Trial of the Primary Care Practice Improvement Tool: Building organisational performance in Australian general practice and primary health care

Objective: To nationally trial the Primary Care Practice Improvement Tool (PC-PIT), an organisational performance improvement tool previously co-created with Australian primary care practices to increase their focus on relevant quality improvement (QI) activities. Design: The study was conducted from March to December 2015 with volunteer general practices from a range of Australian primary care settings. We used a mixed-methods approach in two parts. Part 1 involved staff in Australian primary care practices assessing how they perceived their practice met (or did not meet) each of the 13 PC-PIT elements of high-performing practices, using a 1–5 Likert scale. In Part 2, two external raters conducted an independent practice visit to independently and objectively assess the subjective practice assessment from Part 1 against objective indicators for the 13 elements, using the same 1–5 Likert scale. Concordance between the raters was determined by comparing their ratings. In-depth interviews conducted during the independent practice visits explored practice managers’ experiences and perceived support and resource needs to undertake organisational improvement in practice. Results: Data were available for 34 general practices participating in Part 1. For Part 2, independent practice visits and the inter-rater comparison were conducted for a purposeful sample of 19 of the 34 practices. Overall concordance between the two raters for each of the assessed elements was excellent. Three practice types across a continuum of higher- to lower-scoring practices were identified, with each using the PC-PIT in a unique way. During the in-depth interviews, practice managers identified benefits of having additional QI tools that relate to the PC-PIT elements. Conclusions: The PC-PIT is an organisational performance tool that is acceptable, valid and relevant to our range of partners and the end users (general practices). Work is continuing with our partners and end users to embed the PC-PIT in existing organisational improvement programs.

Topography of the combining region of a Thomsen-Friedenreich-antigen-specific lectin jacalin (Artocarpus integrifolia agglutinin). A thermodynamic and circular-dichroism spectroscopic study

Thermodynamic analysis of carbohydrate binding by Artocarpus integrifolia (jackfruit) agglutinin (jacalin) shows that, among monosaccharides, Me alpha GalNAc (methyl-alpha-N-acetylgalactosamine) is the strongest binding ligand. Despite its strong affinity for Me alpha GalNAc and Me alpha Gal, the lectin binds very poorly when Gal and GalNAc are in alpha-linkage with other sugars such as in A- and B-blood-group trisaccharides, Gal alpha 1-3Gal and Gal alpha 1-4Gal. These binding properties are explained by considering the thermodynamic parameters in conjunction with the minimum energy conformations of these sugars. It binds to Gal beta 1-3GalNAc alpha Me with 2800-fold stronger affinity over Gal beta 1-3GalNAc beta Me. It does not bind to asialo-GM1 (monosialoganglioside) oligosaccharide. Moreover, it binds to Gal beta 1-3GalNAc alpha Ser, the authentic T (Thomsen-Friedenreich)-antigen, with about 2.5-fold greater affinity as compared with Gal beta 1-3GalNAc. Asialoglycophorin A was found to be about 169,333 times stronger an inhibitor than Gal beta 1-3GalNAc. The present study thus reveals the exquisite specificity of A. integrifolia lectin for the T-antigen. Appreciable binding of disaccharides Glc beta 1-3GalNAc and GlcNAc beta 1-3Gal and the very poor binding of beta-linked disaccharides, which instead of Gal and GalNAc contain other sugars at the reducing end, underscore the important contribution made by Gal and GalNAc at the reducing end for recognition by the lectin. The ligand-structure-dependent alterations of the c.d. spectrum in the tertiary structural region of the protein allows the placement of various sugar units in the combining region of the lectin. These studies suggest that the primary subsite (subsite A) can accommodate only Gal or GalNAc or alpha-linked Gal or GalNAc, whereas the secondary subsite (subsite B) can associate either with GalNAc beta Me or Gal beta Me. Considering these factors a likely arrangement for various disaccharides in the binding site of the lectin is proposed. Its exquisite specificity for the authentic T-antigen, Gal beta 1-3GalNAc alpha Ser, together with its virtual non-binding to A- and B-blood-group antigens, Gal beta 1-3GalNAc beta Me and asialo-GM1 should make A. integrifolia lectin a valuable probe for monitoring the expression of T-antigen on cell surfaces.

Towards a United States of Africa? Combining Zambian and AU level debate.

