Barriers to effective management of depression in general practice

Objective: The aim of this study was to investigate the effects of prior general practice training in mental health and practice location on general practitioner (GP) attitudes toward depression, self-confidence in assessing and treating depressed patients, identification of doctor, patient and practice barriers to the effective care of depressed patients in general medical practice and GP-reported current clinical practice.

Method: Fifty-two (out of 123) Divisions of General Practice that responded to an invitation to participate in the study distributed 608 anonymous surveys to a representative sample of GPs; 420 (69%) were returned. The questionnaire focused on current clinical practice, perceived barriers to care of depressed patients and doctors' self-efficacy for assessing and treating depressed patients. It also consisted of two scales, based upon previous research, designed to assess doctors' attitudes towards depression and depressed patients.

Results: General practitioners who had undertaken mental health education and training more often used non-pharmacological treatments (p = 0.00), as did female GPs (p = 0.00). Male GPs (p = 0.00) and those in rural settings (p = 0.01) more often prescribed medication for depression. Those without mental health training more often identified incomplete knowledge about depression as a barrier to its effective management (p = 0.00). Urban-based GPs (p = 0.04) and those with prior mental health training (p = 0.00) were more confident in the use of non-pharmacological treatments. Female GPs without mental health training were the least confident in the use of these methods (p = 0.01). Overall, GPs with mental health training were more positive in their attitudes toward depression and their treatment of these patients (p = 0.00). Female GPs appeared more positive in their attitudes toward depression than male GPs (p = 0.01), although the results were not entirely consistent.

Conclusions: Participation in mental health training by GPs appears to be related to their attitudes toward depressed patients and to their confidence and abilities to diagnose and manage the common mental disorders effectively.

Socio-ethical issues for expertise location from electronic mail

Knowledge workers frequently lack sufficient expertise to perform work effectively. This paper describes a recently developed expertise locator system based on automated key-phrase identification of experts from electronic mail (e-mail) messages. The paper provides an analysis of the key socio-ethical challenges involved in the implementation and use of the e-mail expertise locator system. Findings include a set of complex socio-ethical challenges, and their managerial and theoretical implications are discussed. The paper highlights possible sensitivities of employees with respect to their potential identification by the system as domain experts. It also highlights the potential for employee misuse of e-mail expertise locator systems, which must be carefully managed to reduce the risks involved.

Management of tendinopathy

Overuse disorders of tendons, or tendinopathies, present a challenge to sports physicians, surgeons, and other health care professionals dealing with athletes. The Achilles, patellar, and supraspinatus tendons are particularly vulnerable to injury and often difficult to manage successfully. Inflammation was believed central to the pathologic process, but histopathologic evidence has confirmed the failed healing response nature of these conditions. Excessive or inappropriate loading of the musculotendinous unit is believed to be central to the disease process, although the exact mechanism by which this occurs remains uncertain. Additionally, the location of the lesion (for example, the midtendon or osteotendinous junction) has become increasingly recognized as influencing both the pathologic process and subsequent management.

The mechanical, vascular, neural, and other theories that seek to explain the pathologic process are explored in this article. Recent developments in the nonoperative management of chronic tendon disorders are reviewed, as is the rationale for surgical intervention. Recent surgical advances, including minimally invasive tendon surgery, are reviewed. Potential future management strategies, such as stem cell therapy, growth factor treatment, and gene transfer, are also discussed.

