Augmenting the rural health workforce with physician assistants

Health workforce shortages are a global phenomenon and Australia is no exception. Deficiencies are particularly pronounced in general practice, dentistry, nursing and key allied health fields.1,2 Even with the Australian health workforce growing at close to double the rate of the population and despite an increase in medical schools and student numbers, the shortage continues to worsen due to factors such as reductions in work hours, increasing urbanisation and the ageing and feminisation of the workforce.2 A 2005 prediction by the Australian Medical Workforce Advisory Committee estimated a shortage of between 800 and 1300 general practitioner graduates alone by 2013.2 The ageing of the health workforce, increasing life expectancy and the mounting burden of chronic disease are major problems facing all developed nations. Compounding these issues in Australia are the difficulties of caring for significant rural, remote, and Indigenous populations. National and international trends suggest that the shortage and maldistribution of doctors in rural areas is very likely to worsen.2,3 As well, Australia has an increasing reliance on international medical graduates, which poses major moral questions among other dilemmas. Clearly there is a need for change in policy and service delivery models. Simply increasing the number of doctors will not necessarily improve recruitment or retention in general practice and geographically disadvantaged areas. According to Queensland Health there is considerable and ongoing difficulty in recruiting new doctors to rural and remote locations, resulting in a less than adequate rate of replacement for retiring doctors. Many health care advocates and organisations have suggested a variety of innovations to facilitate the needed transformation in the existing system. In 2007 The National Rural Health Alliance (NRHA) declared: We need to redesign the workforce so that services we currently see as ‘medical’ or ‘nursing’ are provided by a broader range of professionals than just doctors and nurses. We will get around the unavoidable shortage of doctors and nurses (given the excessive and escalating level of demand) by redesigning and redistributing the way doctoring and nursing are provided.4 This paper will outline how the introduction of physician assistants (PA) into Australia, may be one strategy to strengthen the health care team and address medical workforce shortages, especially in rural and remote areas

Development and validation of PozQoL: A scale to assess quality of life of PLHIV

Background: Advances in medical treatment for HIV are driving major changes in HIV policy and practice, including the encouragement of intake and adherence to HIV antiretroviral treatment (ART) by people living with HIV (PLHIV) for both personal and public health benefits. However, there is increasing recognition that achieving these goals will require a concurrent focus on the broader psychological and social wellbeing of PLHIV. Increasingly calls are being been made to incorporate a stronger focus on quality of life (QoL) of PLHIV into HIV prevention policy. In order to achieve this goal, HIV community, support and healthcare services need a valid, short and practical way to evaluate QoL of PLHIV accessing their programs. Current QoL measures are either long, complex, restricted in their use, or expensive. To address these shortcomings, the PozQoL study aimed to develop, test and validate a short and freely available scale assessing QoL among PLHIV. Methods: Drawing on a literature review, the prioritisation of domains and development of the initial pool of items was conducted in consultation with PLHIV community organisations in Australia. The items covered health concerns, psychological, social, and functional wellbeing. Testing involved a baseline and a follow-up survey of 465 adult Australians living with HIV. Participants were recruited through social media and various community organizations nationwide. The survey included the pilot PozQoL scale and other validated measures of health and wellbeing. Results: Guided by an Exploratory Factor Analysis and conceptual considerations, a 13-item scale was developed. The PozQoL scale demonstrated high levels of fit in a Confirmatory Factor Analysis, very good internal consistency, test-retest reliability, and concurrent validity with other measures that approximated different aspects of QoL. Conclusion: The PozQoL scale has been tested in a diverse sample of adult PLHIV living in Australia, demonstrating very good reliability and validity. The insights from PLHIV and other stakeholders supported the balancing of statistical rigour and conceptual accuracy. The scale is now ready to be implemented and field-tested across a range of community, support and healthcare programs for PLHIV. This will make a significant contribution to the evaluation and enhancement of programs for PLHIV

Scoping studies to establish the capability and utility of a real-time bioaerosol sensor to characterise emissions from environmental sources

