General practitioners' role in preventive medicine: scenario analysis using alcohol as a case study

The purpose of this analysis is threefold: first, to extract from the literature, current levels of GP detection of at-risk drinking by their patients, rates at which general practitioners (GPs) offer an intervention; and the effectiveness of these interventions; secondly, to develop a model based on this literature to be used in conjunction with scenario analysis; and thirdly, to consider the cost implications of current efforts and various scenarios. This study deals specifically with Australian general practice. A two-step procedure is used in the scenario analysis, which involves identifying opportunities for detection, intervention, effectiveness and assigning probabilities to outcomes. The results suggest that increasing rates of GP intervention achieves greatest benefit and return on resource use. For every 5% point increase in the rate of GP intervention, an additional 26 754 at-risk drinkers modify their drinking behaviour at a cost of $231.45 per patient. This compares with a cost per patient modifying drinking behaviour of $232.60 and $208.31 for every 5% point increase in the rates of detection and effectiveness, respectively. The knowledge, skill and attitude of practitioners toward drinking are significant, and they can be the prime motivators in persuading their patients to modify drinking behaviour.

The health of children in immigration detention: how does Australia compare?

We live in an age when the number of refugees worldwide is increasing. All of them have suffered physically or emotionally to a varying degree in their country of origin. The transit to a country of resettlement is fraught with further difficulties or the risk of death. This article explores the different approach taken to the management of this issue by Denmark and Iceland, in comparison to that of Australia. In particular, the different approaches to health care for children and their families are identified. The management of these issues by Denmark and Iceland would appear to be a model to follow. Outcomes of the different managements have not been assessed.

A preliminary case series on the use of quetiapine for posttraumatic stress disorder in juveniles within a youth detention center

Juveniles within the youth justice system have high rates of psychiatric morbidity, including posttraumatic stress disorder (PTSD). This case series describes 6 young people aged 15 to 17 years within a youth detention center who met the criteria for PTSD and reported an improvement in symptoms after 6 weeks of treatment with low-dose quetiapine. The primary outcome measure used was the Traumatic Symptom Checklist in Children. The dose of quetiapine ranged from 50 to 200 mg/d; T scores for PTSD symptoms decreased from 75 (SD, +/- 5.2; range, 68-82) to 54 (SD: +/- 7.4; range, 43-62) (P <= 0.01). Significant improvements in symptoms of dissociation (P <= 0.01), anxiety (P < 0.01), depression (P < 0.01).. and anger (P < 0.05) were also noted over the 6-week evaluation period. Low-dose quetiapine was tolerated well, with no persisting side effects or adverse events. Nighttime sedation was reported, although this was viewed as beneficial. All young people opted to continue with treatment after the assessment period. This preliminary case series suggests that juveniles in detention who have PTSD may benefit from treatment with quetiapine. Caution is needed in interpreting these findings. Both larger open-label and blinded trials are war-ranted to define the use of quetiapine in the treatment of PTSD in the adolescent forensic population.

Optimal periodic preventive maintenance policy for leased equipment

For leased equipment the lessor incurs penalty costs for failures occurring over the lease period and for not rectifying such failures within a specified time limit. Through preventive maintenance actions the penalty costs can be reduced but this is achieved at the expense of increased maintenance costs. The paper looks at a periodic preventive maintenance policy which achieves a tradeoff between the penalty and maintenance costs. (c) 2005 Elsevier Ltd. All rights reserved.

Optimal preventive maintenance of leased equipment with corrective minimal repairs

For leased equipment, the lessor carries out the maintenance of the equipment. Usually, the contract of lease specifies the penalty for equipment failures and for repairs not being carried out within specified time limits. This implies that optimal preventive maintenance policies must take these penalty costs into account and properly traded against the cost of preventive maintenance actions. The costs associated with failures are high as unplanned corrective maintenance actions are costly and the resulting penalties due to lease contract terms being violated. The paper develops a model to determine the optimal parameters of a preventive maintenance policy that takes into account all these costs to minimize the total expected cost to the lessor for new item lease. The parameters of the policy are (i) the number of preventive maintenance actions to be carried out over the lease period, (ii) the time instants for such actions, and (iii) the level of action. (c) 2005 Elsevier B.V. All rights reserved.

