Sorting Out Autism Spectrum Disorders: Evidence-Based Medicine and the Complexities of the Clinical Encounter

Clinical decisions regarding the diagnosis and treatment of Autism Spectrum Disorders (ASDs) are commonly based upon heterogeneous evidence and ‘expert opinion’. To date, research examining how paediatricians are using (or not using) evidence-based medicine (EBM) to diagnose and treat patients with an ASD has been absent within the literature across all disciplines. To understand how Australian paediatricians are using EBM to conceptualise, diagnose, and treat patients with an ASD, this study interviewed nine paediatricians in private practice using a face-to-face, semi-structured approach. Participants were asked questions about diagnosis and treatment of ASDs, and general questions about their attitudes towards EBM. Analysis of the interviews revealed four key factors affecting the clinical encounter with the ASD patient: the role of experience in the clinical encounter, the tacit and experiential nature of diagnosing and treating ASDs, skilful and creative interaction between the paediatrician and the diagnostic tools (tool “tinkering”), and the influence of political and social forces. This study contributes to sociological understandings of EBM and how it is used by paediatricians to diagnose and treat ASDs. It also demonstrates that this process involves constant negotiation between clinical experience, the evidence, intersubjective evaluation, and social forces

Sorting Out Autism Spectrum Disorders: Evidence-Based Medicine and the Complexities of the Clinical Encounter

Clinical decisions regarding the diagnosis and treatment of Autism Spectrum Disorders (ASDs) are commonly based upon heterogeneous evidence and ‘expert opinion’. To date, research examining how paediatricians are using (or not using) evidence-based medicine (EBM) to diagnose and treat patients with an ASD has been absent within the literature across all disciplines. To understand how Australian paediatricians are using EBM to conceptualise, diagnose, and treat patients with an ASD, this study interviewed nine paediatricians in private practice using a face-to-face, semi-structured approach. Participants were asked questions about diagnosis and treatment of ASDs, and general questions about their attitudes towards EBM. Analysis of the interviews revealed four key factors affecting the clinical encounter with the ASD patient: the role of experience in the clinical encounter, the tacit and experiential nature of diagnosing and treating ASDs, skilful and creative interaction between the paediatrician and the diagnostic tools (tool “tinkering”), and the influence of political and social forces. This study contributes to sociological understandings of EBM and how it is used by paediatricians to diagnose and treat ASDs. It also demonstrates that this process involves constant negotiation between clinical experience, the evidence, intersubjective evaluation, and social forces

Identifying the perceptual role of cultural distance in Norwegian-Brazilian Business relationship conflict

Master's thesis in BusinessBusiness to business relationships across cultures is growing in importance due to improved transportation, communication technologies and globalisation thus making it easier for businesses to trade across national boundaries. Building and maintaining good business relationships is imperative for international business success. However, cultural differences between parties in a business relationship may influence the strength of the relationship because the behaviour and expectation of each party is influenced by their culture. This thesis is designed to explore the perceptual role of cultural distance in Norwegian- Brazilian business relationship conflict. This study seeks to contribute to the understanding of business relationships when parties are pressurised. The findings of this study will equip Norwegian managers with usable and intelligent information for managing cultural differences and conflict. In addition, these findings will provide relevant insights and recommendations to stakeholders wishing to establish businesses in Brazil. The research method is a qualitative, exploratory cross-sectional study of eight Norwegian companies operating in Brazil. Data collection took place in Rio de Janeiro, over a period of two weeks. Semi-structured interviews were conducted with nine informants to find out their perception of cultural differences and how these differences affect their relationship with business partners. The participants were selected using purposive sampling involving both criterion and convenience sampling. The data was analysed through an interpretive paradigm using the Ritchie and Spencer’s (1994) framework analysis. The findings reveal that cultural differences in terms of power distance, uncertainty avoidance, communication pattern, trust and attitude to time, cause misunderstanding, misinterpretation, frustrations, financial loss, etc in business relationship hence increasing the risk of conflict. Implications of the study are highlighted

Identifying the perceptual role of cultural distance in Norwegian-Brazilian Business relationship conflict

