General practitioners learning qualitative research: A case study of postgraduate education

Background Qualitative research is increasingly being recognised as a vital aspect of primary healthcare research. Teaching and learning how to conduct qualitative research is especially important for general practitioners and other clinicians in the professional educational setting. This article examines a case study of postgraduate professional education in qualitative research for clinicians, for the purpose of enabling a robust discussion around teaching and learning in medicine and the health sciences. Method A series of three workshops was delivered for primary healthcare academics. The workshops were evaluated using a quantitative survey and qualitative free-text responses to enable descriptive analyses. Results Participants found qualitative philosophy and theory the most difficult areas to engage with, and learning qualitative coding and analysis was considered the easiest to learn. Discussion Key elements for successful teaching were identified, including the use of adult learning principles, the value of an experienced facilitator and an awareness of the impact of clinical subcultures on learning.

A 3-hour quantitative comparison of glucose-based versus rice-based oral rehydration solution intake by children with diarrhoea in Port Moresby General Hospital

Measurements were made of the intake of a WHO/UNICEF glucose-based and a rice cereal-based oral rehydration solution (ORS) by children with diarrhoea. Twenty children who presented to the Children's Outpatient Department at Port Moresby General Hospital with acute diarrhoea and mild dehydration were randomly assigned to an ORS and measurements were taken over the following 3 hours. For data analysis, the patients were paired by weight. Testing the means of the paired samples by t test showed that there was no significant difference between the amount of rice ORS and the amount of glucose ORS taken over 3 hours. The discovery of oral rehydration solution (ORS) for the treatment of diarrheal disease has been heralded as the most important medical discovery of the century. Cereal-based ORS is able to decrease stool output and the duration of diarrheal illness more than the standard glucose-based ORS, through the increased absorption provided by oligosaccharides without the imposition of a greater osmotic penalty. Moreover, the peptides in cereals enhance amino acid and water absorption, while providing nutritional benefits. UNICEF's glucose-based ORS is becoming more widely used in Papua New Guinea (PNG). 20 children aged 6-37 months (mean age, 15 months) who presented to the Children's Outpatient Department at Port Moresby General Hospital during September-October 1993 with acute diarrhea and mild dehydration were randomly assigned to receive either a rice-based ORS or standard glucose ORS, and measurements were taken over the following 3 hours. The patients were paired by weight for analysis. No statistically significant difference was found between the amount of rice ORS and the amount of glucose ORS taken over 3 hours.

Acceptability of a rice-based oral rehydration solution in Port Moresby General Hospital's Children's Outpatient Department

The guardians of children brought to the Port Moresby General Hospital's Children's Outpatient Department with a chief complaint of diarrhoeal disease were questioned regarding their preference of glucose-based vs rice-based oral rehydration solution (ORS) in order to determine the acceptability of a rice-based ORS. Of the 93 guardians interviewed, greater than 60% preferred the glucose-based solution in its mixability, appearance and taste, and 65% initially reported that their children preferred the taste of the glucose solution. However, after a 30-minute trial, only 58% of children still preferred the glucose solution. In a country where diarrhoeal disease is a leading cause of child death and guardians are the primary health care providers, the acceptability of an ORS is critical to the morbidity and mortality of Papua New Guinea's children. Killing an estimated 2.9 million children annually, diarrheal disease is the second leading cause of child mortality worldwide. Diarrheal disease is also the second leading cause of child mortality in Papua New Guinea (PNG), killing an average 193 inpatient children per year over the period 1984-90. However, despite the high level of diarrhea-related mortality and the proven efficacy of oral rehydration therapy (ORT) in managing diarrhea-related dehydration, standardized ORT has been underutilized in PNG. The current glucose-based oral rehydration solution (ORS) does not reduce the frequency or volume of a child's diarrhea, the most immediate concern of caregivers during episodes of illness. Cereal-based ORS, made from cereals which are commonly available as food staples in most countries, better address the short-term concerns of caregivers while offering a superior nutritional profile. A sample of guardians of children brought to the Port Moresby General Hospital's Children's Outpatient Department complaining of child diarrhea were asked about their preferences on glucose-based versus rice-based ORS in order to determine the acceptability of a rice-based ORS. More than 60% of the 93 guardians interviewed preferred the glucose-based solution for its mixability, appearance, and taste. 65% initially reported that their children preferred the taste of the glucose solution. However, after a 30-minute trial, only 58% of children still preferred the glucose solution.

Gaussian Schell-model beams and general shape invariance

We present two six-parameter families of anisotropic Gaussian Schell-model beams that propagate in a shape-invariant manner, with the intensity distribution continuously twisting about the beam axis. The two families differ in the sense or helicity of this beam twist. The propagation characteristics of these shape-invariant beams are studied, and the restrictions on the beam parameters that arise from the optical uncertainty principle are brought out. Shape invariance is traced to a fundamental dynamical symmetry that underlies these beams. This symmetry is the product of spatial rotation and fractional Fourier transformation.

