Constructions of sustainability and spatial planning: the case of Dalton Flatts, County Durham, planning inquiry

This paper explores the constructions of sustainability within a recent land use planning event. The focus is upon the discursive processes employed by key actors and agents in constructing concepts of sustainability during the local planning inquiry into a retail and leisure proposal in the District of Easington, County Durham 'called in' by the Secretary of State for the Environment. It reveals which discourses in particular were employed and discusses their implications. It concludes that sustainability is very much part of a wider political–economic game and that a high degree of social power lies with those participants who are able to utilise the appropriate discursive spaces and concepts; as a result of these factors the rhetoric of the concept of sustainability is generally not being played out within local level planning contexts

Examining learning achievement and experiences of science learners in a problem-based learning environment

Problem-based learning (PBL) is a facilitation strategy that has the potential to put learners at the centre of activity and to make them accountable for their own learning. However, the assumption is often made, during attempts to utilise PBL, that learners will acquire less information than learners who have been taught through direct, lecture-based strategies. The present work challenged this assumption by exposing experimental and control groups of Grade 10 science learners to different learning environments. Results showed that the PBL-taught experimental group did not sacrifice subject content. PBL learners scored significantly higher than their lecture-taught counterparts on selected questions in the post-test that were classified on Bloom's taxonomy as higher order questions. Through qualitative measures the study also probed the levels of enjoyment experienced by below- and above-average achievers who were exposed to PBL. (South African Journal of Education: 2003 23 (1): 52-57

Bounds relating the weakly connected domination number to the total domination number and the matching number

AbstractLet G=(V,E) be a connected graph. A dominating set S of G is a weakly connected dominating set of G if the subgraph (V,E∩(S×V)) of G with vertex set V that consists of all edges of G incident with at least one vertex of S is connected. The minimum cardinality of a weakly connected dominating set of G is the weakly connected domination number, denoted γwc(G). A set S of vertices in G is a total dominating set of G if every vertex of G is adjacent to some vertex in S. The minimum cardinality of a total dominating set of G is the total domination number γt(G) of G. In this paper, we show that 12(γt(G)+1)≤γwc(G)≤32γt(G)−1. Properties of connected graphs that achieve equality in these bounds are presented. We characterize bipartite graphs as well as the family of graphs of large girth that achieve equality in the lower bound, and we characterize the trees achieving equality in the upper bound. The number of edges in a maximum matching of G is called the matching number of G, denoted α′(G). We also establish that γwc(G)≤α′(G), and show that γwc(T)=α′(T) for every tree T

The impact of dispensing fees on compliance with opioid substitution therapy: a mixed methods study

Background: Opioid substitution therapy (OST) programs involve the dispensing of OST medicines to patients to address their dependence on heroin and/or other opioid substances. OST medicines are subsidised by the Australian government but patients need to pay the dispensing fees. This study explored opinions from OST patients and stakeholders about the potential impact of dispensing fees on compliance and OST program retention. Current and past experiences and the potential impact of OST dispensing fees were evaluated. Methods: Mixed methodology was used to obtain data from OST patients and stakeholders. This involved 1) interviews with OST stakeholders, 2) a focus group of OST patients and 3) surveys of OST patients in Perth, Australia, between June and August 2013.Results: The majority of the eight stakeholders declared cost as the factor mostly impacting on OST compliance. Almost all of the stakeholders commented that there was a positive correlation between time on the OST program and success in terms of relapse. Most stakeholders advocated for OST fees to contribute towards the Pharmaceutical Benefits Scheme Safety Net, and for fee subsidy. Focus group themes supported stakeholder interview findings. A total of 138 surveys were completed. Survey analysis illustrated a strong correlation between patient debt and impacted lifestyle: 82.4% (p < 0.001, Chi-square test) of the 138 survey participants stated that dispensing fees impacted significantly on patients’ finances and lifestyle, specifically those patients with major debt. The cost of dispensing fees was identified by 46.3% (64/138) of survey participants as the biggest impacting factor on patient success. Logistic regression models showed that the cost of dispensing fees was also found to significantly influence both the occurrence of debt (57.7%, p < 0.0001) and lifestyle difficulties (80.0%, p = 0.0004). Conclusion: Findings provided insight into OST patients’ financial difficulties with data suggesting that dispensing fees are likely to have a negative impact on OST patients’ compliance with therapy, retention in the OST program and lifestyle. Government sponsorship of the OST dispensing fees should be considered as sponsorship would potentially increase the retention rates of income-poor OST program recipients

Exploring example models of cross-sector, sessional employment of pharmacists to improve medication management and pharmacy support in rural hospitals

