Who's really hypertensive? - Quality control issues in the assessment of blood pressure for randomized trials

The characterization of blood pressure in treatment trials assessing the benefits of blood pressure lowering regimens is a critical factor for the appropriate interpretation of study results. With numerous operators involved in the measurement of blood pressure in many thousands of patients being screened for entry into clinical trials, it is essential that operators follow pre-defined measurement protocols involving multiple measurements and standardized techniques. Blood pressure measurement protocols have been developed by international societies and emphasize the importance of appropriate choice of cuff size, identification of Korotkoff sounds, and digit preference. Training of operators and auditing of blood pressure measurement may assist in reducing the operator-related errors in measurement. This paper describes the quality control activities adopted for the screening stage of the 2nd Australian National Blood Pressure Study (ANBP2). ANBP2 is cardiovascular outcome trial of the treatment of hypertension in the elderly that was conducted entirely in general practices in Australia. A total of 54 288 subjects were screened; 3688 previously untreated subjects were identified as having blood pressure >140/90 mmHg at the initial screening visit, 898 (24%) were not eligible for study entry after two further visits due to the elevated reading not being sustained. For both systolic and diastolic blood pressure recording, observed digit preference fell within 7 percentage points of the expected frequency. Protocol adherence, in terms of the required minimum blood pressure difference between the last two successive recordings, was 99.8%. These data suggest that adherence to blood pressure recording protocols and elimination of digit preferences can be achieved through appropriate training programs and quality control activities in large multi-centre community-based trials in general practice. Repeated blood pressure measurement prior to initial diagnosis and study entry is essential to appropriately characterize hypertension in these elderly patients.

Ergonomic issues in team lifting

In this article we review and critique the current body of scientific knowledge regarding the use of team lifting including: (a) psychophysical studies of team lifting capacity, and (b) studies of manual handling, patient handling, and stretcher carriage performed by lifting teams. The consensus of the research literature is that team-lifting capacity is greater than the lifting capacity of an individual, but that the capacity of lifting teams is less than the summed capacity of individual team members. Further, biomechanical, psychophysical, and physiological stress tends to be reduced compared to the equivalent lifts and transfers performed by individuals. However, the stress associated with team lifting depends on a broad range of individual team member, load, task and environmental factors, which can interact in unexpected ways. Caution is therefore recommended against making broad assumptions regarding the use of team lifting. Future studies are needed to examine how effort and load are distributed among lifting team members, with emphasis on identifying factors that may increase the risk of injury.

Assisted reproductive technologies and equity of access issues

In Australia and other countries, certain groups of women have traditionally been denied access to assisted reproductive technologies (ARTs). These typically are single heterosexual women, lesbians, poor women, and those whose ability to rear children is questioned, particularly women with certain disabilities or who are older. The arguments used to justify selection of women for ARTs are most often based on issues such as scarcity of resources, and absence of infertility ( in lesbians and single women), or on social concerns: that it goes against nature''; particular women might not make good mothers; unconventional families are not socially acceptable; or that children of older mothers might be orphaned at an early age. The social, medical, legal, and ethical reasoning that has traditionally promoted this lack of equity in access to ARTs, and whether the criteria used for client deselection are ethically appropriate in any particular case, are explored by this review. In addition, the issues of distribution and just gatekeeping'' practices associated with these sensitive medical services are examined.

Safety issues in functional capacity evaluation: Findings from a trial of a new approach for evaluating clients with chronic back pain

Although safety is recognized as a critical issue in functional capacity evaluations (FCEs), it has rarely been investigated. This paper reports on the findings of a study which examined safety aspects of a new approach to FCE. Fourteen rehabilitation clients with chronic back pain participated in the study. Aspects examined included the pre-FCE screening procedures, the monitoring of performance and safety during the FCE, and the end of FCE measures and follow-up procedures. Support was found for the screening procedures of the approach, particularly blood pressure measurement, and for the combined approach to monitoring of the persons performance from biomechanical, physiological and psychophysical perspectives. Issues for FCE safety in general are identified and discussed, including the importance of screening procedures to determine readiness for FCEs and the issue of load handling in FCEs, especially in relation to clients with chronic back pain.