Submission on NSW Attorney-General's Discussion Paper on Amendment of Limitation of Actions Act 1969 to remove time limit for civil claims for child abuse

The New South Wales Attorney-General and Justice Policy Division released a Discussion Paper about reform of the Limitation of Actions Act 1969. The key question was whether and how to amend the statute to better provide access to justice for civil claimants in child abuse cases. This submission draws on published literature and multidisciplinary research to support the Discussion Paper's Option A, namely, to abolish the time limit for civil claims for injuries in criminal child abuse cases, and for this to be made retrospective.

General practitioner utilisation amongst urban Aboriginal and Torres Strait Islander children aged less than 5 years

Aim There are limited studies documenting the frequency and reason for attendance to primary health care services in Australian children, particularly for urban Aboriginal and Torres Strait Islander children. This study describes health service utilisation in this population in an urban setting. Methods An ongoing prospective cohort study of Aboriginal and Torres Strait Islander children aged <5 years registered with an urban Aboriginal and Torres Strait Islander primary health care centre in Brisbane, Australia. Detailed demographic, clinical, health service utilisation and risk factor data are collected by Aboriginal researchers at enrolment and monthly for a period of 12 months on each child. The incidence of health service utilisation was calculated according to the Poisson distribution. Results Between 14 February 2013 and 31 October 2014, 118 children were recruited, providing data for 535 child-months of observation. Ninety-one percent of children were Aboriginal, 4% Torres Strait Islander and 5% were both Aboriginal and Torres Strait Islander. The incidence of presentations to see a doctor for any reason was 43.9 episodes/100 child months (95%CI 38.4 – 49.9) The most common reasons for presentation were for immunisations (23%), respiratory illnesses (19%) and for Australian Government funded Indigenous child health check (16%). The primary health services used, for majority of these visits were Aboriginal and Torres Strait Islander specific medical services (61%). Conclusions Within a cultural-specific service for an urban Aboriginal and Torres Strait Islander people, there is a high frequency of childhood attendance at for primary health care services. Well-health checks and respiratory illnesses were the most common reasons. The high proportion of visits for well child services suggests a potential for opportunistic health promotion, education and early interventions across a range of child health issues.

General ranked set sampling for efficient treatment comparisons

In treatment comparison experiments, the treatment responses are often correlated with some concomitant variables which can be measured before or at the beginning of the experiments. In this article, we propose schemes for the assignment of experimental units that may greatly improve the efficiency of the comparison in such situations. The proposed schemes are based on general ranked set sampling. The relative efficiency and cost-effectiveness of the proposed schemes are studied and compared. It is found that some proposed schemes are always more efficient than the traditional simple random assignment scheme when the total cost is the same. Numerical studies show promising results using the proposed schemes.

A comparative study of side-band Fresnel holograms recorded with self-imaging and general objects

This paper deals with new results obtained in regard to the reconstruction properties of side-band Fresnel holograms (SBFH) of self-imaging type objects (for example, gratings) as compared with those of general objects. The major finding is that a distribution I2, which appears on the real-image plane along with the conventional real-image I1, remains a 2Z distribution (where 2Z is the axial distance between the object and its self-imaging plane) under a variety of situations, while its nature and focusing properties differ from one situation to another. It is demonstrated that the two distributions I1 and I2 can be used in the development of a novel technique for image subtraction.

Estimation for the general sample selection models

Consider a general regression model with an arbitrary and unknown link function and a stochastic selection variable that determines whether the outcome variable is observable or missing. The paper proposes U-statistics that are based on kernel functions as estimators for the directions of the parameter vectors in the link function and the selection equation, and shows that these estimators are consistent and asymptotically normal.

General ranked set sampling with cost considerations

Nahhas, Wolfe, and Chen (2002, Biometrics 58, 964-971) considered optimal set size for ranked set sampling (RSS) with fixed operational costs. This framework can be very useful in practice to determine whether RSS is beneficial and to obtain the optimal set size that minimizes the variance of the population estimator for a fixed total cost. In this article, we propose a scheme of general RSS in which more than one observation can be taken from each ranked set. This is shown to be more cost-effective in some cases when the cost of ranking is not so small. We demonstrate using the example in Nahhas, Wolfe, and Chen (2002, Biometrics 58, 964-971), by taking two or more observations from one set even with the optimal set size from the RSS design can be more beneficial.

