Paediatric outreach services

Paediatric outreach services are provided in Australia and overseas to regional and rural communities. More recently telehealth services have been established to support the delivery of paediatric services and clinical management at distant sites. It is suggested that with the large distances separating centres in Australia that a combination of telehealth clinics and outreach visits may provide the most efficient means of delivering paediatric specialty and subspecialty care to these centres.

Referral patterns in a global store-and-forward telemedicine system

We examined the nature of the referral patterns in the email telemedicine network operated by the Swinfen Charitable Trust with a view to informing long-term resource planning. Over the first six years of operation, 62 hospitals from 19 countries registered with the Trust in order to be able to refer cases for specialist advice; 55 of these hospitals (89%) actually referred cases during this period. During the first six years of operation, nearly 1000 referrals were submitted and answered, from a wide range of specialty areas. Between July 2002 and March 2005 the referral rate rose from 127 to 318 cases per year. The median length of time required to provide a specialist's response was 2.3 days during the first 12 months and 1.8 days during the last 12 months. Five hospitals submitted cases for more than four years (together sending a total of 493 cases). Their activity data showed a trend to declining referral rates over the four-year period, which may represent successful knowledge transfer. There is some evidence that over the last three years the growth in demand has been exponential, while the growth in resources available (i.e. specialists) has been linear, a situation which cannot continue for very long before demand outstrips supply.

Teleneurology

Teleneurology enables neurology to be practised when the doctor and patient are not present in the same place, and possibly not at the same time. The two main techniques are: (1) videoconferencing, which enables communication between a doctor and a patient who are in different places at the same time (often called real-time or synchronous), and (2) email, where the consultation is carried out without the patient being present, at a time convenient to the doctors involved (asynchronous or store-and-forward teleneurology). Some problems that can be solved by teleneurology include: (1) patients admitted to hospital with acute neurological symptoms rarely see a neurologist; (2) delayed treatment for acute stroke; (3) non-optimum management of epilepsy; (4) unproductive travel time for neurologists; (5) extremely poor access to a neurologist for doctors in the developing world; (6) long waiting times to see a neurologist. Neurology is a specialty that, because of the emphasis on accurate interpretation of a history, does lend itself to telemedicine. It has been a late starter in realizing the benefits of telemedicine and most of the publications on teleneurology have been in the last five years. Its uptake within the neurological community is low but increasing. Telemedicine requires a significant change in how neurologists practise. The evidence to date is that teleneurology can narrow the gap between patients with neurological disease and the doctors who are trained to look after them.

Guest Editorial: Some population perspectives on chronic kidney disease

In this issue of Advances in Chronic Kidney Disease, emphasis is placed on populationbased perspectives on kidney and related chronic diseases and their risk factors. The articles remind us that we must expand our views, break down specialty barriers, work on improved primary care models and prevention modalities, and think in terms of wholeof- person and whole-of-community, rather than in organ-specific approaches.

Does customer satisfaction lead to improved brand equity? An empirical examination of two categories of retail brands

Purpose – The objective of the present research is to examine the relationship between consumers' satisfaction with a retailer and the equity they associate with the retail brand. Design/methodology/approach – Retail brand equity is conceptualized as a four-dimensional construct comprising: retailer awareness, retailer associations, retailer perceived quality, and retailer loyalty. Then the associative network memory model is applied from cognitive psychology to the specific context of the relationships between customer satisfaction and consumer-based retailer equity. A survey was undertaken using a convenience sample of shopping mall consumers in an Australian state capital city. The questionnaire used to collect data included an experimental design such that two categories of retailers were included in the study: department stores and specialty stores, with three retailers representing each category. The relationship between consumer-based retailer equity and customer satisfaction was examined using multivariate analysis of variance. Findings – Results indicate that retail brand equity varies with customer satisfaction. For department stores, each consumer-based retailer equity dimension varied according to customer satisfaction with the retailer. However, for specialty stores, only three of the consumer-based retailer equity dimensions, namely retailer awareness, retailer associations and retailer perceived quality, varied according to customer satisfaction level with the retailer. Originality/value – The principal contribution of the present research is that it demonstrates empirically a positive relationship between customer satisfaction and an intangible asset such as retailer equity.

