Is dietary management a responsibility of general practitioners? The views of Victorian general practitioners

Rationale : Australia is experiencing an evolving healthcare system, resulting in an aim of systematic managed care for patients with chronic disease. One outcome has been debate on doctors' dietary management responsibilities.
Aim : To identify general practitioners' perceptions of their dietary management responsibilities for adult cardiac patients.
Methods : A Two phase study was conducted. First, semi-structured interviews with 30 Melbourne general practitioners were conducted to gather preliminary information about dietary management. The results informed a questionnaire for the second phase. This was completed by 248 general practitioners (30%) in Victoria.
Principal findings : Themes arising in interviews, and also supported by cross-sectional survey showed that doctors perceive themselves as filling one or more of three roles. The majority (87.4%) endorsed an 'Influencing' role, 27.4% endorsed 'Dietary Educator' and 44.0% a 'Coordinator' role. The Influencer role was characterised by encouragement of dietary behaviour change, such as discussing benefits and consequences of inaction to dietary change. The Educator role was characterised by the provision of a range of behaviour change strategies- 'how to' achieve change. 'Coordinators' reported the provision of dietary counselling belonged to dietitians alone.
Implications : The results indicate doctors' awareness of need for patients' dietary education should be increased. This could be accomplished by one-on-one education. Patients' access to dietary education should also be facilitated by doctors' referring on. Embedding dietary management protocols in doctors' managed care templates could improve patients' access to dietary education and enhance doctor's collaborative roles.
Presentation type : Paper
Session theme : Getting Evidence into Practice 2

Fracture of DP590 steel : a multi-scale modeling approach

Advanced high strength steel sheets are one of the higher strength advance material developed by the steel industry for automotive bodies. One of the categories of this advanced high strength steel is Dual Phase (DP) steel. This steel consists of a two phase microstructure where soft and hard phase acts together to offer a high strength composite effect. The combination of high strength and ductility exhibited by these sheets allows the design and manufacture of complex parts. However, during forming certain grades of DP steel sudden cracking can occur without any intimation of necking. This abnormal forming behavior is difficult to accurately predict because most classical modelling approaches are not designed for such micro-structurally heterogeneous materials. These modelling approaches are generally based on an average representation of the material behaviour in a continuum mechanics formulation. This works for materials that are homogenous, or at least could be assumed to be homogenous at scales lower than the naked eye can see. However, for a material like advanced high strength steel, the microstructure plays a significant role in dictating the mechanical behavior at the macro-scale. This paper studies the forming and fracture behavior through multi-scale modeling of DPO590 steel. It is found that the sufficient accuracy can be achieved from multi-scale modeling when comparing with experiments.

Extraction of silver(i) from aqueous solutions in the absence and presence of copper(ii) with a methimazole-based ionic liquid

The ionic liquid (IL) 2-butylthiolonium bis(trifluoromethanesulfonyl)amide, [mimSBu][NTf₂], facilitates the efficient extraction of silver(i) from aqueous media via interaction with both the cation and anion components of the IL. Studies with a conventional aqueous-IL two phase system as well as microextraction of silver(i) by a thick IL film adhered to an electrode monitored in situ by cyclic voltammetry, established that [mimSBu][NTf₂] can extract electroactive silver(i) ions from an aqueous solution. The pH of the aqueous phase decreases upon addition of [mimSBu]⁺, which is attributed to partial release of the hydrogen attached to the N(3) nitrogen atom of the imidazolium ring. The presence of silver(i) further increase the acidity of the aqueous phase as a consequence of coordination with the IL cation component. Voltammetric and ¹H and ¹³C NMR techniques have been used to establish the nature of the silver(i) complexes extracted, and show that the form of interaction with the IL differs from that outlined previously for the extraction of copper(ii). Insights on the competition established when silver(i) is extracted in the presence of copper(ii) are provided. Finally, it is noted that metallic silver can be directly electrodeposited at the electrode surface after extraction of silver(i) into [mimSBu][NTf₂] and that back extraction of silver(i) into aqueous media is achieved by addition of an acidic aqueous solution.

