Inter-observer variation in the diagnosis of coronal articular fracture lines in the lunate facet of the distal radius

Background: Several studies support the use of CT for diagnosing coronal fractures of the distal radius but the inter-observer reliability of these observations is less well studied. We tested the null hypothesis that radiographs alone and the combination of radiographs and two-dimensional computed tomography scans (2DCT) have the same inter-observer variation for the diagnosis of coronal articular fracture lines in the distal radius. Methods: Using a web-based survey, 63 surgeons were randomized to evaluate 16 fractures of the distal radius on radiographs alone or radiographs and 2DCT for the presence or absence of a coronal fracture line of the lunate facet and, if present, the stability of the fracture. The kappa multirater measure was calculated to estimate agreement between observers. Results: The inter-observer variation in diagnosis of a coronal fracture line was fair with both radiographs and 2DCT, as was the diagnosis of instability of the volar lunate facet fracture when present. Conclusion: Two-dimensional computed tomography does not improve observer agreement on the diagnosis of coronal plane articular fracture lines in the lunate facet of the distal radius. © 2012 American Association for Hand Surgery.

The inter-section of political history and health policy in Asia - the historical foundations for health policy analysis

One of the challenges for health reform in Asia is the diverse set of socio-economic and political structures, and the related variability in the direction and pace of health systems and policy reform. This paper aims to make comparative observations and analysis of health policy reform in the context of historical change, and considers the implications of these findings for the practice of health policy analysis. We adopt an ecological model for analysis of policy development, whereby health systems are considered as dynamic social constructs shaped by changing political and social conditions. Utilizing historical, social scientific and health literature, timelines of health and history for five countries (Cambodia, Myanmar, Mongolia, North Korea and Timor Leste) are mapped over a 30-50 year period. The case studies compare and contrast key turning points in political and health policy history, and examines the manner in which these turning points sets the scene for the acting out of longer term health policy formation, particularly with regard to the managerial domains of health policy making. Findings illustrate that the direction of health policy reform is shaped by the character of political reform, with countries in the region being at variable stages of transition from monolithic and centralized administrations, towards more complex management arrangements characterized by a diversity of health providers, constituency interest and financing sources. The pace of reform is driven by a country's institutional capability to withstand and manage transition shocks of post conflict rehabilitation and emergence of liberal economic reforms in an altered governance context. These findings demonstrate that health policy analysis needs to be informed by a deeper understanding and questioning of the historical trajectory and political stance that sets the stage for the acting out of health policy formation, in order that health systems function optimally along their own historical pathways.

Legal issues: Disciplinary proceedings for inappropriate prescription of opioid medications by medical practitioners in Australia (2010-2014)

An analysis of 32 cases reported between July 2010 and September 2014 byprofessional disciplinary tribunals in New South Wales and Victoria againstmedical practitioners found guilty of inappropriately prescribing Sch 8 medications(mainly opioids) and Sch 4 drugs (mainly benzodiazepines) demonstrated, among others, a lengthy delay between the occurrence of the miscreant conduct and the conclusion of disciplinary proceedings. The study also raised questions about the appropriateness of utilising common criminal law theories of punishment and deterrence by non-judicial tribunals.

Direct perception, inter-subjectivity and social cognition: why phenomenology is a necessary but not sufficient condition

In this paper I argue that many of the core phenomenological insights, including the emphasis on direct perception, are a necessary but not sufficient condition for an adequate account of inter-subjectivity today. I take it that an adequate account of inter-subjectivity must involve substantial interaction with empirical studies, notwithstanding the putative methodological differences between phenomenological description and scientific explanation. As such, I will need to explicate what kind of phenomenology survives, and indeed, thrives, in a milieu that necessitates engagement with the relevant sciences, albeit not necessarily deference to them. There will be two central aims to this paper: 1. to defend the centrality and vitality of phenomenological treatments of inter-subjectivity via a consideration of some remarks in Sartre - which I do think possess a non-trivial unity amongst the various interlocutors - and the manner in which they in fact serve to provide the basis for a better explanation of an array of empirical data than existing inferentialist or mindreading accounts of social cognition (notably Theory Theory, Simulation Theory, and hybrid versions); 2. to offer the methodological resources for renewing phenomenology in a manner that acknowledges ostensibly non-phenomenological moments in theory production - which involve explanation, inference to the best explanation, etc. - but does not abandon phenomenology for all that, allowing it to be simply absorbed into empirical explanation or other forms of philosophical analysis without remainder.

