Telemedicine for rural and remote child and youth mental health services

The E-Child and Youth Mental Health Service was designed to provide children and adolescents in Queensland with access to specialist mental health consultations using telemedicine. A project officer provided a single point of contact for referral management and clinic coordination, thereby reducing barriers of access to the service. Over a six-month period from November 2004, 42 point-to-point videoconferences were conducted to nine sites in Queensland. Three multipoint conferences were also conducted. Eleven videoconferences (24%) were arranged for administrative purposes, and 34 (76%) were conducted for the delivery of clinical services (30 patients). The referral and consultation activity suggests an improvement in the capacity of rural and remote mental health service providers to deliver specialist services for children and adolescents.

Interagency collaboration between child protection and mental health services: Practices, attitudes and barriers

Objective: The aim of this paper is to examine some of the factors that facilitate and hinder interagency collaboration between child protection services and mental health services in cases where there is a parent with a mental illness and there are protection concerns for the child(ren). The paper reports on agency practices, worker attitudes and experiences, and barriers to effective collaboration. Method: A self-administered, cross-sectional survey was developed and distributed via direct mail or via line supervisors to workers in statutory child protection services, adult mental health services, child and youth mental health services, and Suspected Child Abuse and Neglect (SCAN) Teams. There were 232 completed questionnaires returned, with an overall response rate of 21%. Thirty-eight percent of respondents were statutory child protection workers. 39% were adult mental health workers, 16% were child and youth mental health workers, and 4% were SCAN Team medical officers (with 3% missing data). Results: Analysis revealed that workers were engaging in a moderate amount of interagency contact, but that they were unhappy with the support provided by their agency. Principle components analysis and multivariate analysis of variance (MANOVA) on items assessing attitudes toward other workers identified four factors, which differed in rates of endorsement: inadequate training, positive regard for child protection workers, positive regard for mental health workers, and mutual mistrust (from highest to lowest level of endorsement). The same procedure identified the relative endorsement of five factors extracted from items about potential barriers: inadequate resources, confidentiality, gaps in interagency processes, unrealistic expectations, and professional knowledge domains and boundaries. Conclusions: Mental health and child protection professionals believe that collaborative practice is necessary; however, their efforts are hindered by a lack of supportive structures and practices at the organizational level. (c) 2005 Published by Elsevier Ltd.

How can experience in clinical and community settings contribute to early medical education? A BEME systematic review

Review date: Review period January 1992-December 2001. Final analysis July 2004-January 2005. Background and review context: There has been no rigorous systematic review of the outcomes of early exposure to clinical and community settings in medical education. Objectives of review: (1) Identify published empirical evidence of the effects of early experience in medical education, analyse it, and synthesize conclusions from it. (2) Identify the strengths and limitations of the research effort to date, and identify objectives for future research. Search strategy: Ovid search of. BEI, ERIC, Medline, CIATAHL and EMBASE Additional electronic searches of: Psychinfo, Timelit, EBM reviews, SIGLE, and the Cochrane databases. Hand-searches of: Medical Education, Medical Teacher, Academic Medicine, Teaching and Learning in Medicine, Advances in Health Sciences Education, Journal of Educational Psychology. Criteria: Definitions: Experience: Authentic (real as opposed to simulated) human contact in a social or clinical context that enhances learning of health, illness and/or disease, and the role of the health professional. Early: What would traditionally have been regarded as the preclinical phase, usually the first 2 years. Inclusions: All empirical studies (verifiable, observational data) of early experience in the basic education of health professionals, whatever their design or methodology, including papers not in English. Evidence from other health care professions that could be applied to medicine was included. Exclusions: Not empirical; not early; post-basic; simulated rather than 'authentic' experience. Data collection: Careful validation of selection processes. Coding by two reviewers onto an extensively modified version of the standard BEME coding sheet. Accumulation into an Access database. Secondary coding and synthesis of an interpretation. Headline results: A total of 73 studies met the selection criteria and yielded 277 educational outcomes; 116 of those outcomes (from 38 studies) were rated strong and important enough to include in a narrative synthesis of results; 76% of those outcomes were from descriptive studies and 24% from comparative studies. Early experience motivated and satisfied students of the health professions and helped them acclimatize to clinical environments, develop professionally, interact with patients with more confidence and less stress, develop self-reflection and appraisal skill, and develop a professional identity. It strengthened their learning and made it more real and relevant to clinical practice. It helped students learn about the structure and function of the healthcare system, and about preventive care and the role of health professionals. It supported the learning of both biomedical and behavioural/social sciences and helped students acquire communication and basic clinical skills. There were outcomes for beneficiaries other than students, including teachers, patients, populations, organizations and specialties. Early experience increased recruitment to primary care/rural medical practice, though mainly in US studies which introduced it for that specific purpose as part of a complex intervention. Conclusions: Early experience helps medical students socialize to their chosen profession. It. helps them acquire a range of subject matter and makes their learning more real and relevant. It has potential benefits for other stakeholders, notably teachers and patients. It can influence career choices.

