Emergency healthcare of the future

Emergency healthcare is a high profile component of modern healthcare systems, which over the past three decades has fundamentally transformed in many countries. However, despite this rapid development, and associated investments in service standards, there is a high level of concern with the performance of emergency health services relating principally to system wide congestion. The factors driving this problem are complex but relate largely to the combined impact of growing demand, expanded scope of care and blocked access to inpatient beds. These factors are unlikely to disappear in the medium term despite the National Emergency Access Target. The aim of this article is to stimulate a conversation about the future design and functioning of emergency healthcare systems; examining what we understand about the problem and proposing a rationale that may underpin future strategic approaches. This is also an invitation to join the conversation.

Inhibition of the JAK2/STAT3 pathway in ovarian cancer results in the loss of cancer stem cell-like characteristics and a reduced tumor burden

Background Current treatment of ovarian cancer patients with chemotherapy leaves behind a residual tumor which results in recurrent ovarian cancer within a short time frame. We have previously demonstrated that a single short-term treatment of ovarian cancer cells with chemotherapy in vitro resulted in a cancer stem cell (CSC)-like enriched residual population which generated significantly greater tumor burden compared to the tumor burden generated by control untreated cells. In this report we looked at the mechanisms of the enrichment of CSC-like residual cells in response to paclitaxel treatment. Methods The mechanism of survival of paclitaxel-treated residual cells at a growth inhibitory concentration of 50% (GI50) was determined on isolated tumor cells from the ascites of recurrent ovarian cancer patients and HEY ovarian cancer cell line by in vitro assays and in a mouse xenograft model. Results Treatment of isolated tumor cells from the ascites of ovarian cancer patients and HEY ovarian cancer cell line with paclitaxel resulted in a CSC-like residual population which coincided with the activation of Janus activated kinase 2 (JAK2) and signal transducer and activation of transcription 3 (STAT3) pathway in paclitaxel surviving cells. Both paclitaxel-induced JAK2/STAT3 activation and CSC-like characteristics were inhibited by a low dose JAK2-specific small molecule inhibitor CYT387 (1 μM) in vitro. Subsequent, in vivo transplantation of paclitaxel and CYT387-treated HEY cells in mice resulted in a significantly reduced tumor burden compared to that seen with paclitaxel only-treated transplanted cells. In vitro analysis of tumor xenografts at protein and mRNA levels demonstrated a loss of CSC-like markers and CA125 expression in paclitaxel and CYT387-treated cell-derived xenografts, compared to paclitaxel only-treated cell-derived xenografts. These results were consistent with significantly reduced activation of JAK2 and STAT3 in paclitaxel and CYT387-treated cell-derived xenografts compared to paclitaxel only-treated cell derived xenografts. Conclusions This proof of principle study demonstrates that inhibition of the JAK2/STAT3 pathway by the addition of CYT387 suppresses the ‘stemness’ profile in chemotherapy-treated residual cells in vitro, which is replicated in vivo, leading to a reduced tumor burden. These findings have important implications for ovarian cancer patients who are treated with taxane and/or platinum-based therapies. Keywords: Ovarian carcinoma, Cancer stem cell, Metastasis, Ascites, Chemoresistance, Recurrence, JAK2/STAT3 pathway

Non-square-well potential profile and suppression of blinking in compositionally graded Cd1−xZnxSe/CdxZn1−xSe nanocrystals

Random blinking is a major problem on the way to successful applications of semiconducting nanocrystals in optoelectronics and photonics, which until recently had neither a practical solution nor a theoretical interpretation. An experimental breakthrough has recently been made by fabricating non-blinking Cd1-xZnxSe/ZnSe graded nanocrystals [Wang et al., Nature, 2009, 459, 686]. Here, we (1) report an unequivocal and detailed theoretical investigation to understand the properties (e.g., profile) of the potential-well and the distribution of Zn content with respect to the nanocrystal radius and (2) develop a strategy to find the relationship between the photoluminescence (PL) energy peaks and the potential-well due to Zn distribution in nanocrystals. It is demonstrated that the non-square-well potential can be varied in such a way that one can indeed control the PL intensity and the energy-level difference (PL energy peaks) accurately. This implies that one can either suppress the blinking altogether, or alternatively, manipulate the PL energy peaks and intensities systematically to achieve a controlled non-random intermittent luminescence. The approach developed here is based on the ionization energy approximation and as such is generic and can be applied to any non-free-electron nanocrystals.

