Field evaluation of a community scale solar powered water purification technology: A case study of a remote Mexican community application

Objective. To understand how community members of a remote First Nations community respond to an emergency first aid education programme.Study design. A qualitative study involving focus groups and participant observation as part of a community-based participatory research project, which involved the development and implementation of a wilderness first aid course in collaboration with the community.Methods. Twenty community members participated in the course and agreed to be part of the research focus groups. Three community research partners validated and reviewed the data collected from this process. These data were coded and analysed using open coding.Results. Community members responded to the course in ways related to their past experiences with injury and first aid, both as individuals and as members of the community. Feelings of confidence and self-efficacy related access to care and treatment of injury surfaced during the course. Findings also highlighted how the context of the remote First Nations community influenced the delivery and development of course materials.Conclusions. Developing and delivering a first aid course in a remote community requires sensitivity towards the response of participants to the course, as well as the context in which it is being delivered. Employing collaborative approaches to teaching first aid can aim to address these unique needs. Though delivery of a first response training programme in a small remote community will probably not impact the morbidity and mortality associated with injury, it has the potential to impact community self-efficacy and confidence when responding to an emergency situation.

Pathogen reduction requirements for direct potable reuse in Antarctica: Evaluating human health risks in small communities

Solid and sensitive infectious disease surveillance systems need to be developed and implemented to prevent and control epidemics. Although statutory national infectious disease surveillance systems have been developed in many countries, some challenges remain, such as their limited timeliness, representativeness, and sensitivity, as well as the fact that they cannot capture all local outbreaks that occur in small communities. To overcome these limitations, local community-based infectious disease surveillance systems that meet local needs and can operate with constrained resources need to be developed, especially in remote and rural low-resource areas. This study aimed to develop, implement, and evaluate a voluntary and unique local community-based ophthalmology sentinel surveillance system in Isa city (OSSS-Isa), a remote rural area in Japan. For the development of OSSS-Isa, one hospital in Isa city assumed a leading role and developed a network with all medical institutions - 20 hospitals and clinics in the local community, including two ophthalmology clinics - as sentinel reporting sites. Surveillance was conducted on a weekly basis from Monday to Sunday. The collection, aggregation, and reporting of the surveillance data were implemented promptly on the same day, Monday, using a paper-based form and fax. For the evaluation of OSSS-Isa, the study followed the updated guidelines for evaluating public health surveillance systems proposed by the Centers for Disease Control and Prevention to select the evaluation criteria and develop a questionnaire. The questionnaires were then distributed to 20 hospitals and clinics, with the responses evaluated on a five-point Likert scale. For the implementation of OSSS-Isa, the system issued alerts twice to the networked hospitals and clinics when signs of an increase in the prevalence of a target infectious eye disease appeared in Isa city. After the alerts, the number of cases decreased in the community. Regarding the evaluation survey, physicians from 18 hospitals and clinics responded to the questionnaire (response rate 90%). In contrast to flexibility, more than 75% of the respondents gave high ratings to simplicity, data quality, acceptability, timeliness, and stability in evaluating OSSS-Isa, with the mean score for these evaluation criteria higher than 3.67. The present results indicate that OSSS-Isa has high simplicity, data quality, acceptability, timeliness, and stability, which is highly embedded with the local healthcare providers in Isa city. OSSS-Isa contributed to the early and accurate detection of signs of infectious eye disease outbreaks emerging in a small remote rural local community. The success factors seem to include its simple well-designed implementation methods, good external factors, and active human factors suited to the characteristics of the small remote rural community. The OSSS-Isa initiative appears to be a meaningful practical example of successful health advocacy by healthcare providers by developing a system at the local social level while going beyond the boundaries of routine medical practice. If voluntary small-scale surveillance systems can complement statutory large-scale ones and work together locally, nationally, and internationally, it might be possible to detect small, unusual happenings that occur in the community, such as emerging infectious diseases, and thereby help avert global outbreaks.

