Doctors’ perspectives on law and life-sustaining treatment: Survey design and recruitment strategies for a challenging cohort

- Background Palliative medicine and other specialists play significant legal roles in decisions to withhold and withdraw life-sustaining treatment at the end of life. Yet little is known about their knowledge of or attitudes to the law, and the role they think it should play in medical practice. Consideration of doctors’ views is critical to optimizing patient outcomes at the end of life. However, doctors are difficult to engage as participants in empirical research, presenting challenges for researchers seeking to understand doctors’ experiences and perspectives. - Aims To determine how to engage doctors involved in end-of-life care in empirical research about knowledge of the law and the role it plays in medical practice at the end of life. - Methods Postal survey of all specialists in palliative medicine, emergency medicine, geriatric medicine, intensive care, medical oncology, renal medicine, and respiratory medicine in three Australian states: New South Wales, Victoria, and Queensland. The survey was sent in hard copy with two reminders and a follow up reminder letter was also sent to the directors of hospital emergency departments. Awareness was further promoted through engagement with the relevant medical colleges and publications in professional journals; various incentives to respond were also used. The key measure is the response rate of doctors to the survey. - Results Thirty-two percent of doctors in the main study completed their survey with response rate by specialty ranging from 52% (palliative care) to 24% (medical oncology). This overall response rate was twice that of the reweighted pilot study (16%). - Conclusions Doctors remain a difficult cohort to engage in survey research but strategic recruitment efforts can be effective in increasing response rate. Collaboration with doctors and their professional bodies in both the development of the survey instrument and recruitment of participants is essential.

Effects of solar radiation pressure and Aerodynamic forces on satelliteattitude Dynamics and their utilization for Control: a survey

The environmcnl exerts an important inJuence on the pefirmance of space systems. A brief rel'iew of mo.s/ of the studies, pre.~ented over the past eightem years, relating to the influence ar7d the possible utilization of thc solar radiation pressure &d aero&namic forces, with particular reference to attitude dynamics and control qf satellites is presented here. The semi-passive stabilizers employing rhese forces show p~qmise of long life, low power and economic sjsfems, which though slower in response, compare we1I wit11 the octiw coi~trollers. It is felt that mud more attention is necessary to the actual implema~tution of these ideas and devices: some of which me quite ingenious und unique.

Scoping study for a national survey of the prevalence of child abuse and neglect

This is a report produced as a result of a study commissioned by the Australian Government Royal Commission into Institutional Responses to Child Sexual Abuse.

Fatigue self-management behaviors in patients with advanced cancer: A prospective longitudinal survey

Purpose: To explore the fatigue self-management behaviors and factors associated with effectiveness of these behaviors in patients with advanced cancer. Design: Prospective longitudinal interviewer-administered survey. Setting: A tertiary cancer center in Queensland Australia. Sample: One hundred fifty two outpatients with metastatic breast, lung, colorectal and prostate cancer experiencing fatigue (>3/10) were recruited. Main Research Variables: Fatigue self-management behaviors outcomes (perceived effectiveness, self-efficacy and frequency), medical/demographic characteristics (including sites of primary cancer and metastasis, comorbidity, performance status), social support, depressive, anxiety, and other symptoms were assessed. Findings: The participants reported moderate levels of fatigue at baseline (M=5.85, SD 1.44), and maintained moderate levels at 4 weeks and 8 weeks. On average, participants consistently used approximately nine behaviors at each time point. Factors significantly associated with higher levels of perceived effectiveness of fatigue self-management behaviors were higher self-efficacy (p<.001), higher education level (p=.02), and lower levels of depressive symptoms (p=.04). Conclusions: The findings of this study demonstrate that patients with cancer, even with advanced disease, still want and are able to use a number of behaviors to control their fatigue. Self-management interventions that aim to enhance self-efficacy and address any concurrent depressive symptoms have the potential to reduce fatigue severity. Implications for Nursing: Nurses are well positioned to play a key role in supporting patients in their fatigue self-management. Knowledge Translation: This study particularly focused on the perspectives of patients about fatigue self-management, highlighting a number of issues requiring further attention in clinical practice and the potential for future research.

"Why are you crying? You got what you wanted!": Psychosocial experiences of sex reassignment surgery

Little is known about the psychosocial needs of trans individuals as they make the surgical transition to their preferred gender. This qualitative study explored the lived experiences of 14 Australian trans men and women, aged between 25 and 78 who had undergone sex reassignment surgery to determine if their needs were met. The key findings suggest that while the surgery met their personal needs, there are inconsistencies in the level of care and support provided at the medical level throughout the transition process. In legal terms, the complex legislative framework does little but increase the psychosocial burden of Australian trans people.

