Dispensing doctor : an underutilise resource?

Introduction Multidisciplinary models of organising and providing care have been proposed to decrease the health services gap between urban and rural populations but health workforce shortages exist across most professions and are further exacerbated by maldistribution. Flexibility and expansion of the range of tasks that a health professional can undertake were proposed. Dispensing doctors (DDs) are such an example. As part of DDs’ routine medical practice, DDs are able to both prescribe and dispense medicines to their patients. The granting of a dispensing licence to a doctor is intended to improve rural community access to medicines where there is no pharmacy within a reasonable distance. Method An iterative, qualitative descriptive methodology was used to identify factors which influenced DDs’ practice. Qualitative data were collected by in-depth face-to-face and telephone interviews with DDs. A combination of processes: qualitative content analysis and constant comparison were used to analyse the interview transcripts thematically. Member checking and separate coding were utilised to ensure rigour. Result Thirty-one interviews were conducted. The respondents universally acknowledged that the main reason for dispensing were for the convenience and benefits of their patients and to ensure continuity of care. DDs’ communities were generally more isolated and smaller when compared to their non-dispensing counterparts. DD-respondents viewed their dispensary as a service to the community. Peer pressure on prescribing was a key factors in self-regulating prescribing and dispensing. Conclusion DDs fulfill an important area of unmet needs by providing continuity of pharmaceutical care but the practice is hindered by significant barriers

Measuring the effects of small group deliberation on public attitudes towards sentencing : benefits and challenges

This article reports on the outcomes of small group deliberations on levels of punitiveness and public confidence in the sentencing functions of Australian criminal courts, conducted as part of a larger project investigating public attitudes to sentencing. One hypothesis of the project as a whole was that a more informed and involved public is likely to be less punitive in their views on the sentencing of offenders, and to express less cynical views about the role of sentencing courts. The aim of the small group deliberations as part of the broader project was to engender a more thoughtful and considered approach by participants to issues around sentencing. It was hypothesised that the opportunity to discuss, deliberate and consider would lead to a measurable reduction in punitiveness and an increase in people’s confidence in the courts. While the results do indeed indicate such changes in attitudes, the current study also shed light on some of the conceptual, methodological and practical challenges inherent in this type of research.

Assessment Understood as Enabling

This chapter outlines a perspective of educational assessment as enabling, whereby the learner is central and assessment is focused on supporting the knowledge, skills and dispositions necessary for lifelong learning. It argues that better education for young people is achievable when educational policy and practice give priority to learning improvement, thereby making assessment for accountability a related, though secondary, concern. The chapter describes how this work of internationally recognized scholars brings together diverse perspectives and theoretical frameworks and, in so doing, provides readers with a range of ways to consider their pathway through the book. A ‘map’ and summaries of chapters suggest a reading according to a thematic approach, geographical setting, author/s profile or content purposes depending on the reader’s own priorities. A section on assessment past, present, and futures calls for a rebalancing of improvement and accountability goals, and for countries to be careful to avoid privileging large-scale testing over other forms of data about learning and achievement.

Elements of Better Assessment for the Improvement of Learning

Building a community of shared practice at the classroom level calls for clarity about the important assessment capabilities and dispositions of teachers, especially when teachers are expected to take a direct focus on learning. In this chapter, we present new ways of thinking about teachers’ assessment literacies, offering a formulation of better assessment for the improvement of learning, including three elements, namely (i) assessment criteria and standards; (ii) the teacher’s professional judgment; and (iii) social moderation. The potential of the first element lies in teachers’ classroom practices that deliberately embed assessment criteria and standards in pedagogy in productive ways. The second element involves the engagement of teachers and students in judgment practice, that develops the understanding that judgment involves more than the application of explicit or stated criteria. More fundamental is the matter of how teachers bring to bear stated features of quality and other intellectual and experiential resources in arriving at judgment. That is to say, they range across and orient to explicit (stated), tacit (unstated) and meta-criteria in judgment making. These insights have direct relevance to teachers’ efforts to develop students’ own evaluative experience, especially as this involves students working with stated features of quality for self-assessment and peer-assessment purposes. Further, practices for social moderation are discussed, giving examples of good practice in moderation, how teachers experience moderation and the potential benefits of various types.

Synthesis of novel inhibitors blocking Wnt signaling downstream of β-Catenin

Large scale screening of libraries consisting of natural and small molecules led to the identification of many small molecule inhibitors repressing Wnt/β-Catenin signaling. However, targeted synthesis of novel Wnt pathway inhibitors has been rarely described. We developed a modular and expedient way to create the aromatic ring system with an aliphatic ring in between. Our synthesis opens up the possibility, in principle, to substitute all positions at the ring system with any desired substituent. Here, we tested five different haloquinone analogs carrying methoxy- and hydroxy-groups at different positions. Bona fide Wnt activity assays in cell culture and in Xenopus embryos revealed that two of these compounds act as potent inhibitors of aberrant activated Wnt/β-Catenin signaling.

