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The primary health care management of chronic disease affecting Aboriginal and Torres Strait Islander peoples requires healthcare quality and equity demands to be met, and systems that foster better team-based care. Non-dispensing pharmacists (NDPs) integrated within primary healthcare settings can enhance the quality of patient care, although factors that enable or challenge integration within these settings need to be better understood.To investigate enabling factors and barriers influencing integration of NDPs within Aboriginal community-controlled health services delivering primary health care. This was achieved through qualitative evaluation of the Integrating Pharmacists within Aboriginal Community Controlled Health Services (IPAC) Trial exploring the perceptions of NDPs, community pharmacists, healthcare staff, managers, and Aboriginal and Torres Strait Islander patients of these services.NDPs were employed across twenty urban, rural, and remote services in three Australian states and provided pre-defined medication-related roles to adult Aboriginal and Torres Strait Islander patients. Perceptions were elicited from online surveys, interviews, and focus groups. Transcripts were thematically analyzed using the constant comparison method to identify, compare, and refine emerging themes.One hundred and four participants informed the findings, including 24 NDPs, 13 general practitioners, 12 service managers, 10 community pharmacists, 17 health service staff, and 17 patients. Enablers of integration included: personal (previous experience with Aboriginal and Torres Strait Islander peoples, cultural awareness, skills, individual attributes); health service-related (induction programs, Aboriginal Health Worker support, team-building initiatives); and community-related factors (engaged community elders, leaders, cultural mentors, community pharmacy champions). Barriers to NDP integration included a lack of systems supports for patients and staff to adapt to NDP roles, health service factors, travel requirements, a lack of community linkages, and time and budget constraints.NDP integration within primary health care services has potential to enhance medication-related services to Aboriginal and Torres Strait Islander peoples if enabling factors are supported and health systems and adequate resources facilitate the integration of pharmacists within these settings.

Background Aboriginal and Torres Strait Islander peoples experience a higher burden of chronic disease yet have poorer access to needed medicines than other Australians. Adverse health outcomes from these illnesses can be minimised with improved prescribing quality. This project aims to improve quality of care outcomes for Aboriginal and Torres Strait Islander adult patients with chronic disease by integrating a pharmacist within primary health care teams in Aboriginal Community Controlled Health Services (ACCHSs). Methodology This non-randomised, prospective, pre and post quasi-experimental study, will be pragmatic, community-based and participatory, comparing outcomes and costs using paired patient data. Pharmacists will be integrated at 22 sites for approximately 15 months to conduct patient-related and practice-related activities through 10 core roles: providing medication management reviews, assessing adherence and medication appropriateness, providing medicines information and education and training, collaborating with healthcare teams, delivering preventive care, liaising with stakeholders, providing trnsitional care, and undertaking a drug utilisation review. With patients’ consent, de-identified client-level data will be extracted from clinical information systems and pharmacists will record deidentified activity in an electronic logbook. Primary expected outcomes include improvements in biometric indices (glycated haemoglobin, systolic and diastolic blood pressure, lipids, cardiovascular risk, albumin-creatinine ratio) from baseline to end of study. Expected secondary outcomes include improvements in estimated glomerular filtration rate, prescribing indices (appropriateness, overuse and underuse), medication adherence, self-assessed health, and health service utilisation indices. A qualitative assessment of stakeholder and patient perceptions and a cost-effectiveness analysis will be undertaken. Discussion Numerous inquiries have recommended evaluating the impact of pharmacists integrated within primary health care settings. This study is the first to explore this impact on the health of Aboriginal and Torres Strait Islander peoples who are medically underserved. Evaluation of innovative integrated workforce models is necessary to address the challenges of delivering quality care together with this population.