A novel dual excitation wavelength based bioaerosol sensor with multiple fluorescence bands called Spectral Intensity Bioaerosol Sensor (SIBS) has been assessed across five contrasting outdoor environments. The mean concentrations of total and fluorescent particles across the sites were highly variable being the highest at the agricultural farm (2.6 cm−3 and 0.48 cm−3, respectively) and the composting site (2.32 cm−3 and 0.46 cm−3, respectively) and the lowest at the dairy farm (1.03 cm−3 and 0.24 cm−3, respectively) and the sewage treatment works (1.03 cm−3 and 0.25 cm−3, respectively). In contrast, the number-weighted fluorescent fraction was lowest at the agricultural site (0.18) in comparison to the other sites indicating high variability in nature and magnitude of emissions from environmental sources. The fluorescence emissions data demonstrated that the spectra at different sites were multimodal with intensity differences largely at wavelengths located in secondary emission peaks for λex 280 and λex 370. This finding suggests differences in the molecular composition of emissions at these sites which can help to identify distinct fluorescence signature of different environmental sources. Overall this study demonstrated that SIBS provides additional spectral information compared to existing instruments and capability to resolve spectrally integrated signals from relevant biological fluorophores could improve selectivity and thus enhance discrimination and classification strategies for real-time characterisation of bioaerosols from environmental sources. However, detailed lab-based measurements in conjunction with real-world studies and improved numerical methods are required to optimise and validate these highly resolved spectral signatures with respect to the diverse atmospherically relevant biological fluorophores

Understanding metacognitive confidence : insights from judgment-of-learning justifications

This research was supported by the Economic and Social Research Council Studentship awarded to Radka Jersakova [ES/J500215/1].This study employed the delayed judgment-of-learning (JOL) paradigm to investigate the content of metacognitive judgments; after studying cue-target word-pairs, participants predicted their ability to remember targets on a future memory test (cued recognition in Experiments 1 and 2 and cued recall in Experiment 3). In Experiment 1 and the confidence JOL group of Experiment 3, participants used a commonly employed 6-point numeric confidence JOL scale (0–20–40–60–80–100%). In Experiment 2 and the binary JOL group of Experiment 3 participants first made a binary yes/no JOL prediction followed by a 3-point verbal confidence judgment (sure-maybe-guess). In all experiments, on a subset of trials, participants gave a written justification of why they gave that specific JOL response. We used natural language processing techniques (latent semantic analysis and word frequency [n-gram] analysis) to characterize the content of the written justifications and to capture what types of evidence evaluation uniquely separate one JOL response type from others. We also used a machine learning classification algorithm (support vector machine [SVM]) to quantify the extent to which any two JOL responses differed from each other. We found that: (i) participants can justify and explain their JOLs; (ii) these justifications reference cue familiarity and target accessibility and so are particularly consistent with the two-stage metacognitive model; and (iii) JOL confidence judgements do not correspond to yes/no responses in the manner typically assumed within the literature (i.e. 0–40% interpreted as no predictions).PostprintPeer reviewe

Apoptotic Cleavage of Cytoplasmic Dynein Intermediate Chain and P150GluedStops Dynein-Dependent Membrane Motility

Cytoplasmic dynein is the major minus end–directed microtubule motor in animal cells, and associates with many of its cargoes in conjunction with the dynactin complex. Interaction between cytoplasmic dynein and dynactin is mediated by the binding of cytoplasmic dynein intermediate chains (CD-IC) to the dynactin subunit, p150Glued. We have found that both CD-IC and p150Glued are cleaved by caspases during apoptosis in cultured mammalian cells and in Xenopus egg extracts. Xenopus CD-IC is rapidly cleaved at a conserved aspartic acid residue adjacent to its NH2-terminal p150Glued binding domain, resulting in loss of the otherwise intact cytoplasmic dynein complex from membranes. Cleavage of CD-IC and p150Glued in apoptotic Xenopus egg extracts causes the cessation of cytoplasmic dynein–driven endoplasmic reticulum movement. Motility of apoptotic membranes is restored by recruitment of intact cytoplasmic dynein and dynactin from control cytosol, or from apoptotic cytosol supplemented with purified cytoplasmic dynein–dynactin, demonstrating the dynamic nature of the association of cytoplasmic dynein and dynactin with their membrane cargo

Unusual and tunable negative linear compressibility in the metal–organic framework MFM-133(M)(M = Zr, Hf)

