Up close and personal with those experiencing homelessness: Pharmacist involvement in a multidisciplinary healthcare team

Introduction. The Brisbane City Council holds a biannual Homeless Connect event which brings together business and community groups on one day to provide free services to people experiencing or at risk of homelessness. Pharmacists were involved in this initiative and provided health services in a multidisciplinary healthcare environment building on the lessons of previous Homeless Connect events (Chan et al, 2015) Aims. To explore pharmacists reflections on their role in a multidisciplinary healthcare team providing services at a community outreach event for those experiencing homelessness. Methods. The pharmacists (n=2) documented the types of services provided during the Homeless Connect event. A semi-structured interview was conducted post-event to investigate barriers, facilitators and changes that would be recommended for future events. Their perceptions of their role in the multidisciplinary healthcare team were also explored. Results. Primarily, the services provided included delivery of primary healthcare, advice on accessing cost effective pharmacy services and addressing medication enquiries. The pharmacists also provided moisturiser samples and health information leaflets. Interdisciplinary referrals were primarily between the pharmacists and podiatrists; no pharmacist-medical practitioner referrals occurred. The pharmacists did believe they had a positive role in this health initiative but improvements could be implemented to improve the delivery of these services in future events. Discussion. Pharmacists can play an important role in providing services to people experiencing or at risk of homelessness and the overall experience was positive for the pharmacists. They were able to integrate into a multidisciplinary healthcare team in this setting but strategies for further collaboration were identified. The possibility of involving pharmacy students in future events was identified.

On states, on a lattice, with half-integral charge

In certain molecular models, and related one-dimensional field theories, localized objects appear with half-integral expectation values of charge. We consider whether these states are eigenstates of charge, with half-integral eigenvalue. We find that it is indeed so for a suitably diffuse definition of the charge operator in question. This diffuse charge operator has a spectrum which approaches a continuum. The analysis is made on a lattice, to avoid divergence ambiguities, and on a finite length, which is only subsequently made large. The half-integral charge phenomenon is not tied to solitons, but can also arise as an end effect.

Radical nursing and the emergence of technique as healthcare technology

The integration of technology in care is core business in nursing and this role requires that we must understand and use technology informed by evidence that goes much deeper and broader than actions and behaviours. We need to delve more deeply into its complexity because there is nothing minor or insignificant about technology as a major influence in healthcare outcomes and experiences. Evidence is needed that addresses technology and nursing from perspectives that examine the effects of technology, especially related to increasing demands for efficiency, the relationship of technology to nursing and caring, and a range of philosophical questions associated with empowering people in their healthcare choices. Specifically, there is a need to confront in practice the ways technique influences care. Technique is the creation of a kind of thinking that is necessary for contemporary healthcare technology to develop and be applied in an efficient and rational manner. Technique is not an entity or specific thing, but rather a way of thinking that seeks to shape and organize nursing activity, and manage efficiently individual difference(s) in care. It emphasizes predetermined causal relationships, conformity, and sameness of product, process, and thought. In response is needed a radical vision of nursing that attempts in a real sense to ensure we meet the needs of individuals and their community. Activism and advocacy are needed, and a willingness to create a certain detachment from the imperatives that technique demands. It is argued that our responsibility as nurses is to respond in practice to the errors, advantages, difficulties, and temptations of technology for the benefit of those who most need our assistance and care.

