e-Mental health for mood and anxiety disorders in general practice

Background Australia is a world leader in the development of internetdelivered programs for the prevention and management of mood and anxiety disorders. Despite a strong evidence base of time- and cost-effectiveness, as well as clinical efficacy, the uptake of these programs in general practice remains low. Objective To familiarise general practitioners (GPs) with the range of online programs in Australia that have demonstrated efficacy and are currently available for use by patients with mental health problems. Discussion E-mental health programs provide an efficacious and accessible form of mental healthcare and have the potential to fill the gap for those for whom such care is inaccessible, unaffordable or unacceptable. Clinicians can also use it in a stepped-care manner to augment existing healthcare services. There are a number of online resources currently available to Australians who have mood or anxiety disorders. These resources have strong evidence to support their effectiveness. Online portals facilitate access to these programs. Recently the Australian Federal Government has funded an education program (eMHPrac) for GPs and mental health professionals, to outline what is available, indicate situations where recommending such resources is appropriate, and suggest ways in which they can be incorporated into general practice.

General approach for electrochemical functionalization of glassy carbon surface by in situ generation of diazonium ion under acidic and non-acidic condition with a cascade protocol

Immobilization of catechol derivatives on GC electrode surfaces can be performed by in situ generation and reduction of nitrocatechol. We present the oxidative nitration of catechol in the presence of nitrous acid followed by electrochemically reduction of the generated nitro aromatic group to the corresponding amine group and its conversion to diazonium cation at the electrode surface to yield a surface covalently modified with catechol. In this manner, some derivatives of catechol can be immobilized on the electrode surface. Whole of the process is carried out in Triethylammonium acetate ionic liquid as an inert and neutral medium (pH∼7.0). Surface coverage can be easily controlled by the applied potential, time and concentration of catechol. After modification, the electrochemical features of modified surface have been studied. Also modified GC electrode exhibited remarkable catalytic activity in the oxidation of NADH. The catalytic currents were proportional to the concentration of NADH over the range 0.01-0.80 mM. This condition can be used for modification of GC surfaces by various aromatic molecules for different application such as design of sensors and biosensors. © 2014 Elsevier Ltd. All rights reserved.

Post-exercise depression in corticomotor excitability after dynamic movement: a general property of fatiguing and non-fatiguing exercise

Transcranial magnetic stimulation has been used to study changes in central excitability associated with motor tasks. Recently, we reported that a finger flexion–extension task performed at a maximal voluntary rate (MVR) could not be sustained and that this was not due to muscle fatigue, but was more likely a breakdown in central motor control. To determine the central changes that accompany this type of movement task, we tracked motor-evoked potential (MEP) amplitude from the first dorsal interosseous (FDI) and abductor pollicis brevis (APB) muscles of the dominant hand in normal subjects for 20 min after a 10 sec index finger flexion–extension task performed at MVR and at a moderate sustainable rate (MSR) and half the MSR (MSR/2). The FDI MEP amplitude was reduced for up to 6–8 min after each of the tasks but there was a greater and longer-lasting reduction after the MSR and MSR/2 tasks compared to the MVR task. There was a similar reduction in the amplitude of the FDI MEP after a 10 sec cyclic index finger abduction–adduction task when the FDI was acting as the prime mover. The amplitude of the MEP recorded from the inactive APB was also reduced after the flexion–extension tasks, but to a lesser degree and for a shorter duration. Measurements of short-interval cortical inhibition revealed an increase in inhibition after all of the finger flexion–extension tasks, with the MSR task being associated with the greatest degree of inhibition. These findings indicate that a demanding MVR finger movement task is followed by a period of reduced corticomotor excitability and increased intracortical inhibition. However, these changes also occur with and are greater with slower rates of movement and are not specific for motor demand, but may be indicative of adaptive changes in the central motor pathway after a period of repetitive movement.