Neighbourhood environments and children's social capital : investigating the pattern of relationships

The main purpose of this work was to investigate the pattern of relationships among three constructs: neighbourhood socio-physical environment, children's social interactions and their social capital. This work was designed as a two-phase mixed-methods research. Phase I included several qualitative studies to develop a scale of neighbourhood socio-physical environment, a scale of children's social interactions and a scale of children's social capital. Phase II was a cross-national survey that used these three scales to collect information from high school students in Beijing and Sydney. The main finding of this work was that there were strong and significant correlations among the three constructs. Children's assessment of their neighbourhood socio-physical environment was positively correlated with their social interactions and social capital, which indicated that children who lived in better neighbourhoods had more social interactions and larger volumes of social capital. Strong positive relationship was also found between children's social interactions and social capital, which implied that better-connected children interacted with their friends more.

Discovery of activity structures using the hierarchical hidden Markov model

In building a surveillance system for monitoring people behaviours, it is important to understand the typical patterns of people's movement in the environment. This task is difficult when dealing with high-level behaviours. The flat model such as the hidden Markov model (HMM) is inefficient in differentiating between signatures of such behaviours. This paper examines structure learning for high-level behaviours using the hierarchical hidden Markov model (HHMM).We propose a two-phase learning algorithm in which the parameters of the behaviours at low levels are estimated first and then the structures and parameters of the behaviours at high levels are learned from multi-camera training data. Our algorithm is then evaluated using data from a real environment, demonstrating the robustness of the learned structure in recognising people's behaviour.

Professional midwifery education : blended teaching and learning approaches

Blended teaching and learning approaches are used in the postgraduate course of Graduate Diploma of Midwifery for students who are predominately women with family responsibilities residing in metropolitan, regional, or rural Victoria, a major state in Australia. The Virtual Maternity Clinic (VMC), a virtual learning experience (VLE) research project, was implemented during trimester 2, 2009. The purpose of the project was to expand the blend of teaching and learning activities to support students in their preparation for professional practice. The VMC includes four characters in early pregnancy and care provided by their midwife. All students enrolled in midwifery courses (postgraduate and undergraduate) at Deakin University were recruited to participate in a two-phase, pre- and post-use evaluation process related to the VMC. Findings from the pre-evaluation included that students 'had high expectations of the VMC in supporting their learning. The results from the post-evaluation of the VMC indicated that students 'were very satisfied that the VMC supported their learning. Future research directions include further development of the VMC.

Robust channel estimation algorithm for dual-hop MIMO relay channels

In conventional two-phase channel estimation algorithms for dual-hop multiple-input multiple-output (MIMO) relay systems, the relay-destination channel estimated in the first phase is used for the source-relay channel estimation in the second phase. For these algorithms, the mismatch between the estimated and the true relay-destination channel affects the accuracy of the source-relay channel estimation. In this paper, we investigate the impact of such channel state information (CSI) mismatch on the performance of the two-phase channel estimation algorithm. By explicitly taking into account the CSI mismatch, we develop a robust algorithm to estimate the source-relay channel. Numerical examples demonstrate the improved performance of the proposed algorithm. © 2012 IEEE.

Developing an analytical framework to assess the uncertainty and flexibility mismatches across the supply chain