The inter-relationship between depressive, anxiety and stress symptoms in fathers during the antenatal period

Objective: The aim of this study was to examine whether depressive symptoms predict anxiety and stress or whether anxiety and stress precede depressive symptoms in fathers during the antenatal period. Background: The findings of previous studies suggest that there is an association between paternal depression, anxiety and stress during the antenatal period. However, the temporal inter-relationship between these variables has yet to be investigated. Method: Data were collected from 150 expectant couples at approximately 18, 25 and 33 weeks’ gestation. Results: After accounting for the relative stability of depression, anxiety and stress over time, for men higher levels of anxiety earlier in pregnancy predicted higher levels of depression and stress in middle pregnancy, which predicted higher depression during late pregnancy. A similar relationship remained after partialling out the effects of partner’s depression, perceived social support and sleep quality. Further analyses also revealed significant differences in the manifestation of distress symptoms between men and women, but not between first-time and non-first-time fathers. Conclusion: Our findings indicated a possible inter-relationship between depression, anxiety and stress for men antenatally. Our findings also showed that men who reported elevated depression, anxiety and stress earlier in the antenatal period also reported elevated symptomology at later time points. Finally, the current findings revealed that antenatal paternal stress may play a key role in the development of depression and anxiety later in pregnancy. Therefore, it may be important to screen for early levels of antenatal stress in men, as well as depression and anxiety.

Trust and technology in modern inter-organisational relationships: a study in the petrochemical industry

 This research provided fresh insights into the role of trust and technology in modern inter-organisational relationships (IORs). The study highlighted the importance and contribution of various aspects of IORs in the petrochemical industry; however, it emphasised the role of trust and technology as pivotal to business success. The study was undertaken in Iran, where the petrochemical industry faces a great many sociopolitical and economic challenges, where the situation is volatile, and where the lack of trust and shortage of suitable technology to support global trade, accentuate the intricate web of dependencies between those aspects influencing the development and maintenance of business-to-business (B2B) relationships.

Disciplinary proceedings against doctors who abuse controlled substances

Study examined 27 reports from disciplinary tribunals against medical practitioners who abused narcotic analgesics (often combined with other drugs of addiction) between 2010 and 2015. The study covered all States and Territories except Tasmania (no reports were accessible for this jurisdiction. The reports revealed that 12 medical practitioners were in their 40s; five in their 30s; and one person still in the 20s. Although majority were General Practitioners (15 out of 27), other medical specialties were also represented. Self-administered Pethidine was the most prevalent opioid (11 out of 27), and was the only drug used alone. Morphine was self-administered by six doctors; the same number used high doses of Panadeine Forte, Codeine and Codeine Phosphate, and Fentanyl was abused by five doctors. Surprisingly, fewer medical practitioners appear to use such opiates such as Propofol, Tramadol and Tramol, Oxycodone and Endone. The examination of cases suggests lack of consistency in the imposition of professional sanctions and penalties by the relevant tribunals. The study concludes that disciplinary tribunals should apply the test of proportionality in the form of ‘reasonable necessity’ when deciding whether to remove or suspend the addicted medical practitioner from the Register.

Stillness and movement: a bodily approach to photography

My paper will address both Duration and temporality of the ‘still’ imageand Sensorial and bodily experience of photography through a discussion of a recent body of work ‘Fly Rhythm’, a series of photographs and video works exhibited in a gallery context.By acknowledging the inter-relationship between the body and the camera my project seeks to challenge a perceived separation between performance and photography. Fly Rhythm was conceived through a performative somatic process. Through using a custom made camera I was able to negotiate time and space to create a visual drawing of movement and stillness together in photography. The resultant images are discussed as a notation of body movement – a record of bodily history enabled through a self imposed discipline of learning to read light.I initially constructed a human size camera to understand how photography works. Spending time inside observing the way light moves and affects the formation of sight is also a way of embodying the act of photography. I responded by making a bespoke camera that enabled light to be captured during extended periods while moving. My project is dependent upon a self-imposed discipline of intuiting light’s strength and erratic changes, a skill developed by making analogue prints while inside a camera obscura. Once I had developed an ability to read light’s changes and gain an understanding of camera mechanics I made durational recordings moving through the landscape on Bruny Island Tasmania and industrial sites in Melbourne, photographs exhibited as part of Fly Rhythm. I will discuss these prints in context with the idea that light is a conduit through which past and present fuse together in a bodily act of photographing and processing images.I will explore durational aspects of photography by discussing light’s relative motion while taking photographs without using the viewfinder or composing images in the traditional way. Rather, the camera at the end of my arm is directed through how I read light therefore a choreography notated in the prints – a kind of body signatureMy practice enables a new the way of seeing, in a spontaneous hand held process creating a sense of embodiment. By analyzing process my paper will consider how the body together with analogue and 21st century digital technology coalesce cross-disciplinary practice combining visual art, performance and photographic disciplines.I also explored limitations of digital light in contrast with ‘natural’ light by a making a gamut of dissolving colour determined by the software based on two pixels. Projected into the ambient light ‘Glide’ is an 11minute durational work installed at the Substation Contemporary Art Space in Melbourne Australia.