990 resultados para GP shortage


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The Hong Kong construction industry is currently facing ageing problem and labour shortage. There are opportunities for employing ethnic minority construction workers to join this hazardous industry. These ethnic minority workers are prone to accidents due to communication barriers. Safety communication is playing an important role for avoiding the accidents on construction sites. However, the ethnic minority workers are not very fluent in the local language and facing safety communication problems while working with local workers. Social network analysis (SNA), being an effective tool to identify the safety communication flow on the construction site, is used to attain the measures of safety communication like centrality, density and betweenness within the ethnic minorities and local workers, and to generate sociograms that visually represent communication pattern within the effective and ineffective safety networks. The aim of this paper is to present the application of SNA for improving the safety communication of ethnic minorities in the construction industry of Hong Kong. The paper provides the theoretical background of SNA approaches for the data collection and analysis using the software UCINET and NetDraw, to determine the predominant safety communication network structure and pattern of ethnic minorities on site.

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Infectious diseases such as SARS, influenza and bird flu have the potential to cause global pandemics; a key intervention will be vaccination. Hence, it is imperative to have in place the capacity to create vaccines against new diseases in the shortest time possible. In 2004, The Institute of Medicine asserted that the world is tottering on the verge of a colossal influenza outbreak. The institute stated that, inadequate production system for influenza vaccines is a major obstruction in the preparation towards influenza outbreaks. Because of production issues, the vaccine industry is facing financial and technological bottlenecks: In October 2004, the FDA was caught off guard by the shortage of flu vaccine, caused by a contamination in a US-based plant (Chiron Corporation), one of the only two suppliers of US flu vaccine. Due to difficulties in production and long processing times, the bulk of the world's vaccine production comes from very small number of companies compared to the number of companies producing drugs. Conventional vaccines are made of attenuated or modified forms of viruses. Relatively high and continuous doses are administered when a non-viable vaccine is used and the overall protective immunity obtained is ephemeral. The safety concerns of viral vaccines have propelled interest in creating a viable replacement that would be more effective and safer to use.

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In order to protect our planet and ourselves from the adverse effects of excessive CO2 emissions and to prevent an imminent non-renewable fossil fuel shortage and energy crisis, there is a need to transform our current ‘fossil fuel dependent’ energy systems to new, clean, renewable energy sources. The world has recognized hydrogen as an energy carrier that complies with all the environmental quality and energy security, demands. This research aimed at producing hydrogen through anaerobic fermentation, using food waste as the substrate. Four food waste substrates were used: Rice, fish, vegetable and their mixture. Bio-hydrogen production was performed in lab scale reactors, using 250 mL serum bottles. The food waste was first mixed with the anaerobic sewage sludge and incubated at 37°C for 31 days (acclimatization). The anaerobic sewage sludge was then heat treated at 80°C for 15 min. The experiment was conducted at an initial pH of 5.5 and temperatures of 27, 35 and 55°C. The maximum cumulative hydrogen produced by rice, fish, vegetable and mixed food waste substrates were highest at 37°C (Rice =26.97±0.76 mL, fish = 89.70±1.25 mL, vegetable = 42.00±1.76 mL, mixed = 108.90±1.42 mL). A comparative study of acclimatized (the different food waste substrates were mixed with anaerobic sewage sludge and incubated at 37°C for 31days) and non-acclimatized food waste substrate (food waste that was not incubated with anaerobic sewage sludge) showed that acclimatized food waste substrate enhanced bio-hydrogen production by 90 - 100%.

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The preservation technique of drying offers a significant increase in the shelf life of food materials, along with the modification of quality attributes due to simultaneous heat and mass transfer. Variations in porosity are just one of the microstructural changes that take place during the drying of most food materials. Some studies found that there may be a relationship between porosity and the properties of dried foods. However, no conclusive relationship has yet been established in the literature. This paper presents an overview of the factors that influence porosity, as well as the effects of porosity on dried food quality attributes. The effect of heat and mass transfer on porosity is also discussed along with porosity development in various drying methods. After an extensive review of the literature concerning the study of porosity, it emerges that a relationship between process parameters, food qualities, and sample properties can be established. Therefore, we propose a hypothesis of relationships between process parameters, product quality attributes, and porosity.

