892 resultados para Primary healthcare units


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Establishing a nationwide Electronic Health Record system has become a primary objective for many countries around the world, including Australia, in order to improve the quality of healthcare while at the same time decreasing its cost. Doing so will require federating the large number of patient data repositories currently in use throughout the country. However, implementation of EHR systems is being hindered by several obstacles, among them concerns about data privacy and trustworthiness. Current IT solutions fail to satisfy patients’ privacy desires and do not provide a trustworthiness measure for medical data. This thesis starts with the observation that existing EHR system proposals suer from six serious shortcomings that aect patients’ privacy and safety, and medical practitioners’ trust in EHR data: accuracy and privacy concerns over linking patients’ existing medical records; the inability of patients to have control over who accesses their private data; the inability to protect against inferences about patients’ sensitive data; the lack of a mechanism for evaluating the trustworthiness of medical data; and the failure of current healthcare workflow processes to capture and enforce patient’s privacy desires. Following an action research method, this thesis addresses the above shortcomings by firstly proposing an architecture for linking electronic medical records in an accurate and private way where patients are given control over what information can be revealed about them. This is accomplished by extending the structure and protocols introduced in federated identity management to link a patient’s EHR to his existing medical records by using pseudonym identifiers. Secondly, a privacy-aware access control model is developed to satisfy patients’ privacy requirements. The model is developed by integrating three standard access control models in a way that gives patients access control over their private data and ensures that legitimate uses of EHRs are not hindered. Thirdly, a probabilistic approach for detecting and restricting inference channels resulting from publicly-available medical data is developed to guard against indirect accesses to a patient’s private data. This approach is based upon a Bayesian network and the causal probabilistic relations that exist between medical data fields. The resulting definitions and algorithms show how an inference channel can be detected and restricted to satisfy patients’ expressed privacy goals. Fourthly, a medical data trustworthiness assessment model is developed to evaluate the quality of medical data by assessing the trustworthiness of its sources (e.g. a healthcare provider or medical practitioner). In this model, Beta and Dirichlet reputation systems are used to collect reputation scores about medical data sources and these are used to compute the trustworthiness of medical data via subjective logic. Finally, an extension is made to healthcare workflow management processes to capture and enforce patients’ privacy policies. This is accomplished by developing a conceptual model that introduces new workflow notions to make the workflow management system aware of a patient’s privacy requirements. These extensions are then implemented in the YAWL workflow management system.

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We report the long term outcome of the flangeless, cemented all polyethylene Exeter cup at a mean of 14.6 years (range 10-17) after operation. Of the 263 hips in 243 patients, 122 hips are still in situ, 112 patients (119 hips) have died, eighteen hips were revised, and three patients (four hips) had moved abroad and were lost to follow-up (1.5%). Radiographs demonstrated two sockets had migrated and six more had radiolucent lines in all three zones. The Kaplan Meier survivorship at 15 years with endpoint revision for all causes is 89.9% (95% CI 84.6 to 95.2%) and for aseptic cup loosening or lysis 91.7% (CI 86.6 to 96.8%). In 210 hips with a diagnosis of primary osteoarthritis survivorship for all causes is 93.2% (95% CI 88.1 to 98.3%), and for aseptic cup loosening 95.0% (CI 90.3 to 99.7%). The cemented all polyethylene Exeter cup has an excellent long-term survivorship.

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A nutrient amendment experiment was conducted for two growing seasons in two alpine tundra communities to test the hypotheses that: (1) primary production is limited by nutrient availability, and (2) physiological and developmental constraints act to limit the responses of plants from a nutrient-poor community more than plants from a more nutrient-rich community to increases in nutrient availability. Experimental treatments consisted of N, P, and N+P amendments applied to plots in two physiognomically similar communities, dry and wet meadows. Extractable N and P from soils in nonfertilized control plots indicated that the wet meadow had higher N and P availability. Photosynthetic, nutrient uptake, and growth responses of the dominants in the two communities showed little difference in the relative capacity of these plants to respond to the nutrient additions. Aboveground production responses of the communities to the treatments indicated N availability was limiting to production in the dry meadow community while N and P availability colimited production in the wet meadow community. There was a greater production response to the N and N+P amendments in the dry meadow relative to the wet meadow, despite equivalent functional responses of the dominant species of both communities. The greater production response in the dry meadow was in part related to changes in community structure, with an increase in the proportion of graminoid and forb biomass, and a decrease in the proportion of community biomass made up by the dominant sedge Kobresia myosuroides. Species richness increased significantly in response to the N+P treatment in the dry meadow. Graminoid biomass increased significantly in the wet meadow N and N+P plots, while forb biomass decreased significantly, suggesting a competitive interaction for light. Thus, the difference in community response to nutrient amendments was not the result of functional changes at the leaf level of the dominant species, but rather was related to changes in community structure in the dry meadow, and to a shift from a nutrient to a light limitation of production in the wet meadow.

