Questions about multidisciplinary teams

Multidisciplinary care (MDC) involves health professionals from a range of disciplines working together as a team (a multidisciplinary team – MDT) to deliver comprehensive care that addresses as many of a patient's needs as possible. Writing in 2011, Wilcoxon and others concluded: ‘Multidisciplinary care is accepted as best practice in cancer treatment planning and care.’ Yet their report (of the national audit of multidisciplinary cancer care in Australia) indicated that two-thirds of the surveyed hospitals did not have a MDT. Further, they found that where teams did exist, one-third of patients were not told that their case would be discussed by the team; the MDT-recommended treatment plan was not included in the patient’s record one-quarter of the time; and less than 1 per cent of teams reported routine attendance by the tumour-specific minimum core team. There is sparse case authority as to the potential medico-legal consequences of MDC by MDTs. This article raises five questions about legal aspects of MDC for consideration. The questions are not limited to cancer care, as MDTs are increasingly used in other areas of medicine.

Strategically Pleading Intentional Torts in medical cases

The opportunities and challenges faced by litigants who strategically plead intentional torts are borne out by two recent medical cases. Both arose out of dental treatment. Dean v Phung established some key principles which were clarified in White v Johnston. Before considering those two cases it is worth examining the environment in which such intentional torts claims now exist. Following the Ipp Review of the Law of Negligence, non-uniform legislative changes to the law of negligence were introduced across Australia which have imposed limitations on liability and quantum of damages in cases where a person has been injured through the fault of another. While it seems that, given the limitation of the scope of the review and recommendations to negligently caused damage, the Ipp Review reforms were meant to be limited to injury resulting from negligent acts rather than intentional torts, the extent to which the civil liability legislation applies to intentional torts differs across Australia.

Effects of electrical muscle stimulation on oxygen consumption

Electrical muscle stimulation (EMS) devices are being marketed as weight/ fat loss devices throughout the world. Commercially available stimulators have the ability to evoke muscle contractions that may affect caloric expenditure while the device is being used. The aim of this study was to test the effects of two different EMS devices (Abtronic and Feminique) on oxygen consumption at rest. Subjects arrived for testing after an overnight fast, had the devices fitted, and then positioned supine with expired air measured to determine oxygen consumption. After a 10-minute acclimation period, oxygen consumption was measured for 20 minutes with the device switched off (resting) then 20 minutes with the device switched on (stimulated). There were no significant differences (p > 0.05) in oxygen consumption between the resting and stimulated periods with either the Abtronic (mean +/- SD; resting, 3.40 +/- 0.44; stimulated, 3.45 +/- 0.53 ml of O2[middle dot]kg-1[middle dot]min-1) or the Feminique (resting, 3.73 +/- 0.45; stimulated, 3.75 +/- 0.46 ml of O2[middle dot]kg-1[middle dot]min-1). In summary, the EMS devices tested had no effect on oxygen consumption during muscle stimulation.

Feasibility of an in-patient exercise intervention for children undergoing haematopoietic stem cell transplant

With improving survival rates following HSCT in children, QOL and management of short- and long-term effects need to be considered. Exercise may help mitigate fatigue and declines in fitness and strength. The aims of this study were to assess the feasibility of an inpatient exercise intervention for children undergoing HSCT and observe the changes in physical and psychological health. Fourteen patients were recruited, mean age 10 yr. A 6MWT, isometric upper and lower body strength, balance, fatigue, and QOL were assessed prior to Tx and six wk post-Tx. A supervised exercise program was offered five days per week during the inpatient period and feasibility assessed through uptake rate. The study had 100% program completion and 60% uptake rate of exercise sessions. The mean (±s.d.) weekly activity was 117.5 (±79.3) minutes. Younger children performed significantly more minutes of exercise than adolescents. At reassessment, strength and fatigue were stabilized while aerobic fitness and balance decreased. QOL revealed a non-statistical trend towards improvement. No exercise-related adverse events were reported. A supervised inpatient exercise program is safe and feasible, with potential physiological and psychosocial benefits.

