Inequitable distribution of general practitioners in Australia: estimating need through the Robin Hood Index

Objective: From Census data, to document the distribution of general practitioners in Australia and to estimate the number of general practitioners needed to achieve an equitable distribution accounting for community health need. Methods: Data on location of general practitioners, population size and crude mortality by statistical division (SD) were obtained from the Australian Bureau of Statistics. The number of patients per general practitioner by SD was calculated and plotted. Using crude mortality to estimate community health need, a ratio of the number of general practitioners per person:mortality was calculated for all Australia and for each SD (the Robin Hood Index). From this, the number of general practitioners needed to achieve equity was calculated. Results: In all, 26,290 general practitioners were identified in 57 SDs. The mean number of people per general practitioner is 707, ranging from 551 to 1887. Capital city SDs have most favourable ratios. The Robin Hood Index for Australia is 1, and ranges from 0.32 (relatively under-served) to 2.46 (relatively over-served). Twelve SDs (21%) including all capital cities and 65% of all Australians, have a Robin Hood Index > 1. To achieve equity per capita 2489 more general practitioners (10% of the current workforce) are needed. To achieve equity by the Robin Hood Index 3351 (13% of the current workforce) are needed. Conclusions: The distribution of general practitioners in Australia is skewed. Nonmetropolitan areas are relatively underserved. Census data and the Robin Hood Index could provide a simple means of identifying areas of need in Australia.

Discovery and characterization of a family of insecticidal neurotoxins with a rare vicinal disulfide bridge

We have isolated a family of insect-selective neurotoxins from the venom of the Australian funnel-web spider that appear to be good candidates for biopesticide engineering. These peptides, which we have named the Janus-faced atracotoxins (J-ACTXs), each contain 36 or 37 residues, with four disulfide bridges, and they show no homology to any sequences in the protein/DNA databases. The three-dimensional structure of one of these toxins reveals an extremely rare vicinal disulfide bridge that we demonstrate to be critical for insecticidal activity. We propose that J-ACTX comprises an ancestral protein fold that we refer to as the disulfide-directed beta-hairpin.

Coupled experimental and thermodynamic modeling studies for metallurgical smelting and coal combustion slag systems

An extensive research program focused on the characterization of various metallurgical complex smelting and coal combustion slags is being undertaken. The research combines both experimental and thermodynamic modeling studies. The approach is illustrated by work on the PbO-ZnO-Al2O3-FeO-Fe2O3-CaO-SiO2 system. Experimental measurements of the liquidus and solidus have been undertaken under oxidizing and reducing conditions using equilibration, quenching, and electron probe X-ray microanalysis. The experimental program has been planned so as to obtain data for thermodynamic model development as well as for pseudo-ternary Liquidus diagrams that can be used directly by process operators. Thermodynamic modeling has been carried out using the computer system FACT, which contains thermodynamic databases with over 5000 compounds and evaluated solution models. The FACT package is used for the calculation of multiphase equilibria in multicomponent systems of industrial interest. A modified quasi-chemical solution model is used for the liquid slag phase. New optimizations have been carried out, which significantly improve the accuracy of the thermodynamic models for lead/zinc smelting and coal combustion processes. Examples of experimentally determined and calculated liquidus diagrams are presented. These examples provide information of direct relevance to various metallurgical smelting and coal combustion processes.

Indicators used to measure the innovation process: defects and possible remedies

Some diverse indicators used to measure the innovation process are considered, They include those with art aggregate, and often national, focus, and rely on data from scientific publications, patents and R&D expenditures, etc. Others have a firm-level perspective, relying primarily on surveys or case studies. Also included are indicators derived from specialized databases, or consensual agreements reached through foresight exercises. There is an obvious need for greater integration of the various approaches to capture move effectively the richness of available data and better reflect the reality of innovation. The focus for such integration could be in the area of technology strategy, which integrates the diverse scientific, technological, and innovation activities of firms within their operating environments; improved capacity to measure it has implications for policy-makers, managers and researchers.

Assessing perceived need for mental health care in a community survey: development of the Perceived Need for Care Questionnaire (PNCQ)

Background: The Perceived Need for Care Questionnaire (PNCQ) was designed for the Australian National Survey of Mental Health and Wellbeing. The PNCQ complemented collection of data on diagnosis and disability with the survey participants' perceptions of their needs for mental health care and the meeting of those needs. The four-stage design of the PNCQ mimics a conversational exploration of the topic of perceived needs. Five categories of perceived need are each assigned to one of four levels of perceived need (no need, unmet need, partially met need and met need). For unmet need and partially met need, information on barriers to care is collected, Methods: Inter-rater reliabilities of perceived needs assessed by the PNCQ were examined in a study of 145 anxiety clinic attenders. Construct validity of these items was tested, using a multi-trait multi-method approach and hypotheses regarding extreme groups, in a study with a sample of 51 general practice and community psychiatric service patients. Results: The instrument is brief to administer and has proved feasible for use in various settings. Inter-rater reliabilities for major categories, measured by the kappa statistic, exceeded 0.60 in most cases; for the summary category of all perceived needs, inter-rater reliability was 0.62. The multi-trait multi-method approach lent support to the construct validity of the instrument, as did findings in extreme groups. Conclusions: The PNCQ shows acceptable feasibility, reliability and validity, adding to the range of assessment tools available for epidemiological and health services research.

