Self-help organisations: A qualitative study of successful collaboration with general practice

Thousands of self-help organisations (SHOs) exist in Australia but little is known about how they relate to the mainstream health care system. This qualitative study, based in south-east Queensland, aimed to identify examples of collaboration between general practitioners (GPs) and SHOs in order to examine the attributes of successful partnerships. Representatives of six SHOs, identified by key informants as having good collaborative links with GPs, and seven GPs with whom they collaborated, completed semi-structured interviews. The interviews focused on evidence of collaboration and perceptions of benefits and barriers experienced. Maximum variation sampling enabled a cross-section of SHOs in terms of size, funding, and health issue. Although GPs readily identified SHO benefits, they referred patients to them only rarely. SHO credibility, evidence of tangible benefits for patients, ease of contacting the SHO, and correspondence between the SHO?s focus and the GP?s personal and professional interests appear to contribute to the success of partnerships. We conclude that mutually beneficial partnerships between GPs and SHOs exist but are under-utilised. A more coordinated effort is needed to strengthen links between the two sectors.

Suitability of acoustic perturbation measures in analysing periodic and nearly periodic voice signals

In recent years, acoustic perturbation measurement has gained clinical and research popularity due to the ease of availability of commercial acoustic analysing software packages in the market. However, because the measurement itself depends critically on the accuracy of frequency tracking from the voice signal, researchers argue that perturbation measures are not suitable for analysing dysphonic voice samples, which are aperiodic in nature. This study compares the fundamental frequency, relative amplitude perturbation, shimmer percent and noise-to-harmonic ratio between a group of dysphonic and non-dysphonic subjects. One hundred and twelve dysphonic subjects ( 93 females and 19 males) and 41 non-dysphonic subjects ( 35 females and 6 males) participated in the study. All the 153 voice samples were categorized into type I ( periodic or nearly periodic), type II ( signals with subharmonic frequencies that approach the fundamental frequency) and type III ( aperiodic) signals. Only the type I ( periodic and nearly periodic) voice signals were acoustically analysed for perturbation measures. Results revealed that the dysphonic female group presented significantly lower fundamental frequency, significantly higher relative amplitude perturbation and shimmer percent values than the non-dysphonic female group. However, none of these three perturbation measures were able to differentiate between male dysphonic and male non-dysphonic subjects. The noise-to-harmonic ratio failed to differentiate between the dysphonic and non-dysphonic voices for both gender groups. These results question the sensitivity of acoustic perturbation measures in detecting dysphonia and suggest that contemporary acoustic perturbation measures are not suitable for analysing dysphonic voice signals, which are even nearly periodic. Copyright (C) 2005 S. Karger AG, Basel.

Early practical experience and the social responsiveness of clinical education: Systematic review

Objectives To find how early experience in clinical and community settings (early experience) affects medical education, and identify strengths and limitations of the available evidence. Design A systematic review rating, by consensus, the strength and importance of outcomes reported in the decade 1992-2001. Data sources Bibliographical databases and journals were searched for publications on the topic, reviewed under the auspices of the recently formed Best Evidence Medical Education (BEME) collaboration. Selection of studies All empirical studies (verifiable, observational data) were included, whatever their design, method, or language of publication. Results Early experience was most commonly provided in community settings, aiming to recruit primary care practitioners for underserved populations. It increased the popularity of primary care residencies, albeit among self selected students. It fostered self awareness and empathic attitudes towards ill people, boosted students' confidence, motivated them, gave them satisfaction, and helped them develop a professional identity. By helping develop interpersonal skills, it made entering clerkships a less stressful experience. Early experience helped students learn about professional roles and responsibilities, healthcare systems, and health needs of a population. It made biomedical, behavioural, and social sciences more relevant and easier to learn. It motivated and rewarded teachers and patients and enriched curriculums. In some countries,junior students provided preventive health care directly to underserved populations. Conclusion Early experience helps medical students learn, helps them develop appropriate attitudes towards their studies and future practice, and orientates medical curriculums towards society's needs. Experimental evidence of its benefit is unlikely to be forthcoming and yet more medical schools are likely to provide it. Effort could usefully be concentrated on evaluating the methods and outcomes of early experience provided within non-experimental research designs, and using that evaluation to improve the quality of curriculums.

Allozyme electrophoresis still represents a powerful technique in the management of coral reefs

Understanding genetic variability and gene flow between populations of scleractinian corals separated by one to several hundred kilometers is crucially important as we head into a century of climate change in which an understanding of the connectivity of populations is a critically important question in management. Genetic methods that directly use molecular variance in the DNA should offer greater precision in detecting differences among individuals and populations than the more traditional allozyme electrophoresis. However, this paper highlights the point that the limited number of DNA markers that have been identified for scleractinian coral genetic studies do not necessarily offer greater precision than that offered by allozymes. In fact, at present allozyme electrophoresis yields greater information than the eight different DNA markers used in this study. Given the relative ease of use of allozymes and the wealth of comparable data sets from numerous previously published studies, allozyme electrophoresis should not be dismissed for population structure and connectivity studies on coral reefs. While continued effort should be placed into searching for new DNA markers, until a more sensitive DNA marker becomes available for scleractinian corals, allozyme electrophoresis remains a powerful and relevant technique for understanding the connectivity of coral population studies.

