Image of Nelson Mandela Bay (NMB): an external stakeholder's perspective

A distinctive destination image is required in order to compete with other destinations for tourists and investors alike. This main objective of this study is to develop a model for destination image formation for Nelson Mandela Bay as a secondary economy to boost its global competitiveness. Several researchers have studied destination image and based on the fact that tourists and investors usually have a limited knowledge of destinations they have not previously visited, destination image fulfils an important function insofar as destinations with strong, positive, discriminatory and recognisable images. A literature study was conducted to identify the key influencers on destination image as well as to identify which forces are likely to influence the destination image of Nelson Mandela Bay. The different factors of destination image were identified from the literature sources and these factors provided a basis for an empirical study that was conducted amongst external stakeholders. The primary research objective was to create a model of destination image for Nelson Mandela Bay and to explain the cause and effect relationship between the dependent and independent variables. Added to the primary research objective, eight secondary research objectives were identified. The primary research question for this study was to identify what influences the destination image of Nelson Mandela Bay. Added to the primary research question, the researcher also identified eight research questions as part of the study. The empirical analysis was used to test the hypotheses and ultimately develop a model for destination image formation for Nelson Mandela Bay. This study was exploratory in nature and thus used a limited sample to gain insights for further research. Data were obtained through questionnaires that were distributed electronically to 120 respondents. This study concluded with the development of a destination image model for Nelson Mandela Bay that can be expanded upon with further research. The results indicate that general infrastructure and social environment; leisure and recreation; and culture influence the Affective component of Nelson Mandela Bay. Information sources and Political stability and risk influence the Cognitive component of Nelson Mandela Bay. Together the Affective and Cognitive component makes up the overall image of Nelson Mandela Bay

Charmel Helmick Senior Interior Design Exhibit 2015

DESIGN PHILOSOPHY Design is relating the beauty and cultural richness of the exotic and the admired. Design is styling spaces that express the soul; creating environs one longs to come home to. Design is shaping communities for growth, success and a sense of belonging

Economic evaluation of pharmacist-led medication reviews in residential aged care facilities

Introduction: Medication reviews is a widely accepted approach known to have a substantial impact on patients’ pharmacotherapy and safety. Numerous options to optimise pharmacotherapy in older people have been reported in literature and they include medication reviews, computerised decision support systems, management teams, and educational approaches. Pharmacist-led medication reviews are increasingly being conducted, aimed at attaining patient safety and medication optimisation. Cost effectiveness is an essential aspect of a medication review evaluation. Areas covered: A systematic searching of articles that examined the cost-effectiveness of medication reviews conducted in aged care facilities was performed using the relevant databases. Pharmacist-led medication reviews confer many benefits such as attainment of biomarker targets for improved clinical outcomes, and other clinical parameters, as well as depict concrete financial advantages in terms of decrement in total medication costs and associated cost savings. Expert commentary: The cost-effectiveness of medication reviews are more consequential than ever before. A critical evaluation of pharmacist-led medication reviews in residential aged care facilities from an economical aspect is crucial in determining if the time, effort, and direct and indirect costs involved in the review rationalise the significance of conducting medication reviews for older people in aged care facilities

Testing accelerated experience-based co-design : a qualitative study of using a national archive of patient experience narrative interviews to promote rapid patient-centred service improvement