Os jovens e o jornal nacional: fragmentos das relações entre cultura e educação na recepção do noticiário

Este estudo aborda as matérias edificantes do Jornal Nacional e a maneira como elas são compreendidas pelos grupos de jovens selecionados para esta pesquisa. O objetivo é avaliar se há diferença na percepção das informações dessas matérias por jovens de diferentes estratos sociais e culturais, pretende-se também, verificar se esses jovens percebem nas matérias edificantes algum tipo de ação cidadã. Este estudo se torna relevante visto que as transformações no processo de informação nos meios de comunicação de massa têm proporcionado grande velocidade na transmissão das mensagens. Sendo assim, alguns autores acreditam que o surgimento das novas tecnologias faz com que as pessoas sejam influenciadas por várias mídias, simultaneamente. Nesse sentido, o público jovem é um segmento importante dentro do universo dos receptores. É na juventude que o indivíduo tem sua formação aprimorada pelos meios que cumprem esse papel formador, como a escola, os pais e os meios de comunicação, cada um interagindo de acordo com a sua especificidade. Utilizando a discussão em grupo com alunos do Ensino Médio de uma escola pública e uma particular, foi possível ter a visão de como a amostra selecionada assimila a temática.(AU)

A INSTITUIÇÃO ESCOLAR ESPECIAL E SEUS CONFLITOS ESTUDO DE CASO

O presente estudo realiza uma análise dos conflitos entre profissionais especialistas na organização escolar especial privada, segundo a percepção e análise dos registros da pesquisadora como docente e coordenadora na área de Educação Especial. Há algum tempo, a organização escolar especial é composta de diversos especialistas para atender às necessidades dos seus alunos. Tais profissionais possuem formações e desempenho de papéis distintos que são combustíveis para conflitos. A pesquisa trata do assunto por meio das teorias: clássica, das relações humanas e teoria estruturalista, da sociologia e psicologia das organizações. Por meio da união dos registros da experiência vivida pela pesquisadora com os estudos bibliográficos confirmou as hipóteses de que os conflitos na organização escolar especial ocorrem por disputa, por legitimidade, por desempenho de papéis, pelas especialidades e por mudanças.

Sedation in paediatric intensive care

Paediatric intensive care is an expanding specialty that has been shown to improve the quality of care provided to critically ill children. An important aspect of the management of critically ill children includes the provision of effective sedation to reduce stress and anxiety during their stay in intensive care. However, to achieve effective and safe sedation in these children, is recognised as a challenge that is not without risk. Often children receive too much or too little sedation resulting in over sedation or under sedation respectively. These problems have arisen owing to a lack of information regarding altered pharmacokinetics and pharmacodynamics of medicines administered to critically ill children. In addition there are few validated sedation scoring systems in practice with which to monitor level of sedation and titrate medication appropriately. This study consisted of two stages. Stage 1 investigated the reproducibility and practicality of two observational sedation assessment scales for use in critically ill children. The two scales were different in design, the first being simple in design requiring a single assessment of the patient. The second was more complex in design requiring assessment of five patient parameters to obtain an overall sedation score. Both scales were found to achieve good reproducibility (kappa values 0.50 and 0.62 respectively). Practicality of each sedation scale was undertaken by obtaining nursing staff opinion about both scales using questionnaire and interview technique. It was established that nursing staff preferred the second, more complex sedation scale mainly because it was perceived to give a more accurate assessment of level of sedation and anxiety rather than merely level of sedation. Stage 2 investigated the pharmacokinetics and pharmacodynamics of midazolam in critically ill children. 52 children, aged between 0 and 18 years were recruited to the study and 303 blood samples taken to analyse midazolam and its metabolites, I-hydroxyrnidazolam (I-OR) and 4-hydroxymidazolam (4-0H). Analysis of plasma was undertaken using high performance liquid chromatography. A significant correlation was found between midazolam plasma concentration and sedative effect (r=0.598, p=O.OI). It was found that a midazolam plasma concentration of 223ng/ml (±31.9) achieved a satisfactory level of sedation. Only a poor correlation was found between dose of midazolam and plasma concentration of midazolam. Similarly only a poor correlation was found between sedative effect and dose of midazolam. Clearance of midazolam was found to be 6.3mllkglmin (±0.36), which is lower than that reported in healthy children (9.Il-13.3mllkg/min). Age related differences in midazolam clearance were observed in the study. Neonates produced the lowest clearance values (l.63mllkg/min), compared to children aged 1 to 12 months (8.52mllkg/min) who achieved the highest clearance values. Clearance was found to decrease after the age of 12 months to values of 5.34mllkglmin in children aged 7 years and above. Patients with renal (n=5) and liver impairment (n~4) were found to have reduced midazolam clearance (1.37 and 0.74ml/kg/min respectively). Plasma concentrations of I-OH and 4-0H ranged from 0-5 1 89nglml and 0-27 Inglml respectively. All children were found to be capable of producing both metabolites irrespective of age, although no trend was established between age and extent of production of either metabolite. Disease state was found to affect production of l-OH. Patients with renal impairment (n=5) produced the lowest I-OH midazolam plasma ratio (0.059) compared to patients with head injury (0.858). Patients with severe liver impairment were found to be capable of manufacturing both metabolites despite having a severely damaged liver.