Tekstiilityötä ja matematiikkaa yhdistävän oppimateriaalin käyttökelpoisuus perusopetuksen yläluokilla

In this study the researcher wanted to show the observed connection of mathematics and textile work. To carry this out the researcher designed a textbook by herself for the upper secondary school in Tietoteollisuuden Naiset TiNA project at Helsinki University of Technology (URL:http://tina.tkk.fi/). The assignments were designed as additional teaching material to enhance and reinforce female students confidence in mathematics and in the management of their textile work. The research strategy applied action research, out of which two cycles two have been carried out. The first cycle consists of establishing the textbook and in the second cycle its usability is investigated. The third cycle is not included in this report. In the second cycle of the action research the data was collected from 15 teachers, five textile teachers, four mathematics teachers and six teachers of both subjects. They all got familiar with the textbook assignments and answered a questionnaire on the basis of their own teaching experience. The questionnaire was established by applying the theories of usability and teaching material assessment study. The data consisted of qualitative and quantitative information, which was analysed by content analysis with computer assisted table program to either qualitative or statistical description. According to the research results, the textbook assignments seamed to be applied better to mathematics lessons than textile work. The assignments pointed out, however, the clear interconnectedness of textile work and mathematics. Most of the assignments could be applied as such or as applications in the upper secondary school textile work and mathematics lessons. The textbook assignments were also applicable in different stages of the teaching process, e.g. as introduction, repetition or to support individual work or as group projects. In principle the textbook assignments were in well placed and designed in the correct level of difficulty. Negative findings concerned some too difficult assignments, lack of pupil motivation and unfamiliar form of task for the teacher. More clarity for some assignments was wished for and there was especially expressed a need for easy tasks and assignments in geometry. Assignments leading to the independent thinking of the pupil were additionally asked for. Two important improvements concerning the textbook attainability would be to get the assignments in html format over the Internet and to add a handicraft reference book.

My First 6701 Days : July 31 1921 to December 1939 /

The memoirs contain photocopies of documents and photos as well as extracts from letters and were written in October 1989 in the United States. Description of life in Baden, a famous health resort near Vienna. The family lived in Vienna in the second district (Leopoldstadt). Recollections of schoolteachers and childhood friends. Occasional Friday night services in the Leopoldstadt temple. Theater and opera visits and cultural life in Vienna. Private piano and music lessons. Description of the family apartment and Jewish life in the Leopoldstadt. The family celebrated Christmas and observed the high Jewish holidays. Recollections of the author's bar mitzvah celebration. His mother Charlotte, nee Schwadron, was an artistic woman, who studied painting at the Frauenakademie with Tina Blau. Walter's father Leo Schaffir was born in Byalistock, Russia and studied in Berlin. He was a travelling businessmen. His family lived in Lemberg, Galicia. Leo and Charlotte Schaffir got married in 1919 in Vienna by rabbi Dr. Grunwald. Recollections of a family trip to Poland and to the World Fair in Posen in 1930. Suicide of the author's father due to business failure in 1930. Schaffir and Schwadron family history. Both families originated in Galicia, Poland. Family and social life. Summer vacation at the Semmering. Austrian politics in the 1930's and rising National Socialism. Life in Vienna after the "Anschluss" in 1938. Walter had to leave school and took lessons in graphic arts with the artist Heinrich Koerner. Preparations to emigrate. Walter was picked up in the streets in the days after Kristallnacht and released due to his mother's intervention. He was sent with his brother Kurt on a "Kindertransport" to Holland. They were sent to a quarantine camp at Heyplaat. Reunition with their mother in the United States in December 1939. Reflections on life as an emigre.

Conclaves and concurrent expert evidence: A positive development in Australian legal practice?

Many Australian courts now prefer pre-hearing meetings of experts (conclaves) being convened to prepare joint reports to identify areas of agreement and disagreement, followed by concurrent expert evidence at trial. This contrasts to the traditional approach where experts did not meet before trial and did not give evidence together. Most judges, lawyers and expert witnesses favour this as a positive development in Australian legal practice, at least for civil disputes. This new approach impacts medical practitioners who are called upon to give expert evidence, or who are parties to disputes before the courts. Arguably, it is too soon to tell whether the relative lack of transparency at the conclave stage will give rise to difficulties in the coronial, disciplinary and criminal arenas.