MHCWeb: Converting a WWW database into a knowledge-based collaborative environment

The World Wide Web (WWW) is useful for distributing scientific data. Most existing web data resources organize their information either in structured flat files or relational databases with basic retrieval capabilities. For databases with one or a few simple relations, these approaches are successful, but they can be cumbersome when there is a data model involving multiple relations between complex data. We believe that knowledge-based resources offer a solution in these cases. Knowledge bases have explicit declarations of the concepts in the domain, along with the relations between them. They are usually organized hierarchically, and provide a global data model with a controlled vocabulary, We have created the OWEB architecture for building online scientific data resources using knowledge bases. OWEB provides a shell for structuring data, providing secure and shared access, and creating computational modules for processing and displaying data. In this paper, we describe the translation of the online immunological database MHCPEP into an OWEB system called MHCWeb. This effort involved building a conceptual model for the data, creating a controlled terminology for the legal values for different types of data, and then translating the original data into the new structure. The 0 WEB environment allows for flexible access to the data by both users and computer programs.

Computational immunology: The coming of age

The explosive growth in biotechnology combined with major advancesin information technology has the potential to radically transformimmunology in the postgenomics era. Not only do we now have readyaccess to vast quantities of existing data, but new data with relevanceto immunology are being accumulated at an exponential rate. Resourcesfor computational immunology include biological databases and methodsfor data extraction, comparison, analysis and interpretation. Publiclyaccessible biological databases of relevance to immunologists numberin the hundreds and are growing daily. The ability to efficientlyextract and analyse information from these databases is vital forefficient immunology research. Most importantly, a new generationof computational immunology tools enables modelling of peptide transportby the transporter associated with antigen processing (TAP), modellingof antibody binding sites, identification of allergenic motifs andmodelling of T-cell receptor serial triggering.

The incidence of schizophrenia: A systematic review

There has been a debate on whether or not the incidence of schizophrenia varies across time and place. In order to optimise the evidence upon which this debate is based, we have undertaken a systematicsystematic review of the literature. In this paper we provide an overview of the methods of the review and a preliminary analysis of the studies identified to date. Electronic databases (Medline, Psychlnfo, Embase, LILAC) were systematically searched for articles published between January 1965 and December 2001. The search terms were: (schizo* OR psycho*)AND (incidence OR prevalence). References were also identified from review articles, reference list and by writing to authors. To date we have identified 137 papers drawn from 33 nations. 37 papers in language other than English await translation. The currently included papers have generated 1413 different items of rate information data. In order to analyze these data we have undertaken several sequential filters in order to identify (a) non-overlapping data, (b) birth cohort study versus noncohort studies, (c) overall and sex-specific rates, (d) diagnostic criteria, (e) age ranges, (f) epoch of study, and (g) data on migrant or other special interest groups. In addition, we will examine the impact of urbanicity of site, age and/or sex standardization, and quality score on the incidence rates. The various discrete incidence rates will be presented graphically and the impact of various filters on these rates will be inspected using meta-analytic techniques. The use of meta-analysis may help elucidate the epidemiological landscape with respect to the incidence of schizophrenia and aid in the generation of new hypothesis. Acknowledgements: The Stanley Medical Research Institute supported project

Bioinformatics for characterisation of allergens, allergenicity and allergic crossreactivity

Allergies are a major cause of chronic ill health in industrialised countries with the incidence of reported cases steadily increasing. This Research Focus details how bioinformatics is transforming the field of allergy through providing databases for management of allergen data, algorithms for characterisation of allergic crossreactivity, structural motifs and B- and T-cell epitopes, tools for prediction of allergenicity and techniques for genomic and proteomic analysis of allergens.

Identification of a minimal promoter sequence for the human N-acetyltransferase Type I gene that binds AP-1 (activator protein 1) and YY-1 (Yin and Yang 1)

Human N-acetyltransferase Type I (NAT1) catalyses the acetylation of many aromatic amine and hydrazine compounds and it has been implicated in the catabolism of folic acid. The enzyme is widely expressed in the body, although there are considerable differences in the level of activity between tissues. A search of the mRNA databases revealed the presence of several NAT1 transcripts in human tissue that appear to be derived from different promoters. Because little is known about NAT1 gene regulation, the present study was undertaken to characterize one of the putative promoter sequences of the NAT1 gene located just upstream of the coding region. We show with reverse-transcriptase PCR that mRNA transcribed from this promoter (Promoter 1) is present in a variety of human cell-lines, but not in quiescent peripheral blood mononuclear cells. Using deletion mutant constructs, we identified a 20 bp sequence located 245 bases upstream of the translation start site which was sufficient for basal NAT1 expression. It comprised an AP-1 (activator protein 1)-binding site, flanked on either side by a TCATT motif. Mutational analysis showed that the AP-1 site and the 3' TCATT sequence were necessary for gene expression, whereas the 5' TCATT appeared to attenuate promoter activity. Electromobility shift assays revealed two specific bands made up by complexes of c-Fos/Fra, c-Jun, YY-1 (Yin and Yang 1) and possibly Oct-1. PMA treatment enhanced expression from the NAT1 promoter via the AP-1-binding site. Furthermore, in peripheral blood mononuclear cells, PMA increased endogenous NAT1 activity and induced mRNA expression from Promoter I, suggesting that it is functional in vivo.