Potential for broad range multiplexing of fibre Bragg gratings in polymer optical fibres and operation in the 700-nm wavelength range

Refractive index and structural characteristics of optical polymers are strongly influenced by the thermal history of the material. Polymer optical fibres (POF) are drawn under tension, resulting in axial orientation of the polymer molecular chains due to their susceptibility to align in the fibre direction. This change in orientation from the drawing process results in residual strain in the fibre and also affects the transparency and birefringence of the material (1-3). PMMA POF has failure strain as high as over 100%. POF has to be drawn under low tension to achieve this value. The drawing tension affects the magnitude of molecular alignment along the fibre axis, thus affecting the failure strain. The higher the tension the lower the failure stain will be. However, the properties of fibre drawn under high tension can approach that of fibre drawn under low tension by means of an annealing process. Annealing the fibre can generally optimise the performance of POF while keeping most advantages intact. Annealing procedures can reduce index difference throughout the bulk and also reduce residual stress that may cause fracture or distortion. POF can be annealed at temperatures approaching the glass transition temperature (Tg) of the polymer to produce FBG with a permanent blue Bragg wave-length shift at room temperature. At this elevated temperature segmental motion in the structure results in a lower viscosity. The material softens and the molecular chains relax from the axial orientation causing shrinking of the fibre. The large attenuation of typically 1dB/cm in the 1550nm spectral region of PMMA POF has limited FBG lengths to less than 10cm. The more expensive fluorinated polymers with lower absorption have had no success as FBG waveguides. Bragg grating have been inscribed onto various POF in the 800nm spectral region using a 30mW continuous wave 325nm helium cadmium laser, with a much reduced attenuation coefficient of 10dB/m (5). Fabricating multiplexed FBGs in the 800nm spectral region in TOPAS and PMMA POF consistently has lead to fabrication of multiplexed FBG in the 700nm spectral region by a method of prolonged annealing. The Bragg wavelength shift of gratings fabricated in PMMA fibre at 833nm and 867nm was monitored whilst the POF was thermally annealed at 80°C. Permanent shifts exceeding 80nm into the 700nm spectral region was attained by both gratings on the fibre. The large permanent shift creates the possibility of multiplexed Bragg sensors operating over a broad range. -------------------------------------------------------------------------------------------------------------------- 1. Pellerin C, Prud'homme RE, Pézolet M. Effect of thermal history on the molecular orientation in polystyrene/poly (vinyl methyl ether) blends. Polymer. 2003;44(11):3291-7. 2. Dvoránek L, Machová L, Šorm M, Pelzbauer Z, Švantner J, Kubánek V. Effects of drawing conditions on the properties of optical fibers made from polystyrene and poly (methyl methacrylate). Die Angewandte Makromolekulare Chemie. 1990;174(1):25-39. 3. Dugas J, Pierrejean I, Farenc J, Peichot JP. Birefringence and internal stress in polystyrene optical fibers. Applied optics. 1994;33(16):3545-8. 4. Jiang C, Kuzyk MG, Ding JL, Johns WE, Welker DJ. Fabrication and mechanical behavior of dye-doped polymer optical fiber. Journal of applied physics. 2002;92(1):4-12. 5. Johnson IP, Webb DJ, Kalli K, Yuan W, Stefani A, Nielsen K, et al., editors. Polymer PCF Bragg grating sensors based on poly (methyl methacrylate) and TOPAS cyclic olefin copolymer2011: SPIE.

