Audit and comprehensive health assessment programme in the primary healthcare of adults with intellectual disability: a pilot study

International research has demonstrated significant shortcomings in the health of adults with intellectual disability (ID). Because general practitioners (GPs) are the main providers of primary healthcare for this population, strategies to improve general practice care are an important aspect of rectifying these shortcomings. The present pilot study aimed to determine the effect of various interventions on health maintenance activities and to assess their acceptability to GPs, with a view to informing larger scale studies. The GPs were recruited through an earlier questionnaire-based postal survey. The GPs identified all their adult patients with ID, then obtained consent for participation from three patients randomly selected by the investigators. The GPs completed two self-evaluation forms and case note audits 12 months apart, read a synopsis of the relevant literature provided by the researchers, and completed a comprehensive health assessment (CHA) of their three patients. Forty-five GPs agreed to participate in the CHA programme (CHAP), and 15 completed the project. Thirty-eight patients completed the project. The number of patient-GP dyads who completed the project was too small to demonstrate statistically significant changes in health issues over time. The GPs found that the synopsis of the literature was the best intervention for increasing knowledge and was also the most practical to use in general practice. The CHAP was the intervention that prompted the most action from the GP which would not have been undertaken otherwise. The CHAP appeared to provide a superior review process compared to the other interventions used in the present study. The numbers of health maintenance activities found to be overdue and the number of health issues detected as a result of the process were considerable. The CHAP served as a communication tool and an educative instrument, providing a basis for future studies and strategies to improve the general practice care of adults with ID.

Information internalisation in internationalising the firm

Internationalisation occurs when the firm expands its selling, production, or other business activities into international markets. Many enterprises, especially small- and medium-size firms (SMEs), are internationalising today at an unprecedented rate. Managers are strategically using information to achieve degrees of internationalisation previously considered the domain of large firms. We extend existing explanations of firm internationalisation by examining the nature and fundamental, antecedent role of internalising appropriate information and translating it into relevant knowledge. Based on case studies of internationalising firms, we advance a conceptualisation of information internalisation and knowledge creation within the firm as it achieves internationalisation readiness. In the process, we offer several propositions intended to guide future research. (C) 2002 Elsevier Science Inc. All rights reserved.

The future role of government in knowledge-based economies

In this article, we draw together aspects of contemporary theories of knowledge (particularly organisational knowledge) and complexity theory to demonstrate how appropriate conceptual rigor enables both the role of government and the directions of policy development in knowledge-based economies to be identified. Specifically we ask, what is the role of government in helping shape the knowledge society of the future? We argue that knowledge policy regimes must go beyond the modes of policy analysis currently used in innovation, information and technology policy because they are based in an industrial rather than post-industrial analytical framework. We also argue that if we are to develop knowledge-based economies, more encompassing images of the future than currently obtain in policy discourse are required. We therefore seek to stimulate and provoke an array of lines of thought about government and policy for such economies. Our objective is to focus on ideas more than argument and persuasion.

What is the value of firms' prior knowledge? Building organisational knowledge capabilities

A firm's prior knowledge facilitates the absorption of new knowledge, thereby renewing a firm's systematic search, transfer and absorption capabilities. The rapidly expanding field of biotechnology is characterised by the convergence of disparate sciences and technologies. This paper, the shift from proteinbased to DNA-based diagnostic technologies, quantifies the value of a firm's prior knowledge and its relation to future knowledge development. Four dimensions of diagnostic and four dimensions of knowledge in biotechnology firms are analysed. A simple scaled matrix method is developed to quantify the positive and negative heuristic values of prior scientific and technological knowledge that is useful for the acquisition and absorption of new knowledge.

Dispersal strategies in Tasmanian native hens (Gallinula mortierii)

Individuals in cooperatively breeding species face a complex set of decisions when they reach reproductive maturity. During an 8-year study, we examined the histories of 214 Tasmanian native hens (Gallinula mortierii) from hatching to examine the strategies they used to acquire breeding positions and the reproductive success they experienced in those breeding positions. Two-thirds of young delayed dispersal from their natal groups for at least a year. Ecological constraints were a partial cause of delayed dispersal; high-quality territories were rare and remained occupied due to high adult survivorship. There were also clear benefits of philopatry. Individuals that inherited breeding positions on their natal territories gained better quality positions and experienced higher reproductive success in their first breeding attempts than did individuals who dispersed to other groups. Multivariate analyses showed that the method of acquisition of breeding positions was the only factor significantly related to the quality of the breeding positions attained. Males were more likely to inherit breeding positions in their natal groups than were females. The compositions of individuals' natal groups had no effect on whether they inherited breeding positions or dispersed. In contrast, the compositions of groups did appear to affect whether other birds dispersed into them, with birds rarely moving into groups that contained breeders or nonbreeders of the same sex as the potential dispersers. Short-term removals of breeders confirmed this finding. These results suggest that both ecological constraints and benefits of philopatry explain delayed dispersal in this species.