Planted forests and biodiversity

Expansion of planted forests and intensification of their management has raised concerns among forest managers and the public over the implications of these trends for sustainable production and conservation of forest biological diversity. We review the current state of knowledge on the impacts of plantation forestry on genetic and species diversity at different spatial scales and discuss the economic and ecological implications of biodiversity management within plantation stands and landscapes. Managing plantations to produce goods such as timber while also enhancing ecological services such as biodiversity involves tradeoffs, which can be made only with a clear understanding of the ecological context of plantations in the broader landscape and agreement among stakeholders on the desired balance of goods and ecological services from plantations.

Employment services in an age of e-government

The increasing use of information and communications technologies among government departments and non-government agencies has fundamentally changed the implementation of employment services policy in Australia. The administrative arrangements for governing unemployment and unemployed people are now constituted by a complex contractual interplay between government departments as ‘purchasers’ and a range of small and large private organizations as ‘providers’. Assessing, tracking and monitoring the activities of unemployed people through the various parts of the employment services system has been made possible by developments in information technology and tailored computer programs. Consequently, the discretionary capacity that is traditionally associated with ‘street-level bureaucracy’ has been partly transformed into more prescriptive forms of ‘screen-level bureaucracy’. The knowledge embedded in these new computer-based technologies is considered superior because it is based on ‘objective calculations’, rather than subjective assessments of individual employees. The relationship between the sociopolitical context of unemployment policy and emerging forms of e-government is explored using illustrative findings from a qualitative pilot study undertaken in two Australian sites. The findings suggest that some of the new technologies in the employment services system are welcomed, while other applications are experienced as contradictory to the aims of delivering a personalized and respectful service.

Organochlorine and heavy metal concentrations in blubber and liver tissue collected from Queensland (Australia) dugong (Dugong dugon)

Tissue samples of liver and blubber were salvaged from fifty-three dugong (Dugong dugon) carcasses stranded along the Queensland coast between 1996 and 2000. Liver tissue was analysed for a range of heavy metals and blubber samples were analysed for organochlorine compounds. Metal concentrations were similar in male and female animals and were generally highest in mature animals. Liver concentrations of arsenic, chromium, iron, lead, manganese, mercury and nickel in a number of individual animals were elevated in comparison to concentrations previously reported in Australian dugong. Dieldrin, DDT (and its breakdown products) and/or heptachlor epoxide were detected in 59% of dugong blubber samples. In general, concentrations of organochlorines were similar to those reported in dugong 20 years earlier, and were low in comparison to concentrations recorded from marine mammal tissue collected elsewhere in the world. With the exception of lead, the extent of carcass decomposition, the presence of disease or evidence of animal starvation prior to death did not significantly affect dugong tissue concentrations of metals or organochlorines. The results of the study suggest that bioaccumulation of metals and organochlorine compounds (other than dioxins) does not represent a significant risk to Great Barrier Reef dugong populations, particularly in the context of other pressures associated with coastal development and other anthropogenic activities. (c) 2004 Elsevier Ltd. All rights reserved.