High pressure single-crystal X-ray structural analyses of isostructural MFM-133(M) (M = Zr, Hf) of flu topology and incorporating the tetracarboxylate ligand TCHB4– [H4TCHB = 3,3',5,5'-tetrakis(4-carboxyphenyl)-2,2',4,4',6,6'-hexamethyl-1,1'-biphenyl] and {M6(μ-OH)8(OH)8(COO)8} clusters, confirm negative linear compressibility (NLC) behavior along the c axis. This occurs via a three-dimensional winerack NLC mechanism leading to distortion of the octahedral cage towards a more elongated polyhedron under static compression. Despite the isomorphous nature of these two structures, MFM-133(Hf) shows a higher degree of NLC than the Zr(IV) analogue. Thus, for the first time, we demonstrate here that the NLC property can be effectively tuned in a framework material by simply varying the inorganic component of the frameworks without changing the network topology and structure

Serum concentrations of chlorinated dibenzo-p-dioxins, furans and PCBs, among former phenoxy herbicide production workers and firefighters in New Zealand.

PURPOSE: To quantify serum concentrations of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and dioxin-like compounds in former phenoxy herbicide production plant workers and firefighters, 20 years after 2,4,5-T production ceased. METHODS: Of 1025 workers employed any time during 1969-1984, 430 were randomly selected and invited to take part in a morbidity survey and provide a blood sample; 244 (57%) participated. Firefighters stationed in close proximity of the plant and/or engaged in call-outs to the plant between 1962 and 1987 also participated (39 of 70 invited). Reported here are the serum concentrations of TCDD and other chlorinated dibenzo-dioxins, dibenzofurans, and polychlorinated biphenyls (PCBs). Determinants of the serum concentrations were assessed using linear regression. RESULTS: The 60 men who had worked in the phenoxy/TCP production area had a mean TCDD serum concentration of 19.1 pg/g lipid, three times the mean concentration of the 141 men and 43 women employed in other parts of the plant (6.3 and 6.0 pg/g respectively), and more than 10 times the mean for the firefighters (1.6 pg/g). Duration of employment in phenoxy herbicide synthesis, maintenance work, and work as a boilerman, chemist, and packer were associated with increased serum concentrations of TCDD and 1,2,3,4,7-pentachlorodibenzo-p-dioxin (PeCDD). Employment as a boilerman was also associated with elevated serum concentrations of PCBs. CONCLUSIONS: Occupations in the plant associated with phenoxy herbicide synthesis had elevated levels of TCDD and PeCDD. Most other people working within the plant, and the local firefighters, had serum concentrations of dioxin-like compounds comparable to those of the general population

Winter wave climate, storms and regional cycles: the SW Spanish Atlantic coast

Climatic change-related impacts on coastal areas became an important issue in past decades and nowadays threaten many human settlements and activities. Coastal hazards are linked to flooding and erosion processes associated with sea level rise and the increased strength of hurricanes, cyclones and storms. The main aim of this work is the characterization of coastal storms in Cadiz (SW Spain) and the determination of their recurrence intervals and relationships with several regional cycles. Storm characterization was carried out using the Storm Power Index (Dolan and Davis, 1992) and five classes were obtained, from class I (weak events) to V (extreme events). Storm occurrence probability was 96% for class I (i.e. almost one event per year) to 3% for class V. The return period for class V was 25 years and ranged from 6 to 8 years for classes III and IV storms, e.g. significant and severe events. Classes I and II showed a period of recurrence ranging from 1 to 3 years. Stormy winter seasons were 2009/10 (12 events), 1995/6 and 2002/3 (with 10 events each) and 1993/4 (8 events). Approximately 40% of the change in monthly wave data and storminess indices was related to several teleconnection patterns, the most important drivers of change being the Arctic Oscillation (AO), 21.45%, and the North Atlantic Oscillation (NAO), 19.65%. It is interesting to note that a great number of storms, larger storm duration and higher values of Storm Power Index were only observed when neutral to strong negative NAO and AO phases occurred at the same time (89 storms and 3355 h) and/or when there was an abrupt change of NAO and AO phases, i.e. they moved from a positive to negative phase without passing through a neutral phase. The results obtained in this work have wider applications for ocean and coastal management. It is suggested that methodology used can be easily applied in different areas where wave buoy data are available. In the same way, information obtained with this kind of work constitutes the first step in the development of coastal protection plans to preserve socio-economic activities from the impact of severe storm events

Characterization of regulatory T cells in urban newborns

© 2009 Ly et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens