Australian GP attitudes to clinical practice guidelines and some implications for translating osteoarthritis care into practice

Abstract Clinical practice guidelines (CPGs) have been shown to improve processes of care and health outcomes, but there is often a discrepancy between recommendations for care and clinical practice. We sought to explore general practitioner attitudes toward CPGs, in general and specifically for osteoarthritis (OA) with the implications for translating OA care into practice. A self-administered questionnaire was conducted in January 2013 of a sample of 228 GPs in New South Wales and South Australia. Seventy-nine GPs returned questionnaires (response rate 35%). Nearly all GPs considered that CPGs support decision making in practice (94%) and medical education (92%). Very few respondents regarded CPGs as a threat to clinical autonomy, and most recognised that individual patient circumstances must be taken into account. Shorter CPG formats were preferred over longer and more comprehensive formats, with preferences being evenly divided amongst respondents for short, 2-3 page summaries, flowcharts or algorithms and single page checklists. GPs considered accessibility to CPGs to be important, and electronic formats were popular. Familiarity and use of The Royal Australian College of General Practitioners OA Guideline was poor with most respondents either not aware of it (30%: 95% CI 27% - 41%), had never used it (19%; 95% CI 12% - 29%), or rarely used it (34%; 95% CI 25% - 45%). If CPGs are to assist with the translation of evidence into practice, they must be easily accessible and in a format that encourages use. Key words: arthritis, primary care, evidence-based medicine, decision making Summary statement What is known about the topic? • Clinical practice guidelines (CPGs) can improve processes of care and health outcomes, however, there is often a gap between evidence-based recommendations for care and clinical practice. What does this paper add? • A better understanding of GP attitudes toward CPGs helps to explain potential barriers to the uptake of evidence-based practice and provides guidance on remedial action that may lead to better health outcomes.a National Health and Medical Research Council Program Grant (Australia, no.568612

Capturing quantitative zooplankton information in the sea : Performance test of laser optical plankton counter and video plankton recorder in Calanus finmarchicus dominated summer situation

Author's accepted version (post-print).NOTICE: this is the author’s version of a work that was accepted for publication in Progress in Oceanography (2012). Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Progress in Oceanography (2012), 108. doi: http://dx.doi.org/10.1016/j.pocean.2012.10.005.We compared two optical plankton counters, the Laser Optical Plankton Counter (LOPC) and the Video Plankton Recorder (VPR) for their abundance estimates of Calanus finmarchicus during an early summer situation (June 2008) in two North Norwegian fjords. The LOPC was mounted on the VPR frame in order to sample the same body of water. The combined system of LOPC and VPR was operated by vertical profiling from the surface to 100 m of depth in several locations of the fjords representing different blooming conditions and zooplankton community structures. Data from the two instruments, as well as from CTD-F, were logged concurrently and retrieved on deck after about 15 depth profiles. Primary data were analysed according to standard routines, and choices made during sampling and analyses (sampling volume, selection of size range, transparency of particles, statistics) are discussed. Data were averaged for every 5, 10 and 15 m depth bins. The vertical profiles of C. finmarchicus CIV–CVI abundance that were obtained by LOPC and VPR, respectively, showed a striking similarity. No significant differences between profiles sampled by these two instruments were observed when data were binned into 15 m bins. At low abundances (<100 Calanus sp. L−1) profiles were significantly different when data were binned into 5- or 10-m bins. This is attributed to the small sampling volumes of the LOPC and the VPR, and to very patchy distributions of copepods, resulting in a high standard deviation between consecutive profiles. Based on the results we conclude that the time is mature for a more extensive use of optical instruments to estimate zooplankton abundances and distributions in the sea

Functioning and disability in multiple sclerosis from the patient perspective

Multiple sclerosis (MS) has a great impact on functioning and disability. The perspective of those who experience the health problem has to be taken into account to obtain an in-depth understanding of functioning and disability. The objective was to describe the areas of functioning and disability and relevant contextual factors in MS from the patient perspective. A qualitative study using focus group methodology was performed. The sample size was determined by saturation. The focus groups were digitally recorded and transcribed verbatim. The meaning condensation procedure was used for data analysis. Identified concepts were linked to International Classification of Functioning, Disability and Health (ICF) categories according to established linking rules. Six focus groups with a total of 27 participants were performed. In total, 1327 concepts were identified and linked to 106 ICF categories of the ICF components Body Functions, Activities and Participation and Environmental Factors. This qualitative study reports on the impact of MS on functioning and disability from the patient perspective. The participants in this study provided information about all physical aspects and areas of daily life affected by the disease, as well as the environmental factors influencing their lives