Expression profile of endothelin 1 and its receptor endothelin receptor A in papillary thyroid carcinoma and their correlations with clinicopathologic characteristics

The endothelin axis is a group of signaling molecules and their receptors that have been implicated in vascularization of cancers, with their expression being observed to change in different cancer types. In this research, we examined the expression of endothelin 1 and endothelin receptor A at the protein and messenger RNA (mRNA) levels in 123 papillary thyroid carcinomas and 40 matched lymph nodes with metastatic papillary thyroid carcinomas. We found altered endothelin axis mRNA expression in several clinicopathologic parameters with increased endothelin 1 expression in thyroid papillary carcinoma showing stromal calcification, cancers in men, and primary cancers with lymph node metastases. Increased endothelin receptor A mRNA expression was noted in the larger cancers. There is a significant correlation between expression of endothelin receptor A and endothelin 1 in papillary thyroid carcinoma. Both endothelin receptor A and endothelin 1 mRNA expressions were significantly higher in metastatic carcinoma in the lymph node than in primary thyroid cancer. The metastatic carcinoma in the lymph node had increased expression compared with matched primary thyroid carcinoma. Expressions of endothelin 1 and endothelin receptor A were also documented as being high at the protein level. Our results indicate that in thyroid cancer, endothelin 1 and endothelin receptor A are associated with growth in advanced stages and lymph node metastases, likely through known angiogenic linkages. Targeting the endothelin axis may be useful in planning angiogenesis therapy for thyroid cancer.

Contributions of the private sector to global biodiversity protection: case study of the Fortune 500 companies

Since the inception of the UN Convention on Biological Diversity (CBD) in 1992, little progress has been achieved in terms of involving the business community in protecting biological diversity worldwide. This article assesses the current activities of US Fortune 500 companies with respect to global biodiversity protection and the goals of the CBD. Data and information collected from 500 companies within eight major industrial sectors were further categorized at the company level to assess each company's involvement in global biodiversity protection. Our findings show that although companies' business profiles highly influence their decision-making process regarding the adoption of biodiversity protection policies and measures, their revenue profiles are less influential. We show that despite generating low revenues, companies in the utility sector are more active in the adoption of biodiversity protection policy than those in the financial sector, which generate high revenues. This study also demonstrates that companies must be convinced of the major effects of biodiversity loss on their bottom lines to be motivated to protect biological diversity. Companies' business and business-related risk profiles can also influence the adoption of biodiversity protection policies within the company. The study further demonstrates that a measurable biodiversity impact indicator is necessary for the companies to get seriously involved in the mitigation action. Finally, this study proposes a three-step biodiversity loss mitigation action framework that is drawn upon the assessment of the 500 companies that can contribute to develop an elaborative framework of business sector-specific mitigation plan. © 2013 Copyright Taylor and Francis Group, LLC.

Improving voltage profile of residential distribution systems using rooftop PVs and Battery Energy Storage systems

Large number of rooftop Photovoltaics (PVs) have turned traditional passive networks into active networks with intermittent and bidirectional power flow. A community based distribution network grid reinforcement process is proposed to address technical challenges associated with large integration of rooftop PVs. Probabilistic estimation of intermittent PV generation is considered. Depending on the network parameters such as the R/X ratio of distribution feeder, either reactive control from PVs or coordinated control of PVs and Battery Energy Storage (BES) has been proposed. Determination of BES capacity is one of the significant outcomes from the proposed method and several factors such as variation in PV installed capacity as well as participation from community members are analyzed. The proposed approach is convenient for the community members providing them flexibility of managing their integrated PV and BES systems

Profile of a narcissistic leader : coffee’s for closers only

Purpose In the past, leadership scholars have tended to focus on leadership as a force for good and productivity (Ashworth, 1994; Higgs, 2009; Padilla, Hogan, & Kaiser, 2007). However, recently attention has been given to the ‘dark side’ of leadership (see Higgs, 2009; Judge, Piccolo, & Kosalka, 2009). The aim of this chapter is to explore dark leadership from the perspective of the narcissistic leader using a fictional character from a popular film. Methodology/approach Using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, 1994 (DSM-IV) (American Psychiatric Association, 2000) as an operational definition of narcissistic personality disorder we explore the psychology of the narcissistic leader through a fictional character study in a popular film. Findings We have created a psychological profile of a narcissistic leader which identifies specific behavioural characteristics within a toxic organizational culture. Social implications This study has implications for employees within any organizational culture. It is significant because it can illustrate how dark leadership can impact negatively within organizations. Originality/value The use of actual living persons on which to base case study material in the study of dark leadership is problematic and constrained by ethical issues. However, the use of characters in fiction, such as contemporary film and drama, represents an excellent source of case study material. Given that little empirical works exists on narcissistic leaders and leadership, the chapter adds originality and value to the field.

