Falls prevention in rural general practice: what stands the test of time and where to from here?

Objective: General practitioner recall of the 1992-96 'Stay on Your Feet'(SOYF) program and its influence on practice were surveyed five years post-intervention to gauge sustainability of the SOYF General Practice (GP) component. Methods: A survey assessed which SOYF components were still in existence, current practice related to falls prevention, and interest in professional development. All general practitioners (GPs) situated within the boundaries of a rural Area Health Service were mailed a survey in late 2001. Results: Response rate was 66.5% (139/ 209). Of 117 GPs in practice at the time of SOYF, 80.2% reported having heard of SOYF and 74.4% of those felt it had influenced practice. Half (50.9%) still had a copy of the SOYF GP resource and of those, 58.6% used it at least 'occasionally'. Three-quarters of GPs surveyed (75.2%) checked medications 'most/almost all' of the time with patients over 60 years; 46.7% assessed falls risk factors; 41.3% gave advice; and 22.6% referred to allied health practitioners. GPs indicated a strong interest in falls prevention- related professional development. There was no significant association between use of the SOYF resource package and any of the current falls prevention practices (all chi(2)>0.05). Conclusions and implications: There was high recall of SOYF and a general belief that it influenced practice. There was little indication that use of the resource had any lasting influence on GPs' practices. In future, careful thought needs to go into designing a program that has potential to affect long-term change in GPs' falls prevention practice.

Interferon-gamma is required for killing keratinocytes in vitro and in vivo

Epithelial malignancies are common in immunosuppressed individuals and the general population. However the mechanisms by which the adaptive immune system can eliminate immunogenic epithelial cells remain undefined. The aim of this project was to determine the effector molecules required for induction of apoptosis in murine epidermal keratinocytes (MEKs) in vitro and in vivo. HPV16E7-specific CTL lines and T cell receptor transgenic (E7TCRtg) effector cells were obtained from wild type (wt)-C57 and syngeneic mice rendered functionally inactive for perforin (Pfp), interferon-g (IFN-g) or FasL. CTLs or E7TCRtg spleen cells were co-cultured with primary MEKs in vitro or transferred into skin graft recipients. Inhibition of colony formation and skin graft rejection were used as indicators of T cell:KC interaction. Wt E7-specific CTLs and CTLs deficient in perforin, FasL or IFN-g produced mean reductions in colony formation of 67% (62.4–71.3%), 72% (71.1–72%), 76% (73–78%) and 21.5% (14– 34%) respectively. Wt, perforin deficient or FasL deficient CTLs all induced rejection of skin grafts (wt: 6/12; Pfp: 9/15; FasL: 3/13 survival). Transfer and immunisation of wt E7TCRtg spleen cells induces rejection of 50% of grafts (4/8 survival). In contrast, perforin or IFN-g deficient E7TCRtg failed to induce graft rejection (5/6; 4/4 survival). FasL deficient E7TCRtg induced nonspecific rejection of grafts (E7- 2/6 survival; C57- 4/7 survival). Therefore IFN-g production by CTL is necessary and sufficient in vitro and in vivo to kill epithelial cells which express a nonself antigen. Assessment of immunotherapies directed against epithelial tissues may be more effectively achieved by assaying the amount of IFN-g production by CD8 T cells, and the number and affinity of those cells, in conjunction with quantitation of perforin mediated effects in short term assays.

Topological charge and angular momentum of light beams carrying optical vortices

We analyze the properties of light beams carrying phase singularities, or optical vortices. The transformations of topological charge during free-space propagation of a light wave, which is a combination of a Gaussian beam and a multiple charged optical vortex within a Gaussian envelope, are studied both in theory and experiment. We revise the existing knowledge about topological charge conservation, and demonstrate possible scenarios where additional vortices appear or annihilate during free propagation of such a combined beam. Coaxial interference of optical vortices is also analyzed, and the general rule for angular-momentum density distribution in a combined beam is established. We show that, in spite of any variation in the number of vortices in a combined beam, the total angular momentum is constant during the propagation. [S1050-2947(97)09910-1].

