The management of adolescents at risk of suicide by Australian general practitioners: issues in practice and confidence

This study involved an anonymous survey of 41Victorian GPs regarding their diagnostic and treatment practices with adolescent patients with depression and/or suicide ideation. The results indicated that the majority of respondents correctly diagnosed the level of depression and the risk of suicide in a case scenario. Although they commonly asked some of the questions related to an assessment of suicide risk, they rarely conducted a comprehensive risk assessment and the level of referral to telephone and internet crisis services was poor. Most GPs indicated a lack of confidence in their ability to detect and manage depression and suicide in this population and strongly emphasized a need for more training.

Skin friction coefficient on a yarn package surface in ring spinning

The skin friction coefficient on the surface of a rotating yarn package affects the power required to drive the package. This paper examines the relationship between the skin friction coefficient on the package surface and its diameter and rotating speed, based on the fundamentals of aerodynamics and the experimental results of power consumption. Skin friction coefficients on the surfaces of an airplane, car top, and yarn package are discussed. The results indicate that the skin friction coefficient on the package surface without hairiness depends on the package diameter and spindle speed only. The skin friction coefficient on the yarn package surface is about three times that on the top surface of a car, and is about twenty times that on an airplane surface. The power consumed to overcome skin friction drag is more than that consumed to drive the spindle if the spindle speed is very slow. However, the situation reverses when the spindle speed is fast.

Separoh jalan (halfway)

The sign that marked the exact mid-point of the journey between Launceston and Hobart was located at the far side of the road in one of the overtaking lanes on the highway. The road that connected the two main towns in the state of Tasmania was full of overtaking lanes, special lanes that allowed drivers to pass others going in the same direction at slower speeds. Even though the north-south highway was wide and newly surfaced, there was only one lane in each direction. The passing lanes brought relief to a driver trapped behind a truck with a heavy load or who was in a hurry like Rusli that morning. He had only been in the southernmost Australian state for four months but had travelled back and forth between Launceston and Hobart nearly 20 times in a car belonging to the University of Tasmania where he worked. For some reason, he had never before noticed the marker which was only a knee-high sign with three sides. The one facing north to Launceston said H100 while the one facing south to Hobart said L100. Rusli had been hired as a lecturer for one academic year of about eight months to teach at the Indonesian programme at the university. Because Indonesian was the one language offered on both campuses, at least once a week Rusli had to drive from Launceston where he was appointed.

Dietary intake measurements

To provide a concise summary of field and laboratory methods for the measurement of dietary intake with particular reference to the assessment of energy and protein intake and to the pitfalls and difficulties that may be encountered in practice when implementing the methods both in the field and under laboratory conditions.

Assessing cost-effectiveness in mental health : family interventions for schizophrenia and related conditions

Objective: Existing evidence suggests that family interventions can be effective in reducing relapse rates in schizophrenia and related conditions. Despite this, such interventions are not routinely delivered in Australian mental health services. The objective of the current study is to investigate the incremental cost-effectiveness ratios (ICERs) of introducing three types of family interventions, namely: behavioural family management (BFM); behavioural intervention for families (BIF); and multiple family groups (MFG) into current mental health services in Australia.

Method: The ICER of each of the family interventions is assessed from a health sector perspective, including the government, persons with schizophrenia and their families/carers using a standardized methodology. A two-stage approach is taken to the assessment of benefit. The first stage involves a quantitative analysis based on disability-adjusted life years (DALYs) averted. The second stage involves application of 'second filter' criteria (including equity, strength of evidence, feasibility and acceptability to stakeholders) to results. The robustness of results is tested using multivariate probabilistic sensitivity analysis.

Results: The most cost-effective intervention, in order of magnitude, is BIF (A$8000 per DALY averted), followed by MFG (A$21 000 per DALY averted) and lastly BFM (A$28 000 per DALY averted). The inclusion of time costs makes BFM more cost-effective than MFG. Variation of discount rate has no effect on conclusions.

Conclusions: All three interventions are considered 'value-for-money' within an Australian context. This conclusion needs to be tempered against the methodological challenge of converting clinical outcomes into a generic economic outcome measure (DALY). Issues surrounding the feasibility of routinely implementing such interventions need to be addressed.

Improving on- and off-campus student performance in structural mechanics

This paper investigates the performance of 329 (173 on- and 186  off-campus) students enrolled in two structural mechanics units at Deakin University, a leader in engineering distance-education in Australia. The two units experience unacceptably high rates of failure. An analysis of the assignment, laboratory and examination marks is presented. Consideration is also given to the total marks. The results show that on-campus students perform better in structural mechanics than their off-campus counterparts. Plots of the student performance distributions for the three assessment methods are provided (for each unit) and high failure rates are linked to low examination marks. Students tend to perform best in assignments and worst in examinations. Parametric statistical tests show a correlation between the continuous assessment and examination marks. To motivate students to fully participate in continuous assessment tasks the authors therefore propose several changes to the assessment criteria and marking schemes.

The production of ultrafine ferrite in low-carbon steel by strain-Induced transformation

An investigation into the production of ultrafine (1 µm) equiaxed ferrite (UFF) grains in low-carbon steel was made using laboratory rolling, compression dilatometry, and hot torsion techniques. It was found that the hot rolling of thin strip, with a combination of high shear strain and high undercooling, provided the conditions most suitable for the formation of this type of microstructure. Although high strains could be applied in compression and torsion experiments, large volume fractions of UFF were not observed in those samples, possibly due to the lower level of undercooling achieved. It is thought that ferrite refinement was due to a strain-induced transformation process, and that ferrite grains nucleated on parallel and linear deformation bands that traversed austenite grains. These bands formed during the deformation process, and the undercooling provided by the contact between the strip and the work rolls was sufficient to drive the transformation to homogeneous UFF grains.

Human rights and the treatment of sex offenders

Human rights create a protective zone around persons and allow them the opportunity to further their own valued personal projects without interference from others. All human beings hold human rights and that includes sex offenders, although some of their freedom rights may be legitimately curtailed by the State. In this paper we apply the concept of human rights to sex offenders. First we briefly analyze the concept of human rights, their structure, and justification. Second, we apply our own model of human rights to the assessment and treatment of sex offenders. We conclude that a significant advantage of a human rights approach is that it is able to integrate the value and capability aspects of offender treatment.

Assessing cost-effectiveness in mental health : vocational rehabilitation for schizophrenia and related conditions

Objective: Existing evidence suggests that vocational rehabilitation services, in particular individual placement and support (IPS), are effective in assisting people with schizophrenia and related conditions gain open employment. Despite this, such services are not available to all unemployed people with schizophrenia who wish to work. Existing evidence suggests that while IPS confers no clinical advantages over routine care, it does improve the proportion of people returning to employment. The objective of the current study is to investigate the net benefit of introducing IPS services into current mental health services in Australia.

Method: The net benefit of IPS is assessed from a health sector perspective using cost–benefit analysis. A two-stage approach is taken to the assessment of benefit. The first stage involves a quantitative analysis of the net benefit, defined as the benefits of IPS (comprising transfer payments averted, income tax accrued and individual income earned) minus the costs. The second stage involves application of 'second-filter' criteria (including equity, strength of evidence, feasibility and acceptability to stakeholders) to results. The robustness of results is tested using the multivariate probabilistic sensitivity analysis.

Results: The costs of IPS are $A10.3M (95% uncertainty interval $A7.4M–$A13.6M), the benefits are $A4.7M ($A3.1M–$A6.5M), resulting in a negative net benefit of $A5.6M ($A8.4M–$A3.4M).

Conclusions: The current analysis suggests that IPS costs are greater than the monetary benefits. However, the evidence-base of the current analysis is weak. Structural conditions surrounding welfare payments in Australia create disincentives to full-time employment for people with disabilities.

The role of Riparian habitats in forest mosaics in promoting Avifauna at the landscape scale

The importance of riparian habitats to bird communities is well documented internationally, however the value of these habitats in largely intact landscapes is less well understood, particularly in Australia. Thirty paired riparian and adjacent non-riparian sites were selected within extensive forest mosaics of the Victorian Central Highlands and were surveyed over a two year period. Bird assemblages occurring within riparian habitats supported a significantly greater richness, abundance and diversity of species. These assemblages were also found to have species compositions significantly different from those occurring at adjacent non-riparian sites separated by a distance of approximately 750 m. Differences were attributed to a suite of distinctive species and significant contrasts in the densities of a range of species that occur in both habitat types. At the landscape level, there was a strong patterning of the avifauna centred on riparian habitats. Bird assemblages typically comprised four distinct suites of species: 1. species widespread in forests and woodlands of southeastern Australia; 2. riparian associated species (wet forest intruders); 3. riparian selective species, and; 4. riparian avoiding species. Both physiognomic and floristic differences between riparian and adjacent non-riparian habitats appear to drive responses in the structure of bird communities. There exists a distinctiveness and variability among the range of vegetation types and associated bird assemblages occurring throughout the forest matrix, including in riparian habitats. The occurrence of complimentary bird assemblages throughout the landscape mosaic highlights the importance of whole landscape planning for avifauna conservation.