Globalisaatio on luonut uuden maailmanjärjestelmän jonka myötä yksittäisten valtioiden vaikutusvalta on vähentynyt entisestään. Tämä pitää paikkansa erityisesti kehittyvien maiden kohdalla, esimerkiksi Afrikassa. Afrikka on pyrkinyt taistelemaan globalisaation tuomia negatiivisia vaikutuksia vastaan alueellistumisen ja maanosan yhtenäisyyttä ajavien hankkeiden kautta jo vuosikymmenien ajan, mutta toistaiseksi tulokset eivät ole olleet vakuttavia. Tällä hetkellä Afrikan Unionissa keskustellaan hankkeesta muodostaa Afrikan Yhdysvallat. Aiemmista hankkeista poiketen tämän uuden aloitteen ajatus perustuu ylikansallisuudelle, jossa yksittäiset valtiot luovuttavat valtaansa ylikansallisille elimille, kuten Afrikan Unionin hallitukselle. Näin ollen on tärkeää tarkastella aloitetta Afrikan Yhdysvaltojen perustamiseksi ja arvioida, voisiko tällainen ylikansallinen organisaatio auttaa Afrikkaa kääntämään globalisaation haittavaikutukset myönteisiksi. Tämä Pro Gradu-tutkielma väittää sen olevan mahdollista, mutta vain siinä tapauksessa että Afrikka on valmis hyväksymään yhtenäisyyden rajoitukset. Aiemman tutkimuksen vähyyden vuoksi on myös tarpeen tutkia Afrikan Yhdysvalloista kansallisilla tasoilla käytävää keskustelua. Tämän vuoksi tässä tutkielmassa painotetaan esimerkkimaa Sambian kautta yhden Afrikan Unionin jäsenmaan keskinäistä keskustelua aiheesta ja verrataan sitä Afrikan Unionin tason keskusteluun. Tutkielma sisältää kirjallisuuskatsauksen sekä tapaustutkimuksen. Tutkimusaineisto koostuu sambialaisista sanomalehtiotteista sekä Sambian valtion ja Afrikan Unionin virallisista asiakirjoista. Pääasiallisena tutkimusmenetelmänä on laadullinen sisällönanalyysi. Teoreettinen viitekehys perustuu afrikkalaisen valtion ja kansalaisyhteiskunnan, alueellistumisen, globalisaation hallinnan, pan-afrikkalaisuuden ja poliittisen integraation teorioihin sekä historialliseen katsaukseen Afrikan yhtenäisyydestä. Perimmäisenä tarkoituksena on lisätä ymmärrystä afrikkalaisesta valtiosta ja politiikasta. Tutkimuksen tulosten mukaan on havaittavissa aukko valtioiden virallisten toimijoiden näkemysten ja kansalaisyhteiskunnan huolenaiheiden välillä. Viralliset toimijat näyttävät olevan kansalaisyhteiskuntaa vahvemmin Afrikan Yhdysvaltojen kannalla. Virallisten toimijoiden korostaessa Afrikan aatteellista yhtenäisyyttä kansalaisyhteiskunta on huolissaan sen toteutumisesta käytännössä. Esiin nousee myös kysymys 'afrikkalaisesta' identiteetistä ja kansalaisuudesta sekä kommunikaatiosta valtion ja kansalaisten välillä.