An investigation into the wavelength stability of polymer optical fibre Bragg gratings

The inscription of Bragg gratings has been demonstrated in PMMA-based polymer optical fibre. The water affinity of PMMA can introduce significant wavelength change in a polymer optical fibre Bragg grating (POFBG). In polymer optical fibre losses are much higher than with silica fibre. Very strong absorption bands related to higher harmonics of vibrations of the C-H bond dominate throughout the visible and near infrared. Molecular vibration in substances generates heat, which is referred to as the thermal effect of molecular vibration. This means that a large part of the absorption of optical energy in those spectral bands will convert into thermal energy, which eventually drives water content out of the polymer fibre and reduces the wavelength of POFBG. In this work we have investigated the wavelength stability of POFBGs in different circumstances. The experiment has shown that the characteristic wavelength of a POFBG starts decreasing after a light source is applied to it. This decrease continues until equilibrium inside the fibre is established, depending on the initial water content inside the fibre, the surrounding humidity, the optical power applied, and the fibre size. Our investigation has shown that POFBGs operating at around 850 nm show much smaller wavelength reduction than those operating at around 1550 nm in the same fibre; POFBGs with different diameters show different changes; POFBGs powered by a low level light source, or operating in a very dry environment are least affected by this thermal effect.

An intrinsic biochemical concentration sensor using a polymer optical fibre Bragg grating

A new type of fibre-optic biochemical concentration sensor based on a polymer optical fibre Bragg grating (POFBG) is proposed. The wavelength of the POFBG varies as a function of analyte concentration. The feasibility of this sensing concept is demonstrated by a saline concentration sensor. When polymer fibre is placed in a water based solution the process of osmosis takes place in this water-fibre system. An osmotic pressure which is proportional to the solution concentration, will apply to the fibre in addition to the hydraulic pressure. It tends to drive the water content out of the fibre and into the surrounding solution. When the surrounding solution concentration increases the osmotic pressure increases to drive the water content out of the fibre, consequently increasing the differential hydraulic pressure and reducing the POFBG wavelength. This process will stop once there is a balance between the osmotic pressure and the differential hydraulic pressure. Similarly when the solution concentration decreases the osmotic pressure decreases, leading to a dominant differential hydraulic pressure which drives the water into the fibre till a new pressure balance is established. Therefore the water content in the polymer fibre - and consequently the POFBG wavelength - depends directly on the solution concentration. A POFBG wavelength change of 0.9 nm was measured for saline concentration varying from 0 to 22%. For a wavelength interrogation system with a resolution of 1 pm, a measurement of solution concentration of 0.03% can be expected.

Photonic crystal fiber Bragg grating based sensors : opportunities for applications in healthcare

We review the state-of-the-art in photonic crystal fiber (PCF) and microstructured polymer optical fiber (mPOF) based mechanical sensing. We first introduce how the unique properties of PCF can benefit Bragg grating based temperature insensitive pressure and transverse load sensing. Then we describe how the latest developments in mPOF Bragg grating technology can enhance optical fiber pressure sensing. Finally we explain how the integration of specialty fiber sensor technology with bio-compatible polymer based micro-technology provides great opportunities for fiber sensors in the field of healthcare.