INTRODUCTION: Many rural hospitals in Australia are not large enough to sustain employment of a full-time pharmacist, or are unable to recruit or retain a full-time pharmacist. The absence of a pharmacist may result in hospital nurses undertaking medication-related roles outside their scope of practice. A potential solution to address rural hospitals' medication management needs is contracted part-time ('sessional') employment of a local pharmacist external to the hospital ('cross-sector'). The aim of this study was to explore the roles and experiences of pharmacists in their provision of sessional services to rural hospitals with no on-site pharmacist and explore how these roles could potentially address shortfalls in medication management in rural hospitals. METHODS: A qualitative study was conducted to explore models with pharmacists who had provided sessional services to a rural hospital. A semi-structured interview guide was informed by a literature review, preliminary research and stakeholder consultation. Participants were recruited via advertisement and personal contacts. Consenting pharmacists were interviewed between August 2012 and January 2013 via telephone or Skype for 40-55 minutes.RESULTS: Thirteen pharmacists with previous or ongoing hospital sessional contracts in rural communities across Australia and New Zealand participated. Most commonly, the pharmacists provided weekly services to rural hospitals. All believed the sessional model was a practical solution to increase hospital access to pharmacist-mediated support and to address medication management gaps. Roles perceived to promote quality use of medicines were inpatient consultation services, medicines information/education to hospital staff, assistance with accreditation matters and system reviews, and input into pharmaceutical distribution activities. CONCLUSIONS: This study is the first to explore the concept of sessional rural hospital employment undertaken by pharmacists in Australia and New Zealand. Insights from participants revealed that their sessional employment model increased access to pharmacist-mediated medication management support in rural hospitals. The contracting arrangements and scope of services may be evaluated and adapted in other rural hospitals

An Exploratory Study of Extended Health Care Practitioner Roles in Medication Supply and Management in a Rural Community

Australia has a recognised shortage of qualified health professionals, particularly in rural and regional areas. Research has shown that rural patients indeed have poorer health status compared to metropolitan communities, with rates of mortality and morbidity constantly higher in rural regions. A number of ‘novel’ and ‘extended’ roles have been developed for existing health care professionals. Some of these roles have application to rural areas, such as additional functions in terms of provision of medicines. In Queensland in particular, the Health (Drugs and Poisons) Regulation 1996 (the Regulation), which provides the regulatory framework for the handling of medicines, has been amended to include a range of endorsements, including Indigenous Health Workers (IHW) and Rural and Isolated Practice-endorsed Nurses (RIPRN). Another development is the amendment of the Regulation to allow for a range of health professionals, namely optometrists, physicians’ assistants and nurse practitioners, to prescribe medicines. Whether such developments have addressed the needs of rural communities remains unknown. Inherently, rural communities will suffer from limited access to health care services, and the services of the existing health care providers may be stretched to, or beyond, the scope of their recognised practice in order to meet the needs of the community. Little is known about the extent and nature of these ‘extended’ practices, the perceived need for (or obligation on) health professionals to adopt these roles, and the ethical, professional and legal considerations if/when they extend their services into non-traditional territories. This research specifically focussed on the involvement of various health care providers in patients’ medication management in a defined community or region. In doing so, it aimed to identify medication-related issues of a community and the potential roles for pharmacists to enhance safe, effective and efficient access to medicines in a rural setting.Griffith Health, School of PharmacyFull Tex

Preoperatiewe spesiale ondersoeke en intraoperatiewe arteriele suurstofspanning tydens eenlongnarkose

The value of preoperative lung function tests was examined in 11 patients as a method to predict changes in intraoperative Pa02 (dPa02) during one-lung ventilation in pulmonary surgery. Ventilation (Kr-81m and Xe-133) and perfusion (Tc-99m microspheres) to the lung to be operated upon significantly predicted the intra-operative decrease in Pa02. The correlation between ventilation percentage to the diseased lung and dPa02 was 0,87 (SEE = 9,99) and between perlusion and dPa020,84 (SEE = 9,51).S Afr Med J 1990; 78: 104-10

Exploring an increased role for Australian community pharmacy in mental health professional service delivery: evaluation of the literature

Background: Australian general practitioners primarily treat mental health problems by prescribing medication dispensed by community pharmacists. Pharmacists therefore have regular interactions with mental health consumers and carers.Aims: This narrative review explored the potential role of community pharmacy in mental health services.Method: Medline, CINAHL, ProQuest, Emerald, PsycINFO, Science Direct, PubMed, Web of Knowledge and IPA were utilised. The Cochrane Library as well as grey literature and “lay” search engines such as GoogleScholar were also searched.Results: Four systematic reviews and ten community pharmacy randomised controlled trials were identified. Various relevant reviews outlining the impact of community pharmacy based disease state or medicines management services were also identified.Conclusion: International studies involving professional service interventions for mental health consumers could be contextualised for the Australian setting. Australian studies of pharmacy professional services for chronic physical health conditions provided further guidance for the expansion of community pharmacy mental health professional services