Purpose: The purpose of this paper is to discuss how decisions regarding organisational flexibility can be improved through targeted resource allocation, by focusing on the supply chain's level of uncertainty exposure. Specifically, the issue of where and in what ways flexibility has been incorporated across the organisation's supply chain is addressed. Design/methodology/approach: A two-phase methodology design based on literature review and case study was used. Using 83 journal articles in the areas of uncertainty and flexibility an analytical process for assessing uncertainty-flexibility mismatches was developed. Furthermore, results from ten interviews with senior/middle managers within the Australian manufacturing sector were used to provide preliminary insights on the usefulness and importance of the analytical process and its relationship with organisational practice. Findings: The paper emphasises the importance of having a systematic and encompassing view of uncertainty-flexibility mismatches across the supply chain, as well as the significance of socio-technical engagement. The paper both conceptually and empirically illustrates how, using a structured analytical process, flexibility requirements across the supply, process, control and demand segments of a supply chain might be assessed. A four-step analytical process was accordingly developed and, its application, usefulness and importance discussed using empirical data. Practical implications: The analytical process presented in this paper can assist managers to obtain a comprehensive overview of supply chain flexibility when dealing with situations involving uncertainty. This can facilitate and improve their decision-making with respect to prioritising attention on identified flexibility gaps in order to ensure stability of their performance. Originality/value: The paper presents a supply chain-wide discussion on the difficulties that uncertainty brings to organisations, and how organisational flexibility might serve to moderate those challenges for supply chain management. It discusses how to identify the flexibility gap and proposes an original analytical process for systematic assessment of uncertainty-flexibility mismatches. © Emerald Group Publishing Limited.

The study protocol of: 'initiating end of life care in stroke: clinical decision- making around prognosis'

 Background: The initiation of end of life care in an acute stroke context should be focused on those patients and families with greatest need. This requires clinicians to synthesise information on prognosis, patterns (trajectories) of dying and patient and family preferences. Within acute stroke, prognostic models are available to identify risks of dying, but variability in dying trajectories makes it difficult for clinicians to know when to commence palliative interventions. This study aims to investigate clinicians’ use of different types of evidence in decisions to initiate end of life care within trajectories typical of the acute stroke population.
Methods/design: This two-phase, mixed methods study comprises investigation of dying trajectories in acute stroke (Phase 1), and the use of clinical scenarios to investigate clinical decision-making in the initiation of palliative care (Phase 2). It will be conducted in four acute stroke services in North Wales and North West England. Patient and public involvement is integral to this research, with service users involved at each stage.
Discussion: This study will be the first to examine whether patterns of dying reported in other diagnostic groups are transferable to acute stroke care. The strengths and limitations of the study will be considered. This research will produce comprehensive understanding of the nature of clinical decision-making around end of life care in an acute stroke context, which in turn will inform the development of interventions to further build staff knowledge, skills and confidence in this challenging aspect of acute stroke care.

Chip formation mechanism and machinability of wrought duplex stainless steel alloys

This paper investigates the chip formation mechanism and machinability of two-phase materials, such as, wrought duplex stainless steel alloys SAF 2205 and SAF 2507. SEM and optical microscopic details of the frozen cutting zone and chips revealed that the harder austenite phase dissipates in the advancement of the cutting tool, being effectively squeezed out of the softer ferrite phase. Microhardness profiles reveal correlation in hardness from the workpiece material transitioning to the chip. The tool wear (TiAIN + TiN coated solid carbide twist drill) and machining forces were investigated. Tool wear, was dominantly due to the adhesion process which developed from built-up edge formation, is highly detrimental to the flank face. Flute damage was also observed as a major issue in the drilling of duplex alloys leading to premature tool failure. Duplex 2507 shows higher sensitivity to cutting speed during machining and strain hardening at higher velocity and less machinability due to presence of higher percentage of Ni, Mo and Cr.

Comparing the strength of auditing and reporting standards and investigating their predictors in Europe and Asia

The World Economic Forum conducted an opinion survey to determine the strength of auditing and reporting standards (SARS) in 133 countries. It then assigned a score for SARS to each country as one of its global competitive indices. This is a unique dataset on SARS at country level. Using this dataset, this paper compares SARS scores for 72 countries (41 European and 31 Asian). A multi-phase regression analysis is employed to empirically investigate the predictors of SARS using five sub-models. Findings from the study support existing theory and add new findings to the auditing and reporting literature at a regional level. It suggests that there are nine predictors of SARS which are similar for both Europe and Asia but with different magnitude. In Asia the efficiency of the legal framework and the size of the foreign export market are also significant predictors of SARS compared to Europe.