Exploring the myths of morphine in cancer: views of the general practice population

Abstract
Background: Morphine is widely used in cancer care, and understanding the concerns and perceptions of patients, family and friends is vital to managing pain and distress effectively. The ‘myths of morphine’ have frequently been discussed in medical literature, yet the extent to which such views are held is not clear. This qualitative project explores the perceptions and attitudes of the wider community towards morphine use in cancer care, to understand this ‘mythology’ according to those who in the future may themselves require its use.
Methods: Semi-structured interviews were held with patients presenting to a metropolitan general practice clinic in Melbourne, Australia. A grounded theory framework underpinned the data collection and thematic analysis undertaken.
Results: Interviewees (15) were aged 24 – 81, with a variety of experiences with cancer care and previous morphine use. Interviewees were highly supportive of morphine use in cancer care, with this attitude founded on the perceived severity of cancer pain and the powerful nature of morphine. They described a number of reasons morphine may be used in cancer care: to treat pain, to enable peace and also as a treatment for cancer.
Conclusion: The public view of morphine to emerge from this study is markedly different from that discussed in the myths of morphine. It is viewed as a medication that has the ability to provide peace and control both pain and the course of cancer. The participants in this study described a wish for greater involvement in pain control decisions, perceiving morphine as a facilitator rather than a barrier to good cancer care.

Religion, heritage and the sustainable city : Hinduism and urbanisation in Jaipur

The speed and scale of urbanisation in India is unprecedented almost anywhere in the world and has tremendous global implications. The religious influence on the urban experience has resonances for all aspects of urban sustainability in India and yet it remains a blind spot while articulating sustainable urban policy.This book explores the historical and on-going influence of religion on urban planning, design, space utilisation, urban identities and communities. It argues that the conceptual and empirical approaches to planning sustainable cities in India need to be developed out of analytical concepts that define local sense of place and identity. Examining how Hindu religious heritage, beliefs and religiously influenced planning practices have impacted on sustainable urbanisation development in Jaipur and Indian cities in general, the book identifies the challenges and opportunities that ritualistic and belief resources pose for sustainability. It focuses on three key aspects: spatial segregation and ghettoisation; gender-inclusive urban development; and the nexus between religion, nature and urban development. This cutting-edge book is one of the first case studies linking Hindu religion, heritage, urban development, women and the environment in a way that responds to the realities of Indian cities. It opens up discussion on the nexus of religion and development, drawing out insightful policy implications for the sustainable urban planning of many cities in India and elsewhere in South Asia and the developing world.

Spirituality, religion, social support and health among older Australian adults

AIM: To examine the impact of perceived importance of spirituality or religion (ISR) and religious service attendance (RSA) on health and well-being in older Australians. METHODS: A cross-sectional survey of 752 community-dwelling men and women aged 55-85 years from the Hunter Region, New South Wales. RESULTS: Overall, 51% of participants felt spirituality or religion was important in their lives and 24% attended religious services at least 2-3 times a month. In univariate regression analyses, ISR and RSA were associated with increased levels of social support (P < 0.001). However, ISR was also associated with more comorbidities (incidence-rate ratio= 1.2, 95% confidence interval 1.08-1.33). There were no statistically significant associations between ISR or RSA and other measures such as mental and physical health. CONCLUSION: Spirituality and religious involvement have a beneficial impact on older Australians' perceptions of social support, and may enable individuals to better cope with the presence of multiple comorbidities later in life.

Time - Dependency of chloride diffusion in concrete: a brief review and preliminary results

Abstract
Chloride ingress into concrete has long been known to decrease the service life of built infrastructure. Inadequate knowledge of the physical reasons associated with chloride diffusion into concrete could generate chloride penetration profiles that become meaningless for prediction of service life. In this study, the effects of pore closure (physical effect) and changes in chloride binding (chemical effect) on chloride diffusion through Australian General Purpose (GP) cement pastes were investigated. Through - diffusion tests and “in - and - out” diffusion tests were conducted to monitor the time - dependent chloride diffusion through cement pastes cured from 1 to 28 days. The through - diffusion test quantified the overall chloride diffusion behaviour at different stages of cement hydration, which was a combined result of physical and chemical processes controlling diffusion. The “in - and - out” test differentiated the contributions of the physical and chemical processes on the chloride diffusion at different stages of cement hydration. As expected, the reduction of chloride diffusivity was significant during the first two weeks of curing, most likely attributed to the significant reduction of porosity as well as establishment of capillary discontinuities within the pore structure. It was also observed that the amount of bound chloride was not constant but increased significantly from 1 to 28 days of curing age.