The targeting of nutritionally at-risk children attending a primary health care facility in the Western Cape Province of South Africa

AIM: The aim of this study was to determine the practices of primary health care (PHC) nurses in targeting nutritionally at-risk infants and children for intervention at a PHC facility in a peri-urban area of the Western Cape Province of South Africa. METHODOLOGY: Nutritional risk status of infants and children <6 years of age was based on criteria specified in standardised nutrition case management guidelines developed for PHC facilities in the province. Children were identified as being nutritionally at-risk if their weight was below the 3rd centile, their birth weight was less than 2500 g, and their growth curve showed flattening or dropping off for at least two consecutive monthly visits. The study assessed the practices of nurses in identifying children who were nutritionally at-risk and the entry of these children into the food supplementation programme (formerly the Protein-Energy Malnutrition Scheme) of the health facility. Structured interviews were conducted with nurses to determine their knowledge of the case management guidelines; interviews were also conducted with caregivers to determine their sociodemographic status. RESULTS: One hundred and thirty-four children were enrolled in the study. The mean age of their caregivers was 29.5 (standard deviation 7.5) years and only 47 (38%) were married. Of the caregivers, 77% were unemployed, 46% had poor household food security and 40% were financially dependent on non-family members. Significantly more children were nutritionally at-risk if the caregiver was unemployed (54%) compared with employed (32%) (P=0.04) and when there was household food insecurity (63%) compared with household food security (37%) (P<0.004). Significantly more children were found not to be nutritionally at-risk if the caregiver was financially self-supporting or supported by their partners (61%) compared with those who were financially dependent on non-family members (35%) (P=0.003). The weight results of the nurses and the researcher differed significantly (P<0.001), which was largely due to the different scales used and weighing methods. The researcher's weight measurements were consistently higher than the nurses' (P<0.00). The researcher identified 67 (50%) infants and children as being nutritionally at-risk compared with 14 (10%) by the nurses. The nurses' poor detection and targeting of nutritionally at-risk children were largely a result of failure to plot weights on the weight-for-age chart (55%) and poor utilisation of the Road to Health Chart. CONCLUSIONS: Problems identified in the practices of PHC nurses must be addressed in targeting children at nutritional risk so that appropriate intervention and support can be provided. More attention must be given to socio-economic criteria in identifying children who are nutritionally at-risk to ensure their access to adequate social security networks

Evaluation of the first pharmacist administered immunisations in Western Australia: a mixed methods study

Objectives This study evaluated the uptake of Western Australian (WA) pharmacist vaccination services, the profiles of consumers being vaccinated and the facilitators and challenges experienced by pharmacy staff in the preparation, implementation and delivery of services. Design Mixed-methods methodology with both quantitative and qualitative data through surveys, pharmacy computer records and immuniser pharmacist interviews. Setting Community pharmacies in WA that provided pharmacist vaccination services between March and October 2015. Participants Immuniser pharmacists from 86 pharmacies completed baseline surveys and 78 completed exit surveys; computer records from 57 pharmacies; 25 immuniser pharmacists were interviewed. Main outcome measures Pharmacy and immuniser pharmacist profiles; pharmacist vaccination services provided and consumer profiles who accessed services. Results 15,621 influenza vaccinations were administered by immuniser pharmacists at 76 WA community pharmacies between March and October 2015. There were no major adverse events, and <1% of consumers experienced minor events which were appropriately managed. Between 12% and 17% of consumers were eligible to receive free influenza vaccinations under the National Immunisation Program but chose to have it at a pharmacy. A high percentage of vaccinations was delivered in rural and regional areas indicating that provision of pharmacist vaccination services facilitated access for rural and remote consumers. Immuniser pharmacists reported feeling confident in providing vaccination services and were of the opinion that services should be expanded to other vaccinations. Pharmacists also reported significant professional satisfaction in providing the service. All participating pharmacies intended to continue providing influenza vaccinations in 2016. Conclusions This initial evaluation of WA pharmacist vaccination services showed that vaccine delivery was safe. Convenience and accessibility were important aspects in usage of services. There is scope to expand pharmacist vaccination services to other vaccines and younger children; however, government funding to pharmacists needs to be considered