Asthma management by New Zealand pharmacists: a pharmaceutical care demonstration project

Background: Pharmaceutical care services became recognized in New Zealand in the mid-1990s, albeit with limited evidence of the acceptability and effectiveness of the model. An asthma-specific pharmaceutical care service was trialled in southern New Zealand, based on a 'problem-action-outcome' method, with pharmacists adopting a patient-centred, outcome-focused approach with multidisciplinary consultation. Objective: To report on the implementation and outcomes of a specialist asthma service offered by community pharmacists. Design: Pharmacists in five pharmacies, servicing predominantly rural, established clientele, received training in the asthma service and research documentation. Ten patients per pharmacy were recruited in each year (years 1 and 2) of the study. The patients were entered into the study in cohorts of five per pharmacy twice yearly, with year 2 mirroring year 1. The phase-in design minimized the impact on the pharmacists. The patients acted as their own controls. All patients received individualized care and had approximately monthly consultations with the pharmacist, with clinical and quality of life (QoL) monitoring. Results: A total of 100 patients were recruited. On average, 4.3 medication-related problems were identified per patient; two-thirds of them were compliance-related. The most common interventions were revision of patients' asthma action plans, referral and medication counselling. Clinical outcomes included reduced bronchodilator use and improved symptom control in around two-thirds of patients. Asthma-specific QoL changes were more positive and correlated well with clinical indicators. Conclusion: Further research is warranted to integrate this service into daily practice. Clinical outcomes were generally positive and supported by QoL indicators. Characteristics of New Zealand practice and this sample of pharmacies may limit the generalizability of these findings.

Development and evaluation of an automated annotation pipeline and cDNA annotation system

Manual curation has long been held to be the gold standard for functional annotation of DNA sequence. Our experience with the annotation of more than 20,000 full-length cDNA sequences revealed problems with this approach, including inaccurate and inconsistent assignment of gene names, as well as many good assignments that were difficult to reproduce using only computational methods. For the FANTOM2 annotation of more than 60,000 cDNA clones, we developed a number of methods and tools to circumvent some of these problems, including an automated annotation pipeline that provides high-quality preliminary annotation for each sequence by introducing an uninformative filter that eliminates uninformative annotations, controlled vocabularies to accurately reflect both the functional assignments and the evidence supporting them, and a highly refined, Web-based manual annotation tool that allows users to view a wide array of sequence analyses and to assign gene names and putative functions using a consistent nomenclature. The ultimate utility of our approach is reflected in the low rate of reassignment of automated assignments by manual curation. Based on these results, we propose a new standard for large-scale annotation, in which the initial automated annotations are manually investigated and then computational methods are iteratively modified and improved based on the results of manual curation.

The influence of social communications networks on intentions to purchase on the web

Despite the increased offering of online communication channels to support web-based retail systems, there is limited marketing research that investigates how these channels act singly, or in combination with offline channels, to influence an individual's intention to purchase online. If the marketer's strategy is to encourage online transactions, this requires a focus on consumer acceptance of the web-based transaction technology, rather than the purchase of the products per se. The exploratory study reported in this paper examines normative influences from referent groups in an individual's on and offline social communication networks that might affect their intention to use online transaction facilities. The findings suggest that for non-adopters, there is no normative influence from referents in either network. For adopters, one online and one offline referent norm positively influenced this group's intentions to use online transaction facilities. The implications of these findings are discussed together with future research directions.

Dissemination of a community-based physical activity project: The case of 10,000 steps

This paper describes the use of a web-site for the dissemination of the community-based '10,000 steps' program which was originally developed and evaluated in Rockhampton, Queensland in 2001-2003. The website provides information and interactive activities for individuals, and promotes resources and programs for health promotion professionals. The dissemination activity was assessed in terms of program adoption and implementation. In a 2-year period (May 2004-March 2006) more than 18,000 people registered as users of the web-site (togging more than 8.5 billion steps) and almost 100 workplaces and 13 communities implemented aspects of the 10,000 steps program. These data support the use of the internet as an effective means of disseminating ideas and resources beyond the geographical borders of the original project. Following this preliminary dissemination, there remains a need for the systematic study of different dissemination strategies, so that evidence-based physical activity programs can be translated into more widespread public health practice. (c) 2006 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Paediatric research in emergency departments international collaborative (PREDICT): First steps towards the development of an Australian and New Zealand research network

Paediatric emergency research is hampered by a number of barriers that can be overcome by a multicentre approach. In 2004, an Australia and New Zealand-based paediatric emergency research network was formed, the Paediatric Research in Emergency Departments International Collaborative (PREDICT). The founding sites include all major tertiary children’s hospital EDs in Australia and New Zealand and a major mixed ED in Australia. PREDICT aims to provide leadership and infrastructure for multicentre research at the highest standard, facilitate collaboration between institutions, health-care providers and researchers and ultimately improve patient outcome. Initial network-wide projects have been determined. The present article describes the development of the network, its structure and future goals.