Policing has recently attracted a great deal of controversy set against the recent wave of student disturbances and the use of paramilitary tactics to disperse, contain, and kettle protestors. Moreover, the controversial application of stop and search powers under the Terrorism Act 2000 has raised further questions about the accountability of the police. The responsibility of holding the police to account currently falls to the 43 police authorities operating across England and Wales. This article draws on ground-breaking research on police authorities using questionnaire and in-depth interview data to outline just how it is that police authority members approach their duties and responsibilities. It outlines the role and potential of police authorities to influence police policy and operations and discusses how the work of police authorities has impacted on participation by local citizens. Our starting position is that citizen participation is a prerequisite for the effective delivery of accountable policing. This has serious consequences for the proposed Police and Crime Commissioners, which are intended to replace police authorities in November 2012.

Habermas’s amendments to his original public sphere thesis have been recognized by a number of media scholars in recent years. His original thesis of a decline or re-feudalization of the public sphere where politics is played out in front of the public has been modified, under the influence of Bernhard Peters’ work, to incorporate the possibility of action from the periphery of the public sphere influencing, if not exclusively determining, decisions made at the administrative core via sluice-gates. There has been limited work, however, on exploring the operation of the sluices in greater detail, and particularly on the role of the mass media in acting as a communication channel between peripheral publics and core elites. The purpose of this article is to do so via a case study of the mass media public debate in the UK about the existence and extent of the national DNA database as it is a prima facie candidate for observing the operation of the sluice-gates.

In recent times policing has attracted a good deal of controversy, such as the paramilitary tactics employed at demonstrations, the use of stop and search powers under the Terrorism Act 2000, and the manner in which police officers are deployed on day-to-day duties. This paper outlines the role and potential of police authorities to influence police policy and operations and also highlights the need to seek greater citizen participation in holding the police to account. The major part of the paper draws on ground-breaking research on police authorities using questionnaire and in-depth interview data to outline just how it is that police authority members approach their duties.

IntroductionThe age-adjusted rate of potentially preventable hospitalisations for Aboriginal and Torres Strait Islander people is almost five times the rate of other Australians. Quality use of medicines has an important role in alleviating these differences. This requires strengthening existing medication reviewing services through collaboration between community pharmacists and health workers, and ensuring services are culturally appropriate. This Indigenous Medication Review Service (IMeRSe) study aims to develop and evaluate the feasibility of a culturally appropriate medication management service delivered by community pharmacists in collaboration with Aboriginal health workers.Methods and analysisThis study will be conducted in nine Aboriginal health services (AHSs) and their associated community pharmacies in three Australian states over 12 months. Community pharmacists will be trained to improve their awareness and understanding of Indigenous health and cultural issues, to communicate the quality use of medicines effectively, and to strengthen interprofessional relationships with AHSs and their staff. Sixty consumers (with a chronic condition/pregnant/within 2 years post partum and at risk of medication-related problems (MRPs) per site will be recruited, with data collection at baseline and 6 months. The primary outcome is the difference in cumulative incidence of serious MRPs in the 6 months after IMeRSe introduction compared with the 6 months prior. Secondary outcomes include potentially preventable medication-related hospitalisations, medication adherence, total MRPs, psychological and social empowerment, beliefs about medication, treatment satisfaction and health expenditure.Ethics and disseminationThe protocol received approval from Griffith University (HREC/2018/251), Queensland Health Metro South (HREC/18/QPAH/109), Aboriginal Health and Medical Research Council of New South Wales (1381/18), Far North Queensland (HREC/18/QCH/86-1256) and the Central Australian HREC (CA-18-3090). Dissemination to Indigenous people and communities will be a priority. Results will be available on the Australian Sixth Community Pharmacy Agreement website and published in peer-reviewed journals.Trial registration numberACTRN12618000188235; Pre-results.