Management of SPMD based parallel processing on clusters of workstations

Current attempts to manage parallel applications on Clusters of Workstations (COWs) have either generally followed the parallel execution environment approach or been extensions to existing network operating systems, both of which do not provide complete or satisfactory solutions. The efficient and transparent management of parallelism within the COW environment requires enhanced methods of process instantiation, mapping of parallel process to workstations, maintenance of process relationships, process communication facilities, and process coordination mechanisms. The aim of this research is to synthesise, design, develop and experimentally study a system capable of efficiently and transparently managing SPMD parallelism on a COW. This system should both improve the performance of SPMD based parallel programs and relieve the programmer from the involvement into parallelism management in order to allow them to concentrate on application programming. It is also the aim of this research to show that such a system, to achieve these objectives, is best achieved by adding new special services and exploiting the existing services of a client/server and microkernel based distributed operating system. To achieve these goals the research methods of the experimental computer science should be employed. In order to specify the scope of this project, this work investigated the issues related to parallel processing on COWs and surveyed a number of relevant systems including PVM, NOW and MOSIX. It was shown that although the MOSIX system provide a number of good services related to parallelism management, none of the system forms a complete solution. The problems identified with these systems include: instantiation services that are not suited to parallel processing; duplication of services between the parallelism management environment and the operating system; and poor levels of transparency. A high performance and transparent system capable of managing the execution of SPMD parallel applications was synthesised and the specific services of process instantiation, process mapping and process interaction detailed. The process instantiation service designed here provides the capability to instantiate parallel processes using either creation or duplication methods and also supports multiple and group based instantiation which is specifically design for SPMD parallel processing. The process mapping service provides the combination of process allocation and dynamic load balancing to ensure the load of a COW remains balanced not only at the time a parallel program is initialised but also during the execution of the program. The process interaction service guarantees to maintain transparently process relationships, communications and coordination services between parallel processes regardless of their location within the COW. The combination of these services provides an original architecture and organisation of a system that is capable of fully managing the execution of SPMD parallel applications on a COW. A logical design of a parallelism management system was developed derived from the synthesised system and was shown that it should ideally be based on a distributed operating system employing the client server model. The client/server based distributed operating system provides the level of transparency, modularity and flexibility necessary for a complete parallelism management system. The services identified in the synthesised system have been mapped to a set of server processes including: Process Instantiation Server providing advanced multiple and group based process creation and duplication; Process Mapping Server combining load collection, process allocation and dynamic load balancing services; and Process Interaction Server providing transparent interprocess communication and coordination. A Process Migration Server was also identified as vital to support both the instantiation and mapping servers. The RHODOS client/server and microkernel based distributed operating system was selected to carry out research into the detailed design and to be used for the implementation this parallelism management system. RHODOS was enhanced to provide the required servers and resulted in the development of the REX Manager, Global Scheduler and Process Migration Manager to provide the services of process instantiation, mapping and migration, respectively. The process interaction services were already provided within RHODOS and only required some extensions to the existing Process Manager and IPC Managers. Through a variety of experiments it was shown that when this system was used to support the execution of SPMD parallel applications the overall execution times were improved, especially when multiple and group based instantiation services are employed. The RHODOS PMS was also shown to greatly reduce the programming burden experienced by users when writing SPMD parallel applications by providing a small set of powerful primitives specially designed to support parallel processing. The system was also shown to be applicable and has been used in a variety of other research areas such as Distributed Shared Memory, Parallelising Compilers and assisting the port of PVM to the RHODOS system. The RHODOS Parallelism Management System (PMS) provides a unique and creative solution to the problem of transparently and efficiently controlling the execution of SPMD parallel applications on COWs. Combining advanced services such as multiple and group based process creation and duplication; combined process allocation and dynamic load balancing; and complete COW wide transparency produces a totally new system that addresses many of the problems not addressed in other systems.

Indoor location prediction using multiple wireless received signal strengths

This paper presents a framework for indoor location prediction system using multiple wireless signals available freely in public or office spaces. We first propose an abstract architectural design for the system, outlining its key components and their functionalities. Different from existing works, such as robot indoor localization which requires as precise localization as possible, our work focuses on a higher grain: location prediction. Such a problem has a great implication in context-aware systems such as indoor navigation or smart self-managed mobile devices (e.g., battery management). Central to these systems is an effective method to perform location prediction under different constraints such as dealing with multiple wireless sources, effects of human body heats or mobility of the users. To this end, the second part of this pa- per presents a comparative and comprehensive study on different choices for modeling signals strengths and prediction methods under different condition settings. The results show that with simple, but effective modeling method, almost perfect prediction accuracy can be achieved in the static environment, and up to 85% in the presence of human movements. Finally, adopting the proposed framework we outline a fully developed system, named Marauder, that support user interface interaction and real-time voice-enabled location prediction.