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Prostate cancer metastasis is reliant on the reciprocal interactions between cancer cells and the bone niche/micro-environment. The production of suitable matrices to study metastasis, carcinogenesis and in particular prostate cancer/bone micro-environment interaction has been limited to specific protein matrices or matrix secreted by immortalised cell lines that may have undergone transformation processes altering signaling pathways and modifying gene or receptor expression. We hypothesize that matrices produced by primary human osteoblasts are a suitable means to develop an in vitro model system for bone metastasis research mimicking in vivo conditions. We have used a decellularized matrix secreted from primary human osteoblasts as a model for prostate cancer function in the bone micro-environment. We show that this collagen I rich matrix is of fibrillar appearance, highly mineralized, and contains proteins, such as osteocalcin, osteonectin and osteopontin, and growth factors characteristic of bone extracellular matrix (ECM). LNCaP and PC3 cells grown on this matrix, adhere strongly, proliferate, and express markers consistent with a loss of epithelial phenotype. Moreover, growth of these cells on the matrix is accompanied by the induction of genes associated with attachment, migration, increased invasive potential, Ca2+ signaling and osteolysis. In summary, we show that growth of prostate cancer cells on matrices produced by primary human osteoblasts mimics key features of prostate cancer bone metastases and thus is a suitable model system to study the tumor/bone micro-environment interaction in this disease.

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This paper presents a high voltage pulsed power system based on low voltage switch-capacitor units connected to a current source for several applications such as plasma systems. A modified positive buck-boost converter topology is used to utilize the current source concept and a series of low voltage switch-capacitor units is connected to the current source in order to provide high voltage with high voltage stress (dv/dt) as demanded by loads. This pulsed power converter is flexible in terms of energy control, in that the stored energy in the current source can be adjusted by changing the current magnitude to significantly improve the efficiency of various systems with different requirements. Output voltage magnitude and stress (dv/dt) can be controlled by a proper selection of components and control algorithm to turn on and off switching devices.

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Background: Acute coronary syndromes are a major cause of mortality and morbidity. Objectives/Methods: The objective of this evaluation is to review the clinical trials of two new drugs being developed for the treatment of acute coronary syndromes. The first drug is the anti-coagulant otamixaban, and the trial compared otamixaban with unfractionated heparin and eptifibatide in acute coronary syndromes. The second drug is the anti-platelet ticagrelor, and the trial compared ticagrelor with clopidogrel in acute coronary syndromes. Results: In the SEPIA-ACS1 TIMI 42 trial, the primary efficacy endpoint occurred in 6.2% of subjects treated with unfractionated heparin and eptifibatide, and to a significantly lesser extent with otamixaban. In the PLATO trial, the primary efficacy endpoint had occurred less in the ticagrelor group (9.8%) than in the clopidogrel group (11.7%) at 12 months. Conclusions: Two new drugs for acute coronary syndromes, otamixaban and ticagrelor, have recently been shown to have benefits in subjects undergoing percutaneous interventions compared to the present standard regimens for this condition.

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A novel model for the potentiostatic discharge of primary alkaline battery cathodes is presented. The model is used to simulate discharges resulting from the stepped potential electrochemical spectroscopy (SPECS) of primary alkaline battery cathodes cathodes, and the results are validated with experimental data. We show that a model based on a single (or mean) reaction framework can be used to simulate multi-reaction discharge behaviour and we develop a consistent functional modification to the kinetic equation of the model that allows for this to occur. The model is used to investigate the effects that the initial exchange current density, i00, and the diffusion coefficient for protons in electrolytic manganese dioxide (EMD), DH+, have on SPECS discharge. The behaviour observed is consistent with the idea that individual reduction reactions, within the multi-reaction, reduction behaviour of EMD, have distinct i00 and DH+ values.

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Objective.To estimate the excess length of stay in an intensive care unit (ICU) due to a central line–associated bloodstream infection (CLABSI), using a multistate model that accounts for the timing of infection. Design.A cohort of 3,560 patients followed up for 36,806 days in ICUs. Setting.Eleven ICUs in 3 Latin American countries: Argentina, Brazil, and Mexico. Patients.All patients admitted to the ICU during a defined time period with a central line in place for more than 24 hours. Results.The average excess length of stay due to a CLABSI increased in 10 of 11 ICUs and varied from −1.23 days to 4.69 days. A reduction in length of stay in Mexico was probably caused by an increased risk of death due to CLABSI, leading to shorter times to death. Adjusting for patient age and Average Severity of Illness Score tended to increase the estimated excess length of stays due to CLABSI. Conclusions.CLABSIs are associated with an excess length of ICU stay. The average excess length of stay varies between ICUs, most likely because of the case‐mix of admissions and differences in the ways that hospitals deal with infections.