Epidemiological and molecular features of dengue virus type-1 in New Caledonia, South Pacific, 2001–2013

Background The epidemiology of dengue in the South Pacific has been characterized by transmission of a single dominant serotype for 3–5 years, with subsequent replacement by another serotype. From 2001 to 2008 only DENV-1 was reported in the Pacific. In 2008, DENV-4 emerged and quickly displaced DENV-1 in the Pacific, except in New Caledonia (NC) where DENV-1 and DENV-4 co-circulated in 2008–2009. During 2012–2013, another DENV-1 outbreak occurred in NC, the third DENV-1 outbreak in a decade. Given that dengue is a serotype-specific immunizing infection, the recurrent outbreaks of a single serotype within a 10-year period was unexpected. Findings This study aimed to inform this phenomenon by examining the phylogenetic characteristics of the DENV-1 viruses in NC and other Pacific islands between 2001 and 2013. As a result, we have demonstrated that NC experienced introductions of viruses from both the Pacific (genotype IV) and South-east Asia (genotype I). Moreover, whereas genotype IV and I were co-circulating at the beginning of 2012, we observed that from the second half of 2012, i.e. during the major DENV-1 outbreak, all analyzed viruses were genotype I suggesting that a genotype switch occurred. Conclusions Repeated outbreaks of the same dengue serotype, as observed in NC, is uncommon in the Pacific islands. Why the earlier DENV-1 outbreaks did not induce sufficient herd immunity is unclear, and likely multifactorial, but the robust vector control program may have played a role by limiting transmission and thus maintaining a large susceptible pool in the population. Keywords: Dengue; Phylogeny; Genotype; Epidemics; New Caledonia

Mapping a candidate gene (MdMYB10) for red flesh and foliage colour in apple

BACKGROUND Integrating plant genomics and classical breeding is a challenge for both plant breeders and molecular biologists. Marker-assisted selection (MAS) is a tool that can be used to accelerate the development of novel apple varieties such as cultivars that have fruit with anthocyanin through to the core. In addition, determining the inheritance of novel alleles, such as the one responsible for red flesh, adds to our understanding of allelic variation. Our goal was to map candidate anthocyanin biosynthetic and regulatory genes in a population segregating for the red flesh phenotypes. RESULTS We have identified the Rni locus, a major genetic determinant of the red foliage and red colour in the core of apple fruit. In a population segregating for the red flesh and foliage phenotype we have determined the inheritance of the Rni locus and DNA polymorphisms of candidate anthocyanin biosynthetic and regulatory genes. Simple Sequence Repeats (SSRs) and Single Nucleotide Polymorphisms (SNPs) in the candidate genes were also located on an apple genetic map. We have shown that the MdMYB10 gene co-segregates with the Rni locus and is on Linkage Group (LG) 09 of the apple genome. CONCLUSION We have performed candidate gene mapping in a fruit tree crop and have provided genetic evidence that red colouration in the fruit core as well as red foliage are both controlled by a single locus named Rni. We have shown that the transcription factor MdMYB10 may be the gene underlying Rni as there were no recombinants between the marker for this gene and the red phenotype in a population of 516 individuals. Associating markers derived from candidate genes with a desirable phenotypic trait has demonstrated the application of genomic tools in a breeding programme of a horticultural crop species.

Mapping eQTLs in the Norfolk Island genetic isolate identifies candidate genes for CVD risk traits

Cardiovascular disease (CVD) affects millions of people worldwide and is influenced by numerous factors, including lifestyle and genetics. Expression quantitative trait loci (eQTLs) influence gene expression and are good candidates for CVD risk. Founder-effect pedigrees can provide additional power to map genes associated with disease risk. Therefore, we identified eQTLs in the genetic isolate of Norfolk Island (NI) and tested for associations between these and CVD risk factors. We measured genome-wide transcript levels of blood lymphocytes in 330 individuals and used pedigree-based heritability analysis to identify heritable transcripts. eQTLs were identified by genome-wide association testing of these transcripts. Testing for association between CVD risk factors (i.e., blood lipids, blood pressure, and body fat indices) and eQTLs revealed 1,712 heritable transcripts (p < 0.05) with heritability values ranging from 0.18 to 0.84. From these, we identified 200 cis-acting and 70 trans-acting eQTLs (p < 1.84 × 10(-7)) An eQTL-centric analysis of CVD risk traits revealed multiple associations, including 12 previously associated with CVD-related traits. Trait versus eQTL regression modeling identified four CVD risk candidates (NAAA, PAPSS1, NME1, and PRDX1), all of which have known biological roles in disease. In addition, we implicated several genes previously associated with CVD risk traits, including MTHFR and FN3KRP. We have successfully identified a panel of eQTLs in the NI pedigree and used this to implicate several genes in CVD risk. Future studies are required for further assessing the functional importance of these eQTLs and whether the findings here also relate to outbred populations.