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This chapter investigates counselling interactions where young clients talk about their experiences of taking on family responsibilities normatively associated with parental roles. In research counselling literature, practices where relationships in families operate so that there is a reversal of roles, with children managing the households and caring for parents and siblings, is described as parentification. Parentification is used in the counselling literature as a clinician/researcher term, which we ‘respecify’ (Garfinkel, 1991) the tem by beginning with an investigation of young clients’ own accounts of being an adult or parent and how counsellors orient to these accounts. As well as providing understandings of how young people propose accounts of their experiences of adult-child role reversal, the chapter contributes to understanding how children and young people use the resources of counselling helplines, and how counselors can communicate effectively with children and young people.

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This chapter provides a theoretical overview of literature that uses conversation analysis (CA) to explore children’s interactions related to trauma and associated mental health matters. The relatively new approach of using CA to understand trauma reveals the importance of talk in the process of recovery, and also how the participants co-construct talk about traumatic experiences. The chapter will explore literature using a CA approach to investigate children’s trauma talk with professionals as well as literature specifically discussing children’s talk about their traumatic experiences with people who are not qualified therapists or psychiatrists. We conclude by calling for more research using a CA approach for investigating children’s traumatic experiences due to the insight it provides into each child’s personal sense making of traumatic events with a range of people.

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With the increasing need to adapt to new environments, data-driven approaches have been developed to estimate terrain traversability by learning the rover’s response on the terrain based on experience. Multiple learning inputs are often used to adequately describe the various aspects of terrain traversability. In a complex learning framework, it can be difficult to identify the relevance of each learning input to the resulting estimate. This paper addresses the suitability of each learning input by systematically analyzing the impact of each input on the estimate. Sensitivity Analysis (SA) methods provide a means to measure the contribution of each learning input to the estimate variability. Using a variance-based SA method, we characterize how the prediction changes as one or more of the input changes, and also quantify the prediction uncertainty as attributed from each of the inputs in the framework of dependent inputs. We propose an approach built on Analysis of Variance (ANOVA) decomposition to examine the prediction made in a near-to-far learning framework based on multi-task GP regression. We demonstrate the approach by analyzing the impact of driving speed and terrain geometry on the prediction of the rover’s attitude and chassis configuration in a Marsanalogue terrain using our prototype rover Mawson.

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This chapter analyses recent policy reforms in the national history curriculum in both Australia and the Russian Federation. It analyses those emphases in the national curriculum in history that depict new representations and historiography and the ways in which this is foregrounded in History school textbooks. In doing so, it considers the debates about what version of the nation’s past are deemed significant, and what should be transmitted to future generations of citizens. In this discussion of national history curricula, consideration is made of the curriculum’s officially defined status as an instrument in the process of ideological transformation, and nation-building. The chapter also examines how history textbooks are implicit in this process, in terms of reproducing and representing what content is selected and emphasised in a national history curriculum.

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Biomedical systems involve a large number of entities and intricate interactions between these. Their direct analysis is, therefore, difficult, and it is often necessary to rely on computational models. These models require significant resources and parallel computing solutions. These approaches are particularly suited, given parallel aspects in the nature of biomedical systems. Model hybridisation also permits the integration and simultaneous study of multiple aspects and scales of these systems, thus providing an efficient platform for multidisciplinary research.