Management of advanced neuroendocrine tumors with hepatic metastasis

Neuroendocrine tumors (NETs) in general and specifically these gastroenteropancreatic-neuroendocrine tumors often present a considerable diagnostic and therapeutic challenge, especially those that behave in an aggressive fashion. The majority of tumors are diagnosed at a stage that the only curative treatment, radical surgical intervention, is no longer an option and thus long-term therapy with somatostatin analogs is focused on symptom amelioration and in the improvement of quality of life. Although biotherapy is currently the most efficient treatment to achieve palliation, conventional chemotherapy may have some utility in undifferentiated or highly proliferating neuroendocrine carcinomas and pancreatic NETs. Hepatic metastases, depending on size, location, and number may be amenable to surgical resection or radiofrequency ablation. If surgery is not feasible, embolization either alone (bland), in combination with chemotherapeutic agents, or using radioactive microspheres can be used. Peptide receptor targeted radiotherapy using radiolabeled octapeptide analogs (⁹⁰Yttrium or ¹⁷⁷Lutetium-octreotide) may lead to reduction in tumor size, but in most circumstances has a tumor stabilizing effect. A variety of antiangiogenesis and growth factor-targeted agents have been evaluated, but to date, the results have failed to meet our expectations.

Leading the quality management of online learning environments in Australian higher education

The paper presents the findings of the first year of a nationally funded Australian Learning and Teaching Council (ALTC) project on the quality management of online learning environments by and through distributed leadership. The project is being undertaken by five Australian universities with major commitments to online and distance education. Each university, however, has a distinctive location, history and profile in the sector. The first year of the project has seen the development of a quality management framework with six interrelated elements. The framework is being applied, refined and validated in the second year of the project. Allied with the development of the framework, was the conduct of focus groups at each of the five partner institutions in the middle of the first year. These focus groups composed a range of staff involved collectively in the leadership of the organisation's online learning environment. Prominence was given to the nature and value of strategic planning, due diligence conducted in selecting and mainstreaming technologies, evaluation approaches informing decision making, and the various relationships between different leadership levels and domains. A number of key issues which emerged relating to the elements identified in the framework are examined.

Alcohol consumption and sport: a cross-sectional study of alcohol management practices associated with at-risk alcohol consumption at community football clubs

Background
Excessive alcohol consumption is responsible for considerable harm from chronic disease and injury. Within most developed countries, members of sporting clubs participate in at-risk alcohol consumption at levels above that of communities generally. There has been limited research investigating the predictors of at-risk alcohol consumption in sporting settings, particularly at the non-elite level. The purpose of this study was to examine the association between the alcohol management practices and characteristics of community football clubs and at-risk alcohol consumption by club members.

Methods
A cross sectional survey of community football club management representatives and members was conducted. Logistic regression analysis (adjusting for clustering by club) was used to determine the association between the alcohol management practices (including alcohol management policy, alcohol-related sponsorship, availability of low- and non-alcoholic drinks, and alcohol-related promotions, awards and prizes) and characteristics (football code, size and location) of sporting clubs and at-risk alcohol consumption by club members.

Results
Members of clubs that served alcohol to intoxicated people [OR: 2.23 (95% CI: 1.26-3.93)], conducted ‘happy hour’ promotions [OR: 2.84 (95% CI: 1.84-4.38)] or provided alcohol-only awards and prizes [OR: 1.80 (95% CI: 1.16-2.80)] were at significantly greater odds of consuming alcohol at risky levels than members of clubs that did not have such alcohol management practices. At-risk alcohol consumption was also more likely among members of clubs with less than 150 players compared with larger clubs [OR:1.45 (95% CI: 1.02-2.05)] and amongst members of particular football codes.

Conclusions
The findings of this study suggest a need and opportunity for the implementation of alcohol harm reduction strategies targeting specific alcohol management practices at community football clubs.

