Prospective case review of a global e-health system for doctors in developing countries

The Swinfen Charitable Trust has managed email consultations for doctors in developing countries since 1999. The process was handled manually for the first three years and then subsequently using an automatic message-handling system. We conducted a prospective review of email consultations between referring doctors and consulting specialists during six months of automatic operation (December 2003 to May 2004). During the study period 125 consultations took place. These concerned a wide range of specialties (e.g. orthopaedics 17%, dermatology 16%, obstetrics and gynaecology 11%, radiology 10%). Of these referrals, 33% (41) were for paediatric cases. Consulting specialists, who were based in five countries, were volunteers. Referring doctors were from 24 hospitals in 12 developing countries. The median time from referral to definitive reply was 1.5 days (interquartile range 0.6-4.9). There was an 85% response rate (n = 106) to a survey concerning the value of the consultation to the referring doctor. All the referring doctors who responded made positive comments about the service and half said that it improved their management of the case. The second-opinion consultation system operated by the Swinfen Charitable Trust represents an example of a global e-health system operated for altruistic, rather than commercial, reasons.

A voice unknown: Undercurrents in Mussorgsky's 'Sunless'

Mussorgsky's Sunless cycle is aesthetically and stylistically an anomalous member of his oeuvre. Its notably effaced, pared-down, and withdrawn qualities present challenges to critical interpretation. Its uniqueness, however, renders it a crucial work for furnishing the fullest possible picture of Mussorgsky as a creative artist. The author of its texts, Golenishchev-Kutuzov (whose relationship with Mussorgsky at the time of its writing possibly extended beyond the platonic) has been identified by recent scholarship as an essential eye-witness for those to whom Stasov's populist characterization of the composer does not ring entirely true. Golenishchev-Kutuzov believed that in Sunless Mussorgsky first revealed his authentic artistic self. According to Golenishchev-Kutuvoz, Mussorgsky regarded his signal achievement in Sunless to have been the eradication of all elements other than feeling. In other words, he had thrown off the stylistic shackles imposed by the aesthetics of realism and relied entirely on intuitive harmonic invention as the sole conveyor of a purely subjective, affective meaning in the cycle. This hypothesis forms the point of departure for an investigation of select numbers of the cycle. Analysis reveals that the affective aspect is riot the only significant element operative. Alongside remnants of the realist style, there is evidence, of varying degrees of subtlety, for a knowing use of symmetrical pitch organization. Mussorgsky not only adapted the usual referential attachments of symmetrically based chromaticism-typically found in Russian operas of the second half of the nineteenth century-he also, through extremely simple but effective means, synthesized the intuitive harmonic and rational symmetrical elements of the cycle's pitch organization so that the latter emerges seamlessly out of the former. This remarkable synthesis ensures the cycle's uniformity of tone while also allowing for a reading that extends beyond the generally affective to the symbolically more specific. This symbolic level of reading offers several interpretative possibilities, one of which may refer even to the relationship of the poet and the composer. Irrespective of such potentials for interpretation, the most significant achievement in the cycle remains the synthesis of the intuitive/affective and rational/symbolic elements of its organization. Songs 1, 2, 3, and 6 of the cycle are considered in detail.

Striving for a common language: A white feminist parallel to Indigenous ways of knowing and researching

In Striving Towards a Common Language I outline an innovative methodology which consists of three strands encompassing an Indigenous-centred approach based on Indigenous Self-determination (participatory action research), relationship as central to socio-cultural dynamics, and feminist phenomenology. This methodology - which I call Living On the Ground was created in direct concert with 13 Indigenous women elders who were my hosts, teachers and walytja (family) as we worked together to create a dynamic cultural revitalisation project for their community, one of Australia's most remote Aboriginal settlements. I explain the processes I went through as a White Irish-Australian woman living with the women elders and their 11 dogs in a one room tin shed for two years, and tell of how the nexus of land, Ancestors, and the Tjukurrpa (Dreaming) combined with White cultural practices came to inspire a methodology which took the best from Indigenous and (White) feminist ways of knowing and of being. (c) 2005 Z. de Ishtar. Published by Elsevier Ltd. All rights reserved.

How to recognize and manage psychological distress in cancer patients

Psychological distress is common in cancer patients, however, it is often unrecognized and untreated. We aimed to identify barriers to cancer patients expressing their psychological concerns, and to recommend strategies to assist oncologists to elicit, recognize, and manage psychological distress in their patients. Medline, Psychlit, and the Cochrane databases were searched for articles relating to the detection of emotional distress in patients. Patients can provide verbal and non-verbal information about their emotional state. However, many patients may not reveal emotional issues as they believe it is not a doctor's role to help with their emotional concerns. Moreover, patients may normalize or somatize their feelings. Anxiety and depression can mimic physical symptoms of cancer or treatments, and consequently emotional distress may not be detected. Techniques such as active listening, using open questions and emotional words, responding appropriately to patients' emotional cues, and a patient-centred consulting style can assist in detection. Screening tools for psychological distress and patient question prompt sheets administered prior to the consultation can also be useful. In conclusion, the application of basic communication techniques enhances detection of patients' emotional concerns. Training oncologists in these techniques should improve the psychosocial care of cancer patients.

