learning context as they transition into their first field experience in schools. The original research was conducted with a graduate class of 64 secondary science pre-service teachers in Science Education Curriculum Studies in a large Australian university, including males and females from a variety of cultural backgrounds, aged 17-55 years. Online activities involved the participants watching a series of streamed live lectures within a course of 8 weeks duration, providing a varied set of learning experiences, such as viewing live teaching demonstrations. Each week, participants provided feedback on learning by writing and posting an e-motion diary or web log about their emotional response. The blogs answered the question: What emotions you experience during this learning experience? The descriptive data set included 284 online posts, with students contributing multiple entries. The Language of Appraisal framework, following Martin and White (2005), was used to cluster the discrete emotions within six affect groups. The findings demonstrated that the pre-service teachers' emotional responses tended towards happiness and satisfaction within the typology of affect groups - un/happiness, in/security, and dis/satisfaction. Fewer participants reported that online learning mode triggered negative feelings of frustration, and when this occurred, it often pertained expectations of themselves in the forthcoming field experience in schools or as future teachers. The findings primarily contribute new understanding about emotional states in online communities, and recommendations are provided for supporting the happiness and satisfaction of emergent teachers as they interact in online communities. It demonstrates that online environments can play an important role in fulfilling teachers' need for social interaction and inclusion.

A model predictive approach for community battery energy storage system optimization

This paper presents an efficient algorithm for optimizing the operation of battery storage in a low voltage distribution network with a high penetration of PV generation. A predictive control solution is presented that uses wavelet neural networks to predict the load and PV generation at hourly intervals for twelve hours into the future. The load and generation forecast, and the previous twelve hours of load and generation history, is used to assemble load profile. A diurnal charging profile can be compactly represented by a vector of Fourier coefficients allowing a direct search optimization algorithm to be applied. The optimal profile is updated hourly allowing the state of charge profile to respond to changing forecasts in load.

A continent-wide study reveals clear relationships between regional abiotic conditions and post-dispersal seed predation

Aim Large-scale patterns linking energy availability, biological productivity and diversity form a central focus of ecology. Despite evidence that the activity and abundance of animals may be limited by climatic variables associated with regional biological productivity (e.g. mean annual precipitation and annual actual evapotranspiration), it is unclear whether plant–granivore interactions are themselves influenced by these climatic factors across broad spatial extents. We evaluated whether climatic conditions that are known to alter the abundance and activity of granivorous animals also affect rates of seed removal. Location Eleven sites across temperate North America. Methods We used a common protocol to assess the removal of the same seed species (Avena sativa) over a 2-day period. Model selection via the Akaike information criterion was used to determine a set of candidate binomial generalized linear mixed models that evaluated the relationship between local climatic data and post-dispersal seed predation. Results Annual actual evapotranspiration was the single best predictor of the proportion of seeds removed. Annual actual evapotranspiration and mean annual precipitation were both positively related to mean seed removal and were included in four and three of the top five models, respectively. Annual temperature range was also positively related to seed removal and was an explanatory variable in three of the top four models. Main conclusions Our work provides the first evidence that energy and precipitation, which are known to affect consumer abundance and activity, also translate to strong, predictable patterns of seed predation across a continent. More generally, these findings suggest that future changes in temperature and precipitation could have widespread consequences for plant species composition in grasslands, through impacts on plant recruitment.

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.

Wide area control of SVCs for first swing stabilisation and damping in longitudinal systems

A non-linear Kalman filter based control strategy for SVCs located in major load groups is presented. This focusses on the limitation and damping of inter-area modes. It does this through treating local modes as noise and uses a tunable nonlinear control algorithm to improve both first swing stability and system damping. Simulation on a four machine system shows that the Kalman filer can successfully lock on to a desired inter-area mode and obtain a 31% improvement in critical clearing time as well as improved damping.