The ambivalent practices of reflexivity

Reflexivity involves turning one's reflexive gaze oil discourse-turning language back on itself to see the Work it does in constituting the world. The subject/researcher sees simultaneously the object of her or his gaze and the means by which the object (which may include oneself as subject) is being constituted. The consciousness of self that reflexive writing sometimes entails may be seen to slip inadvertently into constituting the very (real) self that seems to contradict a focus on the constitutive power of discourse. This article explores this site of slippage and of ambivalence. In a collective biography oil the topic of reflexivity, the authors tell and write stories about reflexivity and in a doubled reflexive arc, examine themselves at work during the workshop. Examining their own memories and reflexive practices, they explore this place of slippage and provide theoretical and practical insight into what is going on in reflexive research and writing.

Computational methods for prediction of T-cell epitopes - a framework for modelling, testing, and applications

Computational models complement laboratory experimentation for efficient identification of MHC-binding peptides and T-cell epitopes. Methods for prediction of MHC-binding peptides include binding motifs, quantitative matrices, artificial neural networks, hidden Markov models, and molecular modelling. Models derived by these methods have been successfully used for prediction of T-cell epitopes in cancer, autoimmunity, infectious disease, and allergy. For maximum benefit, the use of computer models must be treated as experiments analogous to standard laboratory procedures and performed according to strict standards. This requires careful selection of data for model building, and adequate testing and validation. A range of web-based databases and MHC-binding prediction programs are available. Although some available prediction programs for particular MHC alleles have reasonable accuracy, there is no guarantee that all models produce good quality predictions. In this article, we present and discuss a framework for modelling, testing, and applications of computational methods used in predictions of T-cell epitopes. (C) 2004 Elsevier Inc. All rights reserved.

Re-integration into work

This is the first complete textbook designed for physiotherapists and occupational therapists on the topic of pain. It was developed for use in conjunction with the International Association for the Study of Pain's pain curriculum for OTs and PTs. The book addresses the nature of pain, the neuroanatomical and neurophysiological substrates of pain, the psychological... More aspects of pain, the lifespan approach to pain, pain measurement, pain and placebo, modalities for treating pain, and special topics in pain. It provides an overview of the physiological, psychosocial, and environmental aspects of pain experience across the lifespan. Aimed primarily at OTs and PTs the assessment and interventions issues pertaining to the perspectives of each profession are discussed in detail. The book is also relevant to the other health professions involved in pain management or intending to work in this area.

Guiding intellectual and personal growth across educational contexts

This book recognizes the importance of cooperative learning, in contrast to the traditional classroom, as an effective approach to learning. Its coverage of the subject ranges across the educational spectrum, from pre-school years to university, and offers a fresh perspective on a topic that has gained increasing interest worldwide. With contributions from an international panel of leading experts in the field, this engaging text succeeds in providing key insights, linking the theories that underpin the study of group dynamics to their practical application in the classroom. It presents a comprehensive overview of this alternative educative approach, illustrating how cooperative learning experiences can promote socialisation and friendships, and facilitate learning. The editors assemble a range of well-researched essays, covering such aspects as: * The importance of teacher and student interaction * Small group, virtual and non-virtual teaching environments * Assessment practices for measuring the outcomes of individual and group progress * The effect of cooperative learning on relationships amongst students with diverse cultural, social and learning needs. Illustrated with practical examples throughout, this book will be a crucial read for teacher educators, educational psychologists, student teachers, academics and researchers who want to realize the significant potential of cooperative learning in all educational settings.

Conclusion

Teleneurology is the use of telecommunications to improve the delivery of neurology services. A wide range of telecommunications techniques may be used, including the telephone, email, the Internet and videoconferencing. Teleneurology can improve access to specialist neurological services for patients all over the world. Teleneurology also deals with more specialized fields that are of interest to the neurological practitioner, such as neurophysiology and neuroradiology. The book combines comprehensive reviews of each topic with practical advice on all available telemedicine techniques and on navigating the Internet for the most up-to-date neurological information. The fifth in a line of best selling telemedicine titles edited by Richard Wootton, Teleneurology is written by experts from four continents, providing a succinct introduction to teleneurology. It should prove invaluable for practising neurologists in particular, but also for general practitioners, paramedical staff, health service managers and IT staff. [via]