Rural and Urban Differentials in Primary Care Management of Chronic Heart Failure: New Data from the CASE Study

Objective: To determine whether primary care management of chronic heart failure (CHF) differed between rural and urban areas in Australia. Design: A cross-sectional survey stratified by Rural, Remote and Metropolitan Areas (RRMA) classification. The primary source of data was the Cardiac Awareness Survey and Evaluation (CASE) study. Setting: Secondary analysis of data obtained from 341 Australian general practitioners and 23 845 adults aged 60 years or more in 1998. Main outcome measures: CHF determined by criteria recommended by the World Health Organization, diagnostic practices, use of pharmacotherapy, and CHF-related hospital admissions in the 12 months before the study. Results: There was a significantly higher prevalence of CHF among general practice patients in large and small rural towns (16.1%) compared with capital city and metropolitan areas (12.4%) (P < 0.001). Echocardiography was used less often for diagnosis in rural towns compared with metropolitan areas (52.0% v 67.3%, P < 0.001). Rates of specialist referral were also significantly lower in rural towns than in metropolitan areas (59.1% v 69.6%, P < 0.001), as were prescribing rates of angiotensin-converting enzyme inhibitors (51.4% v 60.1%, P < 0.001). There was no geographical variation in prescribing rates of β-blockers (12.6% [rural] v 11.8% [metropolitan], P = 0.32). Overall, few survey participants received recommended “evidence-based practice” diagnosis and management for CHF (metropolitan, 4.6%; rural, 3.9%; and remote areas, 3.7%). Conclusions: This study found a higher prevalence of CHF, and significantly lower use of recommended diagnostic methods and pharmacological treatment among patients in rural areas.

The beliefs which motivate young male and female drivers to speed : a comparison of low and high intenders

In Australia, young drivers aged 17 to 24 years, and particularly males, have the highest risk of being involved in a fatal crash. Investigation of young drivers’ beliefs allows for a greater understanding of their involvement in risky behaviours, such as speeding, as beliefs are associated with intentions, the antecedent to behaviour. The theory of planned behaviour (TPB) was used to conceptualise beliefs using a scenario based questionnaire distributed to licensed drivers (N = 398). The questionnaire measured individual’s beliefs and intentions to speed in a particular situation. Consistent with a TPB-based approach, the beliefs of those with low intentions to speed (‘low intenders’) were compared with the beliefs of those with high intentions (‘high intenders’) with such comparisons conducted separately for males and females. Overall, significant differences in the beliefs held by low and high intenders and for both females and males were found. Specifically, for females, it was found that high intenders were significantly more likely to perceive advantages of speeding, less likely to perceive disadvantages, and more likely to be encouraged to speed on familiar and inappropriately signed roads than female low intenders. Females, however, did not differ in their perceptions of support from friends, with all females reporting some level of disapproval from most friends and all females (i.e., low and high intenders) reporting approval to speed from their male friends. The results for males revealed that high intenders were significantly more likely to speed on familiar and inappropriately signed roads as well as having greater perceptions of support from all friends, except from those friends with whom they worked. Low and high intending males did not differ in their perceptions of the advantages and disadvantages of speeding, with the exception of feelings of excitement whereby high intenders reported speeding to be more exciting than low intenders. The findings are discussed in terms of how they may directly inform the content of mass media and public education campaigns aimed at encouraging young drivers to slow down.

Car ownership, mileage, and risky driving among young intermediate drivers

Introduction: Young drivers are at greatest risk of injury or death from a car crash in the first six months of independent driving. In Queensland, the graduated driver licensing (GDL) program was extensively modified in July 2007 and aims to minimise this risk. Increased mileage and car ownership have been found to play a role in risky driving, offences and crashes; however GDL programs typically do not consider these variables. The paper explores the mileage and car ownership characteristics of young newly-licensed intermediate (Provisional) drivers and their relation to risky driving, crashes and offences. Methods: Drivers (n = 1032) aged 17-19 years recruited from across Queensland for longitudinal research completed Survey 1 exploring pre-licence and Learner experiences and sociodemographic characteristics. Survey 2 explored the same variables with a subset of these drivers (n = 341) after they had completed their first six months of independent driving. Results: At Survey 2, most young drivers owned their vehicle. Novices who drove more kilometres and who spent more hours each week driving were more likely to report risky driving. These drivers were also more likely to report being detected by Police for a driving-related offence. Conclusions: GDL programs should incorporate education for the parent and novice driver regarding the increased risks associated with increased driving exposure, particularly where the novices own their vehicle. Parents should be encouraged to delay exclusive access to a vehicle for the novice driver.

