Medical termination of pregnancy in general practice in Australia: A descriptive-interpretive qualitative study

© 2017 The Author(s). Background: Australian Government approval in 2012 for the use of mifepristone and misoprostol for medical termination of pregnancy (MTOP) allows general practitioners (GPs) to provide early gestation abortion in primary care settings. However, uptake of the MTOP provision by GPs appears to be low and the reasons for this have been unclear. This study investigated the provision of and referral for MTOP by GPs. Methods: We undertook descriptive-interpretive qualitative research and selected participants for diversity using a matrix. Twenty-eight semi-structured interviews and one focus group (N = 4), were conducted with 32 GPs (8 MTOP providers, 24 non MTOP providers) in New South Wales, Australia. Interviews were recorded and transcribed verbatim. A framework to examine access to abortion services was used to develop the interview questions and emergent themes identified thematically. Results: Three main themes emerged: scope of practice; MTOP demand, care and referral; and workforce needs. Many GPs saw abortion as beyond the scope of their practice (i.e. a service others provide in specialist private clinics). Some GPs had religious or moral objections; others regarded MTOP provision as complicated and difficult. While some GPs expressed interest in MTOP provision they were concerned about stigma and the impact it may have on perceptions of their practice and the views of colleagues. Despite a reported variance in demand most MTOP providers were busy but felt isolated. Difficulties in referral to a local public hospital in the case of complications or the provision of surgical abortion were noted. Conclusions: Exploring the factors which affect access to MTOP in general practice settings provides insights to assist the future planning and delivery of reproductive health services. This research identifies the need for support to increase the number of MTOP GP providers and for GPs who are currently providing MTOP. Alongside these actions provision in the public sector is required. In addition, formalised referral pathways to the public sector are required to ensure timely care in the case of complications or the provision of surgical options. Leadership and coordination across the health sector is needed to facilitate integrated abortion care particularly for rural and low income women

The Emergency Medical Services Sleep Health Study

DTNH2215C00029While fatigue and poor sleep quality affect more than than half of emergency medical services (EMS) clinicians, there is no known standard for educating and training. For this report the research team created the Fatigue Education Program for Emergency Medical Services, 10 brief education modules based on recommendations from the American College of Occupational Environmental Medicine. The primary aim of this study was to determine if providing education and training to EMS personnel on the importance of sleep health and dangers of fatigue improves indicators of sleep quality and fatigue. The researchers used a pragmatic, cluster-randomized, wait-list control, 6-month study design. The primary outcome was the Pittsburgh sleep quality index -measured sleep quality at 3- and 6-month follow-ups. Intention-to-treat analyses revealed no differences between the intervention and comparison groups in mean sleep quality scores at 3- and 6-month follow-ups. Per protocol analyses showed that the greater the number of modules viewed, compared to no viewings, the greater the improvement in sleep quality and greater the reduction in fatigue. The largest improvement in sleep quality was observed among EMS clinicians who viewed eight to 10 education modules. Given these findings, the Fatigue Education Program for Emergency Medical Services may be a useful resource for EMS administrators who aim to fulfill the 2018 evidence-based guideline recommendation of educating and training EMS workers on sleep and fatigue

Proceedings of the Sixth International Workshop on Web Caching and Content Distribution

OVERVIEW The International Web Content Caching and Distribution Workshop (WCW) is a premiere technical meeting for researchers and practitioners interested in all aspects of content caching, distribution and delivery on the Internet. The 2001 WCW meeting was held on the Boston University Campus. Building on the successes of the five previous WCW meetings, WCW01 featured a strong technical program and record participation from leading researchers and practitioners in the field. This report includes all the technical papers presented at WCW'01. Note: Proceedings of WCW'01 are published by Elsevier. Hardcopies of these proceedings can be purchased through the workshop organizers. As a service to the community, electronic copies of all WCW'01 papers are accessible through Technical Report BUCS‐TR‐2001‐017, available from the Boston University Computer Science Technical Report Archives at http://www.cs.bu.edu/techreps. [Ed.note: URL outdated. Use http://www.bu.edu/cs/research/technical-reports/ or http://hdl.handle.net/2144/1455 in this repository to access the reports.]Cisco Systems; InfoLibria; Measurement Factory Inc; Voler