Evolution in design of integral leg prosthesis leads to improved outcomes

Developments of surgical attachments for bone-anchored prostheses are slowly but surely winning over the initial disbelief in the orthopedic community. Clearly, this option is becoming accessible to a wide range of individuals with limb loss. Seminal studies have demonstrated that the pioneering procedure relying on screw-type fixation engenders major clinical benefits and acceptable safety. The surgical procedure for press-fit implants, such as the Integral-Leg-Prosthesis (ILP) has been described Dr Aschoff and his team. Some clinical benefits of press-fit implants have been also established. Here, his team is once again taking a leading role by sharing the progression over 15 years of the rate of deep infections for 69 individuals with transfemoral amputation fitted with three successive refined versions of the ILP. By definition, a double-blind randomized clinical trial to test the effect of different fixation’s design is difficult. Alternatively, Juhnke and colleagues are reporting the outcomes of action-research study for a cohort of participants. The first and foremost important outcome of this study is the confirmation that the current design of the IPL and rehabilitation program are altogether leading to an acceptable rate of deep infection and other adverse events (e.g., structural failure of implant, periprosthetic factures). This study is also providing a strong insight onto the effect of major phases in redesign of an implant on the risk of infection. This is an important reminder that the development of a successful osseointegrated implant is unlikely to be immediate but the results of a learning curve made of empirical and sequential changes led by a reflective clinical practice. Clearly, this study provided better understanding of the safety of the ILP surgical and rehabilitation procedure while establishing standards and benchmark data for future studies focusing on design and infection of press-fit implants. Complementary observations of relationship between infection and cofounders such as loading of the prosthesis and prosthetic components used would be beneficial.Further definitive evidences of the clinical benefits with the latest design would be valuable, although an increase in health related quality of life and functional outcomes are likely to be confirmed. Altogether, the authors are providing compelling evidence that bone-anchored attachments particularly those relying on press-fit implants are an established alternative to socket prostheses.

Healthcare users’ experiences of communicating with healthcare professionals about children who have life-limiting conditions: A qualitative systematic review protocol

REVIEW QUESTION / OBJECTIVE The objective of this review is to identify and synthesize the best international qualitative evidence on healthcare users’ experiences of communication with healthcare professionals about children who have life-limiting conditions. For the purposes of this review, “healthcare users” will be taken to include children who have life-limiting conditions and their families. The question to be addressed is: - What are healthcare users’ experiences of communicating with healthcare professionals about children who have life-limiting conditions? INCLUSION CRITERIA - Types of participants: This review will consider all qualitative studies that focus on users of healthcare services for children who have life-limiting conditions. These users are anticipated to include children who have a life-limiting condition and their family members. In instances where children are not under the legal care of one or both parents, service users may also include other types of legal guardians. - Phenomena of interest: This review will consider experiences of communicating with healthcare professionals about children who have life-limiting conditions. - Context: This review will consider studies relating to communication with healthcare professionals about children who have a life-limiting condition, irrespective of whether the healthcare service is based in a hospital, hospice, or community setting. There is no restriction on the country in which a study was conducted.

Derivation of the solution of certain singular integral equations

It is shown that the a;P?lication of the Poincare-Bertrand fcm~ulaw hen made in a suitable manner produces the s~lutiano f certain singular integral equations very quickly, thc method of arriving at which, otherwise, is too complicaled. Two singular integral equations are considered. One of these quaiions is with a Cauchy-tyge kcrnel arid the other is an equalion which appears in the a a w guide theory and the theory of dishcations. Adifferent approach i? alw made here to solve the singular integralquation> of the waveguide theor? ind this i ~ v o l v eth~e use of the inversion formula of the Cauchy-type singular integral equahn and dudion to a system of TIilberl problems for two unknowns which can be dwupled wry easily to obi& tbe closed form solutim of the irilegral equatlou at band. The methods of the prescnt paper avoid all the complicaled approaches of solving the singular integral equaticn of the waveguide theory knowr todate.

Spectral analysis of finite section normal integral operators

Some continuity and differentiability properties of the eigenvalues and eigenfunctions of finite section normal integral operators are proved. These are the extension of corresponding results for symmetric operators ([4.], 554–566; K. B. Athreya and R. Vittal Rao, to appear; [10.], 463–471.

Kac-Akhiezer formula for normal integral operators

The Kac-Akhiezer formula for finite section normal Wiener-Hopf integral operators is proved. This is an extension of the corresponding result for symmetric operator [2, 3, 4, 5, 6, 7].