Cardiac rehabilitation in south west Victoria : factors influencing attendance

Background : The benefits of cardiac rehabilitation (CR) programs are well established. Despite these benefits their utilisation remains sub-optimal, with an average of 24% of eligible cardiac patients attending outpatient CR programs across Victoria.
Aims & rationale/Objectives : The objectives of this study were to (a) identify local barriers and enablers to the uptake of hospital-based CR programs, and (b) identify preferred alternatives for the delivery of CR.
Methods : Six hospital-based CR programs within the region agreed to participate in this study. A consecutive series of patients referred to the programs were surveyed by the CR coordinators to identify the local barriers and enablers influencing CR program attendance. In addition, focus groups with CR participants and health professionals were conducted at two hospitals in order to ascertain their views on current programs, suggestions for improvements and alternative methods of CR delivery.
Principal findings : Survey data was obtained from a total of 97 patients referred to the CR programs during the study period, 27 (28%) females and 70 (72%) males. Main reasons given for CR non-attendance were related to distance to travel, cost of petrol, reliance on others for transport and lack of interest or motivation to attend. For CR attenders, main enablers included encouragement by family, medical and other health professionals, and having someone else to drive them. Suggestions for alternative methods of CR delivery included more programs in outlying communities, home and GP based programs, telephone support and a patient manual or workbook.
Discussion : The results of this study provide valuable information for designing strategies to increase utilisation of existing CR programs as well as pilot testing alternative modes of CR program delivery for cardiac patients in rural areas unable to access hospital-based CR.
Implications : These findings suggest that many of the barriers identified could be addressed by a more creative use of existing resources and the provision of CR services in primary care settings.
Presentation type : Poster

Tale of Gresham's law

Gresham’s law, which says that bad money tends to drive good money out of circulation, may account for many nations’ episodes of money troubles, as far back as ancient Athens. This Commentary discusses the two main explanations for Gresham’s law and suggests some circumstances in which the law does not apply.

Validation of model-based estimates (synthetic estimates) of the prevalence of risk factors for coronary heart disease for wards in England

Several sets of model-based estimates (synthetic estimates) of the prevalence of risk factors for coronary heart disease for small areas in England have been developed. These have been used in policy documents to indicate which areas are in need of intervention. In general, these models have not been subjected to validity assessment. This paper describes a validity assessment of 16 sets of synthetic estimates, by comparison of the models with national, regional and local survey-based estimates, and local mortality rate estimates. Model-based estimates of the prevalence of smoking, low fruit and vegetable consumption, obesity, hypertension and raised cholesterol are found to be valid.

Year 8 students' understanding of astronomy as a representational issue : insights from a classroom video study

The research described in this paper argues that difficulties of leaming science concepts such as those associated with processes involving the Sun, Moon and Earth, such as day and night, the seasons and phases of the moon, are fundamentally representational in nature. There is a need for learners to use their own representational, cultural and cognitive resources to engage with the subject-specific representational practices of science. From this perspective students need to understand and conceptually integrate different representational modalities or forms in learning science and reasoning in science. The researchers worked with two experienced teachers in planning a teaching sequence in astronomy using a teaching approach that highlight representational issues and options in helping students explore and develop key conceptual understandings. Classroom sequences involving the two teachers were videotaped using a combined focus on the teacher and groups of students. Video analysis software was used to capture the variety of representations used, and sequences of representational negotiation. From a pedagogical perspective the representational approach placed a significant agency in the hands of students which resulted in structured discussions around conceptual problems. Representations were used as tools for reasoning and communication to drive classroom discussions and develop higher levels of understanding in the students. The pre- and post-testing showed significant gains in students thinking from naive to more scientific understandings of astronomy.

Detection of depression in patients with low vision

Purpose. Depression is common in people with vision impairment and further reduces levels of functioning independent of vision loss. However, depression most often remains undetected and untreated this group. Eye health  professionals (EHPs) (ophthalmic nurses, ophthalmologists, optometrists, and orthoptists) and rehabilitation workers (RWs) may be able to play a role in detecting depression. This study aimed to identify current practice and investigate factors associated with depression management strategies.
Methods. A self-administered cross-sectional survey of EHPs and RWs assessed current practice including confidence in working with depressed people with vision impairment; barriers to recognition, assessment, and management of depression; beliefs about the consequences, duration, and efficacy of treatment for depression in individuals with vision impariment.
Results. Ninety-four participants aged 23 to 69 years took part. Thirty-seven participants (39.8%) stated that they attempted to identify depression as part of patient management, with RWs significantly more likely to do so (n = 17, 60.7%) than EHPs (n = 20, 30.8%; p = 0.007). Intention to identify depression was not associated with sociodemographic factors, professional experience in eye care services, or the length and number of patient consultations, but a significant relationship was found for confidence, barriers, and beliefs about depression (p < 0.05). No consistent depression management strategy emerged and a range of barriers were highlighted.
Conclusions. Training programs are needed to provide EHPs and RWs with the skills and resources to address depression in people with vision loss under their care and to support the development of procedures by which concerns about depression can be identified objectively, documented, and included as part of a referral to appropriate services.