BACKGROUND: Measuring, understanding and improving patients’ experiences is of central importance to health care systems, but there is debate about the best methods for gathering and understanding patient experiences and how to then use them to improve care. Experience-based co-design (EBCD) has been evaluated as a successful approach to quality improvement in health care, drawing on video narrative interviews with local patients and involving them as equal partners in co-designing quality improvements. However, the time and cost involved have been reported as a barrier to adoption. The Health Experiences Research Group at the University of Oxford collects and analyses video and audio-recorded interviews with people about their experiences of illness. It now has a national archive of around 3000 interviews, covering around 75 different conditions or topics. Selected extracts from these interviews are disseminated for a lay audience on www.healthtalkonline.org. In this study, we set out to investigate whether or not this archive of interviews could replace the need for discovery interviews with local patients. OBJECTIVES: To use a national video and audio archive of patient experience narratives to develop, test and evaluate a rapid patient-centred service improvement approach (‘accelerated experience-based co-design’ or AEBCD). By using national rather than local patient interviews, we aimed to halve the overall cycle from 12 to 6 months, allowing for EBCD to be conducted in two clinical pathways rather than one. We observed how this affected the process and outcomes of the intervention. DESIGN: The intervention was an adapted form of EBCD, a participatory action research approach in which patients and staff work together to identify and implement quality improvements. The intervention retained all six components of EBCD, but used national trigger films, shortened the time frame and employed local service improvement facilitators. An ethnographic process evaluation was conducted, including observations, interviews, questionnaires, cost and documentary analysis including previous EBCD evaluation reports. SETTING: Intensive care and lung cancer services in two English NHS hospital trusts (Royal Berkshire and Royal Brompton and Harefield). PARTICIPANTS: Ninety-six clinical staff (primarily nursing and medical) and 63 patients and family members. INTERVENTION: For this accelerated intervention, the trigger film was derived from pre-existing national patient experience interviews. Local facilitators conducted staff discovery interviews. Thereafter, the process followed the usual EBCD pattern: the film was shown to local patients in a workshop meeting, and staff had a separate meeting to discuss the results of their feedback. Staff and patients then came together in a further workshop to view the film, agree priorities for improvement and set up co-design working groups to take these priorities forward. RESULTS: The accelerated approach proved readily acceptable to staff and patients; using films of national rather than local narratives did not adversely affect local NHS staff engagement, and may in some cases have made the process less threatening or challenging. Local patients felt that the national films generally reflected important themes, although a minority felt that they were more negative than their own personal experience. However, they served their purpose as a ‘trigger’ to discussion, and the resulting 48 co-design activities across the four pathways were similar in nature to those in EBCD but achieved at reduced cost. AEBCD was nearly half the cost of EBCD. However, where a trigger film already exists, pathways can be implemented for as little as 40% of the cost of traditional EBCD. It was not necessary to do additional work locally to supplement the national interviews. The intervention carried a ‘cost’ in terms of heavy workload and intensive activity for the local facilitators, but also brought benefits in terms of staff development/capacity-building. Furthermore, as in previous EBCDs, the approach was subsequently adopted in other clinical pathways in the trusts. CONCLUSIONS: Accelerated experience-based co-design delivered an accelerated version of EBCD, generating a comparable set of improvement activities. The national film acted as an effective trigger to the co-design process. Based on the results of the evaluation, AEBCD offers a rigorous and effective patient-centred quality improvement approach. We aim to develop further trigger films from the archived material as resources permit, and to investigate different ways of conducting the analysis (e.g. involving patients in doing the analysis)

A patient-centred model of care incorporating a palliative approach: A framework to meet the needs of people with advanced COPD?

BACKGROUND: Current models of care for people with advanced chronic obstructive pulmonary disease (COPD) have been demonstrated to be inadequate, particularly in areas such as advance care planning, symptom control and psychosocial and spiritual care. AIM: This paper aims to explore how a model of patient-centred care can incorporate a palliative approach to form a practical and useful framework for care that meets the needs of people with advanced COPD. DISCUSSION: There is increasing recognition of the need to provide active disease management at the same time as supportive care for people with chronic disease. A palliative approach can incorporate these two care imperatives but a number of barriers often make implementation problematic. A patient-centred care approach can help to address these barriers and is increasingly being seen as an appropriate framework for all healthcare service provision. Significant changes are required to health systems and service provision for this model of care to be implemented; specialist palliative care services can take a leading role in change management. CONCLUSION: Patient-centred care provides an appropriate framework for the development of a model of care for advanced COPD. It allows for a need-based approach to service provision, rather than the current prognosis-based system and brings patient and carer needs and concerns to the forefront of care.Crawford, Gregory B.; Burgess, Teresa A.; Young, Mary; Brooksbank, Mary A.; Brown, Margare

Analysis of impact by government policy in the agribusiness on the beef agrichain in Venezuela