Australia and Japan after the second world war: constructing new futures in Asia

The subject of my lecture is Australian-Japanese relations since the end of the Second World War, but I’m keen to explore these relations in the context of ideas, efforts and practical results in relation to collaborative and other efforts towards regionalism in the Asia Pacific. My general argument is that, on the one hand, Australian-Japanese relations have developed with a strength that would have been hard to imagine in 1945, and with an important focus on regional growth and security. The incremental steps taken may have been small and at a steady pace but, given the legacy of deep scars resulting from the Second World War and given the limitations on the defence aspects of Japan’s postwar involvement in regional affairs (ie the self defence requirement of the Constitution and the practice of spending not more than one per cent of Gross National Product on defence), these have been very successfully negotiated steps. On the other hand, there are some opportunities for greater joint leadership in the region which may or may not be realized. The incremental steps took place in difficult and changing circumstances; and what I would like to do now is remind us of how many unknowns attached to what might happen in Australian- Japan relationships after the Second World War, partly because there were so many unknowns about how the post-war international order would settle, and partly because Australian-Japanese relations started from such a desperately low point. I will try to walk through some of the key features of different periods, as I see the periodisation logically falling out after the war, and draw some thoughts together in relation to more recent initiatives on regional and bilateral co-operation. My training is as a historian, and that shapes the way this lecture works, and for most of my career I have been an Australian historian of international relations, looking particularly at Australia’s changing role in world affairs, and that is also likely to show in what follows－possibly at the expense of greater detail from Japanese perspectives. But I hope you will understand that, and also the limitations involved in trying to paint with a broad brush on a huge historical canvas.

I can see clearly now the moderating effects of role clarity on subordinate responses to ethical leadership

© Emerald Group Publishing Limited. Purpose – Although there is growing research on the relationship between ethical leadership and subordinate work behaviors, limited research has examined the boundary conditions under which ethical leadership is more or less effective. The purpose of this paper is to investigate whether subordinate perceptions of role clarity in their job role influence the relationship between ethical leadership and subordinate work behaviors. Drawing on both social exchange and social learning theories, the authors predict that in contexts where subordinates perceive low levels of role clarity, the relationship between ethical leadership behavior and subordinate helping and deviant behaviors will be weaker. Design/methodology/approach – In total, 239 employees in the Chinese public sector completed surveys across three separate time points. Confirmatory factor analysis and hierarchical regression analysis were used to analyze the data. Findings – Analyses provided support for the hypothesized relationships. When subordinates perceived higher levels of role clarity the positive relationship between ethical leadership and helping behavior was stronger, and the negative relationship between ethical leadership and deviant behavior was stronger. Research limitations/implications – As with all research the findings of this study need to be viewed in light of its limitations. First, the use of data from a single set of respondents opens up the possibility of common method bias. Second, given the study used of a sample of public sector employees from one part of China, there would be value in future research examining whether the findings from the present study are generalizable to other industrial and cultural contexts. Practical implications – This research has a number of practical implications. Given that the authors found a significant positive relationship between ethical leadership and helping behavior, and a significant negative relationship between ethical leadership and deviant behavior, it is crucial for organizations to include ethical training as an essential part of leadership development programs. However, the findings also suggest at the same time as facilitating the development of ethical leadership behaviors amongst supervisory employees, it is important for organizations to also provide employees with clarity over what is expected of them in their jobs, and the means they should employ to facilitate goal achievement. Originality/value – This study responds to recent calls for more research to identify factors which may strengthen or mitigate the influence of ethical leadership in the workplace.

Do performance and image enhancing drug users in regional Queensland experience difficulty accessing health services?

INTRODUCTION AND AIM: To understand health service access and needs of people who use performance and image enhancing drugs (PIED) in regional Queensland. DESIGN AND METHODS: Semi-structured interviews were conducted with 21 people (n = 19 men) who reported the use of a range of PIEDs, including anabolic-androgenic steroids, human chorionic gonadotropin, growth hormone, clenbuterol, tamoxifen, insulin and peptides. RESULTS: Participants reported accessing a range of services, including needle and syringe programs and pharmacies, for sterile injecting equipment. While PIEDs users attributed some stigma to needle and syringe programs, they were seen as an important service for injecting equipment. Participants reported receiving either positive care from health-care providers, such as general practitioners (GP), or having negative experiences due to the stigma attached with PIED use. Few participants reported disclosing their PIED use to their GP not only because of the concerns that their GP would no longer see them but also because they felt their GP was not knowledgeable about these substances. DISCUSSION AND CONCLUSION: Participants in the study reported no difficulty in accessing health services based on living in a regional area, with their concern focused more upon how they were viewed and treated by service staff. [Dunn M, Henshaw R, Mckay F. H. Do performance and image enhancing drug users in regional Queensland experience difficulty accessing health services? Drug Alcohol Rev 2015;00:000-000].