How useful is the genuine savings rate as a sustainability indicator for regions within countries? Australia and Queensland compared

This article shows how macroeconomic indicators of sustainable development can be applied to the Queensland economy. While recognising the complex and contentious theoretical and practical issues in deriving the Genuine Savings Rate (GSR) to serve as such an indicator, we use the World Bank's methodology, which includes only mineral depletion, deforestation and carbon dioxide emissions as environmental terms, to estimate GSRs for Queensland for the period 1989 to 1999, and compare these to World Bank estimates of Australia's GSR for the same period. We find that Queensland has a higher rate of natural resource depletion and a lower GSR than the whole of Australia. We also examine how well the World Bank GSR performs as a 'headline' measure of overall sustainability, review criticisms of the GSR, and compare its implicit policy implications with those of net state savings, and of the GSR plus a suite of other indicators.

Obesity in pre-school children: Issues and challenges for community based child health nurses

Childhood obesity is becoming a topical issue in both the health literature and the popular media and increasingly child health nurses are observing preschool children who appear to be disproportionately heavy for their height when plotted on standardised growth charts. In this paper literature related to childhood obesity in New Zealand and internationally is explored to identify current issues, and the implications of these issues for nurses in community based child health practice are discussed. Themes that emerged from the literature relate to the measurement of obesity, links between childhood and adult obesity and issues for families. A theme in the literature around maternal perception was of particular interest. Studies that investigated maternal perceptions of childhood obesity found that mothers identified their child as being overweight or obese only when it imposed limitations on physical activity or when the children were teased rather than by referring to individual growth graphs. The implications for nursing in the area of child health practice is discussed as nurses working in this area need an understanding of the complex and often emotive issues surrounding childhood obesity and an awareness of the reality of people's lives when devising health promotion strategies.

E-Government, targeting and data profiling: Policy and ethical issues of differential treatment

Networked information and communication technologies are rapidly advancing the capacities of governments to target and separately manage specific sub-populations, groups and individuals. Targeting uses data profiling to calculate the differential probabilities of outcomes associated with various personal characteristics. This knowledge is used to classify and sort people for differentiated levels of treatment. Targeting is often used to efficiently and effectively target government resources to the most disadvantaged. Although having many benefits, targeting raises several policy and ethical issues. This paper discusses these issues and the policy responses governments may take to maximise the benefits of targeting while ameliorating the negative aspects.

Major issues and solutions to applied climate education in Australia

In the past decade, Australian agriculture has evolved considerably. During this period, climate variability has been of considerable concern, compounded recently by the threat of climate change. Applied climate education has attempted to keep up-to-date with these developments. Understanding the issues and solutions to applied climate education is a challenge confronting agriculture in Australia. This paper reports on the major issues and solutions to applied climate education in Australia as identified in the literature.

Matching poultry production with available feed resources: issues and constraints

Corn and soyabeans may not be available in many countries particularly those which do not have sufficient foreign currency or the capacity to grow them. This paper outlines strategies that may be important under these circumstances. Alternative feedstuffs and various feeding systems may be used to support poultry production. Alternative ingredients such as rice bran, pearl millet, cottonseed meal and grain legumes are discussed. Evidence is presented showing that amino acid requirements of layers and broilers may be too generous particularly in countries where climate, management and disease can impose production constraints. The ability of finishing broilers to perform well on very low-energy diets allows the inclusion of alternative feeds and by-products into formulations. Very low protein diets based on cereals and free amino acids can be used for layers without loss of performance. Self-selection of feedstuffs may be an important strategy in reducing feed costs of broilers and layers. The concept of matching production with available feed resources may compromise broiler growth and egg production, but in many countries this may be the most economical choice. Countries in the humid tropics usually have reduced poultry performance. The effects of high temperature and humidity are difficult to overcome. The vexed questions of the escalation in the price of fossil fuel and the outbreak of avian influenza, both seemingly without a solution, are clouds hanging over an otherwise buoyant industry.

