487 resultados para quality use of medicines


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This paper is a qualitative, practice based study describing the use of the Focus-Action-Reflection (FAR) Guide (Harrison and Treagust, 2000) to address the shortcomings of a pedagogical analogical model in Year 10 Science. The aim of this paper is to present my experience of the FAR Guide in relation to an analogical model that gave rise to perceived shortcomings by both teachers and students. This study found the FAR Guide to be a highly valuable tool, transforming the presentation of the analogical model, and enabling students to develop a deeper understanding of the nature of scientific knowledge.

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A large population-based survey of persons with multiple sclerosis (MS) and their caregivers was conducted in Ontario using self-completed mailed questionnaires. The objectives included describing assistance arrangements, needs, and use of and satisfaction with services, and comparing perceptions of persons with MS and their caregivers. Response rates were 83% and 72% for those with MS and caregivers, respectively. Based on 697 respondents with MS whose mean age is 48 years, 70% are female, and 75% are married. While 24% experience no mobility restrictions, the majority require some type of aid or a wheelchair for getting around. Among 345 caregivers, who have been providing care for 9 years on average, the majority are spouses. Caregivers report providing more frequent care than do persons with MS report receiving it, particularly for the following activities of daily living: eating, meal preparation, and help with personal finances. Caregivers also report assistance of longer duration per day than do care recipients with MS. Frequency and duration of assistance are positively associated with increased MS symptom severity and reduced mobility. Generally there is no rural-urban disparity in service provision, utilization or satisfaction, and although there is a wide range of service utilization, satisfaction is consistently high. Respite care is rarely used by caregivers. Use of several services is positively associated with increased severity of MS symptoms and reduced mobility. Assistance arrangements and use of services, each from the point of view of persons with MS and their caregivers, must be taken into account in efforts to prolong home care and to postpone early institutionalization of persons with MS.

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Bug fixing is a highly cooperative work activity where developers, testers, product managers and other stake-holders collaborate using a bug tracking system. In the context of Global Software Development (GSD), where software development is distributed across different geographical locations, we focus on understanding the role of bug trackers in supporting software bug fixing activities. We carried out a small-scale ethnographic fieldwork in a software product team distributed between Finland and India at a multinational engineering company. Using semi-structured interviews and in-situ observations of 16 bug cases, we show that the bug tracker 1) supported information needs of different stake holder, 2) established common-ground, and 3) reinforced issues related to ownership, performance and power. Consequently, we provide implications for design around these findings.

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In a medical negligence context, and under the causation provisions enacted pursuant to Civil Liability Legislation in most Australian jurisdictions, the normative concept of “scope of liability” requires a consideration of whether or not and why a medical practitioner should be responsible for a patient’s harm. As such, it places a limit on the extent to which practitioners are deemed liable for a breach of the duty of care owed by them, in circumstances where a legal factual connection between that breach and the causation of a patient’s harm has already been shown. It has been said that a determination of causation requires ‘the identification and articulation of an evaluative judgement by reference to “the purposes and policy of the relevant part of the law”’: Wallace v Kam (2013) 297 ALR 383, 388. Accordingly, one of the normative factors falling within scope of liability is an examination of the content and purpose of the rule or duty of care violated – that is, its underlying policy and whether this supports an attribution of legal responsibility upon a practitioner. In this context, and with reference to recent jurisprudence, this paper considers: the policy relevant to a practitioner’s duty of care in each of the areas of diagnosis, treatment and advice; how this has been used to determine an appropriate scope of liability for the purpose of the causation inquiry in medical negligence claims; and whether such an approach is problematic for medical standards or decision-making.

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Electric-motored personal mobility devices (PMDs) are appearing on Australian roads. While legal to import and own, their use is typically illegal for adult riders within the road transport system. However, these devices could provide an answer to traffic congestion by getting people out of cars for short trips (“first-and-last mile” travel). City of Ryde council, Macquarie University, and Transport for NSW examined PMD use within the road transport system. Stage 1 of the project examined PMD use within a controlled pedestrian environment on the Macquarie University campus. Three PMD categories were used: one-wheelers (an electric unicycle, the Solowheel); two-wheelers (an electric scooter, the Egret); and three-wheelers (the Qugo). The two-wheeled PMD was most effective in terms of flexibility. In contrast, the three-wheeled PMD was most effective in terms of speed. One-wheeled PMD riders were very satisfied with their device, especially at speed, but significant training and practice was required. Two-wheeled PMD riders had less difficulty navigating through pedestrian precincts and favoured the manoeuvrability of the device as the relative narrowness of the two-wheeled PMD made it easier to use on a diversity of path widths. The usability of all PMDs was compromised by the weight of the devices, difficulties in ascending steeper gradients, portability, and parking. This was a limited trial, with a small number of participants and within a unique environment. However, agreement has been reached for a Stage 2 extension into the Macquarie Park business precinct for further real-world trials within a fully functional road transport system.