A general communication cost optimization framework for big data stream processing in geo-distributed data centers

With the explosion of big data, processing large numbers of continuous data streams, i.e., big data stream processing (BDSP), has become a crucial requirement for many scientific and industrial applications in recent years. By offering a pool of computation, communication and storage resources, public clouds, like Amazon's EC2, are undoubtedly the most efficient platforms to meet the ever-growing needs of BDSP. Public cloud service providers usually operate a number of geo-distributed datacenters across the globe. Different datacenter pairs are with different inter-datacenter network costs charged by Internet Service Providers (ISPs). While, inter-datacenter traffic in BDSP constitutes a large portion of a cloud provider's traffic demand over the Internet and incurs substantial communication cost, which may even become the dominant operational expenditure factor. As the datacenter resources are provided in a virtualized way, the virtual machines (VMs) for stream processing tasks can be freely deployed onto any datacenters, provided that the Service Level Agreement (SLA, e.g., quality-of-information) is obeyed. This raises the opportunity, but also a challenge, to explore the inter-datacenter network cost diversities to optimize both VM placement and load balancing towards network cost minimization with guaranteed SLA. In this paper, we first propose a general modeling framework that describes all representative inter-task relationship semantics in BDSP. Based on our novel framework, we then formulate the communication cost minimization problem for BDSP into a mixed-integer linear programming (MILP) problem and prove it to be NP-hard. We then propose a computation-efficient solution based on MILP. The high efficiency of our proposal is validated by extensive simulation based studies.

Promoting clinical reasoning in general practice trainees: role of the clinical teacher

BACKGROUND: Clinical reasoning requires knowledge, cognition and metacognition, and is contextually bound. Clinical teachers can and should play a key role in explicitly promoting clinical reasoning.

CONTEXT: The aim of this article is to relate the clinical reasoning literature to the general practice or family medicine context, and to provide clinical teachers with strategies to promote clinical reasoning.

INNOVATION: It is important that the clinical teacher teaches trainees the specific skills sets of the expert general practitioner (e.g. synthesising skills, recognising prototypes, focusing on cues and clues, using community resources and dealing with uncertainty) in order to promote clinical reasoning in the context of general practice or family medicine. Clinical teachers need to understand their own reasoning processes as well as be able to convey that knowledge to their trainees. They also need to understand the developmental stages of clinical reasoning and be able to nurture each trainee's own expertise. Strategies for facilitating effective clinical reasoning in trainees include adequate exposure to patients, offering the trainees opportunity for reflection and feedback, and coaching on the techniques of reasoning in the general practice context.

IMPLICATIONS: The journey to expertise in clinical reasoning is unique to each clinician, with different skills developing at different rates, depending on content, context and past experience. Doctors enter into general practice training with the building blocks of biomedical and clinical knowledge and a desire to learn how to be a general practitioner. Clinical teachers are integral in the process of helping trainees learn how to 'think like a general practitioner'.

You kind of want to fix it don’t you? Exploring general practice trainees’ experiences of managing patients with medically unexplained symptoms

Background
Much of a General Practitioner’s (GP) workload consists of managing patients with medically unexplained symptoms (MUS). GP trainees are often taking responsibility for looking after people with MUS for the first time and so are well placed to reflect on this and the preparation they have had for it; their views have not been documented in detail in the literature. This study aimed to explore GP trainees’ clinical and educational experiences of managing people presenting with MUS.
Method
A mixed methods approach was adopted. All trainees from four London GP vocational training schemes were invited to take part in a questionnaire and in-depth semi-structured interviews. The questionnaire explored educational and clinical experiences and attitudes towards MUS using Likert scales and free text responses. The interviews explored the origins of these views and experiences in more detail and documented ideas about optimising training about MUS. Interviews were analysed using the framework analysis approach.


Results

Eighty questionnaires out of 120 (67 %) were returned and a purposive sample of 15 trainees interviewed. Results suggested most trainees struggled to manage the uncertainty inherent in MUS consultations, feeling they often over-investigated or referred for their own reassurance. They described difficulty in broaching possible psychological aspects and/or providing appropriate explanations to patients for their symptoms. They thought that more preparation was needed throughout their training. Some had more positive experiences and found such consultations rewarding, usually after several consultations and developing a relationship with the patient.
Conclusion
Managing MUS is a common problem for GP trainees and results in a disproportionate amount of anxiety, frustration and uncertainty. Their training needs to better reflect their clinical experience to prepare them for managing such scenarios, which should also improve patient care.