Phospholipid cytochrome c interactions

The ability of the peripherally associated membrane protein cytochrome c (cyt c) to bind phospholipids in vitro was studied using fluorescence spectroscopy and large unilamellar liposomes. Previous work has shown that cyt c can bind phospholipids using two distinct mecha- nisms and sites, the A-site and the C-site. This binding is mediated by electrostatic or hydrophobic interactions, respectively. Here, we focus on the mechanism underlying these interactions. A chemically modified cyt c mutant Nle91 was used to study the ATP-binding site, which is located near the evolutionarily invariant Arg 91 on the protein surface. This site was also demonstrated to mediate phospholipid binding, possibly by functioning as a phospholipid binding site. Circular dichroism spectroscopy, time resolved fluorescence spectroscopy of zinc- porphyrin modified [Zn2+-heme] cyt c and liposome binding studies of the Nle91 mutant were used to demonstrate that ATP induces a conformational change in membrane- bound cyt c. The ATP-induced conformational changes were mediated by Arg 91 and were most pronounced in cyt c bound to phospholipids via the C-site. It has been previously reported that the hydrophobic interaction between phospho- lipids and cyt c (C-site) includes the binding of a phospholipid acyl chain inside the protein. In this mechanism, which is known as extended phospholipid anchorage, the sn-2 acyl chain of a membrane phospholipid protrudes out of the membrane surface and is able to bind in a hydrophobic cavity in cyt c. Direct evidence for this type of bind- ing mechanism was obtained by studying cyt c/lipid interaction using fluorescent [Zn2+- heme] cyt c and fluorescence quenching of brominated fatty acids and phospholipids. Under certain conditions, cyt c can form fibrillar protein-lipid aggregates with neg- atively charged phospholipids. These aggregates resemble amyloid fibrils, which are involved in the pathogenesis of many diseases. Congo red staining of these fibers con- firmed the presence of amyloid structures. A set of phospholipid-binding proteins was also found to form similar aggregates, suggesting that phospholipid-induced amyloid formation could be a general mechanism of amyloidogenesis.

A general treatment of two dimensional plane flows, for a micropolar fluid

In this paper we have studied the flow of a micropolar fluid, whose constitutive equations were given by Eringen, in two dimensional plane flow. In two notes, we have discussed the validity of the boundary condition v=a ω and its effect on the entire flow field. We have restricted our study to the case when Stokes' approximation is valid, i. e. slow motion for it is difficult to uncouple the equations in the most general case.

Bilingual Notaries in Hellenistic Egypt : A Study of Language Use

The impact of Greek-Egyptian bilingualism on language use and linguistic competence is the key issue in this dissertation. The language use in a corpus of 148 Greek notarial contracts is analyzed on phonological, morphological and syntactic levels. The texts were written by bilingual notaries (agoranomoi) in Upper Egypt in the later Hellenistic period. They present, for the most part, very good administrative Greek. On the other hand, their language contains variation and idiosyncrasies that were earlier condemned as ungrammatical and bad Greek, and were not subjected to closer analysis. In order to reach plausible explanations for those phenomena, a thorough research into the sociohistorical and linguistic context was needed before the linguistic analysis. The general linguistic landscape, the population pattern and the status and frequency of Greek literacy in Ptolemaic Egypt in general, and in Upper Egypt in particular, are presented. Through a detailed examination of the notaries themselves (their names, families and handwriting), it became evident that there were one to three persons at the notarial office writing under the signature of one notary. Often the documents under one notary's name were written in the same hand. We get, therefore, exceptionally close to studying idiolects in written material from antiquity. The qualitative linguistic analysis revealed that the notaries made relatively few orthographic mistakes that reflect the ongoing phonological changes and they mastered the morphological forms. The problems arose at the syntactic level, for example, with the pattern of agreement between the noun groups or a noun with its modifiers. The significant structural differences between Greek and Egyptian can be behind the innovative strategies used by some of the notaries. Moreover, certain syntactic structures were clearly transferred from the notaries first language, Egyptian. This is obvious in the relative clause structure. Transfer can be found in other structures, as well, although, we must not forget the influence of parallel Greek structures. Sometimes these can act simultaneously. The interesting linguistic strategies and transfer features come mostly from the hand of one notary, Hermias. Some other notaries show similar patterns, for example, Hermias' cousin, Ammonios. Hermias' texts reveal that he probably spoke Greek more than his predecessors. It is possible to conclude, then, that the notaries of the later generations were more fluently bilingual; their two languages were partly integrated in their minds as an interlanguage combining elements from both languages. The earlier notaries had the two languages functionally separated and they followed the standardized contract formulae more rigidly.

Method for obtaining minimum noise in a general purpose hot wire amplifier

It has been shown that the conventional practice of designing a compensated hot wire amplifier with a fixed ceiling to floor ratio results in considerable and unnecessary increase in noise level at compensation settings other than optimum (which is at the maximum compensation at the highest frequency of interest). The optimum ceiling to floor ratio has been estimated to be between 1.5-2.0 ωmaxM. Application of the above considerations to an amplifier in which the ceiling to floor ratio is optimized at each compensation setting (for a given amplifier band-width), shows the usefulness of the method in improving the signal to noise ratio.