O objetivo deste trabalho foi analisar o desempenho da cadeia de carne bovina na Venezuela sob o efeito de políticas de intervenção estatal principalmente nas últimas décadas. Para tanto, foi empregada a abordagem teórica do enfoque sistêmico em conjunto com metodologia que se apoiou em um modelo econométrico para explicar o efeito de variáveis tecnológicas e macroeconômicas no agronegócio vis a vis a resultante da produção doméstica de carne bovina nas últimas décadas. Os resultados mostram que, no marco de mudanças institucionais estabelecidas desde a década de 1980 e especialmente as intervenções governamentais vigentes a partir do ano de 2003, a cadeia de carne bovina da Venezuela apresenta um desempenho negocial preocupante e não sustentável. Na última década, a Venezuela decresceu seu inventário bovino a uma taxa média anual de 2,56% entre 2003 e 2014. O número de cabeças/habitante diminuiu a uma taxa anual de 1,30% entre 1960 e 2014, ficando em 0,38 cabeças/habitante. O número de cabeças abatidas sobre o total do rebanho (taxa de desfrute geral do rebanho) foi de 10,82% para o ano de 2014, inferior à média de países vizinhos como Colômbia e Brasil que ficaram em 20,85% e 19,42% respectivamente. A produção doméstica de carne bovina decresceu a uma taxa anual de 2,22% entre 1997 e 2014 (mesmo considerando o abate de bovinos importados). A quantidade de carne oriunda de animais importados cresceu até alcançar um máximo de 58,51% do abate nacional, em 2013. Isto significou um decréscimo real da produção endógena de 71,55% entre os anos de 1997 e 2013. Neste contexto, a produção nacional percapita diminuiu de 18,31 kg/habitante (em 1997) para um mínimo de 3,97 kg/habitante (em 2013). Para o atendimento da demanda doméstica passou-se a contar, crescentemente, com importações de carne in natura que cresceram em volume inicial de 0,59 mil toneladas (t) de equivalente carcaça (em 1997) para um máximo de 307,57 mil t em 2008. A taxa de penetração das importações de carne bovina equivalente (carne e bovinos em pé) resultou em 79,54% do atendimento da demanda doméstica em 2013 (cerca de 15,45 kg/habitante/ano). Neste contexto, as intervenções mais relevantes têm sido a Lei de Terras que propiciou um ambiente de insegurança jurídica; os controles de preços e a política cambial que criaram distorções no mercado; e, a crescente influência nas redes de distribuição de alimentos, com forte dependência do comércio exterior, alavancado com os incrementos no preço internacional do petróleo entre 2003 e 2014. Tudo isto tem resultado em um cenário de desmonte da produção interna da carne bovina, que pode ser visualizado em episódios crescentes de escassez deste produto no mercado interno. Ao final, são sugeridas algumas práticas de políticas pública e setoriais para a reversão desse quadro insustentável para esta importante cadeia de negócios da Venezuela.The objective of this study was to analyze the performance of the beef agrichain in Venezuela on the effect of policies of state intervention mainly in the last decades. For this was used the system approach methodology to describe the policies framework and an econometric model seeking to explain the effect of technologies and macroeconomics variables in the agribusiness on the beef domestic production. The results show that in the framework of institutional changes introduced in Venezuela since the 1980s and specially the government interventions effective from 2003, the beef agrichain in this country show a worry and not sustainable business performance. In the last decade, Venezuela decreased their cattle stock at an average annual rate of 2.56% between 2003 and 2014. The number of bovine head per capita decrease at an average annual of 1.30% between 1960 and 2014 to reach 0.38 bovine head per capita. The rate of slaughter was 10.82% in 2014, lower than Colombia that was 20.85% and Brazil in 19.42%. Domestic beef production decreased at an annual rate of 2.22% between 1997 and 2014 (even considering the slaughter of imports animals). The amount of meat from slaughter of imports animals grew to a maximum of 58.51% of total slaughter in 2013. This represented and real decline of the national production of 71.55% between 1997 and 2013. In this context, the capita national production decreased of 18.31 kg/capita in 1997 to minimum 3.97 kg/capita in 2013. To supply the domestic demand was increase of meat imports that increase of 0,59 carcass weight equivalent thousand tons (1000 MT CWE) in 1997 for a maximum of 307,57 1000 MT CWE in 2008. The bovine meat equivalent import penetration rate (meat and live animals) was of 79.54% of total domestic demand in 2013 (about 15.45 kg/capita/year). In this context, the most important interventions have been the Land Law, that cause a juridical insecurity environment; price control and the exchange policy that created distortions in the markets; and, the growing state participation in the food distribution, with a strong external market dependency, promote by increase in international oil price between 2003 and 2014. All this conjugated in a non-competitive situation of beef domestic production that can observed in increasing shortage episodes of this product in the domestic market. For this reason, are suggested some practices of public and sectorial policies to reverse this unsustainable situation in this important business agrichain in Venezuela