Health improvement and prevention study (HIPS) - evaluation of an intervention to prevent vascular disease in general practice

Background

The Health Improvement and Prevention Study (HIPS) study aims to evaluate the capacity of general practice to identify patients at high risk for developing vascular disease and to reduce their risk of vascular disease and diabetes through behavioural interventions delivered in general practice and by the local primary care organization.

Methods/Design

HIPS is a stratified randomized controlled trial involving 30 general practices in NSW, Australia. Practices are randomly allocated to an 'intervention' or 'control' group. General practitioners (GPs) and practice nurses (PNs) are offered training in lifestyle counselling and motivational interviewing as well as practice visits and patient educational resources. Patients enrolled in the trial present for a health check in which the GP and PN provide brief lifestyle counselling based on the 5As model (ask, assess, advise, assist, and arrange) and refer high risk patients to a diet education and physical activity program. The program consists of two individual visits with a dietician or exercise physiologist and four group sessions, after which patients are followed up by the GP or PN. In each practice 160 eligible patients aged between 40 and 64 years are invited to participate in the study, with the expectation that 40 will be eligible and willing to participate. Evaluation data collection consists of (1) a practice questionnaire, (2) GP and PN questionnaires to assess preventive care attitudes and practices, (3) patient questionnaire to assess self-reported lifestyle behaviours and readiness to change, (4) physical assessment including weight, height, body mass index (BMI), waist circumference and blood pressure, (5) a fasting blood test for glucose and lipids, (6) a clinical record audit, and (7) qualitative data collection. All measures are collected at baseline and 12 months except the patient questionnaire which is also collected at 6 months. Study outcomes before and after the intervention is compared between intervention and control groups after adjusting for baseline differences and clustering at the level of the practice.

Discussion

This study will provide evidence of the effectiveness of a primary care intervention to reduce the risk of cardiovascular disease and diabetes in general practice patients. It will inform current policies and programs designed to prevent these conditions in Australian primary health care.

A viabilidade do teletrabalho na PROCEMPA

Dentre as profundas modificações experimentadas na Sociedade e, em especial, as que se produzem no mundo do trabalho, observamos movimentos em direção a formas de trabalho flexível, entre as quais se insere o Teletrabalho. Sem ser propriamente novo no cenário mundial, no Brasil ele surge com maior expressão recentemente, passando a ocupar espaços na mídia em geral e nos ambientes universitários. Todavia, são poucas as referências acadêmicas brasileiras ao assunto e estudos se fazem necessários. Com a pretensão de contribuir com conhecimentos a respeito do assunto, sob o prisma da realidade brasileira e de uma situação particular, o estudo utilizou referências teóricas e empíricas para examinar a viabilidade do Teletrabalho na Companhia de Processamento de Dados do Município de Porto Alegre. Abrangeu a análise de condições organizacionais, técnicas, humanas, legais e sindicais compreendidas na proposta e incluiu, igualmente, uma sugestão para um projeto de demonstração. O estudo, notadamente qualitativo, valoriza as perspectivas de segmentos potencialmente envolvidos num processo de adoção de Teletrabalho pela Empresa, como elemento para a sua compreensão. Foi desenvolvido mediante a realização de entrevistas com representantes dos sindicatos da categoria, dos funcionários e chefias, Diretoria da Empresa e especialistas em assuntos jurídicos e segurança de informações. O estudo concluiu ser a introdução do Teletrabalho viável em parte, num sistema de voluntariado, em regime de tempo parcial e, pelo menos inicialmente, em ambientes de telecentros. Mesmo existindo uma série de condições favoráveis, o atendimento de certos prérequisitos e o equacionamento de dúvidas e dificuldades são essenciais para promover uma implementação adequada, considerando as condições internas da Empresa, seu papel institucional e o contexto social onde está inserida. A pesquisa, na verdade, pode ser considerada um passo inicial dentro de um processo mais amplo, que integra o domínio da tecnologia do Teletrabalho para uso interno na Empresa, se assim for desejado, ou como uma alternativa para proposição de novos serviços a clientes e à comunidade.