Origins of the sex differences in handedness and mental rotation ability : genetic, environmental and hormonal effects

In humans, well-replicated and robust sex differences in cognitive functions exist for handedness and mental rotation ability. A common characteristic in human cognitive functions is the lateralization of language functions. Handedness is a common measure of laterality and is related to language lateralization. The prevalence of left-handedness is higher in males than in females, the male to female ratio being about 1.2. Among cognitive abilities, the largest sex difference is evident in the Vandenberg and Kuse Mental Rotation Test (MRT), which requires the ability to rotate objects in mental space. On average, males achieve scores one standard deviation higher than females in the MRT. The present thesis investigated the origins of the sex differences in laterality and spatial ability as represented by handedness and mental rotation ability, respectively. Two population-based Finnish twin cohorts were utilized in this study. Handedness was studied in 25 810 twins and 4068 singletons born before 1958 from the Older Finnish Twin Cohort, and in 4736 twins born in 1983-87 from the FinnTwin12. MRT was studied in a sub-sample of 804 young adult participants from the FinnTwin12 sample. The main findings of this study were: 1) the prevalence of left-handedness was higher among males than among females in both singletons and in twins; 2) males had significantly higher scores than females in MRT; 3) about one quarter of the variance in handedness and about half of the variance in MRT was explained by genetic effects, whereas the remainder of the variance in these traits was explained by environmental effects unique to each individual. The magnitude of the genetic effects was similar in both sexes; 4) left-handedness was significantly less common in female co-twins of a male than in female co-twins of a female, and female co-twins of a male scored significantly higher than did female co-twins of a female in the Mental Rotation Test. This dissertation discusses whether these differences between females from opposite- and same-sex twin pairs are due to the prenatal transfer of testosterone from the male fetus in females with male co-twins or whether they arise from postnatal socialization effects.

A Simple and General Strategy for the Design of Fluorescent Cation Sensor Beads

Chenodeoxycholic acid based PET sensors for alkali metal ions have been immobilized on Merrifield resin and on Tentagel. The fluorescence of the sensor beads is enhanced upon binding the cations. The modular nature of the sensor allows designing different sensors based on this concept.

Depression and Cognition in Type 2 Diabetes from a Life Course Perspective

Background: Type 2 diabetes is linked to several complications which add to both physical and mental distress. Depression is a common co-morbidity of diabetes which can occur both as a cause and a consequence of type 2 diabetes. Depression has been shown to correlate with glucose regulation and treating depression might prove beneficial for glucose regulation as well as for mental well being. Another complication which might affect diabetes management is cognitive decline. Several risk factors and complications of diabetes might modify the risk for developing cognitive impairment, which is increased 1.5 times among subjects with type 2 diabetes. Type 2 diabetes, depression and impaired cognitive performance have all been linked to low birth weight. This thesis aimed to explore the effects and interactions of birth weight, depression and cognitive ability in relation to type 2 diabetes from a life course perspective. Subjects and methods: Studies I, II and V were part of the Helsinki Birth Cohort Study. 2003 subjects participated in an extensive clinical examination at an average age of 61 years. A standard glucose tolerance test (OGTT) was performed and depressive symptoms were assessed using the Beck Depression Inventory (BDI). In addition data was obtained from child welfare clinics and national registers. A subset of the cohort (n=1247) also performed a test on cognitive performance (CogState ®) at the average age of 64. Studies III and IV were randomised clinical trials where mildly depressed diabetic subjects were treated with paroxetine or placebo and the effect on metabolic parameters and quality of life was assessed. The first trial included 14 women and lasted 10 weeks, while the second trial included 43 subjects, both men and women, and lasted 6 months. Results: Type 2 diabetes was positively associated with the occurrence of depressive symptoms. Among diabetic subjects 23.6% had depressive symptoms, compared to 16.7% of subjects with normal glucose tolerance (OR = 1.77, p<0.001). Formal mediation analysis revealed that cardiovascular disease (CVD) is likely to act as a mediator in the association. Furthermore, low birth weight was found to modify the association between type 2 diabetes, CVD and depression. The association between BDI score and having type 2 diabetes or CVD was twice as strong in the subgroup with low birth weight (≤ 2500g) compared with the group with birth weight > 2500g (p for interaction 0.058). In the six months long randomised clinical trial (study IV) paroxetine had a transient beneficial effect on glycosylated haemoglobin A1c (GHbA1c) and quality of life when compared to placebo after three months of treatment. In study V we found that subjects with known diabetes had a consistently poorer level of cognitive performance than subjects with normal glucose tolerance in most of the tested cognitive domains. This effect was further amplified among those born with a small birth weight (p for interaction 0.002). Conclusions: Type 2 diabetes is associated with a higher occurrence of depressive symptoms compared to subjects with normal glucose tolerance. This association is especially strong among subjects with CVD and those born with a low birth weight. Treating depressed diabetic subjects with paroxetine has no long term effect on glucose regulation. Physicians should be aware of depression as an important co-morbidity of type 2 diabetes. Both depression and the cognitive decline often seen among diabetic subjects are increased if the subject is born with a low birth weight. Physicians should recognise low birth weight as an additional risk factor and modifier of diabetic complications.