The development of a guideline of care for patients with a Sengstaken-Blakemore Tube insitu in a general Intensive Care Unit using translational change theory

Aims & Objectives - identify and diagnose the current problems associated with patient care with regard to the nursing management of patients with Sengstaken-Blakemore tubes insitu; - Identify current nursing practice currently in place within the ICU and the hospital; identify the method by which the assessment and provision of nursing care is delivered in the ICU

GRDB: A general purpose relational database system

This article discusses the design and development of GRDB (General Purpose Relational Data Base System) which has been implemented on a DEC-1090 system in Pascal. GRDB is a general purpose database system designed to be completely independent of the nature of data to be handled, since it is not tailored to the specific requirements of any particular enterprise. It can handle different types of data such as variable length records and textual data. Apart from the usual database facilities such as data definition and data manipulation, GRDB supports User Definition Language (UDL) and Security definition language. These facilities are provided through a SEQUEL-like General Purpose Query Language (GQL). GRDB provides adequate protection facilities up to the relation level. The concept of “security matrix” has been made use of to provide database protection. The concept of Unique IDentification number (UID) and Password is made use of to ensure user identification and authentication. The concept of static integrity constraints has been used to ensure data integrity. Considerable efforts have been made to improve the response time through indexing on the data files and query optimisation. GRDB is designed for an interactive use but alternate provision has been made for its use through batch mode also. A typical Air Force application (consisting of data about personnel, inventory control, and maintenance planning) has been used to test GRDB and it has been found to perform satisfactorily.

Gauge theory of a group of diffeomorphisms. I. General principles

Any (N+M)-parameter Lie group G with an N-parameter subgroup H can be realized as a global group of diffeomorphisms on an M-dimensional base space B, with representations in terms of transformation laws of fields on B belonging to linear representations of H. The gauged generalization of the global diffeomorphisms consists of general diffeomorphisms (or coordinate transformations) on a base space together with a local action of H on the fields. The particular applications of the scheme to space-time symmetries is discussed in terms of Lagrangians, field equations, currents, and source identities. Journal of Mathematical Physics is copyrighted by The American Institute of Physics.

The credit risk(+) model with general sector correlations

We consider an enhancement of the credit risk+ model to incorporate correlations between sectors. We model the sector default rates as linear combinations of a common set of independent variables that represent macro-economic variables or risk factors. We also derive the formula for exact VaR contributions at the obligor level.

Representing the epistemic nature of teachers’ practical knowledge : The case of class teachers’ general pedagogy

The present study addressed the epistemology of teachers’ practical knowledge. Drawing from the literature, teachers’ practical knowledge is defined as all teachers’ cognitions (e.g., beliefs, values, motives, procedural knowing, and declarative knowledge) that guide their practice of teaching. The teachers’ reasoning that lies behind their practical knowledge is addressed to gain insight into its epistemic nature. I studied six class teachers’ practical knowledge; they teach in the metropolitan region of Helsinki. Relying on the assumptions of the phenomenographic inquiry, I collected and analyzed the data. I analyzed the data in two stages where the first stage involved an abductive procedure, and the second stage an inductive procedure for interpretation, and thus developed the system of categories. In the end, a quantitative analysis nested into the qualitative findings to study the patterns of the teachers’’ reasoning. The results indicated that teachers justified their practical knowledge based on morality and efficiency of action; efficiency of action was found to be presented in two different ways: authentic efficiency and naïve efficiency. The epistemic weight of morality was embedded in what I call “moral care”. The core intention of teachers in the moral care was the commitment that they felt about the “whole character” of students. From this perspective the “dignity” and the moral character of the students should not replaced for any other “instrumental price”. “Caring pedagogy” was the epistemic value of teachers’ reasoning in the authentic efficiency. The central idea in the caring pedagogy was teachers’ intentions to improve the “intellectual properties” of “all or most” of the students using “flexible” and “diverse” pedagogies. However, “regulating pedagogy” was the epistemic condition of practice in the cases corresponding to naïve efficiency. Teachers argued that an effective practical knowledge should regulate and manage the classroom activities, but the targets of the practical knowledge were mainly other “issues “or a certain percentage of the students. In these cases, the teachers’ arguments were mainly based on the notion of “what worked” regardless of reflecting on “what did not work”. Drawing from the theoretical background and the data, teachers’ practical knowledge calls for “praxial knowledge” when they used the epistemic conditions of “caring pedagogy” and “moral care”. It however calls for “practicable” epistemic status when teachers use the epistemic condition of regulating pedagogy. As such, praxial knowledge with the dimensions of caring pedagogy and moral care represents the “normative” perspective on teachers’ practical knowledge, and thus reflects a higher epistemic status in comparison to “practicable” knowledge, which represents a “descriptive” perception toward teachers’ practical knowledge and teaching.