Applying a disciplined approach to the development of a context-aware communication application

Pervasive computing applications must be engineered to provide unprecedented levels of flexibility in order to reconfigure and adapt in response to changes in computing resources and user requirements. To meet these challenges, appropriate software engineering abstractions and infrastructure are required as a platform on which to build adaptive applications. In this paper, we demonstrate the use of a disciplined, model-based approach to engineer a context-aware Session Initiation Protocol (SIP) based communication application. This disciplined approach builds on our previously developed conceptual models and infrastructural components, which enable the description, acquisition, management and exploitation of arbitrary types of context and user preference information to enable adaptation to context changes

Introducing uncertainty into pattern discovery in temporal event sequences

Pattern discovery in temporal event sequences is of great importance in many application domains, such as telecommunication network fault analysis. In reality, not every type of event has an accurate timestamp. Some of them, defined as inaccurate events may only have an interval as possible time of occurrence. The existence of inaccurate events may cause uncertainty in event ordering. The traditional support model cannot deal with this uncertainty, which would cause some interesting patterns to be missing. A new concept, precise support, is introduced to evaluate the probability of a pattern contained in a sequence. Based on this new metric, we define the uncertainty model and present an algorithm to discover interesting patterns in the sequence database that has one type of inaccurate event. In our model, the number of types of inaccurate events can be extended to k readily, however, at a cost of increasing computational complexity.

Spatially clustered associations in health GIS

Overlaying maps using a desktop GIS is often the first step of a multivariate spatial analysis. The potential of this operation has increased considerably as data sources and Web services to manipulate them are becoming widely available via the Internet. Standards from the OGC enable such geospatial mashups to be seamless and user driven, involving discovery of thematic data. The user is naturally inclined to look for spatial clusters and correlation of outcomes. Using classical cluster detection scan methods to identify multivariate associations can be problematic in this context, because of a lack of control on or knowledge about background populations. For public health and epidemiological mapping, this limiting factor can be critical but often the focus is on spatial identification of risk factors associated with health or clinical status. Spatial entropy index HSu for the ScankOO analysis of the hypothetical dataset using a vicinity which is fixed by the number of points without distinction between their labels. (The size of the labels is proportional to the inverse of the index) In this article we point out that this association itself can ensure some control on underlying populations, and develop an exploratory scan statistic framework for multivariate associations. Inference using statistical map methodologies can be used to test the clustered associations. The approach is illustrated with a hypothetical data example and an epidemiological study on community MRSA. Scenarios of potential use for online mashups are introduced but full implementation is left for further research.

Macro-level change and micro-level effects:a twenty year perspective on changing grocery shopping behaviour in Britain

In this paper we summarise key elements of retail change in Britain over a twenty-year period. The time period is that covered by a funded study into long-term change in grocery shopping habits in Portsmouth, England. The major empirical findings—to which we briefly allude—are reported elsewhere: the present task is to assess the wider context underlying that change. For example, it has frequently been stated that retailing in the UK is not as competitive as in other leading economies. As a result, the issue of consumer choice has become increasingly important politically. Concerns over concentration in the industry, new format development and market definition have been expressed by local planners, competition regulators and consumer groups. Macro level changes over time have also created market inequality in consumer opportunities at a local level—hence our decision to attempt a local-level study. Situational factors affecting consumer experiences over time at the local level involve the changing store choice sets available to particular consumers. Using actual consumer experiences thus becomes a yardstick for assessing the practical effectiveness of policy making. The paper demonstrates that choice at local level is driven by store use and that different levels of provision reflect real choice at the local level. Macro-level policy and ‘one size fits all’ approaches to regulation, it is argued, do not reflect the changing reality of grocery shopping. Accordingly, arguments for a more local and regional approach to regulation are made.