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Background Some patients visit a hospital’s emergency department (ED) for reasons other than an urgent medical condition. There is evidence that this practice may differ among patients from different backgrounds. The objective of this study was to examine the reasons why patients from a non-English speaking background (NESB) and patients with an English speaking background but not born in Australia (ESB-NBA) visit the ED, as compared to patients from English-speaking backgrounds but born in Australia (ESB-BA). Methods A cross-sectional survey was conducted at the ED of a tertiary hospital in metropolitan Brisbane, Queensland, Australia. Over a four-month period patients who were assigned an Australasian Triage Scale score of 3, 4 or 5 were surveyed. Pearson chi-square test and multivariate logistic regression analyses were performed to examine the differences between the ESB and NESB patients’ reported reasons for attending the ED. Results A total of 828 patients participated in this study. Compared to ESB-BA patients NESB patients were less likely to consider contacting a general practitioner (GP) before attending the ED (Odds Ratios (OR) 0.6 (95% Confidence Interval (CI) 0.4–0.8, p < .05) While ESB-NBA were more likely to consider contacting a GP 1.7 (1.1–2.5, p < .05). Both the NESB patients and the ESB-NBA patients were far more likely than ESB-BA patients to report that they had visited the ED either because they do not have a GP (OR 7.9, 95% CI 4.7–13.4, p < .001) and 2.2 (95% CI 1.1–4.4, p < .05) respectively and less likely to think that the ED could deal with their problem better than a GP(OR 0.5 (95% CI 0.3–0.8, p < .05) and 0.7 (0.3–0.9, p < .05) respectively. The NESB patients also thought it would take too long to make an appointment to consult a GP (OR 6.2, 95% CI 3.7–10.4, p < 0.001). Conclusions NESB patients were the least likely to consider contacting a GP before attending hospital EDs. Educational interventions may help direct NESB people to the appropriate health services and therefore reduce the burden on tertiary hospitals ED.

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Background Pharmacists are considered medication experts but are underutilized and exist mainly at the periphery of the Malaysian primary health care team. Private general practitioners (GPs) in Malaysia are granted rights under the Poison Act 1952 to prescribe and dispense medications at their primary care clinics. As most consumers obtain their medications from their GPs, community pharmacists’ involvement in ensuring safe use of medicines is limited. The integration of a pharmacist into private GP clinics has the potential to contribute to quality use of medicines. This study aims to explore health care consumers’ views on the integration of pharmacists within private GP clinics in Malaysia. Methods A purposive sample of health care consumers in Selangor and Kuala Lumpur, Malaysia, were invited to participate in focus groups and semi-structured interviews. Sessions were audio recorded and transcribed verbatim and thematically analyzed using NVivo 10. Results A total of 24 health care consumers participated in two focus groups and six semi-structured interviews. Four major themes were identified: 1) pharmacists’ role viewed mainly as supplying medications, 2) readiness to accept pharmacists in private GP clinics, 3) willingness to pay for pharmacy services, and 4) concerns about GPs’ resistance to pharmacist integration. Consumers felt that a pharmacist integrated into a private GP clinic could offer potential benefits such as to provide trustworthy information on the use and potential side effects of medications and screening for medication misadventure. The potential increase in costs passed on to consumers and GPs’ reluctance were perceived as barriers to integration. Conclusion This study provides insights into consumers’ perspectives on the roles of pharmacists within private GP clinics in Malaysia. Consumers generally supported pharmacist integration into private primary health care clinics. However, for pharmacists to expand their capacity in providing integrated and collaborative primary care services to consumers, barriers to pharmacist integration need to be addressed.

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Discounted Cumulative Gain (DCG) is a well-known ranking evaluation measure for models built with multiple relevance graded data. By handling tagging data used in recommendation systems as an ordinal relevance set of {negative,null,positive}, we propose to build a DCG based recommendation model. We present an efficient and novel learning-to-rank method by optimizing DCG for a recommendation model using the tagging data interpretation scheme. Evaluating the proposed method on real-world datasets, we demonstrate that the method is scalable and outperforms the benchmarking methods by generating a quality top-N item recommendation list.