Management of Amphibian Populations in Booderee National Park, South-Eastern Australia

Often land set aside for conservation becomes a multiple use area, which forces land managers to balance biodiversity values against competing needs. Booderee National Park is an important conservation reserve for a range of amphibian species in south-eastern Australia. The Park includes a number of townships, defence facilities, and recreation areas, as well as land for conservation. We examined amphibian communities in the area and related these to broad habitat features and identified potential threats to the long term viability of these populations. Two distinct assemblages occurred within the Park that could be related to broad habitat features of the breeding site (i.e., wet heath and open water wetlands). There are three potential threats to the viability of these populations: (1) inappropriate fire regimes; (2) introduced predators; and (3) infection by the chytrid fungus. While fire regimes and predators can be managed, the chytrid fungus cannot and therefore represents the primary concern for amphibians in the area

The centrality of user modeling to high recall with high precision search

The objective of search is to find documents relevant to a particular user's notion of relevance. However, relevance is often a moving target: imperfectly defined and subject to change as more documents are seen. In this paper, we report on systematic user modeling (UM) and the use of a system-internal agent (proxy) to produce a hybrid human-computer system that achieves extraordinarily high performance on mediated search tasks. We present details of our UM-approach and its four main components: (i) use case (ii) scope (iii) nuance and (iv) linguistic variability. We illustrate how these components provide a framework with which a user and a proxy co-construct a shared representation of information needs and mutual knowledge. This representation serves as the common ground through which external knowledge is shared, mediated, negotiated, synthesized and made accessible to the system. We evaluated the performance of our system on the Legacy Tobacco Documents Library, a corpus of advertising, manufacturing, marketing, sales and scientific research activities of major US tobacco companies. Independently adjudicated results from NIST's 2008 TREC legal track demonstrate that our approach to UM yields high performance on search tasks

Development of an ex vivo technique to achieve reanimation of hearts sourced from a porcine donation after circulatory death model

BACKGROUND: This study reports on the development of a novel method for achieving ex vivo reanimation of hearts from a porcine donation after circulatory death (DCD) model without the use of donor pretreatment. METHODS: Porcine hearts (n = 23) were procured 10-29 min after confirmation of asystole. All hearts underwent initial flush with AQIX RS-I solution (London, UK). A 2-h preservation period followed: group 1 hearts (n1-n11) were preserved using static cold storage, group 2 hearts (n12-n17) were preserved using oxygenated, hypothermic machine perfusion (MP), and group 3 hearts (n18-n23) were subjected to retrograde oxygen persufflation. Reperfusion was performed on a Langendorff modification of a Model 33 Functional Circulation circuit. In hearts n16-n23, a dialysis circuit was incorporated into the circuit to facilitate removal of metabolites. The experimental protocol was allowed to follow an evolutionary course, with the aim of achieving greater success with reanimation. RESULTS: In group 1 (static cold storage), 7 of the 11 hearts (63.6%) achieved reanimation on the ex vivo circuit. Two of the six hearts (33.3%) in group 2 (MP) were successfully reanimated. All the six hearts (100%) in group 3 (persufflation) were successfully reanimated. The period of sustained reanimation increased when dialysis was incorporated into the circuit with a maximum of 300 min. CONCLUSIONS: Porcine DCD hearts after 29 min of warm ischemia can be reanimated using the method described. A mechanism of reoxygenation (oxygenated MP or coronary sinus oxygen persufflation) during preservation appears mandatory for hearts from DCDs. Persufflation was associated with a higher probability of successful reanimation. Dialysis in the warm phase was useful in removing metabolites that could interfere with reanimation. The results demonstrate the potential of DCDs to counter the decline affecting heart transplantation

Douglas Shoal Remediation Project: pre-remediation monitoring report

Prepared by BMT Pty Ltd for the Great Barrier Reef Marine Park Authority. Reference: R.B23282.008.03 Pre-Remediation_Monitoring.docxThis document provides a factual report of the Douglas Shoal Pre-remediation environmental monitoring undertaken by BMT Pty Ltd for the Great Barrier Reef Marine Park Authority (GBRMPA) during spring 2019 and autumn 2020