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Mentors are significant in shaping a preservice teacher’s practices. Developing common understandings about effective mentoring practices can assist the mentoring process. What are mentor educators’ practical ideas towards implementing a mentoring program? This mixed-method study involves surveys, questionnaires, and audio-taped focus group meetings on 14 mentor educators’ views on mentoring preservice primary teachers. This research aims to understand mentor educators’ motivations for mentoring, their views about what makes a good mentor, benefits for mentors, and issues or concerns for mentors and the mentoring process. It also focuses on determining professional development for mentors and troubleshooting potential problems. Findings revealed that these mentor educators were motivated into developing mentoring programs as a way to: (1) influence the quality of preservice teacher education (2) provide personal and professional development in mentoring, and (3) support mentors and the mentoring process within school settings. Outlining what makes a good mentor and benefits for mentors were consistent with the literature. However, these expert mentors also provided potential solutions (e.g., university support and professional development ideas) on issues such as knowing the mentee’s level of development and expectations, building a professional relationship prior to placement and the mentor’s dual role as confidant and assessor.

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For the past twenty years, the disengagement of early adolescents has been the focus of much of the literature related to middle schooling. In response, some universities in Australia have introduced teacher education programs that focus upon graduating specialised middle schooling teachers. Constructing such programs is at the centre of much debate and discussion, however, it is advocated that positive futures for early adolescents can be enhanced through quality middle schooling teacher education programs (Education Queensland, 2004). At a Queensland university campus, middle schooling elective units were introduced as part of the Bachelor of Education (primary) degree. The design of the units was to support preservice teachers to gain the theoretical and pedagogical knowledge to engage and promote early adolescent learning. An innovative approach to the delivery of the units was promoted by a partnership agreement between local schools and the campus. The partnership allowed preservice teachers to combine university classes with opportunities to visit exemplary classrooms to observe, participate and reflect upon middle school teaching practices. The aim of this study was to explore and describe the 38 first-year preservice teachers’ perceptions of their first middle schooling elective unit and to ascertain whether the combination of university classes and school-based experiences assisted their development of middle schooling concepts and approaches. Data were gathered using pre-test and post-test questionnaires combined with guided written reflections to record their views before, after and during the unit delivery. Results indicated that initially 34 preservice teachers had little understanding of middle schooling concepts and pedagogical practices, however, 11 participants recognised that bullying and peer pressure were issues experienced by early adolescents. The collation of the written reflections supported the combined delivery of the middle years unit further supporting the inclusion of school experiences with university delivered units.

