Some problems with life event lists and health outcomes

Lists of life events are widely used in health outcomes research. As part of a large cohort study of women's health in Australia, age- and gender-specific life events lists were developed and administered to women in different age groups over time. In this article, we provide empirical evidence that recall of life events is subject to telescoping (i.e., remote events are reported to have occurred more recently) and to mood (women with lower mental health scores report more life events, especially perceived rather than factual events). Nevertheless, even after adjustment for confounders, there is a clear association between poorer physical health and more life events. Therefore, these results demonstrate a continuing need for lists of life events in health research but also highlight the methodological challenges in using them.

Telemedical support for Iraq

The Swinfen Charitable Trust (SCT) provided two kinds of telemedical support to Iraq during 2004. Starting in January 2004, the Al-Yarmouk Teaching Hospital in Baghdad was able to refer cases into the well established global e-health network that the SCT has operated for the last five years. (In the first quarter of 2004, the SCT dealt with a total of 57 referrals from 15 hospitals in eight countries.) Two cases were referred from Baghdad in March 2004, both gynaecological, which were dealt with by consultants from the UK and Australia. The SCT administrators visited Basrah during April 2004 and met Iraqi doctors at the Shaibah Hospital as part of the international initiatives to improve health care there. Following this visit, the SCT network expanded to include another four hospitals in Iraq (Table 1). In addition, the SCT provided an electronic health records (EHR) system to support the rebuilding of maternity services, which has been led by the British Royal Colleges. The maternity records system is a Web-based EHR system, running on a secure server, which allows integrated access from antenatal clinics, from hospitals and from postnatal clinics in Iraq. Patients can view their own notes, thus promoting ownership of medical information, and doctors can view the notes of their own patients, from any Internet-connected PC. No special software is required by the user.

Early practical experience and the social responsiveness of clinical education: Systematic review

Objectives To find how early experience in clinical and community settings (early experience) affects medical education, and identify strengths and limitations of the available evidence. Design A systematic review rating, by consensus, the strength and importance of outcomes reported in the decade 1992-2001. Data sources Bibliographical databases and journals were searched for publications on the topic, reviewed under the auspices of the recently formed Best Evidence Medical Education (BEME) collaboration. Selection of studies All empirical studies (verifiable, observational data) were included, whatever their design, method, or language of publication. Results Early experience was most commonly provided in community settings, aiming to recruit primary care practitioners for underserved populations. It increased the popularity of primary care residencies, albeit among self selected students. It fostered self awareness and empathic attitudes towards ill people, boosted students' confidence, motivated them, gave them satisfaction, and helped them develop a professional identity. By helping develop interpersonal skills, it made entering clerkships a less stressful experience. Early experience helped students learn about professional roles and responsibilities, healthcare systems, and health needs of a population. It made biomedical, behavioural, and social sciences more relevant and easier to learn. It motivated and rewarded teachers and patients and enriched curriculums. In some countries,junior students provided preventive health care directly to underserved populations. Conclusion Early experience helps medical students learn, helps them develop appropriate attitudes towards their studies and future practice, and orientates medical curriculums towards society's needs. Experimental evidence of its benefit is unlikely to be forthcoming and yet more medical schools are likely to provide it. Effort could usefully be concentrated on evaluating the methods and outcomes of early experience provided within non-experimental research designs, and using that evaluation to improve the quality of curriculums.

The effect of introducing radiographer reporting on the availability of reports for Accident and Emergency and General Practitioner examinations: a time-series analysis

This study explores whether the introduction of selectively trained radiographers reporting Accident and Emergency (A&E) X-ray examinations or the appendicular skeleton affected the availability of reports for A&E and General Practitioner (GP) examinations at it typical district general hospital. This was achieved by analysing monthly data on A&E and GP examinations for 1993 1997 using structural time-series models. Parameters to capture stochastic seasonal effects and stochastic time trends were included ill the models. The main outcome measures were changes in the number, proportion and timeliness of A&E and GP examinations reported. Radiographer reporting X-ray examinations requested by A&E was associated with it 12% (p = 0.050) increase in the number of A&E examinations reported and it 37% (p

Water and nutrient availabilities do not affect lignotuber growth and sprouting ability of three eucalypt species of south-eastern Queensland

Shoot biomass and lignotuber size of seedlings of three eucalypt species, Eucalyptus acmenoides Schauer, E. siderophloia Benth. and Corymbia variegata [syn. E. maculata (F. Muell.)K. D. Hill and L. A. S. Johnson], were measured for glasshouse-grown seedlings established under two water and nutrient regimes. Seedlings were subjected to shoot removal (clipping) at ages from 9 to 19 weeks, and transferred to the high water treatment for a further 8 weeks to assess shoot emergence from lignotubers. Seedling shoot biomass was greater in both the high than the low nutrient and water treatments, but lignotuber diameter was not affected significantly. C. variegata seedlings had the largest lignotuber diameters, followed by E. siderophloia and E. acmenoides, respectively. Although growth of shoots was influenced by nutrient availability, results suggest that species differences in the growth of lignotubers was less affected. It is suggested that lignotuber growth was strongly influenced by genotype. More than 70% of C. variegata seedlings clipped at 9 weeks sprouted, compared with only 5 and 10% of seedlings of E. siderophloia and E. acmenoides, respectively. All C. variegata seedlings sprouted after being clipped at 19 weeks, but < 80% of E. siderophloia and < 60% of E. acmenoides sprouted when clipped at the same age. It was concluded that seedlings forming part of the regeneration stratum in dry sclerophyll forests need to be protected from damage for at least 4 months (for C. variegata) or at least 6 months (for E. siderophloia and E. acmenoides) if they are to survive by sprouting from lignotubers.