A multi-centre open-label randomised non-inferiority trial comparing watchful waiting to antibiotic treatment for acute otitis media without perforation in low-risk urban Aboriginal and Torres Strait Islander children (the WATCH trial): study protocol for a randomised controlled trial

Background Treatment guidelines recommend watchful waiting for children older than 2 years with acute otitis media (AOM) without perforation, unless they are at high risk of complications. The high prevalence of chronic suppurative otitis media (CSOM) in remote Aboriginal and Torres Strait Islander communities leads these children to be classified as high risk. Urban Aboriginal and Torres Strait Islander children are at lower risk of complications, but evidence to support the subsequent recommendation for watchful waiting in this population is lacking. Methods/Design This non-inferiority multi-centre randomised controlled trial will determine whether watchful waiting is non-inferior to immediate antibiotics for urban Aboriginal and Torres Strait Islander children with AOM without perforation. Children aged 2 − 16 years with AOM who are considered at low risk for complications will be recruited from six participating urban primary health care services across Australia. We will obtain informed consent from each participant or their guardian. The primary outcome is clinical resolution on day 7 (no pain, no fever of at least 38 °C, no bulging eardrum and no complications of AOM such as perforation or mastoiditis) as assessed by general practitioners or nurse practitioners. Participants and outcome assessors will not be blinded to treatment. With a sample size of 198 children in each arm, we have 80 % power to detect a non-inferiority margin of up to 10 % at a significance level of 5 %, assuming clinical improvement of at least 80 % in both groups. Allowing for a 20 % dropout rate, we aim to recruit 495 children. We will analyse both by intention-to-treat and per protocol. We will assess the cost- effectiveness of watchful waiting compared to immediate antibiotic prescription. We will also report on the implementation of the trial from the perspectives of parents/carers, health professionals and researchers. Discussion The trial will provide evidence for the safety and effectiveness of watchful waiting for the management of AOM in Aboriginal and Torres Strait Islander children living in urban settings who are considered to be at low risk of complications.

Trial of the Primary Care Practice Improvement Tool: Building organisational performance in Australian general practice and primary health care

Objective: To nationally trial the Primary Care Practice Improvement Tool (PC-PIT), an organisational performance improvement tool previously co-created with Australian primary care practices to increase their focus on relevant quality improvement (QI) activities. Design: The study was conducted from March to December 2015 with volunteer general practices from a range of Australian primary care settings. We used a mixed-methods approach in two parts. Part 1 involved staff in Australian primary care practices assessing how they perceived their practice met (or did not meet) each of the 13 PC-PIT elements of high-performing practices, using a 1–5 Likert scale. In Part 2, two external raters conducted an independent practice visit to independently and objectively assess the subjective practice assessment from Part 1 against objective indicators for the 13 elements, using the same 1–5 Likert scale. Concordance between the raters was determined by comparing their ratings. In-depth interviews conducted during the independent practice visits explored practice managers’ experiences and perceived support and resource needs to undertake organisational improvement in practice. Results: Data were available for 34 general practices participating in Part 1. For Part 2, independent practice visits and the inter-rater comparison were conducted for a purposeful sample of 19 of the 34 practices. Overall concordance between the two raters for each of the assessed elements was excellent. Three practice types across a continuum of higher- to lower-scoring practices were identified, with each using the PC-PIT in a unique way. During the in-depth interviews, practice managers identified benefits of having additional QI tools that relate to the PC-PIT elements. Conclusions: The PC-PIT is an organisational performance tool that is acceptable, valid and relevant to our range of partners and the end users (general practices). Work is continuing with our partners and end users to embed the PC-PIT in existing organisational improvement programs.