Clinicians' evaluations of fetal oximetry sensor placement in a multicentre randomised trial (the FOREMOST trial)

Background: Fetal pulse oximetry (FPO) may improve the assessment of the fetal well-being in labour. Reports of health-care provider's evaluations of new technology are important in the overall evaluation of that technology. Aims: To determine doctors' and midwives' perceptions of their experience placing FPO sensors. Methods: We surveyed clinicians (midwives and doctors) following placement of a FPO sensor during the FOREMOST trial (multicentre randomised trial of fetal pulse oximetry). Clinicians rated ease of sensor placement (poor, fair, good and excellent). Potential influences on ease of sensor placement (staff category, prior experience in Birth Suite, prior experience in placing sensors, epidural analgesia, cervical dilatation and fetal station) were examined by ordinal regression. Results: There were 281 surveys returned for the 294 sensor placement attempts (response rate 96%). Sensors were placed by midwives (29%), research midwives (48%), registrars (22%) and obstetricians (1%). The majority of clinicians had 1 or more years' Birth Suite experience, had placed six or more sensors previously, and rated ease of sensor placement as good. Advancing fetal station (P < 0.001) and the presence of epidural analgesia prior to sensor placement (P = 0.029) predicted improved ease of sensor placement. Having a clinician placing a sensor for the first time predicted a lower rating for ease of sensor placement (P = 0.001), compared to having placed one or more sensors previously. Conclusions: Clinicians with varying levels of Birth Suite experience successfully placed fetal oxygen saturation sensors, with the majority rating ease of sensor placement as good.

Artificial pumping errors in the Kool-Parker scaling model of soil moisture hysteresis

Hysteresis models that eliminate the artificial pumping errors associated with the Kool-Parker (KP) soil moisture hysteresis model, such as the Parker-Lenhard (PL) method, can be computationally demanding in unsaturated transport models since they need to retain the wetting-drying history of the system. The pumping errors in these models need to be eliminated for correct simulation of cyclical systems (e.g. transport above a tidally forced watertable, infiltration and redistribution under periodic irrigation) if the soils exhibit significant hysteresis. A modification is made here to the PL method that allows it to be more readily applied to numerical models by eliminating the need to store a large number of soil moisture reversal points. The modified-PL method largely eliminates any artificial pumping error and so essentially retains the accuracy of the original PL approach. The modified-PL method is implemented in HYDRUS-1D (version 2.0), which is then used to simulate cyclic capillary fringe dynamics to show the influence of removing artificial pumping errors and to demonstrate the ease of implementation. Artificial pumping errors are shown to be significant for the soils and system characteristics used here in numerical experiments of transport above a fluctuating watertable. (c) 2005 Elsevier B.V. All rights reserved.

Laboratory-based simulation of freezing profiles of beef trim for Escherichia coli O157 survival determinations

This study was undertaken to develop a simple laboratory-based method for simulating the freezing profiles of beef trim so that their effect on E. coli 0157 survival could be better assessed. A commercially available apparatus of the type used for freezing embryos, together with an associated temperature logger and software, was used for this purpose with a -80 degrees C freezer as a heat sink. Four typical beef trim freezing profiles, of different starting temperatures or lengths, were selected and modelled as straight lines for ease of manipulation. A further theoretical profile with an extended freezing plateau was also developed. The laboratory-based setup worked well and the modelled freezing profiles fitted closely to the original data. No change in numbers of any of the strains was apparent for the three simulated profiles of different lengths starting at 25 degrees C. Slight but significant (P < 0.05) decreases in numbers (similar to 0.2 log cfu g(-1)) of all strains were apparent for a profile starting at 12 degrees C. A theoretical version of this profile with a freezing plateau phase extended from 11 h to 17 h resulted in significant (P < 0.05) decreases in numbers (similar to 1.2 log cfu g(-1)) of all strains. Results indicated possible avenues for future research in controlling this pathogen. The method developed in this study proved a useful and cost-effective way for simulating freezing profiles of beef trim. (c) 2005 Elsevier B.V. All rights reserved.