Mileage, car ownership, experience of punishment avoidance and the risky driving of young drivers

Objective: Young drivers are at greatest risk of injury or death from a car crash in the first six months of independent driving. In Queensland, the graduated driver licensing (GDL) program was extensively modified in July 2007 in order to reduce this risk. Increased mileage and car ownership have been found to play a role in risky driving, offences and crashes; however GDL programs typically do not consider these variables. In addition, young novice drivers’ experiences of punishment avoidance have not previously been examined. The paper explores the mileage (duration and distance), car ownership and punishment avoidance behaviour of young newly-licensed intermediate (Provisional) drivers and their relationship with risky driving, crashes and offences. Methods: Drivers (n = 1032) aged 17-19 years recruited from across Queensland for longitudinal research completed Survey 1 exploring pre-licence and Learner experiences and sociodemographic characteristics. Survey 2 explored the same variables with a subset of these drivers (n = 341) after they had completed their first six months of independent driving. Results: Most young drivers in Survey 2 reported owning a vehicle and paying attention to Police presence. Drivers who had their own car reported significantly greater mileage and more risky driving. Novices who drove more kilometres, spent more hours each week driving, or avoided actual and anticipated Police presence were more likely to report risky driving. These drivers were also more likely to report being detected by Police for a driving-related offence. The media, parents, friends and other drivers play a pivotal role in informing novices of on-road Police enforcement operations. Conclusions: GDL programs should incorporate education for the parent and novice driver regarding the increased risks associated with greater driving particularly where the novices own a vehicle. Parents should be encouraged to delay exclusive access to a vehicle for the novice driver. Parents should also consider whether their young novice will deliberately avoid Police if they tell them their location. This may reinforce not only the risky behaviour but also the young novice’s beliefs that their parents condone this behaviour.

Predicting employee intentions to support organizational change : an examination of identification processes during a re-brand

This study examined if organizational identification can account for the mechanisms by which two-change management practices (communication and participation) influence employees’ intentions to support change. The context was a sample of 82 hotel employees in the early stages of a re-brand. Identification with the new hotel fully mediated the relationship between communication and adaptive and proactive intentions to support change, as well as between participation and proactive intentions.

Consumer clothing disposal behaviour: A comparative study

Fast fashion retailing is leading consumers towards an increased rate of purchasing and the trend to keep clothing for an ever shorter time with the resulting rise in clothing disposal. The aim of this paper is to empirically explore antecedents of two methods of sustainable clothing disposal behaviour in two countries: donating to charities and giving away to family and friends. Using data from females located in Australia and Chile, the authors test the proposed model with structural equation modelling (SEM). The results of this study show that consumer recycling behaviour is a strong and direct driver of donating to charity. In addition, results find that consumer awareness of the environment and consumer age affect donating behaviour. The findings have value for fast fashion retailers, marketers, environmental activists, ecological researchers, charity institutions and public policy makers.

Serious fears across cultures about the collapse of the world order

This chapter approaches resilience from an evolutionary psychology (socio-biological) perspective. It argues that the internal constitution and mental toughness of the individual will provide a core protection for life’s inevitable tests in the innumerable micro and macro environments humans find themselves. The many descriptors of the construct of resilience used in various studies are explored. Finally, the difference psychologists can make in the therapy of clients whose resilience is being tested, is examined by means of case examples.

Non-combinatorial library screening reveals subsite cooperativity and identifies new high-efficiency substrates for kallikrein-related peptidase 14

An array of substrates link the tryptic serine protease, kallikrein-related peptidase 14 (KLK14), to physiological functions including desquamation and activation of signaling molecules associated with inflammation and cancer. Recognition of protease cleavage sequences is driven by complementarity between exposed substrate motifs and the physicochemical signature of an enzyme's active site cleft. However, conventional substrate screening methods have generated conflicting subsite profiles for KLK14. This study utilizes a recently developed screening technique, the sparse matrix library, to identify five novel high-efficiency sequences for KLK14. The optimal sequence, YASR, was cleaved with higher efficiency (k(cat)/K(m)=3.81 ± 0.4 × 10(6) M(-1) s(-1)) than favored substrates from positional scanning and phage display by 2- and 10-fold, respectively. Binding site cooperativity was prominent among preferred sequences, which enabled optimal interaction at all subsites as indicated by predictive modeling of KLK14/substrate complexes. These simulations constitute the first molecular dynamics analysis of KLK14 and offer a structural rationale for the divergent subsite preferences evident between KLK14 and closely related KLKs, KLK4 and KLK5. Collectively, these findings highlight the importance of binding site cooperativity in protease substrate recognition, which has implications for discovery of optimal substrates and engineering highly effective protease inhibitors.

Using cases in a mixed learning environment : meeting the challenges of higher education reform

This paper explains the context for pedagogy in a specific undergraduate course; the comparative benefits of using cases in a mixed learning environment (simultaneous large and small groups); and illustrates one significant way for universities to respond to increasing demand for delivery efficiency while maintaining high quality learning outcomes. Thus, to achieve objectives of the subject, tutorial classes expand on what is taught in lectures and provide the necessary context to analyse cases in more detail. A small, qualitative study explored experiences of market research tutors with the use of case method teaching reported. Implications of the study for case teaching in higher education are identified.