Problem-based learning: a case study in providing e-health education using the Internet

The current trend among many universities is to increase the number of courses available online. However, there are fundamental problems in transferring traditional education courses to virtual formats. Delivering current curricula in an online format does not assist in overcoming the negative effects on student motivation which are inherent in providing information passively. Using problem-based learning (PBL) online is a method by which computers can become a tool to encourage active learning among students. The delivery of curricula via goal-based scenarios allows students to learn at different rates and can successfully shift online learning from memorization to discovery. This paper reports on a Web-based e-health course that has been delivered via PBL for the past 12 months. Thirty distance-learning students undertook postgraduate courses in e-health delivered via the Internet (asynchronous communication). Data collected via online student surveys indicated that the PBL format was both flexible and interesting. PBL has the potential to increase the quality of the educational experience of students in online environments.

Making the link between engineering management and undergraduate research

This paper describes and analyses an innovative engineering management course that applies a project management framework in the context of a feasibility study for a prospective research project. The aim is to have students learn aspects of management that will be relevant from the outset of their professional career while simultaneously having immediate value in helping them to manage a research project and capstone design project in their senior year. An integral part of this innovation was the development of a web-based project management tool. While the main objectives of the new course design were achieved, a number of important lessons were learned that would guide the further development and continuous improvement of this course. The most critical of these is the need to achieve the optimum balance in the mind of the students between doing the project and critically analyzing the processes used to accomplish the work.

Differential evolution based total transfer capability assessment with optimal dispatch

In this paper, a new differential evolution (DE) based power system optimal available transfer capability (ATC) assessment is presented. Power system total transfer capability (TTC) is traditionally solved by the repeated power flow (RPF) method and the continuation power flow (CPF) method. These methods are based on the assumption that the productions of the source area generators are increased in identical proportion to balance the load increment in the sink area. A new approach based on DE algorithm to generate optimal dispatch both in source area generators and sink area loads is proposed in this paper. This new method can compute ATC between two areas with significant improvement in accuracy compared with the traditional RPF and CPF based methods. A case study using a 30 bus system is given to verify the efficiency and effectiveness of this new DE based ATC optimization approach.

Designing a support system for aerospace maintenance supply chains

Purpose - To develop a systems strategy for supply chain management in aerospace maintenance, repair and overhaul (MRO). Design/methodology/approach - A standard systems development methodology has been followed to produce a process model (i.e. the AMSCR model); an information model (i.e. business rules) and a computerised information management capability (i.e. automated optimisation). Findings - The proof of concept for this web-based MRO supply chain system has been established through collaboration with a sample of the different types of supply chain members. The proven benefits comprise new potential to minimise the stock holding costs of the whole supply chain whilst also minimising non-flying time of the aircraft that the supply chain supports. Research limitations/implications - The scale of change needed to successfully model and automate the supply chain is vast. This research is a limited-scale experiment intended to show the power of process analysis and automation, coupled with strategic use of management science techniques, to derive tangible business benefit. Practical implications - This type of system is now vital in an industry that has continuously decreasing profit margins; which in turn means pressure to reduce servicing times and increase the mean time between them. Originality/value - Original work has been conducted at several levels: process, information and automation. The proof-of-concept system has been applied to an aircraft MRO supply chain. This is an area of research that has been neglected, and as a result is not well served by current systems solutions. © Emerald Group Publishing Limited.

Total factor productivity and the spillover hypothesis: some new evidence

In this paper I test the spillover hypothesis of the endogenous growth literature on a sample of manufacturing firms in Italy, 1989–1994, using a new approach based on the Malmquist index. First, I measure the productivity growth registered by the high- and non-high-tech firms computing the Malmquist index with DEA. I decompose it into technical change and technical efficiency change. Then I test whether the technical change registered by high-tech firms affects productivity growth of non-high-tech firms, after controlling for factors which can potentially affect productivity growth.

A new randomization assay reveals Unexpected elements of sequence bias in model 'randomized' gene libraries:Implications for biopanning

Although techniques such as biopanning rely heavily upon the screening of randomized gene libraries, there is surprisingly little information available on the construction of those libraries. In general, it is based on the cloning of 'randomized' synthetic oligonucleotides, in which given position(s) contain an equal mixture of all four bases. Yet, many supposedly 'randomized' libraries contain significant elements of bias and/or omission. Here, we report the development and validation of a new, PCR-based assay that enables rapid examination of library composition both prior to and after cloning. By using our assay to analyse model libraries, we demonstrate that the cloning of a given distribution of sequences does not necessarily result in a similarly composed library of clones. Thus, while bias in randomized synthetic oligonucleotide mixtures can be virtually eliminated by using unequal ratios of the four phosphoramidites, the use of such mixtures does not ensure retrieval of a truly randomized library. We propose that in the absence of a technique to control cloning frequencies, the ability to analyse the composition of libraries after cloning will enhance significantly the quality of information derived from those libraries. (C) 2000 Published by Elsevier Science B.V. All rights reserved.