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Social media platforms such as Facebook and Twitter are now widely recognised as playing an increasingly important role in the dissemination of information during crisis events. They are used by emergency management organisations as well as by the public to share information and advice. However, the official use of social media for crisis communication within emergency management organisations is still relatively new and ad hoc, rather than being systematically embedded within or effectively coordinated across agencies. This policy report suggests a more effectively coordinated approach to leverage social media use, involving stronger networking between social media staff within emergency management organisations. This could be realised by establishing a national network of social media practitioners managed by the Australia-New Zealand Emergency Management Committee (ANZEMC), reinforced by a Federal government task force that promotes further policy initiatives in this space.

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Purpose A modification of the existing PVA-​FX hydrogel has been made to investigate the use of a functionalised polymer in a Fricke gel dosimetry system to decrease Fe3+ diffusion. Methods The chelating agent, xylenol orange, was chem. bonded to the gelling agent, polyvinyl alc. (PVA) to create xylenol orange functionalised PVA (XO-​PVA)​. A gel was created from the XO-​PVA (20​% w​/v) with ferrous sulfate (0.4 mM) and sulfuric acid (50 mM)​. Results This resulted in an optical d. dose sensitivity of 0.014 Gy-​1, an auto-​oxidn. rate of 0.0005 h-​1, and a diffusion rate of 0.129 mm2 h-​1; an 8​% redn. compared to the original PVA-​FX gel, which in practical terms adds approx. 1 h to the time span between irradn. and accurate read-​out. Conclusions Because this initial method of chem. bonding xylenol orange to polyvinyl alc. has inherently low conversion, the improvement on existing gel systems is minimal when compared to the drawbacks. More efficient methods of functionalising polyvinyl alc. with xylenol orange must be developed for this system to gain clin. relevance.

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Eleven cystic fibrosis children (mean age, 9.6 years) were chosen at random to participate in a study to observe the effects of concurrently stimulating gastric/duodenal bicarbonate secretion and inhibiting gastric acid secretion, using a methylated prostaglandin E1 analogue in patients with pancreatic insufficiency and taking pancreatic enzymes. Percentage fat absorption in 3-day stool collections were calculated before and after commencing therapy with misoprostol, 400 μg/day in divided doses. We found a significant reduction in fat output (14.7 ± 11.7 versus 7.5 ± 3.5 g/day, p < 0.05) in the study group as a whole and a significant reduction in steatorrhoeic level as a percentage of fat intake in all of the patients with abnormal base-line collections (23.1% versus 9.2% p < 0.002). We conclude that misoprostol should be considered in cystic fibrosis patients with steatorrhoea as a means of improving nutrient absorption. © 1988 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.

