Qualitative study of patients' choice between public and private hospital emergency departments

Objective The aim of this study was to gather patients' perceptions regarding their choice between public and private hospital EDs for those who hold private health insurance. The findings of this study will contribute to knowledge regarding patients' decision-making processes and therefore may contribute to the development of evidence based public policies. Methods An in-depth semi-structured guide was used to interview participants at public and private hospital EDs. Questions sought to identify the issues that were considered by the participants to decide to attend that hospital ED, previous ED experience, expectations of ED services and perceived benefits and barriers to accessing services. Interviews were audio recorded, transcribed verbatim and analysed using content and thematic approaches. Results Four core themes emerged: prior good experience with the hospital, perceived quality of care, perceived waiting times and perceived costs that may explain patients' choice. Patients' choice between public and private EDs can be explained by the interaction of these core themes. The principal issues appear to be concern for gap payments at private hospital ED and waiting times at public hospital ED. Conclusions Patients who choose to attend public EDs appear to value financial concern over waiting time; those who choose to attend private EDs appear to value waiting time ahead of financial concerns.

Barriers to and facilitators of cervical screening practice among African immigrant women from refugee and non-refugee backgrounds living in Brisbane

This thesis investigated and compared barriers and facilitators of cervical screening among African-born refugee and non-refugee women living in Brisbane. Refugee women were more likely to have limited or no knowledge about cervical cancer and the screening test and also less likely to use Pap smear services than non-refugee women. The analysis identified belief systems, lack of knowledge about cervical cancer and screening practices, and lack of culturally appropriate screening programs as major barriers. In the context of health promotion interventions, these findings will contribute to addressing major differential screening needs among African immigrant refugee and non-refugee women.

A retrospective case-control study on the prescribing practices of antidepressants administered to cancer patients and non-cancer patients in Australia

Comorbidity of depression risks is common among cancer patients. The pharmacological treatment of depression is antidepressants. However, antidepressants may interact with anticancer drugs or cause adverse reactions. The prescription practice of antidepressants to cancer patients in Australia is not well documented. Our systematic review and meta-analysis identified that the overall prevalence rate of antidepressants was 15.6% varied widely by world-region and gender. A retrospective case-control study was undertaken to determine the recent prescription practice of antidepressants to cancer and non-cancer patients in Australia. Mirtazapine was the highly prescribed antidepressants to cases, whereas Desvenlafaxine was prescribed to controls. Considerable variation in the prescribing patterns of antidepressants was identified. Prospective studies are needed to ascertain whether patients are being treated optimally.

Care for care: Studio REV's strategies of engagement

The artists at Studio REV-, along with their allies in the broader non-profit sector, address domestic workers’ rights in the United States. As a social practice art project, NannyVan works to improve how information about domestic rights is disseminated to these workers, whether nannies, elder caregivers or others. As part of a larger project named CareForce, the NannyVan project shows an ethics of care by using design traces as tactics and transversal methods as strategies.

Classification of Protein Kinases on the Basis of Both Kinase and Non-Kinase Regions

Background: Protein phosphorylation is a generic way to regulate signal transduction pathways in all kingdoms of life. In many organisms, it is achieved by the large family of Ser/Thr/Tyr protein kinases which are traditionally classified into groups and subfamilies on the basis of the amino acid sequence of their catalytic domains. Many protein kinases are multidomain in nature but the diversity of the accessory domains and their organization are usually not taken into account while classifying kinases into groups or subfamilies. Methodology: Here, we present an approach which considers amino acid sequences of complete gene products, in order to suggest refinements in sets of pre-classified sequences. The strategy is based on alignment-free similarity scores and iterative Area Under the Curve (AUC) computation. Similarity scores are computed by detecting common patterns between two sequences and scoring them using a substitution matrix, with a consistent normalization scheme. This allows us to handle full-length sequences, and implicitly takes into account domain diversity and domain shuffling. We quantitatively validate our approach on a subset of 212 human protein kinases. We then employ it on the complete repertoire of human protein kinases and suggest few qualitative refinements in the subfamily assignment stored in the KinG database, which is based on catalytic domains only. Based on our new measure, we delineate 37 cases of potential hybrid kinases: sequences for which classical classification based entirely on catalytic domains is inconsistent with the full-length similarity scores computed here, which implicitly consider multi-domain nature and regions outside the catalytic kinase domain. We also provide some examples of hybrid kinases of the protozoan parasite Entamoeba histolytica. Conclusions: The implicit consideration of multi-domain architectures is a valuable inclusion to complement other classification schemes. The proposed algorithm may also be employed to classify other families of enzymes with multidomain architecture.