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This study investigated preservice teachers’ perceptions for teaching and sustaining gifted and talented students while developing, modifying and implementing activities to cater for the diverse learner. Participants were surveyed at the end of a gifted and talented education program on their perceptions to differentiate the curriculum for meeting the needs of the student (n=22). SPSS data analysis with the five-part Likert scale indicated these preservice teachers agreed or strongly agreed they had developed skills in curriculum planning (91%) with well-designed activities (96%), and lesson preparation skills (96%). They also claimed they were enthusiastic for teaching (91%) and understanding of school practices and policies (96%). However, 46% agreed they had knowledge of syllabus documents with 50% claiming an ability to provide written feedback on student’s learning. Furthermore, nearly two-thirds suggested they had educational language from the syllabus and effective student management strategies. Preservice teachers require more direction on how to cater for diversity and begin creating sustainable societies by building knowledge from direct GAT experiences. Designing diagnostic surveys associated with university coursework can be used to determine further development for specific preservice teacher development in GAT education. Preservice teachers need to create opportunities for students to realise their potential by involving cognitive challenges through a differentiated curriculum. Differentiation requires modification of four primary areas of curriculum development (Maker, 1975) content (what we teach), process (how we teach), product (what we expect the students to do or show) and learning environment (where we teach/our class culture). Ashman and Elkins (2009) and Glasson (2008) emphasise the need for preservice teachers, teachers and other professionals to be able to identify what gifted and talented (GAT) students know and how they learn in relation to effective teaching. Glasson (2008) recommends that educators keep up to date with practices in pedagogy, support, monitoring and profiling of GAT students to create an environment conducive to achieving. Oral feedback is one method to communicate to learners about their progress but has advantages and disadvantages for some students. Oral feedback provides immediate information to the student on progress and performance (Ashman & Elkins, 2009). However, preservice teachers must have clear understandings of key concepts to assist the GAT student. Implementing teaching strategies to engage innovate and extend students is valuable to the preservice teacher in focusing on GAT student learning in the classroom (Killen, 2007). Practical teaching strategies (Harris & Hemming, 2008; Tomlinson et al., 1994) facilitate diverse ways for assisting GAT students to achieve learning outcomes. Such strategies include activities to enhance creativity, co-operative learning and problem-solving activities (Chessman, 2005; NSW Department of Education and Training, 2004; Taylor & Milton, 2006) for GAT students to develop a sense of identity, belonging and self esteem towards becoming an autonomous learner. Preservice teachers need to understand that GAT students learn in a different way and therefore should be assessed differently. Assessment can be through diverse options to demonstrate the student’s competence, demonstrate their understanding of the material in a way that highlights their natural abilities (Glasson, 2008; Mack, 2008). Preservice teachers often are unprepared to assess students understanding but this may be overcome with teacher education training promoting effective communication and collaboration in the classroom, including the provision of a variety of assessment strategies to improve teaching and learning (Callahan et al., 2003; Tomlinson et al., 1994). It is also critical that preservice teachers have enthusiasm for teaching to demonstrate inclusion, involvement and the excitement to communicate to GAT students in the learning process (Baum, 2002). Evaluating and reflecting on teaching practices must be part of a preservice teacher’s repertoire for GAT education. Evaluating teaching practices can assist to further enhance student learning (Mayer, 2008). Evaluation gauges the success or otherwise of specific activities and teaching in general (Mayer, 2008), and ensures that preservice teachers and teachers are well prepared and maintain their commitment to their students and the community. Long and Harris (1999) advocate that reflective practices assist teachers in creating improvements in educational practices. Reflective practices help preservice teachers and teachers to improve their ability to pursue improved learning outcomes and professional growth (Long & Harris, 1999). Context This study is set at a small regional campus of a large university in Queensland. As a way to address departmental policies and the need to prepare preservice teachers for engaging a diverse range of learners (see Queensland College of Teachers, Professional Standards for Teachers, 2006), preservice teachers at this campus completed four elective units within their Bachelor of Education (primary) degree. The electives include: 1. Middle years students and schools 2. Teaching strategies for engaging learners 3. Teaching students with learning difficulties, and 4. Middle-years curriculum, pedagogy and assessment. In the university-based component of this unit, preservice teachers engaged in learning about middle years students and schools, and gained knowledge of government policies pertaining to GAT students. Further explored within in this unit was the importance of: collaboration between teachers, parents/carers and school personnel in supporting middle years GAT students; incorporating challenging learning experiences that promoted higher order thinking and problem solving skills; real world learning experiences for students and; the alignment and design of curriculum, pedagogy and assessment that is relevant to the students development, interests and needs. The participants were third-year Bachelor of Education (primary) preservice teachers who were completing an elective unit as part of the middle years of schooling learning with a focus on GAT students. They were assigned one student from a local school. In the six subsequent ninety minute weekly lessons, the preservice teachers were responsible for designing learning activities that would engage and extend the GAT students. Furthermore, preservice teachers made decisions about suitable pedagogical approaches and designed the assessment task to align with the curriculum and the developmental needs of their middle years GAT student. This research aims to describe preservice teachers’ perceptions of their education for teaching gifted and talented students.

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Young children’s transition into school has been constructed as a time-limited period around initial school entry, a set of teacher or school practices, a process of establishing continuity of experience, a multi-layered, multi-year set of experiences and a dynamic relationship-based process. Although preparedness issues continue to be addressed, there is a trend towards more complex understandings of transition emphasizing continuity, relationships amongst multiple stakeholders, system coherence across extended time periods and enhancement of resilience and transition capital. This article, in the early years of a new century, outlines some conceptualisations of readiness and transition as they relate to diverse children’s pathways through early childhood and early school settings.

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Bullying in all its forms including cyberbullying is a continuing problem in schools. Given the severe consequences it can have on students (socially, psychologically and physically) it is not surprising that a number of intervention programs have been developed, with most advocating a whole school approach. The current study compared students’ self-reports on bullying between schools with and without a Philosophy for Children (P4C) approach. A sample of 35 students in the P4C school and a matched sample of 35 students in other schools between the ages of 10 and 13 completed the Student Bullying Survey. Results indicated that while there were significant differences in incidences of face-to-face bullying, there were similar results from both cohorts in relation to cyberbullying. Both groups of students felt that teachers were more likely to prevent face-to-face bullying than cyberbullying. Findings indicate that teachers and guidance counsellors need to be as overt in teaching strategies about cyberbullying as they are in teaching strategies about reducing face-to-face bullying.