Springs of Florida

bulletin which documented the major and important springs in the state (Ferguson et al., 1947). This publication was revised in 1977, with many previously undocumented springs and many new water-quality analyses being added (Rosenau et al., 1977). The Florida Geological Survey's report on first magnitude springs (Scott et al., 2002) was the initial step in once again updating and revising the Springs of Florida bulletin. The new bulletin includes the spring descriptions and water-quality analyses from Scott et al. (2002). Nearly 300 springs were described in 1977. As of 2004, more than 700 springs have been recognized in the state and more are reported each year. To date, 33 first magnitude springs (with a flow greater than 100 cubic feet per second or approximately 64.6 million gallons of water per day) have been recognized in Florida, more than any other state or country (Rosenau et al., 1977). Our springs are a unique and invaluable natural resource. A comprehensive understanding of the spring systems will provide the basis for their protection and wise use. (Document pdf contains 677 pages)

Proceedings fo the Seventeenth Annual Sea Turtle Symposium, 4-8 March 1997, Orlando, Florida, U.S.A.

The 17th Annual Sea Turtle Symposium was held at the Delta Orlando Resort in Orlando, Florida U.S.A. from March 4-8, 1997. The symposium was hosted by Florida Atlantic University, Mote Marine Laboratory, University of Central Florida, University of Florida, Florida Atlantic University and the Comité Nacional para la Conservación y Protección de las Totugas Marinas. The 17th was the largest symposium to date. A total of 720 participants registered, including sea turtle biologists, students, regulatory personnel, managers, and volunteers representing 38 countries. In addition to the United States, participants represented Australia, Austria, the Bahamas, Bonaire, Bermuda, Brazil, Canada, Colombia, Costa Rica, Croatia, Cuba, Cyprus, Dominican Republic, Ecuador, England, Guatemala, Greece, Honduras, India, Italy, Japan, Madagascar, Malaysia, Mexico, The Netherlands, Nicaragua, Peru, Philippines, Republic of Seychelles, Scotland, Spain, Sri Lanka, Switzerland, Taiwan, Turkey, Uruguay, and Venezuela. In addition to the 79 oral, 2 video, and 120 poster presentations, 3 workshops were offered: Selina Heppell (Duke University Marine Laboratory) provided “Population Modeling,” Mike Walsh and Sam Dover (Sea World-Orlando) conducted “Marine Turtle Veterinary Medicine” and “Conservation on Nesting Beaches” was offered by Blair Witherington and David Arnold (Florida Department of Environmental Protection). On the first evening, P.C.H. Pritchard delivered a thoughtful retrospect on Archie Carr that showed many sides of a complex man who studied and wrote about sea turtles. It was a presentation that none of us will forget. The members considered a number of resolutions at the Thursday business meeting and passed six. Five of these resolutions are presented in the Commentaries and Reviews section of Chelonian Conservation and Biology 2(3):442-444 (1997). The symposium was fortunate to have many fine presentations competing for the Archie Carr Best Student Presentations awards. The best oral presentation award went to Amanda Southwood (University of British Columbia) for “Heart rates and dive behavior of the leatherback sea turtle during the internesting interval.” The two runners-up were Richard Reina (Australian National University) for “Regulation of salt gland activity in Chelonia mydas” and Singo Minamikawa (Kyoto University) for “The influence that artificial specific gravity change gives to diving behavior of loggerhead turtles”. The winner of this year’s best poster competition was Mark Roberts (University of South Florida) for his poster entitled “Global population structure of green sea Turtles (Chelonia mydas) using microsatellite analysis of male mediated gene flow.” The two runners-up were Larisa Avens (University of North Carolina-Chapel Hill) for “Equilibrium responses to rotational displacements by hatchling sea turtles: maintaining a migratory heading in a turbulent ocean” and Annette Broderick (University of Glasgow) for “Female size, not length, is a correlate of reproductive output.” The symposium was very fortunate to receive a matching monetary and subscription gift from Anders J. G. Rhodin of the Chelonian Research Foundation. These enabled us to more adequately reward the fine work of students. The winners of the best paper and best poster awards received $400 plus a subscription to Chelonian Conservation and Biology. Each runner up received $100. The symposium owes a great debt to countless volunteers who helped make the meeting a success. Those volunteers include: Jamie Serino, Alan Bolton, and Karen Bjorndal, along with the UF students provided audio visual help, John Keinath chaired the student awards committee, Mike Salmon chaired the Program Commiteee, Sheryan Epperly and Joanne Braun compiled the Proceedings, Edwin Drane served as treasurer and provided much logistical help, Jane Provancha coordinated volunteers, Thelma Richardson conducted registration, Vicki Wiese coordinated food and beverage services, Jamie Serino and Erik Marin coordinated entertainment, Kenneth Dodd oversaw student travel awards, Traci Guynup, Tina Brown, Jerris Foote, Dan Hamilton, Richie Moretti, and Vicki Wiese served on the time and place committee, Blair Witherington created the trivia quiz, Tom McFarland donated the symposium logo, Deborah Crouse chaired the resolutions committee, Pamela Plotkin chaired the nominations committee, Sally Krebs, Susan Schenk, and Larry Wood conducted the silent auction, and Beverly and Tom McFarland coordinated all 26 vendors. Many individuals from outside the United States were able to attend the 17th Annual Sea Turtle Symposium thanks to the tireless work of Karen Eckert, Marydele Donnelly, and Jack Frazier in soliciting travel assistance for a number of international participants. We are indebted to those donating money to the internationals’ housing fund (Flo Vetter Memorial Fund, Marinelife Center of Juno Beach, Roger Mellgren, and Jane Provancha). We raise much of our money for international travel from the auction; thanks go to auctioneer Bob Shoop, who kept our auction fastpaced and entertaining, and made sure the bidding was high. The Annual Sea Turtle Symposium is unequaled in its emphasis on international participation. Through international participation we all learn a great deal more about the biology of sea turtles and the conservation issues that sea turtles face in distant waters. Additionally, those attending the symposium come away with a tremendous wealth of knowledge, professional contacts, and new friendships. The Annual Sea Turtle Symposium is a meeting in which pretenses are dropped, good science is presented, and friendly, open communication is the rule. The camaraderie that typifies these meetings ultimately translates into understanding and cooperation. These aspects, combined, have gone and will go a long way toward helping to protect marine turtles and toward aiding their recovery on a global scale. (PDF contains 342 pages)