Real-time reverse transcriptase PCR for the endogenous koala retrovirus reveals an association between plasma viral load and neoplastic disease in koalas

Koala retrovirus (KoRV) is a newly described endogenous retrovirus and is unusual in that inserts comprise a full-length replication competent genome. As koalas are known to suffer from an extremely high incidence of leukaemia/lymphoma, the association between this retrovirus and disease in koalas was examined. Using quantitative real-time reverse transcriptase PCR it was demonstrated that KoRV RNA levels in plasma are significantly increased in animals suffering from leukaemia or lymphoma when compared with healthy animals. Increased levels of KoRV were also seen for animals with clinical chlamydiosis. A significant positive association between viral RNA levels and age was also demonstrated. Real-time PCR demonstrated as much as 5 log variation in KoRV proviral DNA levels in genomic DNA extracted from whole blood from different animals. Taken together these data indicate that KoRV is an active endogenous retrovirus and suggests that it may be causally linked to neoplastic disease in koalas.

Tooth wear: diet analysis and advice

Diet analysis and advice for patients with tooth wear is potentially the most logical intervention to arrest attrition, erosion and abrasion. It is saliva that protects the teeth against corrosion by the acids which soften enamel and make it susceptible to wear. Thus the lifestyles and diet of patients at risk need to be analysed for sources of acid and reasons for lost salivary protection. Medical conditions which put patients at risk of tooth wear are principally: asthma, bulimia nervosa, caffeine addiction, diabetes mellitus, exercise dehydration, functional depression, gastroesophageal reflux in alcoholism, hypertension and syndromes with salivary hypofunction. The sources of acid are various, but loss of salivary protection is the common theme. In healthy young Australians, soft drinks are the main source of acid, and exercise dehydration the main reason for loss of salivary protection. In the medically compromised, diet acids and gastroesophageal reflux are the sources, but medications are the main reasons for lost salivary protection. Diet advice for patients with tooth wear must: promote a healthy lifestyle and diet strategy that conserves the teeth by natural means of salivary stimulation; and address the specific needs of the patients' oral and medical conditions. Individualised, patient-empowering erosion WATCH strategies; on Water, Acid, Taste, Calcium and Health, are urgently required to combat the emerging epidemic of tooth wear currently being experienced in westernised societies.

GANN: Genetic algorithm neural networks for the detection of conserved combinations of features in DNA

Background: The multitude of motif detection algorithms developed to date have largely focused on the detection of patterns in primary sequence. Since sequence-dependent DNA structure and flexibility may also play a role in protein-DNA interactions, the simultaneous exploration of sequence-and structure-based hypotheses about the composition of binding sites and the ordering of features in a regulatory region should be considered as well. The consideration of structural features requires the development of new detection tools that can deal with data types other than primary sequence. Results: GANN ( available at http://bioinformatics.org.au/gann) is a machine learning tool for the detection of conserved features in DNA. The software suite contains programs to extract different regions of genomic DNA from flat files and convert these sequences to indices that reflect sequence and structural composition or the presence of specific protein binding sites. The machine learning component allows the classification of different types of sequences based on subsamples of these indices, and can identify the best combinations of indices and machine learning architecture for sequence discrimination. Another key feature of GANN is the replicated splitting of data into training and test sets, and the implementation of negative controls. In validation experiments, GANN successfully merged important sequence and structural features to yield good predictive models for synthetic and real regulatory regions. Conclusion: GANN is a flexible tool that can search through large sets of sequence and structural feature combinations to identify those that best characterize a set of sequences.

Physicians' attitudes towards end-of-life decisions: a comparison between seven countries

In the context of an European collaborative research project (EURELD), a study on attitudes towards medical end-of-life decisions was conducted among physicians in Belgium, Denmark, Italy, the Netherlands, Sweden and Switzerland. Australia also joined the consortium. A written questionnaire with structured questions was sent to practising physicians from specialties frequently involved in the care of dying patients. 10,139 questionnaires were studied. Response rate was equal to or larger than 50% in all countries except Italy (39%). Apart from general agreement with respect to the alleviation of pain and symptoms with possible life-shortening effect, there was large variation in support-between and within countries-for medical decision that may result in the hastening of death. A principal component factor analysis found that 58% of the variance of the responses is explained by four factors. 'Country' explained the largest part of the variation of the standardized factor scores. (c) 2004 Elsevier Ltd. All rights reserved.