Master's thesis in BusinessBusiness to business relationships across cultures is growing in importance due to improved transportation, communication technologies and globalisation thus making it easier for businesses to trade across national boundaries. Building and maintaining good business relationships is imperative for international business success. However, cultural differences between parties in a business relationship may influence the strength of the relationship because the behaviour and expectation of each party is influenced by their culture. This thesis is designed to explore the perceptual role of cultural distance in Norwegian- Brazilian business relationship conflict. This study seeks to contribute to the understanding of business relationships when parties are pressurised. The findings of this study will equip Norwegian managers with usable and intelligent information for managing cultural differences and conflict. In addition, these findings will provide relevant insights and recommendations to stakeholders wishing to establish businesses in Brazil. The research method is a qualitative, exploratory cross-sectional study of eight Norwegian companies operating in Brazil. Data collection took place in Rio de Janeiro, over a period of two weeks. Semi-structured interviews were conducted with nine informants to find out their perception of cultural differences and how these differences affect their relationship with business partners. The participants were selected using purposive sampling involving both criterion and convenience sampling. The data was analysed through an interpretive paradigm using the Ritchie and Spencer’s (1994) framework analysis. The findings reveal that cultural differences in terms of power distance, uncertainty avoidance, communication pattern, trust and attitude to time, cause misunderstanding, misinterpretation, frustrations, financial loss, etc in business relationship hence increasing the risk of conflict. Implications of the study are highlighted

VULNERABILITY ASSESSMENT OF CRITICAL OIL AND GAS INFRASTRUCTURES TO CLIMATE CHANGE IMPACTS IN THE NIGER DELTA

Oil and gas infrastructures are being severely impacted by extreme climate change-induced disasters such as flood, storm, tidal surges, and rising temperature in the Niger Delta with high. There is a high potential for disruption of upstream and downstream activities as the world climate continues to change. The lack of knowledge of the criticality and vulnerability of infrastructures could further exacerbate impacts and the assets management value chain. This thesis, therefore, applied a criteria-based systematic evaluation of the criticality and vulnerability of selected critical oil and gas infrastructure to climate change impacts in the Niger Delta. It applied multi-criteria decision-making analysis (MCDA) tool – analytic hierarchy process (AHP), in prioritising systems according to their vulnerability and criticality and recommended sustainable adaptation mechanisms. Through a critical review of relevant literature, seven (7) criteria each for criticality and vulnerability assessment were synthesised accordingly and implemented in the assessment process. A further exploratory investigation, physical examination of infrastructures, focus groups and elite interviews were conducted to identify possible vulnerable infrastructures and scope qualitative and quantitative data for analysis using Mi-AHP spreadsheet. Results prioritised the criticality of infrastructures in the following order: terminals (27.1%), flow stations (18.5%), roads/bridges (15.5%), and transformers/high voltage cables (11.1%) while the least critical are loading bays (8.6%) and oil wellheads (5.1%). Further analysis indicated that the most vulnerable critical infrastructures are: pipelines (25%), terminals (17%) and roads/bridges (14%) while transformers/high voltage cables and oil wellheads where ranked as least vulnerable with 11% and 9% respectively. In addition to vulnerability assessment, an extended documentary analysis of groundwater geospatial stream flow and water discharge rate monitoring models suggest that an in-situ rise in groundwater level and increase in water discharge rate (WDR) at the upper Niger River could indicate a high probability of flood event at the lower Delta, hence further exacerbates the vulnerability of critical infrastructures. Accordingly, physical examination of infrastructures suggests that an increase in regional and ambient temperature disrupts the functionality of compressors and optimal operation of Flow Stations and inevitably exacerbate corrosion of cathodic systems when mixed with the saltwater flood from the Atlantic. The thesis produced a flexible conceptual framework for the vulnerability assessment of critical oil/gas infrastructures, contextualised and recommended sustainable climate adaptation strategies for the Niger Delta oil/gas industry. Some of these strategies include installation of industrial groundwater and water discharge rate monitoring systems, construction of elevated platforms for critical infrastructures installations, substitution of cathodic pipes with duplex stainless and glass reinforcement epoxy pipes. Others include proper channelisation of drainages and river systems around critical platforms, use of unmanned aerial vehicles (UAVs) for flood monitoring and the establishment of inter-organisational climate impact assessment groups in the oil/gas industry. Climate impact assessment (CIA) is suggested for oil and gas projects as part of best practice in the environmental management and impact assessment framework

Randomised controlled trials of complex interventions and large-scale transformation of services

Complex interventions and large-scale transformations of services are necessary to meet the health-care challenges of the 21st century. However, the evaluation of these types of interventions is challenging and requires methodological development. Innovations such as cluster randomised controlled trials, stepped-wedge designs, and non-randomised evaluations provide options to meet the needs of decision-makers. Adoption of theory and logic models can help clarify causal assumptions, and process evaluation can assist in understanding delivery in context. Issues of implementation must also be considered throughout intervention design and evaluation to ensure that results can be scaled for population benefit. Relevance requires evaluations conducted under real-world conditions, which in turn requires a pragmatic attitude to design. The increasing complexity of interventions and evaluations threatens the ability of researchers to meet the needs of decision-makers for rapid results. Improvements in efficiency are thus crucial, with electronic health records offering significant potential