Utilizing reactive capability of PV inverters and battery systems to improve voltage profile of a residential distribution feeder

Significant increase in installation of rooftop Photovoltaic (PV) in the Low-Voltage (LV) residential distribution network has resulted in over voltage problems. Moreover, increasing peak demand creates voltage dip problems and make voltage profile even worse. Utilizing the reactive power capability of PV inverter (RCPVI) can improve the voltage profile to some extent. Resistive caharcteristic (higher R/X ratio) limits the effectiveness of reactive power to provide voltage support in distribution network. Battery Energy Storage (BES), whereas, can store the excess PV generation during high solar insolation time and supply the stored energy back to the grid during peak demand. A coordinated algorithm is developed in this paper to use the reactive capability of PV inverter and BES with droop control. Proposed algorithm is capable to cater the severe voltage violation problem using RCPVI and BES. A signal flow is also mentioned in this research work to ensure smooth communication between all the equipments. Finally the developed algorithm is validated in a test distribution network.

Across the divide - Criminology as other: Observations on the construction of the field

In 1978 Donald Cressey commented on an emerging division in the study of crime with some scholars concentrating on the development of a “crime fi ghting coalition” and others concerned with the processes associated with “making laws, breaking laws, and the reaction to the breaking of laws” (1978: 175). Since Cressey’s paper, many others have refl ected on the distinction between criminology and the sociology of crime and deviance (Akers, 1992; Garland, 1999; Garland & Sparks, 2000; Konty, 2007). But does such a distinction actually exist? Adopting a pragmatic position, the immediate answer is yes, if we assume that these categories have substance on the basis that they are grounded in everyday beliefs, institutional preferences and research practice (Konty, 2007). Moreover, these are viable categories in that some people studying crime label themselves criminologists (or are given this label by others) while others prefer or are given the label sociologist. Of course, there are further labels that may apply to persons studying crime, which include psychologist, penologist, biologist, chemist, and so on. One could argue that such labels are unimportant, however, it remains that these categories have a practical character. For criminology and the sociology of crime in particular, scholarly discourse frames these categories as oppositional (Bader et al., 1996.; Bendle, 1989; Laub & Sampson, 1991; Sibley, 2002) and to the extent that this has occurred, the categories have social relevance.

Who is seeing the dietitian? we are only seeing the tip of the iceberg

Poor dietary choices are associated with overweight and obesity and the development of chronic conditions. Over 12 million (~60%) Australians are currently overweight or obese. Accredited Practicing Dietitians (APDs) are the experts in nutrition and diet therapy, equipped to provide services and counselling to assist individuals in making dietary modifications to prevent or manage diet-related conditions. However, no existing research has investigated the proportion or characteristics of the Australian population that may be accessing APDs. Data from 25,906 participants in the 2004/05 National Health Survey (NHS) were analysed using logistic regression to identify the sociodemographic and health characteristics of individuals accessing an APD or Nutritionist. Only 0.4% (n = 105) of the sample reported accessing a Dietitian or Nutritionist, this was half the amount accessing a Naturopath. Diabetes Mellitus, cardiovascular disease and obesity were all significantly associated with having seen a Dietitian, and over 90% of those accessing services had a long-term condition. Of the total sample only 10% of those with a diet-related condition had seen an APD or Nutritionist. Household income and education were not associated with accessing an APD. Exploration around the barriers to referral and accessing services may be warranted to assist in enhancing the profile of APDs among the population and other healthcare professionals. The current number of approximately 5000 registered APDs is unlikely to be able to service the proportion of the population who require dietary intervention; further avenues for prevention, rather than acute treatment, and novel strategies for service provision also need to be explored.

Perceived needs for supported self-management of type 2 diabetes : a qualitative investigation of the potential for a web-based intervention

The estimated one million Australians with type 2 diabetes face significant risks of morbidity and premature mortality. Inadequate diabetes self-management is associated with poor glycaemic control, which is further impaired by comorbid dysphoria. Regular access to ongoing self-management and psychological support is limited, especially in rural and regional locations. Web-based interventions can provide complementary support to patients’ usual care. Semi-structured interviews were undertaken with two samples that comprised (a) 13 people with type 2 diabetes and (b) 12 general practitioners (GPs). Interviews explored enablers and barriers to self-care, emotional challenges, needs for support, and potential web-based programme components. Patients were asked about the potential utility of a web-based support programme, and GPs were asked about likely circumstances of patient referral to it. Thematic analysis was used to summarise responses. Most perceived facilitators and barriers to self-management were similar across the groups. Both groups highlighted the centrality of dietary self-management, valued shared decision-making with health professionals, and endorsed the idea of web-based support. Some emotional issues commonly identified by patients varied to those perceived by GPs, resulting in different attributions for impaired self-care. A web-based programme that supported self-management and psychological/emotional needs appears likely to hold promise in yielding high acceptability and perceived utility.