Kinetics of fragmentation-annihilation processes

We investigate the kinetics of systems in which particles of one species undergo binary fragmentation and pair annihilation. In the latter, nonlinear process, fragments react at collision to produce an inert species, causing loss of mass. We analyse these systems in the reaction-limited regime by solving a continuous model within the mean-field approximation. The rate of fragmentation, for a particle of mass $x$ to break into fragments of masses $y$ and $x-y$, has the form $x^{\lambda-1}$ ($\lambda>0$), and the annihilation rate is constant and independent of the masses of the reactants. We find that the asymptotic regime is characterized by the annihilation of small-mass clusters. The results are compared with those for a model with linear mass-loss (i.e.\ with a sink). We also study more complex models, in which the processes of fragmentation and annihilation are controlled by mutually-reacting catalysts. Both pair- and linear-annihilation are considered. Depending on the specific model and initial densities of the catalysts, the time-decay of the cluster-density can now be very unconventional and even non-universal. The interplay between the intervening processes and the existence of a scaling regime are determined by the asymptotic behaviour of the average-mass and of the mass-density, which may either decay indefinitely or tend to a constant value. We discuss further developments of this class of models and their potential applications.Comment: 16 pages(LaTeX), submitted to Phys. Rev.

THE ESTIMATION OF GENETIC DISTANCE BETWEEN GERMAN CATTLE BREEDS

Za budući izbor uzgoja potrebno je očuvanje genetske raznolikosti u životinja. U filogenetskim proučavanjima mikrosateliti su dokazani kao snažno sredstvo. (Bowcock et al. 1994.). Procjena genetskih udaljenosti što se temelji na učestalosti alela mikrosatelitskih markera pomoći će u procjeni veličine razlika između usko povezanih pasmina stoke. Pasmina Shorthom i Angler mogu se identificirati kao sporedne pasmine, pa je stoga razvoj programa očuvanja vrlo koristan. Prilagođenje pasmine Orginal Black Pied još nije jasno. Odredit će se dodatni markeri kako bi se povećala točnost procjene. Niti vrijednosti udaljenosti između Holsteina i mliječnog Red Pied niti slični uzgojni ciljevi čini se da nisu razuman razlog da se ove pasmine drže odijeljeno. Ovaj će rad biti od pomoći u odlučivanju o očuvanju pasmina u posebnim programima očuvanja konzervacijom in vivo i in vitro

Common European Sales Law (CESL) and Private International Law: Some Critical Remarks

This article is an updated and revised version of the contribution published by the author in XI Anuario Español de Derecho Internacional Privado, 2011, 25-61, under the title: “La Propuesta de Reglamento relativo a una normativa común de compraventa europea y el Derecho internacional privado”.La Propuesta de Reglamento del Parlamento Europeo y del Consejo relativo a una normativa común de compraventa europea de 11 de octubre de 2011 (PCESL) introduce una reglamentación material para algunas compraventas transfronterizas que no desplaza la aplicación de las normas de conflicto (en particular de las contenidas de los Reglamentos “Roma I” y “Roma II”). Al contrario, el instrumento opcional contenido en la Propuesta de Reglamento (CESL) presupone la aplicación de la ley de un Estado miembro, como lex contractus. Una vez escogida por las partes, la CESL desplaza a las normas internas cobre compraventa de la ley del Estado miembro. Esta opción del legislador comunitario plantea numerosos problemas e interrogantes acerca de las relaciones entre la CESL y las normas de Derecho internacional privado y en torno a su coexistencia con otros convenios internacionales y el propio acervo comunitario. El análisis de estas relaciones es el objeto del presente estudio, que permite concluir con una valoración negativa de la competitividad internacional de este nuevo instrumento comunitario.The Proposal for a Regulation of the European Parliament and of the Council on a Common European Sales Law of 11 October 2011 (PCESL) introduces a substantive regulation for some cross-border sales contracts that does not displace the application of conflict-of-laws rules (especially those included in “Rome I” and “Rome II” Regulations). On the contrary, the optional instrument included in the Proposal (CESL) presupposes the application of the law of a Member State as lex contractus. Once the parties have chosen the CESL, this regime prevails over the internal rules on sales contracts of the law of that Member State. The formula used by the European legislator gives rise to many concerns and questions about the relationships between the CESL and the conflict-of-laws rules and about its cohabitation with other international conventions and the European acquis itself. The analysis of these relationships is the subject of this article, which concludes with a negative assessment on the international competitiveness of the new European instrument