An analysis of the images attached to referral messages in an e-mail based telemedicine system for developing countries

Little is known about the quality of the images transmitted in email telemedicine systems. The present study was designed to survey the quality of images transmitted in the Swinfen Charitable Trust email referral system. Telemedicine cases were examined for a 3 month period in 2002 and a 3 month period in 2006. The number of cases with images attached increased from 8 (38%) to 37 (53%). There were four types of images (clinical photographs, microscope pictures, notes and X-ray images) and the proportion of radiology images increased from 27 to 48%. The cases in 2002 came from four different hospitals and were associated with seven different clinical specialties. In 2006, the cases came from 19 different hospitals and 20 different specialties. The 46 cases (from both study periods) had a total of 159 attached images. The quality of the images was assessed by awarding each image a score in four categories: focus, anatomical perspective, composition and lighting. The images were scored on a five-point scale (1 = very poor to 5 =very good) by a qualified medical photographer. In comparing image quality between the two study periods, there was some evidence that the quality had reduced, although the average size of the attached images had increased. The median score for all images in 2002 was 16 (interquartile range 14-19) and the median score in 2006 was 15 (13-16). The difference was significant (P < 0.001, Mann-Whitney test).

Ethics and health systems research in 'post'-conflict situations

Although considerable attention has been given to ethical issues related to clinical research in developing countries, in particular related to HIV therapy, there has been limited focus on health systems research, despite its increasing importance in the light of current trends in development assistance. This paper examines ethical issues related to health systems research in 'post'-conflict situations, addressing both generic issues for developing countries and those issues specific to 'post'-conflict societies, citing examples from the author's Cambodian experience. It argues that the destruction of health infrastructure results in a loss of structures and processes that would otherwise protect prospective research subjects who are part of vulnerable populations. It identifies the growth of health systems research as part of a trend towards sectoral and programmatic development assistance, the emergence of 'knowledge generation' as a form of research linked to development, and the potential for conflict where multilateral and bilateral donors are both primary funders and users of health systems research. It also examines the position of the health system researcher in relation to the sponsors of this research, and the health system being analysed.

Complexity, conflict and uncertainty: Issues in collaboration between child protection and mental health services

This paper provides an analysis of data from a state-wide survey of statutory child protection workers, adult mental health workers, and child mental health workers. Respondents provided details of their experience of collaboration on cases where a parent had mental health problems and there were serious child protection concerns. The survey was conducted as part of a large mixed-method research project on developing best practice at the intersection of child protection and mental health services. Descriptions of 300 cases were provided by 122 respondents. Analyses revealed that a great deal of collaboration occur-red across a wide range of government and community-based agencies; that collaborative processes were often positive and rewarding for workers; and that collaboration was most difficult when the nature of the parental mental illness or the need for child protection intervention was contested. The difficulties experienced included communication, role clarity, competing primary focus, contested parental mental health needs, contested child protection needs, and resources. (C) 2004 Elsevier Ltd. All rights reserved.

Attracting, recruiting and retaining male teachers: policy issues in the male teacher debate

Frequent calls for more male teachers are being made in English-speaking countries. Many of these calls are based upon the fact that the teaching profession has become (even more) 'feminized' and the presumption that this has had negative effects for the education of boys. The employment of more male teachers is sometimes suggested as a way to re-masculinize schools so they become more 'boy-friendly' and thus contribute to improving boys' school performance. The focus of this paper is on an Australian education policy document in the state of Queensland that is concerned with the attraction, recruitment and retention of male teachers in the government education system. It considers the failure of this document, as with many of the calls for more male teachers, to take into account complex matters of gender raised by feminism and the sociology of masculinities. The paper then critiques the primary argument given for the need for more male teachers: that is, that male teachers provide boys with much needed role models.

Lessons in ethnonephrology

Only recently has the nephrology community moved beyond a fairly singular focus on terminal kidney failure to embrace population-based studies of earlier stages of disease, its markers and risk factors, and of interventions. Observations in developing countries, and in minority, migrant, and disadvantaged groups in westernized countries, have promoted these developments. We are only beginning to interpret renal disease in the context of public health history, social and health transitions, changing population demography, and competing mortality. Its intimate relationships to other health issues are being progressively exposed. Perspectives on the multideterminant etiology of most disease and the pedestrian nature of most risk factors are maturing. We are challenged to reconcile epidemiologic patterns with morphology in diseased renal tissue, and to consider structural markers, such as nephron number and glomerular size, as determinants of disease susceptibility. New work force models are mandated for population-based studies and intervention programs. Intervention programs need to be integrated with other chronic disease initiatives and nested in a matrix of systematic primary care, and although flexible to changing needs, must be sustained over the long term. Cross-disciplinary collaboration is essential in designing those programs, and in promoting them to health-care funders. Substantial expansion and restructuring of the discipline is needed for the nephrology community to participate effectively in those processes.

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.

Energy consumption, economic growth and prices: A reassessment using panel VECM for developed and developing countries

This paper reinvestigates the energy consumption-GDP growth nexus in a panel error correction model using data on 20 net energy importers and exporters from 1971 to 2002. Among the energy exporters, there was bidirectional causality between economic growth and energy consumption in the developed countries in both the short and long run, while in the developing countries energy consumption stimulates growth only in the short run. The former result is also found for energy importers and the latter result exists only for the developed countries within this category. In addition, compared to the developing countries, the developed countries' elasticity response in terms of economic growth from an increase in energy consumption is larger although its income elasticity is lower and less than unitary. Lastly. the implications for energy policy calling for a more holistic approach are discussed. (c) 2006 Elsevier Ltd. All rights reserved.

Major issues in business process management: An Australian perspective

Business Process Management (BPM) is widely seen as the top priority in organizations wanting to survive competitive markets. However, the current academic research agenda does not seem to map with industry demands. In this paper, we address the need to identify the actual issues that organizations face in their efforts to manage business processes. To that end, we report a number of critical issues identified by industry in what we consider to be the first steps towards an industry-driven research agenda for the BPM area. The reported issues are derived from a series of focus groups conducted with Australian organizations. The findings point to, among others, a need for more consolidated efforts in the areas of business process governance, systematic change management, developing BPM methodologies, and introducing appropriate performance measures.