Qualitative assessment of bubble behaviour for central and asymmetric injection in 2D gas-solid fluidized bed using image analysis technique and CFD modelling

Bubble characteristics such as shape, size, and trajectory control the hydrodynamics and therefore heat transfer in fluidized bed reactors. Thus understanding these characteristics is very important for the design and scaleup of fluidized beds. An earlier developed Eulerian-Eulerian two-fluid model for simulating dense gas–solid two-phase flow has been used to compare the experimental data in a pseudo-two-dimensional (2-D) bed. Bubbles are injected asymmetrically by locating the nozzle at proximity to the wall, thus presenting the effect wall has on asymmetrical injection as compared to symmetrical injection. In this work, a digital image analysis technique was developed to study the bubble behaviour in a two-dimensional bubbling bed. The high-speed photography reveals an asymmetric wake formation during detachment indicating an early onset of mixing process. The wall forces acts tangentially on thebubble and has a significant impact on the bubble shape, neck formation during detachment and its trajectory through the bed. Larger bubbles drifting away from the centre with longer paths are observed. This qualitative behaviour is well predicted by CFD modelling. Asymmetric injection can significantly influence the heat and mass transfer characteristics.

Controllable drug uptake and nongenomic response through estrogen-anchored cyclodextrin drug complex

Breast cancer is a leading killer of women worldwide. Cyclodextrin-based estrogen receptor-targeting drug-delivery systems represent a promising direction in cancer therapy but have rarely been investigated. To seek new targeting therapies for membrane estrogen receptor-positive breast cancer, an estrogen-anchored cyclodextrin encapsulating a doxorubicin derivative Ada-DOX (CDE1-Ada-DOX) has been synthesized and evaluated in human breast cancer MCF-7 cells. First, we synthesized estrone-conjugated cyclodextrin (CDE1), which formed the complex CDE1-Ada-DOX via molecular recognition with the derivative adamantane-doxorubicin (Ada-DOX) (Kd =1,617 M(-1)). The structure of the targeting vector CDE1 was fully characterized using (1)H- and (13)C-nuclear magnetic resonance, mass spectrometry, and electron microscopy. CDE1-Ada-DOX showed two-phase drug-release kinetics with much slower release than Ada-DOX. The fluorescence polarization analysis reveals that CDE1-Ada-DOX binds to recombinant human estrogen receptor α fragments with a Kd of 0.027 µM. Competition assay of the drug complex with estrogen ligands demonstrated that estrone and tamoxifen competed with CDE1-Ada-DOX for membrane estrogen receptor binding in MCF-7 cells. Intermolecular self-assembly of CDE1 molecules were observed, showing tail-in-bucket and wire-like structures confirmed by transmission electronic microscopy. CDE1-Ada-DOX had an unexpected lower drug uptake (when the host-guest ratio was >1) than non-targeting drugs in MCF-7 cells due to ensconced ligands in cyclodextrins cavities resulting from the intermolecular self-assembly. The uptake of CDE1-Ada-DOX was significantly increased when the host-guest ratio was adjusted to be less than half at the concentration of CDE1 over 5 µM due to the release of the estrone residues. CDE1 elicited rapid activation of mitogen-activated protein kinases (p44/42 MAPK, Erk1/2) in minutes through phosphorylation of Thr202/Tyr204 in MCF-7 cells. These results demonstrate a targeted therapeutics delivery of CDE1-Ada-DOX to breast cancer cells in a controlled manner and that the drug vector CDE1 can potentially be employed as a molecular tool to differentiate nongenomic from genomic mechanism.

The analysis of café espresso using two-dimensional reversed phase–reversed phase high performance liquid chromatography with UV-absorbance and chemiluminescence detection

In this study, an activity based screening technique combining two-dimensional liquid chromatography (2DHPLC) with UV-absorbance and chemiluminescence detection was applied to study “Ristretto”, "Decaffeinatto” and “Volluto” espresso coffees. This technique, which coupled the separation power of 2DHPLC with the sensitivity and selectivity of the chemiluminescence detection, offers great potential for screening complex samples for antioxidant compounds. Detailed information regarding the complexity of the sample, and the variation between these three coffees could be obtained using this multidimensional-hyphenated method of analysis.