An investigation into reactivity and selectivity in cycloadditions of 1,3-dipoles with formamidines

The objective of this research was to investigate the synthesis of nitrile oxides and to study their reactivity in 1,3-dipolar cycloadditions with formamidines. Chapter one looks at the literature surrounding the 1,3-dipolar cycloaddition reaction. It explores the generation of 1,3-dipoles (mainly nitrile oxides) and dipolarophiles (predominantly amidines). It discusses the potential synthetic uses of the 1,3-dipolar cycloadducts. It examines both and inter- and intra-molecular cycloaddition reactions. It recognises the use of the 1,3-dipolar cycloadditions as a successful method in building natural products and oxadiazolines. The decomposition of oxadiazolines as a route to nitriles is also outlined in this chapter. Chapter two discusses the results of this research candidate. The preparation of nitrile oxide precursors - hydroximoyl halides - is outlined at first. The generation of nitrile oxides is then demonstrated, followed by the preparation of furoxans. Methods for preparing the reference materials (nitriles and ureas), which result from decomposition of oxadiazolines, then follow. The preparation of series of Δ2-1,2,4- oxadiazolines via the 1,3-dipolar cycloaddition reaction is illustrated in this chapter. The selectivity of the addition of nitrile oxides to dipolarophiles was tested by competition reactions, which are also described in this chapter. NMR techniques were used in the study of the kinetics of the 1,3-dipolar cycloadditions used for the preparation of a series of Δ2-1,2,4-oxadiazolines, which is addressed in this chapter. Chapter three charts the experimental procedures followed to gain results which are discussed in chapter two. It also outlines all analytical data produced during the course of this research.

Using sediment flocculation to reduce the impacts of Chesapeake Bay Microcystis aeruginosa harmful algal blooms

Gemstone Team BREATHE (Bay Revitalization Efforts Against the Hypoxic Environment)

The effect of collagen organization on tensile strength loss in anterior cruciate ligament grafts post-reconstruction surgery

Gemstone Team LEGS