PGSW-OS: a novel approach for resource management in a semantic web operating system based on a P2P grid architecture

A web operating system is an operating system that users can access from any hardware at any location. A peer-to-peer (P2P) grid uses P2P communication for resource management and communication between nodes in a grid and manages resources locally in each cluster, and this provides a proper architecture for a web operating system. Use of semantic technology in web operating systems is an emerging field that improves the management and discovery of resources and services. In this paper, we propose PGSW-OS (P2P grid semantic Web OS), a model based on a P2P grid architecture and semantic technology to improve resource management in a web operating system through resource discovery with the aid of semantic features. Our approach integrates distributed hash tables (DHTs) and semantic overlay networks to enable semantic-based resource management by advertising resources in the DHT based upon their annotations to enable semantic-based resource matchmaking. Our model includes ontologies and virtual organizations. Our technique decreases the computational complexity of searching in a web operating system environment. We perform a simulation study using the Gridsim simulator, and our experiments show that our model provides enhanced utilization of resources, better search expressiveness, scalability, and precision. © 2014 Springer Science+Business Media New York.

Transitioning to routine breast cancer risk assessment and management in primary care: what can we learn from cardiovascular disease?

To capitalise on advances in breast cancer prevention, all women would need to have their breast cancer risk formally assessed. With ~85% of Australians attending primary care clinics at least once a year, primary care is an opportune location for formal breast cancer risk assessment and management. This study assessed the current practice and needs of primary care clinicians regarding assessment and management of breast cancer risk. Two facilitated focus group discussions were held with 17 primary care clinicians (12 GPs and 5 practice nurses (PNs)) as part of a larger needs assessment. Primary care clinicians viewed assessment and management of cardiovascular risk as an intrinsic, expected part of their role, often triggered by practice software prompts and facilitated by use of an online tool. Conversely, assessment of breast cancer risk was not routine and was generally patient- (not clinician-) initiated, and risk management (apart from routine screening) was considered outside the primary care domain. Clinicians suggested that routine assessment and management of breast cancer risk might be achieved if it were widely endorsed as within the remit of primary care and supported by an online risk-assessment and decision aid tool that was integrated into primary care software. This study identified several key issues that would need to be addressed to facilitate the transition to routine assessment and management of breast cancer risk in primary care, based largely on the model used for cardiovascular disease.

Explaining the variation in the management of lifestyle risk factors in primary health care: a multilevel cross sectional study

Background

Despite evidence for the effectiveness of interventions to modify lifestyle behaviours in the primary health care (PHC) setting, assessment and intervention for these behaviours remains low in routine practice. Little is known about the relative importance of various determinants of practice.

This study aimed to examine the relative importance of provider characteristics and attitudes, patient characteristics and consultation factors in determining the rate of assessment and intervention for lifestyle risk factors in PHC.

Methods

A prospective audit of assessment and intervention for lifestyle risk factors was undertaken by PHC nurses and allied health providers (n = 57) for all patients seen (n = 732) over a two week period. Providers completed a survey to assess key attitudes related to addressing lifestyle issues. Multi-level logistic regression analysis of patient audit records was undertaken. Associations between variables from both data sources were examined, together with the variance explained by patient and consultation (level 1) and provider (level 2) factors.

Results

There was significant variance between providers in the assessment and intervention for lifestyle risk factors. The consultation type and reason for the visit were the most important in explaining the variation in assessment practices, however these factors along with patient and provider variables accounted for less than 20% of the variance. In contrast, multi-level models showed that provider factors were most important in explaining the variance in intervention practices, in particular, the location of the team in which providers worked (urban or rural) and provider perceptions of their effectiveness and accessibility of support services. After controlling for provider variables, patients' socio-economic status, the reason for the visit and providers' perceptions of the 'appropriateness' of addressing risk factors in the consultation were all significantly associated with providing optimal intervention. Together, measured patient consultation and provider variables accounted for most (80%) of the variation in intervention practices between providers.

Conclusion

The findings highlight the importance of provider factors such as beliefs and attitudes, team location and work context in understanding variations in the provision of lifestyle intervention in PHC. Further studies of this type are required to identify variables that improve the proportion of variance explained in assessment practices.