Background: The purpose of this study was to describe barriers to adherence among adolescents with inflammatory bowel disease (IBD) and to examine demographic, disease-related, and treatment regimen-related correlates of adherence barriers using a multimethod reporting strategy. A final goal was to examine relationships between the frequencies of barriers and levels of nonadherence. Methods: In all, 64 adolescents (ages 11–18) participated, along with 61 mothers and 25 fathers. Barriers to adherence and ratings of medication adherence were assessed via patient and parent reports. Disease activity ratings were provided by pediatric gastroenterologists. Results: Lack of time and medication side effects were commonly reported barriers across adolescent, mother, and father reports. Other adolescent-reported barriers included missing medication due to feeling well or discontinuing medication based on the belief that the medication was not working. The prevalence of adherence barriers was not consistently associated with adolescent age, sex, time since diagnosis, or disease activity. Adolescents whose regimen involved more than 1 daily medication administration had more adherence barriers based on adolescent and maternal report than did those whose regimen involved 1 or less than 1 daily medication administration. Finally, adherence barriers were significantly higher among families reporting imperfect adherence as compared to those reporting perfect adherence. Conclusions: Barriers to medication adherence do exist among adolescents with IBD and may have negative implications for medication adherence. Systematic assessment of barriers during routine medical appointments may help to identify and modify these barriers and ultimately improve adherence. Inflamm Bowel Dis 2010

Media reports of people murdered by individuals with serious mental health problems have caused a sense of moral panic in the U.K. The government proposes greater powers of compulsory treatment and detention for such individuals. These proposals have been widely criticized by mental health professionals and civil libertarians. The government, however, argues that community care for the most seriously and potentially dangerous individuals has failed. Its insistence upon compulsory detention and treatment is one further example of a drift towards increasing security-minded surveillance of difficult groups. This surveillance is predicated not on a caring basis where risks can be effectively managed but on exclusionary and compulsory means. In contrast, Madison, Wisconsin operates a successful system of community care. There, even the most seriously ill individuals are frequently treated in the community so that they can exercise their civil rights to enjoy as normal and independent a life as possible.

There has been an increasing trend in recent years for public agencies to work in partnership with each other and with commercial organizations, which has presented special managerial issues and pr...

Government plans for the mentally ill include elements of compulsion such as indefinite detention for those with severe personality disorders. In contrast, in Madison, Wisconsin, USA community safety is assured through an integrated network of services dedicated to supporting the mentally ill in the community.

Maize (Zea mays ssp. mays L.) is highly susceptible to drought stress. This work focused on whole-plant physiological mechanisms by which a biotechnology-derived maize event expressing bacterial cold shock protein B (CspB), MON 87460, increased grain yield under drought. Plants of MON 87460 and a conventional control (hereafter ‘control’) were tested in the field under well-watered (WW) and water-limited (WL) treatments imposed during mid-vegetative to mid-reproductive stages during 2009–2011. Across years, average grain yield increased by 6% in MON 87460 compared with control under WL conditions. This was associated with higher soil water content at 0.5 m depth during the treatment phase, increased ear growth, decreased leaf area, leaf dry weight and sap flow rate during silking, increased kernel number and harvest index in MON 87460 than the control. No consistent differences were observed under WW conditions. This indicates that MON 87460 acclimated better under WL conditions than the control by lowering leaf growth which decreased water use during silking, thereby eliciting lower stress under WL conditions. These physiological responses in MON 87460 under WL conditions resulted in increased ear growth during silking, which subsequently increased the kernel number, harvest index and grain yield compared to the control.

In the light of the government's plan to overhaul the system of community care for the mentally ill and to introduce a new policy committed to protecting the public as well as to supporting the mentally ill, now is an appropriate time to throw light on some of the government's individual proposals. At the heart of the new policy will be a focus on secure accommodation, 24-hour nursing care, outreach teams, crisis intervention capabilities and more acute mental health beds. In addition, greater work opportunities for the mentally ill are to be explored and there is to be a thorough reexamination of the Mental Health Act. However, there are also elements of compulsion at the heart of the government's strategy, as community care orders and provisions for compulsory restrictions on those with severe personality disorders testify. Compulsory community treatment runs the great risk that it will prove to be counterproductive and turn people away from seeking help. In Madison, Wisconsin, there has operat...