The growing proportions of older people in rural areas have implications for the provision of health and social care services. Older people are more likely to have complex health needs compared with other age groups, requiring a full range of primary, community and acute hospital services. The provision of services to older people in rural areas is challenged by diseconomies of scale, travel costs and difficulties in attracting staff. Policy-makers are requested to include the 'voice' of older people to help provide services that match needs and context. In spite of this, what older people want from health and social care services is a neglected area of investigation. The reported study was conducted in 2005/2006 as part of a European Union Northern Periphery Programme (EU NPP) project called Our Life as Elderly. Its aims were to explore the views of those aged 55 years and over and living in remote communities about current and future health and social care service provision for older people. Evidence was to be collected that could inform policy-makers about changing or improving service delivery. This article summarises emergent themes and considers their implications. The study selected two small remote mainland Scottish Highland communities for in-depth case study. Semi-structured interviews (n = 23), 10 'informal conversations' and 4 focus groups were held with community members aged 55 years and over, in order to provide different types of qualitative data and 'layers' of data to allow reflection. Data analysis was assisted by computerised data management software and performed using the 'framework analysis' approach. Participants did not consider themselves 'old' and expressed the need for independence in older age to be supported by services. Several aspects of services that were undergoing change or restructuring were identified, including arrangements for home care services, meals provision and technological support. Participants valued elements of the traditional model of care they had been receiving: these were local, personal emphasis and continuity. They were suspicious of new arrangements perceived to emphasise technical efficiency. Health and care services were described as inter-linked with other aspects of rural living, including transport and housing (which might have to be relinquished to pay for care). Proximity to family was desired for social and domestic support only; health and related support should be from generic service providers. Community members were involved in reciprocal help-giving of many types. The findings compare with results of other studies of older rural people internationally, and generic 'principles' of service derived could guide restructuring. There may be systemic challenges to empowering older people's 'voice' in designing sustainable rural services that stem from society's views of older people, attitudes of communities to collective roles and responsibilities, and the fragmented ways that services are sometimes provided.

Objectives. The purpose of this study was to delineate and describe the local palliative care services available to residents of remote Aboriginal communities in northern Manitoba; to identify attitudes and beliefs ab0ut death, dying and palliative care in these communities; and to explore obstacles related to palliative care service delivery from the perspectives of culture and geographic isolation.Study Design. Forty-four in-depth semi-strn.ctured interviews were conducted with a reputational sample of key informants including Aboriginal people resident in remote communities, community elders and religious leaders, doctors, nurses and allied health care providers working in First Nations Communities, as well as specialist service providers in Winnipeg. Thematic qualitative analysis was done on the data collected. Data collected from interviews with northern physicians and nurses was coded and analyzed.Results. Currently, many Aboriginal people living in remote communities are transported to large urban centers to die, isolated from friends, family and their culture. However, the majority of Aboriginal people and health care providers interviewed reported that Aboriginal people living in remote communities would prefer to die at home. The issues surrounding palliative care provision in remote Aboriginal communities are cultural and geographic. Culturally sensitive care requires that patients have access to family supports and traditional services if requested. Geographic isolation requires that:1. patient-specific care plans be created for use in the remote community;2. effective lines of communication are established between remote health care providers and urban specialists;3. health care providers and family care-givers be properly trained to fill their respective roles; and4. appropriate guidelines and resources be available in the community to support this type of care.Conclusions. Providing the equipment, supports and education necessary for home-based palliative care in remote Aboriginal communities can be an effective way of addressing the medical, psycho-social, and spiritual needs of these patients. (Int J Circumpolar Health 2004; 63: 25–38)

Background Remote Australian Aboriginal communities experience high rates of bacterial sexually transmissible infections (STI). A key strategy to reduce STIs is to increase testing in primary health care centres. The current study aimed to explore barriers to offering and conducting STI testing in this setting. A qualitative study was undertaken as part of the STI in Remote communities, Improved and Enhanced Primary Health Care (STRIVE) project; a large cluster randomised controlled trial of a sexual health quality improvement program. We conducted 36 in-depth interviews in 22 participating health centres across four regions in northern and central Australia. Participants identified barriers including Aboriginal cultural norms that require the separation of genders and traditional kinship systems that prevent some staff and patients from interacting, both of which were exacerbated by a lack of male staff. Other common barriers were concerns about client confidentiality (lack of private consulting space and living in small communities), staff capacity to offer testing impacted by the competing demands for staff time, and high staff turnover resulting in poor understanding of clinic systems. Many participants also expressed concerns about managing positive test results. To address some of these barriers, participants revealed informal strategies, such as team work, testing outside the clinic and using adult health checks. Results identify cultural, structural and health system issues as barriers to offering STI testing in remote communities, some of which were overcome through the creativity and enthusiasm of individuals rather than formal systems. Many of these barriers can be readily addressed through strengthening existing systems of cultural and clinical orientation and educating staff to view STI in a population health framework. However others, particularly issues in relation to culture, kinship ties and living in small communities, may require testing modalities that do not rely on direct contact with health staff or the clinic environment.