Do rural consumers expect a prescription from their GP visit? Investigation of patients' expectations for a prescription and doctors' prescribing decisions in rural Australia

Objective: To assess patients’ expectation for receiving a prescription and GPs’ perceptions of patient expectation for a prescription. Design: Matched questionnaire study completed by patients and GPs. Setting: Seven general practices in rural Queensland, Australia. Subjects: The subjects were 481 patients consulting 17 GPs. Main outcome measures: Patients’ expectation for receiving a prescription and GPs’ perceptions of patients’ expectation. Results: Ideal expectation (hope) for a prescription was expressed by 57% (274/481) of patients. Sixty-six per cent (313/481) thought it was likely that the doctor would actually give them a prescription. Doctors accurately predicted hope or lack of hope for a prescription in 65% (314/481) of consultations, but were inaccurate in 19% (93/481). A prescription was written in 55% of consultations. No increase in patients’ expectation, doctors’ perceptions of expectation, or decision to prescribe were detected for patients living a greater distance from the doctors. Conclusions: Rural patients demonstrated similar rates of hope for a prescription to those found in previous urban studies. Rural doctors seem to be similarly ‘accurate’ and ‘inaccurate’ in determining patients’ expectations. Rates of prescribing were comparable to urban rates. Distance was not found to increase the level of patient expectation, affect the doctors’ perception or to influence the decision to prescribe.

Sustainability metrics for coal power generation in Australia

The basis of this work was to investigate the relative environmental impacts of various power generators knowing that all plants are located in totally different environments and that different receptors will experience different impacts. Based on IChemE sustainability metrics paradigm, we calculated potential environmental indicators (P-EI) that represent the environmental burden of masses of potential pollutants discharged into different receiving media. However, a P-EI may not be of significance, as it may not be expressed at all in different conditions, so to try and include some receiver significance we developed a methodology to take into account some specific environmental indicators (S-EI) that refer to the environmental attributes of a specific site. In this context, we acquired site specific environmental data related to the airsheds and water catchment areas in different locations for a limited number of environmental indicators such as human health (carcinogenic) effects, atmospheric acidification, photochemical (ozone) smog and eutrophication. The S-EI results from this particular analysis show that atmospheric acidification has highest impact value while health risks due to fly ash emissions are considered not to be as significant. This is due to the fact that many coal power plants in Australia are located in low population density air sheds. The contribution of coal power plants to photochemical (ozone) smog and eutrophication were not significant. In this study, we have considered emission related data trends to reflect technology performance (e.g., P-EI indicators) while a real sustainability metric can be associated only with the specific environmental conditions of the relevant sites (e.g., S-EI indicators).

The role of uncertainty in the relationship between fairness evaluations and willingness to pay

Participants in contingent valuation studies may be uncertain about a number of aspects of the policy and survey context. The uncertainty management model of fairness judgments states that individuals will evaluate a policy in terms of its fairness when they do not know whether they can trust the relevant managing authority or experience uncertainty due to insufficient knowledge of the general issues surrounding the environmental policy. Similarly, some researchers have suggested that, not knowing how to answer WTP questions, participants convey their general attitudes toward the public good rather than report well-defined economic preferences. These contentions were investigated in a sample of 840 residents in four urban catchments across Australia who were interviewed about their WTP for stormwater pollution abatement. Four sources of uncertainty were measured: amount of prior issue-related thought, trustworthiness of the water authority, insufficient scenario information, and WTP response uncertainty. A logistic regression model was estimated in each subsample to test the main effects of the uncertainty sources on WTP as well as their interaction with fairness and proenvironmental attitudes. Results indicated support for the uncertainty management model in only one of the four samples. Similarly, proenvironmental attitudes interacted rarely with uncertainty to a significant level, and in ways that were more complex than hypothesised. It was concluded that uncertain individuals were generally not more likely than other participants to draw on either fairness evaluations or proenvironmental attitudes when making decisions about paying for stormwater pollution abatement.

Bodies in translation: French feminist influences on anglophone feminist theory: Review article

Review of the following books: French Feminist Theory. Dani Cavallaro, 2003. London and New York, Continuum. The Sex of Knowing, Miche` le Le Doeuff, 2003. translated by Kathryn Hamer and Lorraine Code. New York and London, Routledge. Touching Thought: Ontology and Sexual Difference . Ellen Mortensen, 2003. Lanham, Boulder, New York and Oxford, Lexington.

Stand density management in rainforest plantations

Trees in plantations established for timber production are usually grown at a sufficiently high density that canopy closure occurs within a relatively short time after planting. The trees then shade and outcompete most herbs, shrubs or grasses growing at the site. The closer the spacing (i.e. the greater the density) the faster this will occur. Subsequently, as the trees grow larger, this between-species competition is replaced by within-species competition. If unmanaged, this competition can reduce the commercial productivity of the plantation. Thus, there are two management dilemmas. One is knowing the best initial planting density. The second is knowing how to management the subsequent between-tree competition in order to optimize overall plantation timber productivity. In this chapter we consider initial spacing and thinning for high value timber trees grown in single and mixed species plantations. From growth studies in stands of different ages recommendations are proposed for managing both types of plantations where the primary objective is timber production. It seems that many rainforest species will require more space to achieve optimal growth than most eucalypts and conifers. On the other hand many rainforest species do not have strong apical dominance. Care will be needed to balance these two attributes.