Individual hospitals within the NHS are having to cope with a number of competing priorities and policies in the context of difficult financial circumstances. One such policy is Equal Opportunities (EO). It is within the devolved system of individual trusts that the implementation of (EO) policy takes place. This ‘localisation’ of EO issues also applies to the tackling of racial inequalities in the field of job recruitment, training and promotion. The present study is an examination of EO policies and their implementation at a single National Health Service (NHS) hospital in relation to the recruitment, career development, training and promotion of female ethnic minority employees. Interviews were conducted with fifty ethnic minority females drawn from administrative, domestic and nursing grades; and a further twenty-two with hospital managers with responsibility for recruitment, training and promotion. A number of important deficiencies in the hospital's EO policies were identified by the female ethnic minority interviewees, particularly in respect of the recruitment process, experiences of career development and perceptions of discrimination and harassment. The article details the managers' attitudes towards and knowledge of EO policies in general and their responses to these deficiencies in particular.

In the UK NHS, although there is much national guidance on equal opportunities(EO), it is in individual hospitals that such policies must be implemented. The present study highlights how EO policies were handled by a group of managers at a particular NHS trust hospital. A sample of female ethnic minority employees were interviewed to uncover their experiences of recruitment, career development, training and sexual and racial harassment and discrimination. The disparities between the way that female employees perceived such issues and the manner in which managers tackled them highlighted the many problems facing the effective implementation of EO policies. The research provided a picture of a workforce which experiences considerable disadvantage on grounds of ‘race’ and gender, but where such problems and issues are not sufficiently appreciated or acknowledged by managers.

Summary Unconventional resources encompass a wide range of reservoir types. The art of designing and engineering drilling fluids for unconventional resources should not just enable rotary drilling, but also prevent wellbore instability, protect production, and facilitate formation evaluation. In some cases, geosteering, based on logs or cuttings analysis, is part of the drilling process. In addition, many unconventional wells have trajectories that require excellent lubricity to drill. Drilling fluids must be tailored to achieve the goals for each well. Examples of how drilling fluids have been developed for low-porosity microfractured gas sand, oil shale, and tar sands are presented. In low-permeability gas sands in South Asia, preserving natural fractures in the near wellbore region was critical to obtaining maximum production. In Canadian tar sands, preventing hole washout in the production interval was critical for obtaining maximum production. In the Texas oil shale, replacing oil-based drilling fluid with water based alternatives had implications for formation evaluation, wellbore stability and well length in the production interval. Emphasis is placed on the design process for developing drilling fluid systems that contribute to meeting critical objectives for each project.

Historically, return permeability testing has become a standard to establish minimally damaging fluid properties. This single number is typically focused upon for its simplicity, however the testing procedure and intermediate data provide much more than just this value. The process provides insight into formation damage mechanisms and their overall impact on potential well performance. The variable nature of procedures and apparatus as well as interpretation of data is regularly limited to the percent return permeability - a potentially misleading value in fluid selection. A thorough review of existing literature and experience on recent projects details the recognized potential for variability as well as misperceptions in interpreting results. Examples of test data are reviewed to capture damage mechanisms where fluid formulations require further optimization. In many cases conclusions are drawn and fail to identify why differences in the percent return permeability yields a particular result. Prior published work assessing formation damage tends to focus upon formation characteristics. This paper details the results and data typically provided with these analyses. These data include: fluid loss, initial return permeability, and techniques used to determine the damage mechanism. Test results are reviewed to illustrate where the risk of unwarranted conclusions occurs. Recommendations for appropriate analysis of both final return permeability and intermediate data are provided for optimized fluid design. Through the techniques discussed, testing procedures have the potential to provide the maximum insight into fluid-formation interactions on the core material available.

The use of qualitative research in the study of leadership is growing and its impact on the field is beginning to be felt. This article outlines some of the advantages of qualitative investigations of leadership and reports the results of an investigation of police leadership in England in which a qualitative approach was employed. Drawing on ideas from the New Leadership approach, data deriving from semi-structured interviews with a sample of police officers were analyzed in terms of concepts deriving from typical New Leadership findings. While many findings were consistent with New Leadership approaches, some important divergences emerged too. For example, charisma emerged as much less prominent in notions of what makes an effective leader than might have been expected from New Leadership research; by contrast, instrumental leadership was far more pervasive in police officers' thinking as central to effective leadership. The reasons for such findings are speculated upon. particularly with respect to the sensitivity to context that is a feature of qualitative research.