Mechanical disruption of seagrass in the digestive tract of the dugong

The cheek teeth in dugongs are considered to be largely non-functional whereas the oral horny pads are important both in mechanical disruption of the diet and in conveying seagrass through the mouth. Particle size distributions of digesta from 41 dead stranded dugongs were examined to investigate the relationship between degree of food breakdown, gut region and functional surface area of the mouthparts. The in vitro ease of fracture of major dietary seagrass species were compared. The rate of food breakdown through the gut appears to be more closely linked to fibre level of the diet than to size or age of the dugong and its mouthparts. Low fibre seagrass, for example Halophila ovalis, breaks down at a faster rate than high fibre seagrass, for example Zostera capricorni both in dugong guts and in vitro. Several structural characteristics of seagrass, including level and arrangement of fibre, and water content, make it particularly amenable to mechanical breakdown. The soft mouthparts of the dugong are highly modified so that the entire oral cavity functions to crush low fibre seagrasses. Thus, the dugong has developed an efficient method of food ingestion and mastication that is suited to processing large quantities of soft seagrass during short dive times. The potential cost to the dugong in having lost its hard dental surfaces is that it has become restricted to a low fibre diet.

Comparison of the Berman Intubating Airway and the Williams Airway Intubator for fibreoptic orotracheal intubation in anaesthetised patients

Sixty patients with no clinical indicators of a difficult airway were selected to undergo a fibreoptic assessment after induction of general anaesthesia using both the Berman Intubating Airway and the Williams Airway Intubator. The bronchoscopic view and ease of railroading a tracheal tube during fibreoptic orotracheal intubation were studied. The bronchoscopic views obtained by the Berman Airway and the Williams Airway were significantly different (p < 0.008, test of symmetry). The estimated odds ratio of obtaining an obstructed path was 3.06 times higher for the Berman than the Williams Airway. However, if the glottis could be reached with the bronchoscope, there was no significant difference in the degree of ease of intubation between the two airways.

The graying of R&D workgroups: The effects of age diversity on developing publicly usable knowledge

Does the graying of scientific research teams matter? This study addresses how workgroup processes and external environmental factors contribute and inhibit the effect of age diversity in R&D project groups on the production of innovative publicly usable knowledge outcomes in the form of publication outputs. We examined the relationships between group age diversity (age cohort diversity, mean age, age dispersion), R&D workgroup member self-ratings of workgroup processes, their supervisor�s assessment of the external environmental factors the project groups faced, and their supervisor�s ratings of group performance, the number of scientific publicly available publications produced by the group and the use of multiple authorships on publications. Usable data was obtained from 32 R&D workgroups of a large Government Agricultural Research and Development Agency. Consistent with the literature, workgroup processes and external environmental factors were found to directly effect innovation outcomes. Contrary to expectation, but consistent with Social Identity theory, workgroup age diversity generally negatively impacted upon innovation outcomes. An exception was where multiple authorship on publications for project groups increased as the dispersion of age within groups increased. Importantly, workgroups that were both more age homogeneous and perceived to have optimally functioning work processes produced more R&D innovation outcomes than other groups. Generally, these differences appear to be related to the greater division of labor practices (and less multi-tasking) employed by the older and more homogeneous workgroups. Implications for R&D workgroup resource theory and practices are discussed.

A generalisation of the Delogne-Kasa method for fitting hyperspheres

In this paper, we examine the problem of fitting a hypersphere to a set of noisy measurements of points on its surface. Our work generalises an estimator of Delogne (Proc. IMEKO-Symp. Microwave Measurements 1972,117-123) which he proposed for circles and which has been shown by Kasa (IEEE Trans. Instrum. Meas. 25, 1976, 8-14) to be convenient for its ease of analysis and computation. We also generalise Chan's 'circular functional relationship' to describe the distribution of points. We derive the Cramer-Rao lower bound (CRLB) under this model and we derive approximations for the mean and variance for fixed sample sizes when the noise variance is small. We perform a statistical analysis of the estimate of the hypersphere's centre. We examine the existence of the mean and variance of the estimator for fixed sample sizes. We find that the mean exists when the number of sample points is greater than M + 1, where M is the dimension of the hypersphere. The variance exists when the number of sample points is greater than M + 2. We find that the bias approaches zero as the noise variance diminishes and that the variance approaches the CRLB. We provide simulation results to support our findings.

Using Developmental Theories to Inform the Design of Technology for Children

Electronic Blocks are a new programming environment, designed specifically for children aged between three and eight years. As such, the design of the Electronic Block environment is firmly based on principles of developmentally appropriate practices in early childhood education. The Electronic Blocks are physical, stackable blocks that include sensor blocks, action blocks and logic blocks. Evaluation of the Electronic Blocks with both preschool and primary school children shows that the blocks' ease of use and power of engagement have created a compelling tool for the introduction of meaningful technology education in an early childhood setting. The key to the effectiveness of the Electronic Blocks lies in an adherence to theories of development and learning throughout the Electronic Blocks design process.