Characterization of the highly efficient sucrose isomerase from Pantoea dispersa UQ68J and cloning of the sucrose isomerase gene

Sucrose isomerase (SI) genes from Pantoea dispersa UQ68J, Klebsiella planticola UQ14S, and Erwinia rhapontici WAC2928 were cloned and expressed in Escherichia coli. The predicted products of the UQ14S and WAC2928 genes were similar to known SIs. The UQ68J SI differed substantially, and it showed the highest isomaltulose-producing efficiency in E. coli cells. The purified recombinant WAC2928 SI was unstable, whereas purified UQ68J and UQ14S SIs were very stable. UQ68J SI activity was optimal at pH 5 and 30 to 35 degrees C, and it produced a high ratio of isomaltulose to trehalulose (> 22:1) across its pH and temperature ranges for activity (pH 4 to 7 and 20 to 50 degrees C). In contrast, UQ14S SI showed optimal activity at pH 6 and 35 degrees C and produced a lower ratio of isomaltulose to trehalulose (< 8:1) across its pH and temperature ranges for activity. UQ68J SI had much higher catalytic efficiency; the K-m was 39.9 mM, the V-max was 638 U mg(-1), and the K-cat/K-m was 1.79 x 104 M-1 s(-1), compared to a K-m of 76.0 mM, a V-max. of 423 U mg(-1), and a K-cat/K-m of 0.62 x 104 M-1 s(-1) for UQ14S SI. UQ68J SI also showed no apparent reverse reaction producing glucose, fructose, or trehalulose from isomaltulose. These properties of the P. dispersa UQ68J enzyme are exceptional among purified SIs, and they indicate likely differences in the mechanism at the enzyme active site. They may favor the production of isomaltulose as an inhibitor of competing microbes in high-sucrose environments, and they are likely to be highly beneficial for industrial production of isomaltulose.

Identification of new flaviviruses in the Kokobera virus complex

Novel flavivirus isolates from mosquitoes collected in northern Australia were analysed by partial genomic sequencing, monoclonal antibody-binding assays and polyclonal cross-neutralization tests. Two isolates were found to be antigenically distinct from, but related to, viruses of the Kokobera virus complex, which currently contains Kokobera (KOKV) and Stratford (STRV) viruses. Nucleotide sequence comparison of two separate regions of the genome revealed that an isolate from Saibai Island in the Torres Strait in 2000 (TS5273) was related closely to KOKV and STRV, with 74-80 and 75-76% nucleotide similarity, respectively. An isolate from mainland Cape York in 1998 (CY1014) was found to be more divergent from KOKV and STRV, with

The combined SPE : ToxY-PAM phytotoxicity assay; application and appraisal of a novel biomonitoring tool for the aquatic environment

Mounting concerns regarding the environmental impact of herbicides has meant a growing requirement for accurate, timely information regarding herbicide residue contamination of, in particular, aquatic systems. Conventional methods of detection remain limited in terms of practicality due to high costs of operation and the specialised information that analysis provides. A new phytotoxicity bioassay was trialled for the detection of herbicide residues in filter-purified (Milli-Q) as well as natural waters. The performance of the system, which combines solid-phase extraction (SPE) with the ToxY-PAM dual-channel yield analyser (Heinz Walz GmbH), was tested alongside the traditional method of liquid chromatography-mass spectrometry (LC-MS). The assay methodology was found to be highly sensitive (LOD 0.1 ng L-1 diuron) with good reproducibility. The study showed that the assay protocol is time effective and can be employed for the aquatic screening of herbicide residues in purified as well as natural waters.

Responding to our customers' needs: modifications to assessment in Obstetrics and Gynaecology over 20 years

Background and Objectives: This paper reports on historical changes in assessment culminating in the experience of one discipline with negotiated student feedback that has helped design and modify assessment to cater for the requirements of both students and teachers. The standard of assessment required to pass Obstetrics and Gynaecology in the four year graduate entry program in the School of Medicine at The University of Queensland, Brisbane, Australia has become less formalised and more collaborative. Changes in assessment in this discipline over the last 20 years reflect the development of an understanding of the educational principles associated with adult teaching and learning. Assessment has evolved from being teacher focussed, with questionable reliability, validity, and emphasis on outcomes, to being focussed on learning and the student. Multiplechoice examinations, combined with a collaborative approach to the reliability and validity of questions and answers and a debrief or feedback session have been found to provide an assessment format that is art acceptable measure oflearning for both teachers and students. Changes in assessment reflect a collaborative process between teachers and students based on principles of adult learning and involving negotiated student feedback. Our experience with this form of negotiated outcome for assessment is presented together with suggestions for improvement and is contrasted with assessment methods used in this department over the last 20 years. Change and refinement will continue as medical programs strive to meet the learning needs of students and assessment outcomes that are acceptable to its teachers.

Optimal design for model discrimination and parameter estimation for itraconazole population pharmacokinetics in cystic fibrosis patients

Optimal sampling times are found for a study in which one of the primary purposes is to develop a model of the pharmacokinetics of itraconazole in patients with cystic fibrosis for both capsule and solution doses. The optimal design is expected to produce reliable estimates of population parameters for two different structural PK models. Data collected at these sampling times are also expected to provide the researchers with sufficient information to reasonably discriminate between the two competing structural models.