Volunteered Geographic Information For Water Management: A Prototype Architecture

Driven by Web 2.0 technology and the almost ubiquitous presence of mobile devices, Volunteered Geographic Information (VGI) is knowing an unprecedented growth. These notable technological advancements have opened fruitful perspectives also in the field of water management and protection, raising the demand for a reconsideration of policies which also takes into account the emerging trend of VGI. This research investigates the opportunity of leveraging such technology to involve citizens equipped with common mobile devices (e.g. tablets and smartphones) in a campaign of report of water-related phenomena. The work is carried out in collaboration with ADBPO - Autorità di bacino del fiume Po (Po river basin Authority), i.e. the entity responsible for the environmental planning and protection of the basin of river Po. This is the longest Italian river, spreading over eight among the twenty Italian Regions and characterized by complex environmental issues. To enrich ADBPO official database with user-generated contents, a FOSS (Free and Open Source Software) architecture was designed which allows not only user field-data collection, but also data Web publication through standard protocols. Open Data Kit suite allows users to collect georeferenced multimedia information using mobile devices equipped with location sensors (e.g. the GPS). Users can report a number of environmental emergencies, problems or simple points of interest related to the Po river basin, taking pictures of them and providing other contextual information. Field-registered data is sent to a server and stored into a PostgreSQL database with PostGIS spatial extension. GeoServer provides then data dissemination on the Web, while specific OpenLayers-based viewers were built to optimize data access on both desktop computers and mobile devices. Besides proving the suitability of FOSS in the frame of VGI, the system represents a successful prototype for the exploitation of user local, real-time information aimed at managing and protecting water resources.

Surgical Management of Impacted Teeth Using Three-Dimensional Computed Tomography

The surgical removal of impacted, supernumerary, or ectopic teeth is a routine procedure to the dental surgeon. Because any and all surgical interventions involve anatomic considerations that predispose the patient to a high risk of incidents or complications, it is absolutely necessary to precisely determine the location of the enclosed teeth, to better plan the procedure. Even though the conventional radiographic techniques are commonly used to detect the presence of such teeth, they can present deficiencies. In those situations, additional examinations can be requested. In this article, we are reporting the case of a 12-year-old patient, whose third superior molars appeared in a very atypical position. We chose to request a computed tomography and three-dimensional manipulation of the obtained images. This article, as its main goal, highlighted the importance of computed tomography and of three-dimensional reconstructions as a tool to precisely determine the location of enclosed teeth, thus allowing for a better planning of the surgery and a safer surgical intervention.

Spatial variability of soil attributes and sugarcane yield in relation to topographic location

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Brazilian consensus on gastroesophageal reflux disease: Proposals for assessment, classification, and management

The Brazilian Consensus on Gastroesophageal Reflux Disease considers gastroesophageal reflux disease to be a chronic disorder related to the retrograde flow of gastroduodenal contents into the esophagus and/or adjacent organs, resulting in a variable spectrum of symptoms, with or without tissue damage. Considering the limitations of classifications currently in use, a new classification is proposed that combines three criteria - clinical, endoscopic, and pH-metric - providing a comprehensive and more complete characterization of the disease. The diagnosis begins with the presence of heartburn, acid regurgitation, and alarm manifestations (dysphagia, odynophagia, weight loss, GI bleeding, nausea and/or vomiting, and family history of cancer). Also, atypical esophageal, pulmonary, otorhinolaryngological, and oral symptoms may occur. Endoscopy is the first approach, particularly in patients over 40 yr of age and in those with alarm symptoms. Other exams are considered in particular cases, such as contrast radiological examination, scyntigraphy, manometry, and prolonged pH measurement. The clinical treatment encompasses behavioral modifications in lifestyle and pharmacological measures. Proton pump inhibitors in manufacturers' recommended doses are indicated, with doubling of the dose in more severe cases of esophagitis. The minimum time of administration is 6 wk. Patients who do not respond to medical treatment, including those with atypical manifestations, should be considered for surgical treatment. Of the complications of gastroesophageal reflux disease, Barrett's esophagus presents a potential development of adenocarcinoma; biopsies should be performed, independent of Barrett's esophagus extent or location. In this regard the designation short Barrett's is not important in terms of management and prognosis. © 2002 by Am. Coll. of Gastroenterology.