The paper focuses on the interplay of care and control functions within the British police. There are several areas of police activity, such as child sexual abuse investigations, sexual assault, and the handling of the mentally ill, where there is already an operational mixture of care and control functions. Recently, the police have emphasised the service and care nature of their work. Indeed, there are good operational and ethical reasons to do so. However, the government's priority, expressed through such documents as the White Paper on police reform, the report of the Royal Commission on Criminal Justice, and the Sheehy Report, appears to be one of enhancing the police's control functions. An emphasis on a combination of care and control would, however, result in greater benefits than a focus predominantly on control alone. The paper highlights the obstacles that the police service must overcome to realise that combination.

The principal aim of law centres is to service the claims of poor and low income people in the field of social welfare law. Their successes and limitations in realising this aim constitute the major part of this paper. Levels of demand, the satisfaction of unmet legal needs and the role played by law centres in the spectrum of advice services are important factors in assessing their mission. No assessment can be complete, however, without taking into account the internal problems faced by law centres—such as, funding, caseload levels, and rationing procedures. This paper argues that the formation of a national network of law centres would help to solve many of their operational difficulties and to position them more effectively within the spectrum of legal advice services.

To present psychometric data on youth and parent versions of the Inflammatory Bowel Disease-Family Responsibility Questionnaire (IBD-FRQ), a measure of family involvement in IBD management.Fifty-eight adolescents with inflammatory bowel disease (IBD), along with 55 mothers and 26 fathers completed the IBD-FRQ, a demographics questionnaire, and a measure of family involvement in decision making in non-IBD domains. Medical information was obtained via chart review.Support for the internal consistency of the IBD-FRQ was obtained. Evidence of validity was documented via moderate to high intercorrelations among reporters. Youth involvement increased with youth age, while maternal and paternal involvement decreased with youth age. Across all reporters, maternal involvement was higher than paternal involvement.Preliminary analyses offer support for the measure's reliability and validity. The measure shows promise as a means of assessing family involvement in IBD condition management; however, further validation studies are needed.

This article describes the fluid dynamics video, "A Numerical Simulation of a Plunging Breaking Wave", which was submitted to the gallery of fluid motion at the 2009 APS/DFD conference. The simulation was of a deep-water plunging breaking wave. It was a two-phase calculation which used a Volume of Fluid (VOF) method to simulate the interface between the two immiscible fluids. Surface tension and viscous effects were not considered. The initial wave was generated by applying a spatio-temporal pressure forcing on the free surface. The video shows the 50% isocontour of the volume fraction from several different perspectives. Significant air entrainment is observed as well as the presence of stream-wise vortex structures., Comment: Article to accompany the fluid dynamics video, "A Numerical Simulation of a Plunging Breaking Wave", which was submitted to the gallery of fluid motion at the 2009 APS/DFD conference

All societies require mechanisms for preserving social order and control. Among the most prominent of these are the police and the security or intelligence services. This chapter concentrates on the work of the police, as it is the police that have the higher public profile and the greater impact in the majority of instances relating to the normal social activities of a country. Furthermore, given that within Britain there are distinct police organizational structures in Northern Ireland, Scotland, and England and Wales, this chapter will focus on the largest police body in England and Wales.

This book takes us to the centre of the debate about care and control in the police service. The police face new and renewed challenges to their traditional modes of operation, posed amongst other things by a heightened public and media concern with lawlessness and wrongdoing, by the escalation in reported crime, and by an uncharacteristic assault on the police body politic from a government concerned to improve performance, quality and value for money in all publicly funded utilities (see, for example, Sinclair and Miller, 1984; Audit Commission, 1990; Home Office, 1993; Sheehy, 1993). A rehabilitation of the care/control debate is urgent-it is at the heart of the matter about the future direction of British policing. The ways in which policy makers, chief constables and rank and file officers address the critical balance between care and control, and engage with the policy and procedural issues, will have major implications for the shape, goals and legitimacy of the police service up to, and beyond, the millennium.