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Urbanisation significantly changes the characteristics of a catchment as natural areas are transformed to impervious surfaces such as roads, roofs and parking lots. The increased fraction of impervious surfaces leads to changes to the stormwater runoff characteristics, whilst a variety of anthropogenic activities common to urban areas generate a range of pollutants such as nutrients, solids and organic matter. These pollutants accumulate on catchment surfaces and are removed and trans- ported by stormwater runoff and thereby contribute pollutant loads to receiving waters. In summary, urbanisation influences the stormwater characteristics of a catchment, including hydrology and water quality. Due to the growing recognition that stormwater pollution is a significant environmental problem, the implementation of mitigation strategies to improve the quality of stormwater runoff is becoming increasingly common in urban areas. A scientifically robust stormwater quality treatment strategy is an essential requirement for effective urban stormwater management. The efficient design of treatment systems is closely dependent on the state of knowledge in relation to the primary factors influencing stormwater quality. In this regard, stormwater modelling outcomes provide designers with important guidance and datasets which significantly underpin the design of effective stormwater treatment systems. Therefore, the accuracy of modelling approaches and the reliability modelling outcomes are of particular concern. This book discusses the inherent complexity and key characteristics in the areas of urban hydrology and stormwater quality, based on the influence exerted by a range of rainfall and catchment characteristics. A comprehensive field sampling and testing programme in relation to pollutant build-up, an urban catchment monitoring programme in relation to stormwater quality and the outcomes from advanced statistical analyses provided the platform for the knowledge creation. Two case studies and two real-world applications are discussed to illustrate the translation of the knowledge created to practical use in relation to the role of rainfall and catchment characteristics on urban stormwater quality. An innovative rainfall classification based on stormwater quality was developed to support the effective and scientifically robust design of stormwater treatment systems. Underpinned by the rainfall classification methodology, a reliable approach for design rainfall selection is proposed in order to optimise stormwater treatment based on both, stormwater quality and quantity. This is a paradigm shift from the common approach where stormwater treatment systems are designed based solely on stormwater quantity data. Additionally, how pollutant build-up and stormwater runoff quality vary with a range of catchment characteristics was also investigated. Based on the study out- comes, it can be concluded that the use of only a limited number of catchment parameters such as land use and impervious surface percentage, as it is the case in current modelling approaches, could result in appreciable error in water quality estimation. Influential factors which should be incorporated into modelling in relation to catchment characteristics, should also include urban form and impervious surface area distribution. The knowledge created through the research investigations discussed in this monograph is expected to make a significant contribution to engineering practice such as hydrologic and stormwater quality modelling, stormwater treatment design and urban planning, as the study outcomes provide practical approaches and recommendations for urban stormwater quality enhancement. Furthermore, this monograph also demonstrates how fundamental knowledge of stormwater quality processes can be translated to provide guidance on engineering practice, the comprehensive application of multivariate data analyses techniques and a paradigm on integrative use of computer models and mathematical models to derive practical outcomes.

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Aim To review recent studies which identify the factors that contribute to stress, burnout and job satisfaction for nurses who are working in haemodialysis units. Background Regardless of where nurses work, stress, job burnout and dissatisfaction are known to cause high rates of nurse resignations and for many of those to leave the profession entirely. Understanding factors that contribute to job satisfaction, stress and burnout could increase haemodialysis nurse retention and improve health outcomes for people receiving haemodialysis. Evaluation Studies of job stress, burnout and satisfaction for nurses working in haemodialysis units published in English from January 2000 to December 2009 were identified. Specific inclusion criteria were developed resulting in eleven articles selected for this review. Key issues Specifically for haemodialysis nurses’ job stress and burnout was found to originate from two factors related to either patient care or organisations. Patient care factors included unrealistic patient expectations, progressive decline of a patient’s health, and violence and verbal abuse from patients. Organisational factors included shortage of time to complete tasks, lack of resources and unsupportive work environments. Increased job satisfaction for haemodialysis nurses was due to having job security, freedom to use one’s judgement and the quality of nurse/physician interactions. Conclusion Job stress and burnout are problematic for haemodialysis nurses. Instituting strategies which prevent and/or ameliorate stress or burnout could result in improved job satisfaction and also the retention of highly skilled haemodialysis nurses.

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What potential do artists working with environmental data in public space have for producing new forms of engagement with local environmental conditions? Operating on the edge of heavy bureaucracy, these types of data-driven artistic experiments probe the politics of environmental metrics and explore methods of engaging audiences with issues of environmental health. This discussion considers a small collection of cases studies representative of this growing field of practice. These are works by Natalie Jeremijenko and The Living, Tega Brain and Keith Deverell. The case studies considered are examples of strategic design, works that soften, reveal and potentially shift existing regulations and bureaucratic norms. In doing so they open up new possibilities and questions as to what the smart city is and how it might be realised.