BackgroundSubstantial government funding has been invested to support the training of General Practitioners (GPs) in Australia to serve rural communities. However, there is little data on the impact of this expanded training on smaller communities, particularly for smaller rural and more remote communities. Improved understanding of the impact of training on underserved communities will assist in addressing this gap and inform ongoing investment by governments and communities.MethodA purposive sample of GP supervisors, GP registrars, practice managers and health services staff, and community members (n = 40) from previously identified areas of workforce need in rural and remote North-West Queensland were recruited for this qualitative study. Participants had lived in their communities for periods ranging from a few months to 63 years (Median = 12 years). Semi-structured interviews and a focus group were conducted to explore how establishing GP training placements impacts underserved communities from a health workforce, health outcomes, economic and social perspective. The data were then analysed using thematic analysis.ResultsParticipants reported they perceived GP training to improve communities’ health services and health status (accessibility, continuity of care, GP workforce, health status, quality of health care and sustainable health care), some social factors (community connectedness and relationships), cultural factors (values and identity), financial factors (economy and employment) and education (rural pathway). Further, benefits to the registrars (breadth of training, community-specific knowledge, quality of training, and relationships with the community) were reported that also contributed to community development.ConclusionGP training and supervision is possible in smaller and more remote underserved communities and is perceived positively. Training GP registrars in smaller, more remote communities, matches their training more closely with the comprehensive primary care services needed by these communities.

The high proportion of access distributed energy is the future development trend of the new type of power system, the micro grid is play distributed energy efficiency of the effective ways, it is of great social and economic significance, the community is one of the important application in the field of micro grid scenario, small, remote communities, this paper constructed the "source - net - storage - lotus" coordinated control of micro hybrid network architecture. In order to optimize the economic benefit of micro-grid operation and minimize the peak-valley difference between power supply and demand, a mathematical model of day-ahead optimal scheduling of hybrid micro-grid under the guidance of tOU price and compensation incentive is constructed. The hybrid microgrid of landscape storage community with the participation of flexible load is studied to evaluate the mechanism and effectiveness of the microgrid in making up for the limitation of flat peak and valley suppression ability of small capacity energy storage device, adjusting the peak-valley difference of load consumption and improving the operation economy of the microgrid.

Public health investment planning is a crucial part of health planning. This study evaluates the economic cost-benefit of investing on fluoridation of the water supply in a small remote community in Australia to prevent dental caries. The results indicate that the investment on fluoridation generates an Internal Rate of Return (IRR) of around 4-5% with a pay-back period of 12 years and a positive net present value (NPV) of $ 94,469 at 5% discount rate which is attractive for public investment. The study also reveals that the fluoridation of the water supply in small remote communities with a population of more than 1000 is an economically viable investment. This study supports a policy of investing on fluoridation of water supplies in remote communities with population of more than 1000 people. The public health investment analysis methodology adopted in this study and the findings will be of great interest in making decisions on public financing of small-scale public health investment.

Studies of ‘smart cities’ in Canada primarily focus on large cities but not small, rural and remote communities. As a result, we have a limited understanding of the incentive structures for smaller, remote and rural communities to pursue smart city development. This knowledge deficit is concerning, since the introduction of technology can hold a number of unique benefits for these communities, including easier connections to the rest of Canada and large urban centres, reputation building, improved service delivery and enhanced opportunities for residents. Drawing upon localised forms of knowledge creation, policy development theories, adoption and local competition literature and primary interviews with private and public officials, we examine the challenges and opportunities of ‘smart city’ implementation through case studies of small and rural municipalities in Annapolis Valley in Nova Scotia and a remote community, Iqaluit, Nunavut. We find that collaboration is essential for rural and remote pursuit of smart city development and is necessary to counteract the limitations of capacity, scale and digital divides. Challenges aside, however, the primary rationale for adoption of smart city technology remains the same regardless of size: enhanced quality of life for residents and sustained community health.