San Francisco : a city reinvented by creative innovation

The aim of this paper is to analyse the recent evolution of the city of San Francisco to outline the major features that have made it possible this continuing process of creative innovation in the city. In order to meet this objective, the project is framed around answering two key research questions: (1) what are the main economic and social elements that characterise urban change in the city of San Francisco and (2) which is the role of public strategies in the continuing economic success of San Francisco. The paper concludes that the successful performance of San Francisco is the result of the actions taken by many agents in the city, but the role of public authorities, especially the City and County, must be stressed, both through direct intervention and by coordinating, fostering and supporting the private and non-profit sectors. This is especially relevant in a country like the US where private initiative has been seen in many occasions as the greatest driver of economic and social success. Yet, the performance of San Francisco City cannot be explained without the role played by the public sector, in coordination with the civil society

Policies on poverty and the fisheries sector in Uganda: the current policy trends

There are concerns, at least among the proponents of development, on how to link policy development processes in Uganda and the associated transformation of the poor to high standards of living. In fact some questions have been posed as to whether it's the absence of poverty-targeted policies that a good proportion of individuals or communities are still poor. In the fisheries sector where most of the fish dependent communities live, poverty indications are still prevalent although arguments have been put that current reforms in the sector have transformed the lives of the fish dependent communities. The 1999/2000 household survey report indicates that the poverty levels reduced to 35% of Uganda's total population from 44% in 1997. The question that arose, which still arises anyway, was to define who is actually poor. When measuring poverty one is ultimately interested in the 'standards of living' of individuals especially those, whose standards of living are inadequate. The basic element of measuring this inadequacy/adequacy, at least in Uganda, is to use the household income or consumption per adult equivalent. Studies have demonstrated that household consumption expenditure is a good approximation of household income1. Therefore, for purpose of this report, we define poor households to mean based on that that one adopted by the Ministry of Finance to mean "households whose expenditure per adult equivalent falls below the poverty line 3 ". Many government documents report that the poverty line is one dollar a day. Therefore someone is below the poverty line if he or she lives on less than one dollar a day. In this paper, we analyse the evolution of poverty-driven policies that have been put in place by government and how these policies are shifting or are likely to shift the lives of fish dependent communities. We argue that combinations of poverty-policies are being translated into increased incomes and welfare of most individuals in the fisheries sector. The reasons for this shift, we argue, is as a result of a combination of factors all supported by non other that poverty-led government policies.

Understandings of citizenship education in Northern Ireland and the Republic of Ireland: Public discourses among stakeholders in the public and private sectors

Internationally, citizenship education has come to the fore in the past decade. It may be particularly importantwithin the context of societies with a legacy of political conflict, such as Northern Ireland and the Republic of Ireland, where it is being implemented as part of the statutory curriculum. This article explores understandingsof citizenship education among stakeholders in the private and public sectors in Northern Ireland and the Republic of Ireland with the aim to compare these with curricular conceptualizations of citizenship inboth contexts. Semi-structured interviews were conducted in both societies involving non-governmentalorganizations, political parties, trade unions and the police. Results indicated that levels of awareness aboutcitizenship education varied substantially and understandings mainly reflected current theory and curriculumpractice in citizenship. Commonalities emerged as in both societies similar key concepts were identified whiledifferences transpired over issues relating to national identity and political conflict, which may raise questionsfor history and citizenship education in both societies.

The link between the learning organisation and curriculum innovation:A comparative study of public and private primary schools in Greece

This article examines the relationship between the learning organisation and the implementation of curriculum innovation within schools. It also compares the extent of innovative activity undertaken by schools in the public and the private sectors. A learning organisation is characterised by long-term goals, participatory decision-making processes, collaboration with external stakeholders, effective mechanisms for the internal communication of knowledge and information, and the use of rewards for its members. These characteristics are expected to promote curriculum innovation, once a number of control factors have been taken into account. The article reports on a study carried out in 197 Greek public and private primary schools in the 1999-2000 school year. Structured interviews with school principals were used as a method of data collection. According to the statistical results, the most important determinants of the innovative activity of a school are the extent of its collaboration with other organisations (i.e. openness to society), and the implementation of development programmes for teachers and parents (i.e. communication of knowledge and information). Contrary to expectations, the existence of long-term goals, the extent of shared decision-making, and the use of teacher rewards had no impact on curriculum innovation. The study also suggests that the private sector, as such, has an additional positive effect on the implementation of curriculum innovation, once a number of human, financial, material, and management resources have been controlled for. The study concludes by making recommendations for future research that would shed more light on unexpected outcomes and would help explore the causal link between variables in the research model.