A method for automatically eliciting node weights in a hierarchical knowledge-based structure for reasoning with uncertainty

Hierarchical knowledge structures are frequently used within clinical decision support systems as part of the model for generating intelligent advice. The nodes in the hierarchy inevitably have varying influence on the decisionmaking processes, which needs to be reflected by parameters. If the model has been elicited from human experts, it is not feasible to ask them to estimate the parameters because there will be so many in even moderately-sized structures. This paper describes how the parameters could be obtained from data instead, using only a small number of cases. The original method [1] is applied to a particular web-based clinical decision support system called GRiST, which uses its hierarchical knowledge to quantify the risks associated with mental-health problems. The knowledge was elicited from multidisciplinary mental-health practitioners but the tree has several thousand nodes, all requiring an estimation of their relative influence on the assessment process. The method described in the paper shows how they can be obtained from about 200 cases instead. It greatly reduces the experts’ elicitation tasks and has the potential for being generalised to similar knowledge-engineering domains where relative weightings of node siblings are part of the parameter space.

Managing uncertainty in integrated environmental modelling:the UncertWeb framework

Web-based distributed modelling architectures are gaining increasing recognition as potentially useful tools to build holistic environmental models, combining individual components in complex workflows. However, existing web-based modelling frameworks currently offer no support for managing uncertainty. On the other hand, the rich array of modelling frameworks and simulation tools which support uncertainty propagation in complex and chained models typically lack the benefits of web based solutions such as ready publication, discoverability and easy access. In this article we describe the developments within the UncertWeb project which are designed to provide uncertainty support in the context of the proposed ‘Model Web’. We give an overview of uncertainty in modelling, review uncertainty management in existing modelling frameworks and consider the semantic and interoperability issues raised by integrated modelling. We describe the scope and architecture required to support uncertainty management as developed in UncertWeb. This includes tools which support elicitation, aggregation/disaggregation, visualisation and uncertainty/sensitivity analysis. We conclude by highlighting areas that require further research and development in UncertWeb, such as model calibration and inference within complex environmental models.

Victims of cyberstalking:an exploratory study of harassment perpetrated via the Internet

This paper describes the first study to focus exclusively on the prevalence and impact of cyberstalking. A Web-based questionnaire was used to collect data from a group of respondents who were recruited by snowball sampling via e-mail. A total of 169 respondents completed the questionnaire. The results of the study found that approximately a third of respondents might be considered victims of cyberstalking. Furthermore, when asked to indicate the level of distress felt as a result of their experiences, almost a quarter of respondents chose a value of ten on a ten-point scale. The study also suggests a number of differences between cyberstalking and offline stalking, for instance cyberstalking tends to take place over a shorter period of time than offline stalking and cyberstalking victims are less likely to know the identify of their harassers. These differences add weight to the argument that cyberstalking should be seen as a new form of deviant behaviour that can be distinguished from offline stalking. The work concludes by emphasising a need for further research.

Uncertainty analysis in the Model Web

This thesis provides a set of tools for managing uncertainty in Web-based models and workflows.To support the use of these tools, this thesis firstly provides a framework for exposing models through Web services. An introduction to uncertainty management, Web service interfaces,and workflow standards and technologies is given, with a particular focus on the geospatial domain.An existing specification for exposing geospatial models and processes, theWeb Processing Service (WPS), is critically reviewed. A processing service framework is presented as a solutionto usability issues with the WPS standard. The framework implements support for Simple ObjectAccess Protocol (SOAP), Web Service Description Language (WSDL) and JavaScript Object Notation (JSON), allowing models to be consumed by a variety of tools and software. Strategies for communicating with models from Web service interfaces are discussed, demonstrating the difficultly of exposing existing models on the Web. This thesis then reviews existing mechanisms for uncertainty management, with an emphasis on emulator methods for building efficient statistical surrogate models. A tool is developed to solve accessibility issues with such methods, by providing a Web-based user interface and backend to ease the process of building and integrating emulators. These tools, plus the processing service framework, are applied to a real case study as part of the UncertWeb project. The usability of the framework is proved with the implementation of aWeb-based workflow for predicting future crop yields in the UK, also demonstrating the abilities of the tools for emulator building and integration. Future directions for the development of the tools are discussed.