Socio-economic determinants for industry development : the case of Australia’s Sydney rock oyster industry

Socio-economic characteristics such as age, gender, educational attainment, employment status, and income contain vital information about how an industry may respond to changing circumstances, and hence are of importance to decision makers. While some socio-economic studies exist, relatively little attention has been given to fishery and aquaculture industries in regards to their socio-economic profiles and their role in the development prospects of these industries. In this study, by way of example, we focus on Australia’s Sydney rock oyster (Saccostrea glomerata) (SRO) industry. The aim of this study was identify the socio-economic profile of the SRO industry and to illustrate the value of such information for an industry management assessment. The SRO industry has experienced a major decrease in production volume since the late 1970 and continues to be affected by prevailing diseases and increasing market competition from Australia’s Pacific oyster (Crassostrea gigas) industry. It is likely that socio-economic aspects have influenced this development within the SRO industry. The socio-economic profile was developed using data from a SRO industry farm survey which was undertaken in 2012. Findings suggested that this industry is characterised by a mature aged oyster farmer population and a part-time oyster farming approach. These characteristics may affect the farmers’ ability to drive innovation and growth. The results also suggested that there may be potential industry entry barriers present in the SRO industry which may prevent younger people taking up oyster farming. Given the results, the study concluded that the current socio-economic profile of the industry has likely contributed to the present economic status quo of the industry.

Vibrational spectroscopic characterization of the arsenate mineral barahonaite: Implications for the molecular structure

The mineral barahonaite is in all probability a member of the smolianinovite group. The mineral is an arsenate mineral formed as a secondary mineral in the oxidized zone of sulphide deposits. We have studied the barahonaite mineral using a combination of Raman and infrared spectroscopy. The mineral is characterized by a series of Raman bands at 863 cm−1 with low wavenumber shoulders at 802 and 828 cm−1. These bands are assigned to the arsenate and hydrogen arsenate stretching vibrations. The infrared spectrum shows a broad spectral profile. Two Raman bands at 506 and 529 cm−1 are assigned to the triply degenerate arsenate bending vibration (F 2, ν4), and the Raman bands at 325, 360, and 399 cm−1 are attributed to the arsenate ν2 bending vibration. Raman and infrared bands in the 2500–3800 cm−1 spectral range are assigned to water and hydroxyl stretching vibrations. The application of Raman spectroscopy to study the structure of barahonaite is better than infrared spectroscopy, probably because of the much higher spatial resolution.

A SEM, EDS and vibrational spectroscopic study of the tellurite mineral: Sonoraite Fe3+Te4+O3(OH)·H2O

We have undertaken a study of the tellurite mineral sonorite using electron microscopy with EDX combined with vibrational spectroscopy. Chemical analysis shows a homogeneous composition, with predominance of Te, Fe, Ce and In with minor amounts of S. Raman spectroscopy has been used to study the mineral sonoraite an examples of group A(XO3), with hydroxyl and water units in the mineral structure. The free tellurite ion has C3v symmetry and four modes, 2A1 and 2E. An intense Raman band at 734 cm−1 is assigned to the ν1 (TeO3)2− symmetric stretching mode. A band at 636 cm−1 is assigned to the ν3 (TeO3)2− antisymmetric stretching mode. Bands at 350 and 373 cm−1 and the two bands at 425 and 438 cm−1 are assigned to the (TeO3)2−ν2 (A1) bending mode and (TeO3)2−ν4 (E) bending modes. The sharp band at 3283 cm−1 assigned to the OH stretching vibration of the OH units is superimposed upon a broader spectral profile with Raman bands at 3215, 3302, 3349 and 3415 cm−1 are attributed to water stretching bands. The techniques of Raman and infrared spectroscopy are excellent for the study of tellurite minerals.

Mothers' perception of the quality of childhood sibling relationships affected by disability

The quality of the sibling relationship has an important role in the development of psychosocial skills throughout childhood. While the literature suggests that the significance of sibling relationships is heightened when one sibling has a disability, empirical findings about the quality of these relationships are few and inconsistent. The present study aimed to address this gap, by investigating mothers’ perspectives about the impact of disability on the quality of the childhood sibling relationship. Forty-one mothers with a child with disability, and 48 with no children with disability completed an online questionnaire that assessed the amount of perceived warmth/closeness and conflict in their children’s sibling relationship. It was found that while there were no differences in reported conflict between the two groups, mothers with a child with disability reported significantly lower warmth/closeness in their children’s sibling relationship than mothers without a child with disability. Demographic variables such as number of children, gender grouping, target gender, target age and age order did not moderate this result. Mothers overall reported significantly more warmth/closeness for younger rather than older children, and more conflict when the sibling was younger than the target child as opposed to older than them. Clinical implications for intervention are discussed.