How do Australian podiatrists manage patients with diabetes The Australian diabetic foot management survey

Background Diabetic foot complications are the leading cause of lower extremity amputation and diabetes-related hospitalisation in Australia. Studies demonstrate significant reductions in amputations and hospitalisation when health professionals implement best practice management. Whilst other nations have surveyed health professionals on specific diabetic foot management, to the best of the authors’ knowledge this appears not to have occurred in Australia. The primary aim of this study was to examine Australian podiatrists’ diabetic foot management compared with best practice recommendations by the Australian National Health Medical Research Council. Methods A 36-item Australian Diabetic Foot Management survey, employing seven-point Likert scales (0 = Never; 7 = Always) to measure multiple aspects of best practice diabetic foot management was developed. The survey was briefly tested for face and content validity. The survey was electronically distributed to Australian podiatrists via professional associations. Demographics including sex, years treating patients with diabetes, employment-sector and patient numbers were also collected. Chi-squared and Mann Whitney U tests were used to test differences between sub-groups. Results Three hundred and eleven podiatrists responded; 222 (71%) were female, 158 (51%) from the public sector and 11–15 years median experience. Participants reported treating a median of 21–30 diabetes patients each week, including 1–5 with foot ulcers. Overall, participants registered median scores of at least “very often” (>6) in their use of most items covering best practice diabetic foot management. Notable exceptions were: “never” (1 (1 – 3)) using total contact casting, “sometimes” (4 (2 – 5)) performing an ankle brachial index, “sometimes” (4 (1 – 6)) using University of Texas Wound Classification System, and “sometimes” (4 (3 – 6) referring to specialist multi-disciplinary foot teams. Public sector podiatrists reported higher use or access on all those items compared to private sector podiatrists (p < 0.01). Conclusions This study provides the first baseline information on Australian podiatrists’ adherence to best practice diabetic foot guidelines. It appears podiatrists manage large caseloads of people with diabetes and are generally implementing best practice guidelines recommendations with some notable exceptions. Further studies are required to identify barriers to implementing these recommendations to ensure all Australians with diabetes have access to best practice care to prevent amputations.

A survey and analysis of the GNSS spoofing threat and countermeasures

Detection and prevention of global network satellite system (GNSS) “spoofing” attacks, or the broadcast of false global navigation satellite system services, has recently attracted much research interest. This survey aims to fill three gaps in the literature: first, to assess in detail the exact nature of threat scenarios posed by spoofing against the most commonly cited targets; second, to investigate the many practical impediments, often underplayed, to carrying out GNSS spoofing attacks in the field; and third, to survey and assess the effectiveness of a wide range of proposed defences against GNSS spoofing. Our conclusion lists promising areas of future research.

Privacy architectures in social networks’ state-of-the-art survey

The use of social networking has exploded, with millions of people using various web- and mobile-based services around the world. This increase in social networking use has led to user anxiety related to privacy and the unauthorised exposure of personal information. Large-scale sharing in virtual spaces means that researchers, designers and developers now need to re-consider the issues and challenges of maintaining privacy when using social networking services. This paper provides a comprehensive survey of the current state-of-the-art privacy in social networks for both desktop and mobile uses and devices from various architectural vantage points. The survey will assist researchers and analysts in academia and industry to move towards mitigating many of the privacy issues in social networks.

The inside story: A survey of social work students' supervision and learning opportunities on placement

Practice learning accounts for half of the content of the bachelor of social work degree course requirements in Northern Ireland in their field education programmes and share a professional and ethical responsibility with practice teachers to provide appropriate learning environments to prepare students as competent and professional practitioners. The accreditation standards for practice learning require the placement to provide students with regular supervision and exposure to a range of learning strategies, but there is little research that actually identifies the types of placements offering this learning and the key activities provided. This paper builds on an Australian study and surveys social work students in two programmes in Northern Ireland about their exposure to a range of learning activities, how frequently they were provided and how it compares to what is required by the Northern Ireland practice standards. The results indicated that, although most students were satisfied with the supervision and support they received during their placement, the frequency of supervision and type of learning activities varied according to different settings, year levels and who provided the learning opportunities.