Graves` orbitopathy: frequency of ocular hypertension and glaucoma

Purpose To determine the relationship between ocular hypertension and glaucoma in patients with Graves` orbitopathy. Methods A total of 107 patients with a diagnosis of Graves` orbitopathy, followed at the Oculoplasty sector of the University Hospital, Medical School of Ribeirao Preto, were evaluated by applanation tonometry, computed visual campimetry (Humphrey 30-2, Full Threshold) and analysis and photographic documentation of the optic nerve. The patients considered to have the suspicion of glaucoma were re-evaluated 1 year later for diagnostic confirmation or exclusion. Results A 3.74% prevalence of ocular hypertension (four patients) and a 2.8% prevalence of glaucoma (three patients) was observed. When considering only patients older than 40 years, the prevalence of ocular hypertension was 5.4% (four patients) and the prevalence of glaucoma was 4.76% (three patients). Conclusion The present study did not reveal a statistically significant difference in the prevalence of ocular hypertension or glaucoma between patients with Graves` orbitopathy and the general population.

Proportionally balanced designs: Some further results and general constructions

Proportionally balanced designs were introduced by Gray and Matters in response to a need for the allocation of markers of the Queensland Core Skills Test to have a certain property. Put simply, markers were allocated to pairs of units in proportions that reflected the relative numbers of markers allocated in total to each unit. In this paper, the first author extends the theoretical results relating to such designs and provides further instances, and two general constructions, in the case that the design comprises blocks of precisely two sizes.

General strain theory, situational anger, and social networks: An assessment of conditioning influences

Using a random sample of university students to test general strain theory (GST), this study expanded on previous tests of strain theory in two ways. First, situational anger was measured, a construct that had not been used thus far in assessments of general strain. In addition, this research examined the role of social support networks as a conditioning influence on the effects of strain and anger on intentions to commit three types of criminal behavior (serious assault, shoplifting, and driving under the influence of alcohol [DUI]). The results provided mixed support for GST. While the link between anger and crime was confirmed, the nature of that relationship in some cases ran counter to the theory. Moreover, the evidence indicated that the role of social support networks was complex, and varied as a conditioning influence on intentions to engage in criminal activities. (C) 2001 Elsevier Science Ltd. All rights reserved.

Ring flexibility within tricyclic antidepressant drugs

The internal flexibility of the central seven-membered ring of a series of tricyclic antidepressant drugs (TCAs), imipramine {l}, amitriptyline {2}, doxepin {3}, and dothiepin {4}, has been investigated by H-1 and C-13 nuclear magnetic (NMR) techniques. Two dynamic processes were examined: ring inversion and bridge flexing. H-1 NMR lineshape analysis was used to obtain ring inversion barriers for 2-4. These studies yielded energy barriers of 14.3, 16.7, and 15.7 +/- 0.6 kcal/mol for the hydrochloride salts of doxepin, dothiepin, and amitriptyline, respectively. The barriers for the corresponding free bases were lower by 0.6 kcal/mol on average. (CT1)-C-13 relaxation measurements were used to determine the degree of bridge flexing associated with the central seven-membered ring for all four compounds. By fitting the T-1 data to a two-state jump model, lifetimes and amplitudes of rapid bridge flexing motions were determined. The results show that imipramine has the fastest rate of bridge flexing, followed by amitriptyline, doxepin, and dothiepin. The pharmacological profiles of the TCAs are complex and they interact with many receptor sites, resulting in numerous side effects and a general lack of understanding of their precise mode of action in different anxiety-related disorders. They all have similar three-dimensional structures, which makes it difficult to rationalize their differing relative potency in different assays/clinical settings. However, the clear finding here that there are significantly different degrees of internal mobility suggests that molecular dynamics should be an additional factor considered when trying to understand the mode of action of this clinically important family of molecules. (C) 2001 Wiley-Liss, Inc. and the American Pharmaceutical Association J Pharm Sci 90:713-721, 2001.