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This study aims to help broaden the use of electronic portal imaging devices (EPIDs) for pre-treatment patient positioning verification, from photon-beam radiotherapy to photon- and electron-beam radiotherapy, by proposing and testing a method for acquiring clinicallyuseful EPID images of patient anatomy using electron beams, with a view to enabling and encouraging further research in this area. EPID images used in this study were acquired using all available beams from a linac configured to deliver electron beams with nominal energies of 6, 9, 12, 16 and 20 MeV, as well as photon beams with nominal energies of 6 and 10 MV. A widely-available heterogeneous, approximately-humanoid, thorax phantom was used, to provide an indication of the contrast and noise produced when imaging different types of tissue with comparatively realistic thicknesses. The acquired images were automatically calibrated, corrected for the effects of variations in the sensitivity of individual photodiodes, using a flood field image. For electron beam imaging, flood field EPID calibration images were acquired with and without the placement of blocks of water-equivalent plastic (with thicknesses approximately equal to the practical range of electrons in the plastic) placed upstream of the EPID, to filter out the primary electron beam, leaving only the bremsstrahlung photon signal. While the electron beam images acquired using a standard (unfiltered) flood field calibration were observed to be noisy and difficult to interpret, the electron beam images acquired using the filtered flood field calibration showed tissues and bony anatomy with levels of contrast and noise that were similar to the contrast and noise levels seen in the clinically acceptable photon beam EPID images. The best electron beam imaging results (highest contrast, signal-to-noise and contrast-to-noise ratios) were achieved when the images were acquired using the higher energy electron beams (16 and 20 MeV) when the EPID was calibrated using an intermediate (12 MeV) electron beam energy. These results demonstrate the feasibility of acquiring clinically-useful EPID images of patient anatomy using electron beams and suggest important avenues for future investigation, thus enabling and encouraging further research in this area. There is manifest potential for the EPID imaging method proposed in this work to lead to the clinical use of electron beam imaging for geometric verification of electron treatments in the future.

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Eleven cystic fibrosis children (mean age, 9.6 years) were chosen at random to participate in a study to observe the effects of concurrently stimulating gastric/duodenal bicarbonate secretion and inhibiting gastric acid secretion, using a methylated prostaglandin E1 analogue in patients with pancreatic insufficiency and taking pancreatic enzymes. Percentage fat absorption in 3-day stool collections were calculated before and after commencing therapy with misoprostol, 400 μg/day in divided doses. We found a significant reduction in fat output (14.7 ± 11.7 versus 7.5 ± 3.5 g/day, p < 0.05) in the study group as a whole and a significant reduction in steatorrhoeic level as a percentage of fat intake in all of the patients with abnormal base-line collections (23.1% versus 9.2%, p < 0.002). We conclude that misoprostol should be considered in cystic fibrosis patients with steatorrhoea as a means of improving nutrient absorption.

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It is now widely acknowledged that student mental well-being is a critical factor in the tertiary student learning experience and is important to student learning success. The issue of student mental well-being also has implications for effective student transition out of university and into the world of work. It is therefore vital that intentional strategies are adopted by universities both within the formal curriculum, and outside it, to promote student well-being and to work proactively and preventatively to avoid a decline in student psychological well-being. This paper describes how the Queensland University of Technology Law School is using animation to teach students about the importance for their learning success of the protection of their mental well-being. Mayer and Moreno (2002) define an animation as an external representation with three main characteristics: (1) it is a pictorial representation, (2) it depicts apparent movement, and (3) it consists of objects that are artificially created through drawing or some other modelling technique. Research into the effectiveness of animation as a tool for tertiary student learning engagement is relatively new and growing field of enquiry. Nash argues, for example, that animations provide a “rich, immersive environment [that] encourages action and interactivity, which overcome an often dehumanizing learning management system approach” (Nash, 2009, 25). Nicholas states that contemporary millennial students in universities today, have been immersed in animated multimedia since their birth and in fact need multimedia to learn and communicate effectively (2008). However, it has also been established, for example through the work of Lowe (2003, 2004, 2008) that animations can place additional perceptual, attentional, and cognitive demands on students that they are not always equipped to cope with. There are many different genres of animation. The dominant style of animation used in the university learning environment is expository animation. This approach is a useful tool for visualising dynamic processes and is used to support student understanding of subjects and themes that might otherwise be perceived as theoretically difficult and disengaging. It is also a form of animation that can be constructed to avoid any potential negative impact on cognitive load that the animated genre might have. However, the nature of expository animation has limitations for engaging students, and can present as clinical and static. For this reason, the project applied Kombartzky, Ploetzner, Schlag, and Metz’s (2010) cognitive strategy for effective student learning from expository animation, and developed a hybrid form of animation that takes advantage of the best elements of expository animation techniques along with more engaging short narrative techniques. First, the paper examines the existing literature on the use of animation in tertiary educational contexts. Second, the paper describes how animation was used at QUT Law School to teach students about the issue of mental well-being and its importance to their learning success. Finally, the paper analyses the potential of the use of animation, and of the cognitive strategy and animation approach trialled in the project, as a teaching tool for the promotion of student learning about the importance of mental well-being.