Directionality based preventive link maintenance scheme for mobile ad hoc networks

The purpose of this study was to design a preventive scheme using directional antennas to improve the performance of mobile ad hoc networks. In this dissertation, a novel Directionality based Preventive Link Maintenance (DPLM) Scheme is proposed to characterize the performance gain [JaY06a, JaY06b, JCY06] by extending the life of link. In order to maintain the link and take preventive action, signal strength of data packets is measured. Moreover, location information or angle of arrival information is collected during communication and saved in the table. When measured signal strength is below orientation threshold , an orientation warning is generated towards the previous hop node. Once orientation warning is received by previous hop (adjacent) node, it verifies the correctness of orientation warning with few hello pings and initiates high quality directional link (a link above the threshold) and immediately switches to it, avoiding a link break altogether. The location information is utilized to create a directional link by orienting neighboring nodes antennas towards each other. We call this operation an orientation handoff, which is similar to soft-handoff in cellular networks. ^ Signal strength is the indicating factor, which represents the health of the link and helps to predict the link failure. In other words, link breakage happens due to node movement and subsequently reducing signal strength of receiving packets. DPLM scheme helps ad hoc networks to avoid or postpone costly operation of route rediscovery in on-demand routing protocols by taking above-mentioned preventive action. ^ This dissertation advocates close but simple collaboration between the routing, medium access control and physical layers. In order to extend the link, the Dynamic Source Routing (DSR) and IEEE 802.11 MAC protocols were modified to use the ability of directional antennas to transmit over longer distance. A directional antenna module is implemented in OPNET simulator with two separate modes of operations: omnidirectional and directional. The antenna module has been incorporated in wireless node model and simulations are performed to characterize the performance improvement of mobile ad hoc networks. Extensive simulations have shown that without affecting the behavior of the routing protocol noticeably, aggregate throughput, packet delivery ratio, end-to-end delay (latency), routing overhead, number of data packets dropped, and number of path breaks are improved considerably. We have done the analysis of the results in different scenarios to evaluate that the use of directional antennas with proposed DPLM scheme has been found promising to improve the performance of mobile ad hoc networks. ^

Detention Home Teens as Tutors: A Cooperative Cross-Age Tutoring Pilot Project

Concerned professionals in the juvenile justice field frequently express concern for effective programs that help youth offenders successfully rejoin society. This mixed-method pilot study, involved detention home teens functioning as tutors for special education students in a public school. Tutors experienced gains in self-esteem and overall school/social attitude.

A probabilistic approach to assess hydrate formation and design preventive measures

Formation of hydrates is one of the major flow assurance problems faced by the oil and gas industry. Hydrates tend to form in natural gas pipelines with the presence of water and favorable temperature and pressure conditions, generally low temperatures and corresponding high pressures. Agglomeration of hydrates can result in blockage of flowlines and equipment, which can be time consuming to remove in subsea equipment and cause safety issues. Natural gas pipelines are more susceptible to burst and explosion owing to hydrate plugging. Therefore, a rigorous risk-assessment related to hydrate formation is required, which assists in preventing hydrate blockage and ensuring equipment integrity. This thesis presents a novel methodology to assess the probability of hydrate formation and presents a risk-based approach to determine the parameters of winterization schemes to avoid hydrate formation in natural gas pipelines operating in Arctic conditions. It also presents a lab-scale multiphase flow loop to study the effects of geometric and hydrodynamic parameters on hydrate formation and discusses the effects of geometric and hydrodynamic parameters on multiphase development length of a pipeline. Therefore, this study substantially contributes to the assessment of probability of hydrate formation and the decision making process of winterization strategies to prevent hydrate formation in Arctic conditions.