Lipid-lowering therapy following major cardiac events: progress and deficits

Objective: To assess hospital prescribing of lipid-lowering agents in a tertiary hospital, and examine continuation of, or changes to, such therapy in the 6-18 months following discharge. Design: Retrospective data extraction from the hospital records of patients admitted from October 1998 to April 1999. These patients and their general practitioners were then contacted to obtain information about ongoing management after discharge. Setting: Tertiary public hospital and community. Participants: 352 patients admitted to hospital with acute myocardial infarction or unstable angina, and their GPs. Main outcome measures: Percentage of eligible patients discharged on lipid-lowering therapy and percentage of patients continuing or starting such therapy 6-18 months after discharge. Results: 10% of inpatients with acute coronary syndromes did not have lipid-level estimations performed or arranged during admission. Documentation of lipid levels in discharge summaries was poor. Eighteen per cent of patients with a total serum cholesterol level greater than 5.5 mmol/L did not receive a discharge prescription for a cholesterol-lowering agent. Compliance with treatment on follow-up was 88% in the group discharged on treatment. However, at follow-up, 70% of patients discharged without therapy had not been commenced on lipid-lowering treatment by their GPs. Conclusions: Prescribing of lipid-lowering therapy for secondary prevention following acute coronary syndromes remains suboptimal. Commencing treatment in hospital is likely to result in continuing therapy in the community. Better communication of lipid-level results, treatment and treatment aims between hospitals and GPs might encourage optimal treatment practices.

Theory and applications of fuzzy Volterra integral equations

Formulations of fuzzy integral equations in terms of the Aumann integral do not reflect the behavior of corresponding crisp models. Consequently, they are ill-adapted to describe physical phenomena, even when vagueness and uncertainty are present. A similar situation for fuzzy ODEs has been obviated by interpretation in terms of families of differential inclusions. The paper extends this formalism to fuzzy integral equations and shows that the resulting solution sets and attainability sets are fuzzy and far better descriptions of uncertain models involving integral equations. The investigation is restricted to Volterra type equations with mildly restrictive conditions, but the methods are capable of extensive generalization to other types and more general assumptions. The results are illustrated by integral equations relating to control models with fuzzy uncertainties.

Quantum and classical fidelities for Gaussian states

We examine the physical significance of fidelity as a measure of similarity for Gaussian states by drawing a comparison with its classical counterpart. We find that the relationship between these classical and quantum fidelities is not straightforward, and in general does not seem to provide insight into the physical significance of quantum fidelity. To avoid this ambiguity we propose that the efficacy of quantum information protocols be characterized by determining their transfer function and then calculating the fidelity achievable for a hypothetical pure reference input state. (c) 2007 Optical Society of America.

Investigations into the PCDD contamination of topsoil, river sediments and kaolinite clay in Queensland, Australia

Recent findings of elevated PCDDs from an unknown source in the coastal marine environment of Queensland, Australia has instigated further investigations into the distribution of, and environments associated with the PCDD contamination. This study presents data for OCDD concentrations in the coastal, mountainous and inland environment of Queensland. Additionally, full 2,3,7,8-substituted polychlorinated dibenzo-p-dioxins and dibenzofuran (PCDD/F) profiles from different land-use types and environments in the coastal region were analysed. Distinct east-west gradients were detected in topsoil collected from various bushland regions with elevated OCDD concentrations confined to the coastal region. However, PCDD/F results from topsoil and river sediments collected in the Queensland coastal region suggest that elevated OCDD concentrations cannot be attributed to any of the environments, land-use or industry types investigated. PCDD/F congener profiles from select samples were remarkably similar to those previously described in marine sediments collected along the entire Queensland coastline. In addition, kaolinite clay samples from Queensland exhibited elevated OCDD concentrations, and PCDD/F profiles in these samples were similar to those detected in kaolinite clays elsewhere. Natural formation processes have been hypothesised as the source of elevated PCDDs in Queensland and other locations, where similar PCDD/F profiles and the general lack of anthropogenic sources are evident. This study presents additional data supporting this hypothesis and provides further information that may assist in the identification of the processes involved in the natural formation of PCDDs. (C) 2002 Elsevier Science Ltd. All rights reserved.

General practitioner attitudes to case conferences: how can we increase participation and effectiveness?