Complex Interactions between Dioxin-Like and Non-Dioxin-Like Compounds for in Vitro Cellular Responses: Implications for the Identification of Dioxin Exposure Biomarkers

Despite considerable advances in reducing the production of dioxin-like toxicants in recent years, contamination of the food chain still occasionally occurs resulting in huge losses to the agri-food sector and risk to human health through exposure. Dioxin-like toxicity is exhibited by a range of stable and bioaccumulative compounds including polychlorinated dibenzo-p-dioxins (PCDDs) and dibenzofurans (PCDFs), produced by certain types of combustion, and man-made coplanar polychlorinated biphenyls (PCBs), as found in electrical transformer oils. While dioxinergic compounds act by a common mode of action making exposure detection biomarker based techniques a potentially useful tool, the influence of co-contaminating toxicants on such approaches needs to be considered. To assess the impact of possible interactions, the biological responses of H4IIE cells to challenge by 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in combination with PCB-52 and benzo-a-pyrene (BaP) were evaluated by a number of methods in this study. Ethoxyresorufin-O-deethylase (EROD) induction in TCDD exposed cells was suppressed by increasing concentrations of PCB-52, PCB-153, or BaP up to 10 mu M. BaP levels below 1 mu M suppressed TCDD stimulated EROD induction, but at higher concentrations, EROD induction was greater than the maximum observed when cells were treated with TCDD alone. A similar biphasic interaction of BaP with TCDD co-exposure was noted in the AlamarBlue assay and to a lesser extent with PCB-52. Surface enhanced laser desorption/ionization-time of flight mass spectrometry (SELDI-TOF) profiling of peptidomic responses of cells exposed to compound combinations was compared. Cells co-exposed to TCDD in the presence of BaP or PCB-52 produced the most differentiated spectra with a substantial number of non-additive interactions observed. These findings suggest that interactions between dioxin and other toxicants create novel, additive, and non-additive effects, which may be more indicative of the types of responses seen in exposed animals than those of single exposures to the individual compounds.

Study of oxidation and non-enzymatic glycosylation posttranslational modifications using a proteomic approach

A glicosilação não-enzimática e o stress oxidativo representam dois processos importantes visto desempenharem um papel importante no que respeita às complicações de vários processos patofisiológicos. No presente, a associação entre a glicosilação não-enzimática e a oxidação de proteínas é reconhecida como sendo um dos principais responsáveis pela acumulação de proteínas não-funcionais que, por sua vez, promove uma contínua sensibilização para um aumento do stress oxidativo ao nível celular. Embora esteja disponível bastante informação no que respeita aos dois processos e suas consequências ao nível estrutural e funcional, permanecem questões por esclarecer acerca do que se desenvolve ao nível molecular. Com o objectivo de contribuir para uma melhor compreensão da relação entre a glicosilação não-enzimática e a oxidação, proteínas modelo (albumina, insulina e histonas H2B e H1) foram submetidas a sistemas in vitro de glicosilação não-enzimática e oxidação em condições controladas e durante um período de tempo específico. A identificação dos locais de glicosilação e oxidação foi realizada através de uma abordagem proteómica, na qual após digestão enzimática se procedeu à análise por cromatografia líquida acoplada a espectrometria de massa tandem (MALDI-TOF/TOF). Esta abordagem permitiu a obtenção de elevadas taxas de cobertura das sequências proteicas, permitindo a identificação dos locais preferenciais de glicosilação e oxidação nas diferentes proteínas estudadas. Como esperado, os resíduos de lisina foram os preferencialmente glicosilados. No que respeita à oxidação, além das modificações envolvendo hidroxilações e adições de oxigénio, foram identificadas deamidações, carbamilações e conversões oxidativas específicas de vários aminoácidos. No geral, os resíduos mais afectados pela oxidação foram os resíduos de cisteína, metionina, triptofano, tirosina, prolina, lisina e fenilalanina. Ao longo do período de tempo estudado, os resultados indicaram que a oxidação teve início em zonas expostas da proteína e/ou localizadas na vizinhança de resíduos de cisteína e metionina, ao invés de exibir um comportamente aleatório, ocorrendo de uma forma nãolinear por sua vez dependente da estabilidade conformacional da proteína. O estudo ao longo do tempo mostrou igualmente que, no caso das proteínas préglicosiladas, a oxidação das mesmas ocorreu de forma mais rápida e acentuada, sugerindo que as alterações estruturais induzidas pela glicosilação promovem um estado pro-oxidativo. No caso das proteínas pré-glicosiladas e oxidadas, foi identificado um maior número de modificações oxidativas assim como de resíduos modificados na vizinhança de resíduos glicosilados. Com esta abordagem é realizada uma importante contribuição na investigação das consequências do dano ‘glico-oxidativo’ em proteínas ao nível molecular através da combinação da espectrometria de massa e da bioinformática.

Using creative problem solving (CPS) to improve leadership in a non-profit organization

The purpose of this study was to evaluate the effectiveness of the Creative Problem Solving (CPS) method in improving the leadership process in a non-profit organization. The research was designed around an intervention and structured in three stages (pre-consult, intervention and follow-up), with a team designated by management, in order to bring leadership cohesion to both departments of the organization and also between the board and executive management. The results, expressed in the tasks performed and in the interviews to team members, allowed us to conclude on the effectiveness of the CPS method to improve organizational leadership, by establishing a stronger relationship between departments, as well as, in the long term, between the board and executive management. These results highlight possible solutions to improve the leadership of non-profit organizations.