It is not that individuals fail to appreciate and perceive subtleties, nor to recognise interconnections; it is that in some areas of life we frequently prefer strong and clear messages. We form partial images of many types of activity, which seem to operate at times as a kind of social shorthand. These allow us to distil quickly what we perceive to be the essence of those activities. As far as the police are concerned, and with the image of the Dixon of Dock Green kind of bobby now fast receding from the public’s direct experience and consciousness, there is perhaps an understandable tendency to view the activities of the police as primarily a controlling set of functions.

With the advent of new drug regimes in the 1950s more and more mentally ill patients found themselves being discharged from long-term incarceration in hospital. In 1961 this policy of deinstitutionalisation became official when Enoch Powell, the then Minister of Health, suggested that the majority of longstay mental hospitals should be closed. As a result, the number of patients housed in long-stay hospitals in England and Wales fell from about 150,000 in the mid-1950s to 60,000 by the beginning of 1992. In March 1992, it was reported that 60 of the remaining 90 psychiatric hospitals were planned for closure over the next five years. The policy of deinstitutionalisation clearly has further mileage. Indeed, the ‘twinning’ of deinstitutionalisation with the development of community care initiatives has, in large part, served to justify the closure of psychiatric hospitals and the discharge of their patients.

It's difficult to redirect things once we'd started up as a casework agency. It's difficult to keep casework under control. Cases can only be related to one another; if you justify taking on one case, it's difficult to avoid taking on similar cases. There is still not sufficient priority given to educational and community work. This is so because of the demands of [individual] casework … It's difficult to change approach from casework to educational and community work. (Lawyer at the Urban Community Law Centre) From the beginning we have attempted to do work with people rather than for them. This has meant that wherever possible we have brought people with similar problems together so that they learn how to cope with different establishment bodies … more important, they realize they can exercise control over their own lives. Whether we help an individual deal with his or her own personal problem, or help a group of people get to grips with whatever is oppressing them, our main aim is to inculcate a practical philosophy of self-reliance. (Statement of aims of the Northern Neighbourhood Law Centre1)

When integrating visual features into 3D for a structure from motion algorithm, the connectivity and relationships of features are an important adjunct to any quantitative 3D geometry. This paper describes a general purpose vision system which aims to perceive and refine this topology in conjunction with geometry, using edges, vertices and isolated corners extracted from a sequence of monocular images of an unconstrained scene. Rules which tackle the practical difficulties of imperfect image processing and obscuration features are defined. Results are shown for a rotating view of a polyhedral object and for an outdoor scene viewed from a moving vehicle.

There are many examples of relationships between police officers and social workers being hindered by suspicion and hostility. The problem is often located at street and fieldworker levels where divergent operational philosophies, practices, and goals create misunderstandings and perpetuate stereotyped attitudes. However, in Madison, U.S.A., there is a crisis intervention scheme looking after the mentally disturbed, and diverting them from the criminal justice system, that owes much of its success to close co-operation between the police and the scheme's social workers. Essentially, that co-operation was achieved by identifying the police role as case-finders and by responding to the operational needs of patrol officers.

The problem we are addressing in Alvey Project MMI149 is that of using computer vision to understand the unconstrained 3D world, in which the viewed scenes will in general contain too wide a diversity of objects for topdown recognition techniques to work. For example, we desire to obtain an understanding of natural scenes, containing roads, buildings, trees, bushes, etc., as typified by the two frames from a sequence illustrated in Figure 1. The solution to this problem that we are pursuing is to use a computer vision system based upon motion analysis of a monocular image sequence from a mobile camera. By extraction and tracking of image features, representations of the 3D analogues of these features can be constructed.