A taxonomic approach to understanding managerial ethical decision making approaches of clinically and non-clinically trained healthcare managers in Australia

Objective To understand differences in the managerial ethical decision-making styles of Australian healthcare managers through the exploratory use of the Managerial Ethical Profiles (MEP) Scale. Background Healthcare managers (doctors, nurses, allied health practitioners and non-clinically trained professionals) are faced with a raft of variables when making decisions within the workplace. In the absence of clear protocols and policies healthcare managers rely on a range of personal experiences, personal ethical philosophies, personal factors and organizational factors to arrive at a decision. Understanding the dominant approaches to managerial ethical decision-making, particularly for clinically trained healthcare managers, is a fundamental step in both increasing awareness of the importance of how managers make decisions, but also as a basis for ongoing development of healthcare managers. Design Cross-sectional. Methods The study adopts a taxonomic approach that simultaneously considers multiple ethical factors that potentially influence managerial ethical decision-making. These factors are used as inputs into cluster analysis to identify distinct patterns of influence on managerial ethical decision-making. Results Data analysis from the participants (n=441) showed a similar spread of the five managerial ethical profiles (Knights, Guardian Angels, Duty Followers, Defenders and Chameleons) across clinically trained and non-clinically trained healthcare managers. There was no substantial statistical difference between the two manager types (clinical and non-clinical) across the five profiles. Conclusion This paper demonstrated that managers that came from clinical backgrounds have similar ethical decision-making profiles to non-clinically trained managers. This is an important finding in terms of manager development and how organisations understand the various approaches of managerial decision-making across the different ethical profiles.

On solitons with half integral charge

Can certain soliton states, with half integral expectation value of charge, be also eigenstates of charge X with half integral eigenvalue? It can be so only with a somewhat sophisticated definition of charge.

New Functional Biomaterials for Medicine and Healthcare

The book begins with an overview of the use of biomaterials in contemporary healthcare and the process of developing novel biomaterials; the key issues and challenges associated with the design of complex implantable systems are also highlighted. The book then reviews the main materials used in functional biomaterials, particularly their properties and applications. Individual chapters focus on both natural and synthetic polymers, metallic biomaterials, and bio-inert and bioactive ceramics.

Some direct numerical approaches to the solution of the singular nonlinear transonic integral equation

The nonlinear singular integral equation of transonic flow is examined, noting that standard numerical techniques are not applicable in solving it. The difficulties in approximating the integral term in this expression were solved by special methods mitigating the inaccuracies caused by standard approximations. It was shown how the infinite domain of integration can be reduced to a finite one; numerical results were plotted demonstrating that the methods proposed here improve accuracy and computational economy.

Water-wave scattering by two submerged plane vertical barriers-Abel integral-equation approach

The classical problem of surface water-wave scattering by two identical thin vertical barriers submerged in deep water and extending infinitely downwards from the same depth below the mean free surface, is reinvestigated here by an approach leading to the problem of solving a system of Abel integral equations. The reflection and transmission coefficients are obtained in terms of computable integrals. Known results for a single barrier are recovered as a limiting case as the separation distance between the two barriers tends to zero. The coefficients are depicted graphically in a number of figures which are identical with the corresponding figures given by Jarvis (J Inst Math Appl 7:207-215, 1971) who employed a completely different approach involving a Schwarz-Christoffel transformation of complex-variable theory to solve the problem.

A Fredholm-type theory for third-kind linear integral equations

The third-kind linear integral equation Image where g(t) vanishes at a finite number of points in (a, b), is considered. In general, the Fredholm Alternative theory [[5.]] does not hold good for this type of integral equation. However, imposing certain conditions on g(t) and K(t, t′), the above integral equation was shown [[1.], 49–57] to obey a Fredholm-type theory, except for a certain class of kernels for which the question was left open. In this note a theory is presented for the equation under consideration with some additional assumptions on such kernels.