Leadership propensity and sales performance among sales personnel and managers in a speciality retail store setting

We propose that specialty store managers, as well as outside sales personnel attached to the store, have selling responsibilities. In addition, we propose that sales personnel, as well as store managers, should have a propensity for leadership, which reflects an individual's enduring disposition to exhibit leadership within the context of his or her organizational roles. In two studies, we develop a new individual difference measure of propensity to lead and investigate its nomological validity within a specialty retail store environment. As predicted, leadership propensity was predictive of self-rated sales performance and a proclivity to identify prospects through cold calls to close sales, to reveal customer orientation, and to exhibit organizational citizenship behavior. We found that propensity to lead did not differ between salespeople and retail store managers, but we found that the respondent's role moderated the relationship between propensity to lead and supervisor performance ratings. Study limitations and managerial implications of this heretofore unidentified trait of salespeople are discussed.

Potential for broad range multiplexing of fibre Bragg gratings in polymer optical fibres and operation in the 700-nm wavelength range

Refractive index and structural characteristics of optical polymers are strongly influenced by the thermal history of the material. Polymer optical fibres (POF) are drawn under tension, resulting in axial orientation of the polymer molecular chains due to their susceptibility to align in the fibre direction. This change in orientation from the drawing process results in residual strain in the fibre and also affects the transparency and birefringence of the material (1-3). PMMA POF has failure strain as high as over 100%. POF has to be drawn under low tension to achieve this value. The drawing tension affects the magnitude of molecular alignment along the fibre axis, thus affecting the failure strain. The higher the tension the lower the failure stain will be. However, the properties of fibre drawn under high tension can approach that of fibre drawn under low tension by means of an annealing process. Annealing the fibre can generally optimise the performance of POF while keeping most advantages intact. Annealing procedures can reduce index difference throughout the bulk and also reduce residual stress that may cause fracture or distortion. POF can be annealed at temperatures approaching the glass transition temperature (Tg) of the polymer to produce FBG with a permanent blue Bragg wave-length shift at room temperature. At this elevated temperature segmental motion in the structure results in a lower viscosity. The material softens and the molecular chains relax from the axial orientation causing shrinking of the fibre. The large attenuation of typically 1dB/cm in the 1550nm spectral region of PMMA POF has limited FBG lengths to less than 10cm. The more expensive fluorinated polymers with lower absorption have had no success as FBG waveguides. Bragg grating have been inscribed onto various POF in the 800nm spectral region using a 30mW continuous wave 325nm helium cadmium laser, with a much reduced attenuation coefficient of 10dB/m (5). Fabricating multiplexed FBGs in the 800nm spectral region in TOPAS and PMMA POF consistently has lead to fabrication of multiplexed FBG in the 700nm spectral region by a method of prolonged annealing. The Bragg wavelength shift of gratings fabricated in PMMA fibre at 833nm and 867nm was monitored whilst the POF was thermally annealed at 80°C. Permanent shifts exceeding 80nm into the 700nm spectral region was attained by both gratings on the fibre. The large permanent shift creates the possibility of multiplexed Bragg sensors operating over a broad range. -------------------------------------------------------------------------------------------------------------------- 1. Pellerin C, Prud'homme RE, Pézolet M. Effect of thermal history on the molecular orientation in polystyrene/poly (vinyl methyl ether) blends. Polymer. 2003;44(11):3291-7. 2. Dvoránek L, Machová L, Šorm M, Pelzbauer Z, Švantner J, Kubánek V. Effects of drawing conditions on the properties of optical fibers made from polystyrene and poly (methyl methacrylate). Die Angewandte Makromolekulare Chemie. 1990;174(1):25-39. 3. Dugas J, Pierrejean I, Farenc J, Peichot JP. Birefringence and internal stress in polystyrene optical fibers. Applied optics. 1994;33(16):3545-8. 4. Jiang C, Kuzyk MG, Ding JL, Johns WE, Welker DJ. Fabrication and mechanical behavior of dye-doped polymer optical fiber. Journal of applied physics. 2002;92(1):4-12. 5. Johnson IP, Webb DJ, Kalli K, Yuan W, Stefani A, Nielsen K, et al., editors. Polymer PCF Bragg grating sensors based on poly (methyl methacrylate) and TOPAS cyclic olefin copolymer2011: SPIE.