Objectives: To identify general practitioners' views on the barriers to using case conferencing (as outlined in the Medical Benefits Schedule (MBS) Enhanced Primary Care package) and to develop a set of principles to encourage greater GP participation in case conferences. Design: Qualitative study, involving semistructured questions administered to focus groups of GPs, conducted between April and July 2001 as part of a broader study of case coordination in palliative care. Participants: 29 GPs from urban, regional, and rural areas of Queensland. Principal findings: Many of the GPs' work practices militated against participation in traditionally structured case conferences. GPs thought the range of MBS item numbers should be expanded to cover alternative methods of liaison (eg, phone consultations with other service providers). The onerous bureaucratic processes required to claim reimbursement were an additional disincentive. Conclusions: GPs would probably be more likely to participate in case conferences if they were initiated by specialist services and arranged more flexibly to suit GP work schedules.

Considera????es sobre o trabalho escravo no Brasil do s??culo XXI

Embora pare??a ultrapassado, o instituto da escravid??o ainda ?? uma realidade no Brasil contempor??neo, sobretudo na zona rural do Pa??s. Tal ocorr??ncia fere o Estado Democr??tico de Direito em sua ess??ncia, al??m de representar uma das mais graves viola????es aos direitos humanos. Este artigo apresenta algumas considera????es sobre o Plano Nacional para a Erradica????o do Trabalho Escravo, defendendo que as a????es de repress??o t??m se mostrado insuficientes para a erradica????o da pr??tica. S??o necess??rias a????es preventivas e pol??ticas p??blicas que garantam alternativas de trabalho e renda ??s v??timas potenciais. Adicionalmente, ser??o identificados na literatura alguns aspectos jur??dicos candentes, apontados como nevr??lgicos para a efetividade do combate a essa pr??tica.

Olhares acerca do processo de construção dos Projetos Políticos Pedagógicos dos cursos Técnicos Integrados ao Ensino Médio de Jovens e Adultos no contexto do Ifes campus Vitória

Este trabalho é resultado da investigação que teve como objetivo analisar o processo de construção dos Projetos Políticos Pedagógicos dos cursos do Proeja no contexto do Ifes campus Vitória. O problema de pesquisa buscou captar os movimentos e as experiências desencadeados nesse processo. No percurso metodológico, com ênfase na pesquisa qualitativa, foi necessário entrelaçar duas abordagens: a etnografia escolar e a pesquisa-ação em função da atuação profissional da pesquisadora no lócus de estudo. Variados instrumentos foram utilizados para levantamento e a produção dos dados, dentre os quais: questionários, entrevistas, diário de campo das observações, pesquisa bibliográfica e documental. Participaram da pesquisa aproximadamente 80 pessoas, entre docentes, alunos e gestores, abordados em contextos específicos: o grupo de formação continuada, a comissão dos projetos, o encontros dos alunos, a reunião intermediária dentre outros. O referencial teórico-metodológico pautado na perspectiva do materialismo histórico dialético embasou toda a trajetória investigativa, em coerência com a base da produção das pesquisas sobre trabalho e educação e por se constituir a referência que fundamenta os princípios estruturantes do currículo integrado na perspectiva da formação humana. Por meio da metáfora dos observatórios, focamos nossas lentes sobre as questões que desafiaram a construção dos projetos políticos pedagógicos e sua coerência com os princípios epistemológicos, políticos e pedagógicos do Proeja. Nesse movimento, diversos olhares foram captados, possibilitando-nos levantar os seguintes resultados: o percurso de construção dos projetos foi marcado por contradições que perpassam todo o processo e que constituíram um debate profícuo que tenciona a gestão pedagógica, administrativa e financeira do Ifes campus Vitória. O movimento se constituiu também em um processo de construção, partilha de saberes e experiências, impulsionado pela busca da apreensão dos sentidos da integração, que contraditoriamente não alcançou seus objetivos, embora não se possa negar os resultados positivos do processo no interior da Instituição. Dessa forma, os desafios para efetivação da formação integrada no Ifes persistem. Ganha centralidade nessa discussão os sujeitos a quem o programa se volta e suas demandas de formação, bem como as condições materiais de oferta dos cursos e de forma especial as condições de envolvimento dos professores com o programa e as reflexões sobre suas práticas.