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In this paper we present a novel application of scenario methods to engage a diverse constituency of senior stakeholders, with limited time availability, in debate to inform planning and policy development. Our case study project explores post-carbon futures for the Latrobe Valley region of the Australian state of Victoria. Our approach involved initial deductive development of two ‘extreme scenarios’ by a multi-disciplinary research team, based upon an extensive research programme. Over four workshops with the stakeholder constituency, these initial scenarios were discussed, challenged, refined and expanded through an inductive process, whereby participants took ‘ownership’ of a final set of three scenarios. These were both comfortable and challenging to them. The outcomes of this process subsequently informed public policy development for the region. Whilst this process did not follow a single extant structured, multi-stage scenario approach, neither was it devoid of form. Here, we seek to theorise and codify elements of our process – which we term ‘scenario improvisation’ – such that others may adopt it.

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The Edinburgh Postnatal Depression Scale (EPDS) was sent by post to 206 mothers and 201 fathers of toddlers (aged between 19 and 22 months). At the same time these parents also completed subscales of the Crown—Crisp Experiential Index (CCEI). The responses were used to assess the feasibility of postal completion of the EPDS and its acceptability to parents outside the postpartum year, particularly fathers for whom there have been no previous reports of its use. On a small sub-group, the sensitivity, specificity and predictive values of the measures were assessed using the Present. State Examination. Answers to the depression subscale of the CCEI to the EPDS and to the Present State Examination were compared to assess validity. Completion of the postally-administered EPDS was satisfactory, though some difficulties were experienced in a second postal administration to a subsample. The scale was completed without obvious error or omission and this, combined with positive comments from parents, suggests the acceptability of the scale to both mothers and fathers. The mean scores were higher for mothers than for fathers, but the pattern of distribution was similar with a marked positive skew and a distinct decline in scores above 10. Because the subsample of parents interviewed was small the calculation of sensitivity and specificity has to be treated with caution. However, the results for mothers suggest that the EPDS has satisfactory validity for this group and one superior to the depression subscale of the CCEI. Among the fathers interviewed there were insufficient cases to enable calculation of sensitivity and specificity. Other results were encouraging, however, and suggest the merit of further studies of the application and validity of the EPDS with fathers.

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This paper addresses the ways in which humour is used by university academics to shape teaching personas. Based upon the work of Mauss and Foucault, and employing semi-structured, in-depth interviews with a range of university teachers, this research suggests that most tertiary teachers deliberately fashion various kinds of teaching persona, which they then perform in lectures and tutorials. The use of humour is widely seen as an important component within this form of self-shaping, as it fits within dominant frameworks of expectation regarding contemporary models of “edutainment”. This research demonstrates that a wide range of practices of the self—including physical, verbal, and relational elements—are employed by academics as part of shaping various humorous teaching personas. Some boundaries exist limiting the use of these pedagogic characters; for example, arguments about natural ability with humour prefigure who is most likely to deploy humour as a practice of professional self-formation. Also, professional concerns regarding seniority and job security are also factored into decision-making regarding those humorous personas likely to be considered appropriate within particular tertiary teaching contexts.

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Engineering the production of polyhydroxyalkanoates (PHAs) into high biomass bioenergy crops has the potential to provide a sustainable supply of bioplastics and energy from a single plant feedstock. One of the major challenges in engineering C-4 plants for the production of poly[(R)-3-hydroxybutyrate] (PHB) is the significantly lower level of polymer produced in the chloroplasts of mesophyll (M) cells compared to bundle sheath (BS) cells, thereby limiting the full PHB yield-potential of the plant. In this study, we provide evidence that the access to substrate for PHB synthesis may limit polymer production in M chloroplasts. Production of PHB in M cells of sugarcane is significantly increased by replacing -ketothiolase, the first enzyme in the bacterial PHA pathway, with acetoacetyl-CoA synthase. This novel pathway enabled the production of PHB reaching an average of 6.3% of the dry weight of total leaf biomass, with levels ranging from 3.6 to 11.8% of the dry weight (DW) of individual leaves. These yields are more than twice the level reported in PHB-producing sugarcane containing the -ketothiolase and illustrate the importance of producing polymer in mesophyll plastids to maximize yield. The molecular weight of the polymer produced was greater than 2x10(6)Da. These results are a major step forward in engineering a high biomass C-4 grass for the commercial production of PHB.