Viability of Pseudomonas aeruginosa in cough aerosols generated by persons with cystic fibrosis

Background Person-to-person transmission of respiratory pathogens, including Pseudomonas aeruginosa, is a challenge facing many cystic fibrosis (CF) centres. Viable P aeruginosa are contained in aerosols produced during coughing, raising the possibility of airborne transmission. Methods Using purpose-built equipment, we measured viable P aeruginosa in cough aerosols at 1, 2 and 4 m from the subject (distance) and after allowing aerosols to age for 5, 15 and 45 min in a slowly rotating drum to minimise gravitational settling and inertial impaction (duration). Aerosol particles were captured and sized employing an Anderson Impactor and cultured using conventional microbiology. Sputum was also cultured and lung function and respiratory muscle strength measured. Results Nineteen patients with CF, mean age 25.8 (SD 9.2) years, chronically infected with P aeruginosa, and 10 healthy controls, 26.5 (8.7) years, participated. Viable P aeruginosa were detected in cough aerosols from all patients with CF, but not from controls; travelling 4 m in 17/18 (94%) and persisting for 45 min in 14/18 (78%) of the CF group. Marked inter-subject heterogeneity of P aeruginosa aerosol colony counts was seen and correlated strongly (r=0.73–0.90) with sputum bacterial loads. Modelling decay of viable P aeruginosa in a clinic room suggested that at the recommended ventilation rate of two air changes per hour almost 50 min were required for 90% to be removed after an infected patient left the room. Conclusions Viable P aeruginosa in cough aerosols travel further and last longer than recognised previously, providing additional evidence of airborne transmission between patients with CF.

Development and pilot study of the Primary Care Practice Improvement Tool (PC-PIT) : an innovative approach

Objective To assess the usability and validity of the Primary Care Practice Improvement Tool (PC-PIT), a practice performance improvement tool based on 13 key elements identified by a systematic review. It was co-created with a range of partners and designed specifically for primary health care. Design This pilot study examined the PC-PIT using a formative assessment framework and mixed-methods research design. Setting and participants Six high-functioning general practices in Queensland, Australia, between February and July 2013. A total of 28 staff participated — 10 general practitioners, six practice or community nurses, 12 administrators (four practice managers; one business manager and eight reception or general administrative staff). Main outcome measures Readability, content validity and staff perceptions of the PC-PIT. Results The PC-PIT offers an appropriate and acceptable approach to internal quality improvement in general practice. Quantitative assessment scores and qualitative data from all staff identified two areas in which the PC-PIT required modification: a reduction in the indicative reading age, and simplification of governance-related terms and concepts. Conclusion The PC-PIT provides an innovative approach to address the complexity of organisational improvement in general practice and primary health care. This initial validation will be used to develop a suite of supporting, high-quality and free-to-access resources to enhance the use of the PC-PIT in general practice. Based on these findings, a national trial is now underway.

A digital airport experience : design-led innovation in support of airport strategy

The digital era is proving to be one of disruption, where new technologies matched with innovative business models can be harnessed to attack even the most established of companies. For businesses with the relative certainty of captive customer bases, such as airports, the ability to digitally diversify offers the opportunity to venture into new modes of operation. For an airport, this opportunity can also be leveraged to sustain superior customer support regardless of a customer’s location in the world. This research paper presents a case study of the development of an Australian Airport Corporation’s mobile application as part of a greater digital strategy initiative using a design-led approach to innovate. An action research method provides the platform for an intensive embedded practice and study of design-led innovation within the major Australian Airport Corporation. The findings reveal design-led innovation to be a crucial in-house idea generation and concept development capability enabling the bridging of distinct corporate domains associated with commercialisation, operations and customer experience. A Digital Innovation Checklist is presented as an output of this research which structures an organizational approach toward digital channel innovation. The practitioner’s checklist is designed to aid in the future development of digital channels within the broader spectrum of strategy by addressing business assumptions.

Designing channels for brand value : four meta-models

Channels are becoming an increasingly important area for companies to innovate, specifically as they provide direct points of contact with their customers. However, little is known in regards to multi-channel strategies that embody strategic brand values and how customers experience these channels collectively. The purpose of this paper is to investigate how organisations configure multi- channel strategies to communicate their brand value and experience to their customers. Data was collated from sixty companies through a content analysis methodology within the retail sector. Results uncovered commonalities through the identification of four meta-models surrounding common brand values, intended emotive experience, individual channels and the customer segment. These meta-models are titled: High Quality, Trust, Convenience and Community. This research also presents implications of a multi-channel design tool based on findings from this study to help reinforce company brand values and design an overall connected customer experience.

Design innovation catalyst tools to facilitate organisational change

Organisations have recently looked to design to become more customer oriented and co-create a new kind of value and service offering. This requires changes in the organisation mindset, involving the entire company, innovation processes and often its business model. One tool that has been successful in facilitating this has been Osterwalder and Pigneur (2010) ‘Business Model Canvas’ and more importantly the design process that supports the use of this tool. The aim of this paper is to explore the role design tools play in the translation and facilitation process of innovation in firms. Six ‘Design Innovation Catalysts’ (Wrigley, 2013) were interviewed in regards to their approach and use of design tools in order to better facilitate innovation. Results highlight the value of tools expands beyond their intended use to include; facilitation of communicating, permission to think creatively, and learning and teaching through visualisation. Findings from this research build upon the role of the Design Innovation Catalyst and provide additional implications for organisations.