A review of the perceptual and cognitive issues associated with the use of head-up displays in commercial aviation

A head-up display (HUD) is a projection of symbology into the pilot's forward field of view that enables the pilot to monitor the instrumentation while, theoretically, also viewing the external domain. Although the HUD has been shown to improve flight performance, there are perceptual and cognitive issues that need to be addressed. This article reviews selected literature that investigates these issues and the possible solutions posed and identifies areas that remain in doubt.

Ethical issues in social research

There are numerous ethical issues that one must consider when developing a research project; however, much discussion about ethics in health research has focused on experimental studies such as clinical trials. As a result, there remains some ambiguity as to the ethical issues that need to be considered in health-related social research. This paper outlines a number of important ethical issues that CAM researchers should be aware of when developing, running and writing up social research. Maintaining high ethical standards is extremely important in social research as it protects participants and researchers, improves the quality of the data retrieved and ensures that future researchers will have access to participants within the community. (C) 2005 Elsevier Ltd. All rights reserved.

Individual or population approaches to the promotion of physical activity... is that the question?

A recent editorial raised several issues about the role of exercise physiologists in the fight against physical inactivity in Australia. This opinion piece argues that we must strive to work together in multidisciplinary groups to improve our understanding of the mechanisms which link PA and health and the ways to persuade people to become more active. Prescription of specific exercise programs supported by exercise physiologists is one strategy for helping to activate Australians, but it is unlikely that that this atone will have a significant impact on population health. If we are to activate the 10,000,000 Australians who are currently insufficiently active for health benefit, we will need the combined efforts of governments, NGOs, teachers, planners, marketing experts, veterinarians, and ALL our health professionals, to combine forces to activate Australia. (c) 2006 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Continuous plankton recorder database: history, current issues and future directions

The Continuous Plankton Recorder (CPR) survey, operated by the Sir Alister Hardy Foundation for Ocean Science (SAHFOS), is the largest plankton monitoring programme in the world and has spanned > 70 yr. The dataset contains information from -200 000 samples, with over 2.3 million records of individual taxa. Here we outline the evolution of the CPR database through changes in technology, and how this has increased data access. Recent high-impact publications and the expanded role of CPR data in marine management demonstrate the usefulness of the dataset. We argue that solely supplying data to the research community is not sufficient in the current research climate; to promote wider use, additional tools need to be developed to provide visual representation and summary statistics. We outline 2 software visualisation tools, SAHFOS WinCPR and the digital CPR Atlas, which provide access to CPR data for both researchers and non-plankton specialists. We also describe future directions of the database, data policy and the development of visualisation tools. We believe that the approach at SAHFOS to increase data accessibility and provide new visualisation tools has enhanced awareness of the data and led to the financial security of the organisation; it also provides a good model of how long-term monitoring programmes can evolve to help secure their future.

Is economic philosophy a subject worth teaching?

Economic philosophy is anything but a part of the mainstream diet in the course of an economics education. Yet there are those – including occasional Nobel prizewinners – who argue that an understanding of economic philosophy is absolutely fundamental to an understanding of economics, of why economists disagree and of why “economic rationalists” are often derided by those from other professional backgrounds. The argument put in this paper is that many social science debates hinge more on the values or social philosophy implicitly involved than on technical matters of economic 'science', and that a nuanced understanding of economics requires that each school of thought be traced back to its foundations in terms of its implicit economic philosophy a prioris.

The politics of Australian society: Political issues for the new century

The aim of this book is to assist those who want to understand and analyse social, political and economic issues. In this project we have drawn upon the resources of political science, which typically examines the interaction between political ideas, institutions and policies in its attempt to make sense of the society in which we live. The perspectives offered by political science are evident in the structure of contributions to the volume. The organising framework we have adopted emphasises the importance of political ideas in shaping the way we comprehend political issues; the centrality of political institutions in influencing the possibilities for and limits on politics; and how present and past policies determine the context and direction of the solutions to political problems. This second edition expands upon out original brief. Where we have retained certain topics, the chapters have all been revised and updated. There are also a number of new chapters in each section that deal with significant political doctrines, institutions and policies.