A preliminary survey of dermatomycoses in Bangalore

Clinical and mycological investigations were made on 225 cases of suspected dermatomycoses. Of these, 102 were microscopically positive. But only 63 were culturally positive, and these are analysed here with regard to clinical patterns and aetiological species, age, sex and occupational incidence and susceptibility to griseofulvin in vitro. As in most other parts of India, Trichophyton rubrum was the dominant species. A high proportion of Epidermophyton floccosum was an unusual feature seen. Of the clinical types, tinea cruris was the most common. The isolates were sensitive to griseofulvin at low concentrations of 1 to 5 μg per ml of agar medium, E. floccosum being the most sensitive.

A Survey on Cascaded Multilevel Inverters

Cascaded multilevel inverters synthesize a medium-voltage output based on a series connection of power cells which use standard low-voltage component configurations. This characteristic allows one to achieve high-quality output voltages and input currents and also outstanding availability due to their intrinsic component redundancy. Due to these features, the cascaded multilevel inverter has been recognized as an important alternative in the medium-voltage inverter market. This paper presents a survey of different topologies, control strategies and modulation techniques used by these inverters. Regenerative and advanced topologies are also discussed. Applications where the mentioned features play a key role are shown. Finally, future developments are addressed.

Relation between part position and kinematic freedom: An expository survey

This paper makes explicit the relation between relative part position and kinematic freedom of the parts which is implicitly available in the literature. An extensive set of representative papers in the areas of assembly and kinematic modelling is reviewed to specifically identify how the ideas in the two areas are related and influencing the development of each other. The papers are categorised by the approaches followed in the specification, representation, and solution of the part relations. It is observed that the extent of the part geometry is not respected in modelling schemes and as a result, the causal flow of events (proximity–contact–mobility) during the assembling process is not realised in the existing modelling paradigms, which are focusing on either the relative positioning problem or the relative motion problem. Though an assembly is a static description of part configuration, achievement of this configuration requires availability of relative motion for bringing parts together during the assembly process. On the other hand, the kinematic freedom of a part depends on the nature of contacting regions with other parts in its static configuration. These two problems are thus related through the contact geometry. The chronology of the approaches that significantly contributed to the development of the subject is also included in the paper.

Political Risk in Credit Evaluation: Empirical Studies and Survey Results

Financing trade between economic agents located in different countries is affected by many types of risks, resulting from incomplete information about the debtor, the problems of enforcing international contracts, or the prevalence of political and financial crises. Trade is important for economic development and the availability of trade finance is essential, especially for developing countries. Relatively few studies treat the topic of political risk, particularly in the context of international lending. This thesis explores new ground to identify links between political risk and international debt defaults. The core hypothesis of the study is that the default probability of debt increases with increasing political risk in the country of the borrower. The thesis consists of three essays that support the hypothesis from different angles of the credit evaluation process. The first essay takes the point of view of an international lender assessing the credit risk of a public borrower. The second investigates creditworthiness assessment of companies. The obtained results are substantiated in the third essay that deals with an extensive political risk survey among finance professionals in developing countries. The financial instruments of core interest are export credit guaranteed debt initiated between the Export Credit Agency of Finland and buyers in 145 countries between 1975 and 2006. Default events of the foreign credit counterparts are conditioned on country-specific macroeconomic variables, corporate-specific accounting information as well as political risk indicators from various international sources. Essay 1 examines debt issued to government controlled institutions and conditions public default events on traditional macroeconomic fundamentals, in addition to selected political and institutional risk factors. Confirming previous research, the study finds country indebtedness and the GDP growth rate to be significant indicators of public default. Further, it is shown that public defaults respond to various political risk factors. However, the impact of the risk varies between countries at different stages of economic development. Essay 2 proceeds by investigating political risk factors as conveivable drivers of corporate default and uses traditional accounting variables together with new political risk indicators in the credit evaluation of private debtors. The study finds links between corporate default and leverage, as well as between corporate default and the general investment climate and measeures of conflict in the debtor country. Essay 3 concludes the thesis by offering survey evidence on the impact of political risk on debt default, as perceived and experienced by 103 finance professionals in 38 developing countries. Taken together, the results of the thesis suggest that various forms of political risk are associated with international debt defaults and continue to pose great concerns for both international creditors and borrowers in developing countries. The study provides new insights on the importance of variable selection in country risk analysis, and shows how political risk is actually perceived and experienced in the riskier, often lower income countries of the global economy.