Convergent maternal care strategies in ungulates and macropods

Mammals show extensive interspecific variation in the form of maternal care. Among ungulates, there is a dichotomy between species in which offspring follow the mother (following strategy) versus species in which offspring remain concealed (hiding strategy). Here we reveal that the same dichotomy exists among macropods (kangaroos, wallabies and allies). We test three traditional adaptive explanations and one new life history hypothesis. and find very similar patterns among both ungulates and macropods. The three traditional explanations that we tested were that a ''following'' strategy is associated with (1) open habitat, (2) large mothers, and (3) gregariousness. Our new life-history hypothesis is that a following strategy'' is associated with delayed weaning, and thus with the slow end of the slow-fast mammalian life-history continuum, because offspring devote resources to locomotion rather than rapid growth. Our comparative test strongly supports the habitat structure hypothesis and provides some support for this new delayed weaning hypothesis for both ungulates and macropods. We propose that sedentary young in closed habitats benefit energetically by having milk brought to them. In open habitats, predation pressure will select against hiding. Followers will suffer slower growth to independence. Taken together, therefore, our results provide the first quantitative evidence that macropods and ungulates are convergent with respect to interspecific variation in maternal care strategy. In both clades, differences between species in the form of parental care are due to a similar interaction between habitat, social behavior, and life history.

Pro re nata medication for psychoses: the knowledge and beliefs of doctors and nurses

Objective: To examine the knowledge and beliefs of doctors and nurses in inpatient psychiatric units about pro re nata (PRN) (as needed) medications for psychotic disorders. Methods: Medical (n = 44) and nursing (n = 80) staff in two metropolitan public hospital units completed a structured questionnaire about their use of PRN psychotropic medications on one occasion during the four months from March-June 1999. Results: Nurses selected more indications for PRN antipsychotics than doctors (3.49 vs 2.72, p < 0.05), whereas doctors selected more indications for PRN benzodiazepines (3.77 vs 3.19, p < 0.05). The groups did not differ in the number of selected indications for using anticholinergics. For agitation, the majority of nurses viewed both benzodiazepines (56%) and antipsychotics (86%) as effective, with 60% preferring an antipsychotic. For the acute control of psychotic symptoms, 99% of nurses believed antipsychotics were effective and 58% benzodiazepines, with 87% preferring an antipsychotic. A large majority of doctors viewed both PRN benzodiazepines, 94% ,and antipsychotics, 81%, as effective for agitation, and 55% preferred to use a benzodiazepine. For psychotic symptoms, 80% believed PRN antipsychotics were effective, but only 32% viewed benzodiazepines as effective, and 64% preferred to use an antipsychotic. Nursing staff identified more non-pharmacological techniques for managing both agitation and psychotic symptoms and reported using these more often than doctors. Junior staff, both nursing and medical, had less knowledge of non-pharmacological alternatives to PRN medication than senior staff. Conclusions: Disparities existed between doctors and nurses views on the indications for PRN medication in the acute management of psychoses, thus it is important for doctors to specify indications when writing PRN prescriptions. Despite evidence for the safety and effectiveness of benzodiazepines, there was widespread reluctance to use them as PRN medication in acute psychoses. Beliefs of some staff about PRN medications were at odds with the known properties of these medicines. Educational interventions for both nurses and doctors are required to achieve best practice in PRN medication.

The politics of reintegrating Australian Aboriginal and American Indian indigenous knowledge into resource management: The dynamics of resource appropriation and cultural revival

As the United States and Australia struggle with contemporary crises over competing uses of rapidly depleting natural resources, there are striking parallels between American Indian and Australian Aboriginal communities demanding a place at the management table and offering culturally based understandings of and solutions for the ecosystems at risk. These efforts to integrate indigenous knowledge into mainstream natural resource management are part of larger legal and political debates over land tenure, the locus of control, indigenous self-governance, and holistic ecosystems management.

Global distribution and genetic discontinuities of mangroves - emerging patterns in the evolution of Rhizophora

Mangroves are often described as a group of plants with common features and common origins based mostly on their broad distributional patterns, together with an erroneous view of comparable abilities in long-distance dispersal. However, whilst mangroves have common needs to adapt to rigorous environmental constraints associated with regular seawater inundation, individual taxa have developed different strategies and characteristics. Since mangroves are a genetically diverse group of mostly flowering plants, they may also have evolved at quite different geological periods, dispersed at different rates from different locations and developed different adaptive strategies. Current distributions of individual taxa show numerous instances of unusual extant distribution which demonstrate finite dispersal limitations, especially across open water. Our preliminary assessment of broad distribution and discontinuities reveals important patterns. Discontinuities, in the absence of current dispersal barriers, may be explained by persistent past barriers. As we learn more about discontinuities, we are beginning to appreciate their immense implications and what they might tell us about past geological conditions and how these might have influenced the distribution and evolution of mangroves. In this article, we describe emerging patterns in genetic relationships and distributions based on both current knowledge and preliminary results of our studies of molecular and morphometric characteristics of Rhizophora species in the Indo West Pacific region.