Paediatrics: tackling the common problems

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.Richard T L Couper, Richard L Henry and Michael Sout

The use of segmented regression in analysing interrupted time series studies : an example in pre-hospital ambulance care

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A questionnaire elicitation of surgeons' belief about learning within a surgical trial

PMID: 23145113 [PubMed - indexed for MEDLINE] PMCID: PMC3493499 Free PMC ArticlePeer reviewedPublisher PD

Using the theory of planned behaviour as a process evaluation tool in randomised trials of knowledge translation strategies : A case study from UK primary care

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Does physical activity counselling enhance the effects of a pedometer-based intervention over the long-term : 12-month findings from the Walking for Wellbeing in the West study

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Implementing telephone triage in general practice: a process evaluation of a cluster randomised controlled trial

Background: Telephone triage represents one strategy to manage demand for face-to-face GP appointments in primary care. However, limited evidence exists of the challenges GP practices face in implementing telephone triage. We conducted a qualitative process evaluation alongside a UK-based cluster randomised trial (ESTEEM) which compared the impact of GP-led and nurse-led telephone triage with usual care on primary care workload, cost, patient experience, and safety for patients requesting a same-day GP consultation. The aim of the process study was to provide insights into the observed effects of the ESTEEM trial from the perspectives of staff and patients, and to specify the circumstances under which triage is likely to be successfully implemented. Here we report perspectives of staff. Methods: The intervention comprised implementation of either GP-led or nurse-led telephone triage for a period of 2-3 months. A qualitative evaluation was conducted using staff interviews recruited from eight general practices (4 GP triage, 4 Nurse triage) in the UK, implementing triage as part of the ESTEEM trial. Qualitative interviews were undertaken with 44 staff members in GP triage and nurse triage practices (16 GPs, 8 nurses, 7 practice managers, 13 administrative staff). Results: Staff reported diverse experiences and perceptions regarding the implementation of telephone triage, its effects on workload, and on the benefits of triage. Such diversity were explained by the different ways triage was organised, the staffing models used to support triage, how the introduction of triage was communicated across practice staff, and by how staff roles were reconfigured as a result of implementing triage. Conclusion: The findings from the process evaluation offer insight into the range of ways GP practices participating in ESTEEM implemented telephone triage, and the circumstances under which telephone triage can be successfully implemented beyond the context of a clinical trial. Staff experiences and perceptions of telephone triage are shaped by the way practices communicate with staff, prepare for and sustain the changes required to implement triage effectively, as well as by existing practice culture, and staff and patient behaviour arising in response to the changes made. Trial registration: Current Controlled Trials ISRCTN20687662. Registered 28 May 2009

Cosmological vacuum selection and metastable susy breaking

We study gauge mediation in a wide class of O'Raifeartaigh type models where supersymmetry breaking metastable vacuum is created by gravity and/or quantum corrections. We examine their thermal evolution in the early universe and the conditions under which the susy breaking vacuum can be selected. It is demonstrated that thermalization typically makes the metastable supersymmetry breaking cosmologically disfavoured but this is not always the case. Initial conditions with the spurion displaced from the symmetric thermal minimum and a small coupling to the messenger sector can result in the realization of the susy breaking vacuum even if the reheating temperature is high. We show that this can be achieved without jeopardizing the low energy phenomenology. In addition, we have found that deforming the models by a supersymmetric mass term for messengers in such a way that the susy breaking minimum and the susy preserving minima are all far away from the origin does not change the conclusions. The basic observations are expected to hold also in the case of models with an anomalous U(1) group.Comment: 28 pages, 4 figures, plain Latex, journal versio

The Association of HIV Counseling and Testing with HIV Risk Behaviors in a Random Population-based Survey in Kisumu, Kenya

HIV testing has been promoted as a key HIV prevention strategy in low-resource settings, despite studies showing variable impact on risk behavior. We sought to examine rates of HIV testing and the association between testing and sexual risk behaviors in Kisumu, Kenya. Participants were interviewed about HIV testing and sexual risk behaviors. They then underwent HIV serologic testing. We found that 47% of women and 36% of men reported prior testing. Two-thirds of participants who tested HIV-positive in this study reported no prior HIV test. Women who had undergone recent testing were less likely to report high-risk behaviors than women who had never been tested; this was not seen among men. Although rates of HIV testing were higher than seen in previous studies, the majority of HIV-infected people were unaware of their status. Efforts should be made to increase HIV testing among this population

(De)Constructing a Natural and Flavorful Supersymmetric Standard Model

Using the framework of deconstruction, we construct simple, weakly-coupled supersymmetric models that explain the Standard Model flavor hierarchy and produce a flavorful soft spectrum compatible with precision limits. Electroweak symmetry breaking is fully natural; the mu-term is dynamically generated with no B mu-problem and the Higgs mass is easily raised above LEP limits without reliance on large radiative corrections. These models possess the distinctive spectrum of superpartners characteristic of "effective supersymmetry": the third generation superpartners tend to be light, while the rest of the scalars are heavy.Comment: 36 pages, 4 figures ; v2: references added, expanded discussion of FCNC

Group interventions to improve health outcomes : a framework for their design and delivery

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