Investigations of superconducting bismuth cuprates of the general formula Bi2-xPbx(Ca,Sr,Y)n 1 Cun O2n 4 δ

In the (Bi,Pb)-Sr-Cu-O system we have examined many compositions which are either metallic or semiconducting. In the Bi2-xPbx(Ca, Sr)n+1 Cun O2n+4+δ system, we have established the superconducting properties of the n = 1 to 4 members. The Tc increases from n = 1 to 3 and does not increase further when n = 4. In Bi2Ca1-x,YxSr2Cu2Oy, the Tc decreases with increase in x.

Essays on Managing Knowledge and Work Related Wellbeing

This study explores the relationship between Intellectual Capital and Maintenance of Work Ability. Intellectual Capital is the central framework for analysing the increasing knowledge-intensiveness of business life. It is characteristic of Intellectual Capital that the intersection of human capital, internal structures and external structures is essential. Maintenance of Work Ability, on the other hand, has been the leading paradigm for Finnish occupational health and safety activities since the late 1980s. It is also a holistic approach that emphasises the interdependence of competence, work community, work environment and health as the key to work-related wellbeing. This thesis consists of five essays that scrutinise the focal phenomena both theoretically and empirically. The conceptual model that results from the first research essay provides a general framework for the whole thesis. The case study in the second essay supports a division of intangible assets into generative and commercially exploitable intangibles introduced in the first essay and further into the primary and secondary dimension of generative intangibles. Further scrutiny of the interaction of generative intangible assets in essay three reveals that employees’ wellbeing enhances the readiness to contribute to the knowledge creation process. The fourth essay shows that the MWA framework could benefit knowledge-intensive work but this would require a different approach than has been commonly adopted in Finland. In essay five, deeper analysis of the MWA framework shows that its potential results from comprehensive support of the functioning of an organisation. The general conclusion of this thesis is that organisations must take care of their employees’ wellbeing in order to secure innovativeness that is the key to surviving in today’s competitive business environment.

Worksite Fitness Policy in an Intellectual Capital Framework

In a framework of Intellectual Capital (IC), the effects and interactions of a Worksite Fitness Program (WFP) policy was studied with a multidisciplinary approach. In a preliminary study, indicators for physical activity (PAI), physical fitness (PFI), activity in WFP on a regular (WFPI) and on a events basis (WFPE) were created in line with positive findings regarding the associations between physical activity and fitness patterns and sick leave, perceived health, and self-assessed work ability. The intensity of physical activity was found to be the most important variable to predict positive associations with the above mentioned wellness parameters. In four case study follow-up settings, the effects and interactions of physical activity and fitness patterns and the company’s WFP-policy on different elements of IC were studied. Qualitative methods were applied in constructing indicators and a descriptive IC measure for each case company. In cross-sectional and follow-up settings, several findings with respect to IC were found regarding physical activity in general and activity in WFP in particular. Findings were relatively strong in health and wellness related indicators in Human Capital, where, as also in Structural Capital indicators such as the company climate and employee-superior relationship, revealed positive associations. Physical activity patterns were found to act in minor role in Relational Capital. Overall, WFP was seen to be an integrated part of Structural Capital. From the viewpoint of Worksite Fitness Program as a phenomenon, this study positioned WFP as an active element of Intellectual Capital. The literature in the field of WFP emphasizes the role of WFP as an instrument to activate employees in physical activity, and thus promote their health and wellbeing. With the wider perspective the active and long range WFP policy can support a company’s Structural and Relational Capital in line with the fundamental role it has on Human Capital.