Identify barriers and enablers for remote Tasmanians participating in bowel cancer screening through the National Bowel Cancer Screening Program. A small remote Tasmanian community. Tasmanian remote community members aged 50 years and over. A qualitative study conducted 16 semi-structured interviews. Two researchers conducted in-person and telephone interviews. Questions were directed by an interview guide developed using the Theoretical Domains Framework for behaviour change and Behaviour Change Wheel. Two researchers analysed data using directed content analysis with a flexible inductive approach. Four themes related to barriers and enablers to completing the National Bowel Cancer Screening Program screening kit in remote Tasmania. Themes included the subject of screening, physical screening kit, the process and outcome of the kit. Several barrier and enabler sub-themes overlapped or were linked, as many enablers mitigated barriers. For example, social influences, awareness level, steps in completing screening, and planning and timing to screen. Social support and discussing screening with others were key enablers, whereas lack of these were barriers. For remote communities, taking the kit to the post office was a barrier from often knowing the post officer. A bowel bus providing screening and information support services may reduce the travel burden of follow-up diagnostic tests and support low-literacy individuals to screen. Barriers and enablers exist within each stage of the screening process, from what influences an individual decision to screen, through to the outcome. To improve screening rates in rural/remote Tasmania, barriers and enablers to screening must be considered.

In Australia, the nebulous concept of ‘remoteness’ is central to Indigenous Affairs social policy. An enduring settler-colonial spatial imaginary positions remote Australia as simultaneously both the heartland of authentic Indigeneity, and a wicked policy problem. Over the last 50 years, the small Indigenous communities that predominate in remote Australia have been cyclically and discursively positioned as essentially parasitic: economically unproductive (in a neoliberal market sense), socially dysfunctional, and a consequent drain on government social spending. The state argues that continued investment in essential infrastructure and services in these small communities is not sustainable. The complex and important historical geographies of spatial and procedural justice that produce such renderings demand their own careful analysis and critique. The task of this paper, however, is to critically consider the preferred policy “solution” to the perceived predicament of governing Indigenous remoteness. Specifically, there are tacit, and largely untested, assumptions within Australian public praxis that greater Indigenous migration from small remote and rural communities to larger towns and cities, as a means of increasing Indigenous education and employment outcomes, will more or less automatically resolve this wicked policy problem. The empirical data presented in this paper suggest that the Indigenous Australian population is probably experiencing an urban transition at a similar rate to many more rurally-based societies in Asia and Africa. However, the context, regulation, management, experience and outcomes of remote/rural-urban migration are arguably vastly different in settler-states such as Australia than in low- and middle-income countries and not necessarily always aligned with State social policy objectives. This paper therefore considers alternative approaches to geographical theorising about Indigenous migration. In particular it returns to Mabogunje’s [1970] systems theory of rural-urban migration which is attentive to the specifics of both the wider economic, socio-cultural and political environment within migration occurs, as well as migrant agency, logics, decision-making processes and outcomes. This facilitates a move beyond what Kukutai and Taylor [2012] refer to as conventional ‘postcolonial demography’, to explore how we might engage in decolonising scholarship of Indigenous migration decisions, categories, experiences and outcomes.

Fishing rights and small communities: Alaska halibut IFQ transfer patterns

On the feasibility of small communities wellhead RO treatment for nitrate removal and salinity reduction

To evaluate the implementation of a clinical pathology and clinical skills course designed for delivery at several distributed sites, including a mandatory eight-week placement in small remote communities. All students in the first cohort for the course were invited to complete questionnaires rating the value of their learning experiences and the impact of relying on resources delivered by information technology. Forty-one of 63 students responded. Formal lectures and resources provided at the main campus were most highly valued by the students. Patient presentations in the rural and remote communities were better examples of clinical pathology than those encountered in urban hospitals, and the rural tutors were regarded very highly for their support of student learning. Delivery of resource materials in remote sites was not as successful as planned, due to difficulties with bandwidth and download speeds. Student academic performance appeared unrelated to location of learning. Students were able to achieve learning objectives for the course, relying on a richer patient mix, campus-based core sessions and information technology-based resources. Curriculum planners should be encouraged to further devolve learning in traditionally campus-based content to rural and remote communities, but only after careful planning and resource allocation to support learning in rural teaching sites.