Building service capacity within a Regional District Mental Health Service: recommendations from an indigenous mental health symposium

[Abstract]: In response to recent developments within the mental health services of south-east Queensland, the Toowoomba District Mental Health Service (TDMHS) has developed a Model of Service Delivery, which outlines the range of services provided for consumers across their lifespan. Indigenous consumers of the TDMHS come from a wide area of communities in the surrounding shires (Rural, remote and metropolitan areas (RRMA) 4-7). It was recognised by the service that Indigenous mental health consumers have unique needs and, because of these needs, this area of service delivery required greater attention and further development. In December 2004, a symposium was organised by the service to bring together a range of speakers and delegates working in the area of Indigenous mental health to discuss issues and work towards developing strategies to enable the service to better meet the needs of Indigenous consumers in this region of south-east Queensland. Issues: The symposium program consisted of keynote speakers and invited papers and culminated with an afternoon workshop that collated the symposium’s main issues and themes around building service capacity for Indigenous mental health consumers. The objective of the workshop was ‘Identifying ways to meet Indigenous mental health needs’. This workshop gave the delegates a chance to reflect, discuss and brainstorm the major issues of concern relating to this question. A group facilitator guided the discussion and organised the delegates into groups to evaluate, debate and propose recommendations for each of the major issues that emerged. Lessons learned: The feedback and discussion arising from the workshop is presented. Sixteen major themes emerged from the workshop. Seven of these were voted by the participants as being dominant and in greatest need of discussion: (1) communication; (2) cultural respect; (3) culturally appropriate clinical tools; (4) supportive management; (5) patient compliance; (6) career structure; and (7) empowerment. These seven themes are discussed and recommendations arising from the workshop are noted

Federal government relief programs for grain farmers: rewards for the late adjusters?

Non-Peer ReviewedThe Canadian Federal Government has introduced several major ad hoc relief programs for prairie farmers in the last fifty years, in response to various agricultural crises. Each of these programs has rewarded late adjusters – farmers who contributed to the crises by not responding appropriately to market or environmental conditions. Early adjusters who quickly and innovatively responded have been treated indifferently or penalized by the programs. The 1941 Wheat Acreage Reduction (WAR) program and 1970 Lower Inventory for Tomorrow (LIFT) favoured farmers who grew large acreages of wheat in the preceding years despite high levels of Canadian and world wheat stocks. Farmers who had cut production or diversified received less program money than the late adjusters. The Special Canadian Grains Program (SCGP) of 1986, introduced to offset low world prices in traditional crops, made no payments to special crop producers in its first year. Producers who cultivated below average quality land in a township or who planted traditional rotations regardless of, sometimes in spite of, climatic conditions in 1988 received much of the benefit of the Canadian Crop Drought Assistance Program (CCDAP). The 1989 Permanent Cover Program of the Canada-Saskatchewan Agreement on Soil Conservation will reward, at least in part, late adjusters who brought marginal land under cultivation, some as recently as July 1987, without regard for environmental consequences. Throughout the last fifty years, the delivery quota system, based on the number of acres farmed, has encouraged extensive farming techniques and the cultivation of marginal land. Farmers who practiced annual cultivation of export crops may have maximized short run economic returns given the combined economic and policy signals which were received. Farmers who have tried to farm according to the best long-term agronomic practices have not been rewarded through policy initiatives. Ad hoc programs which have tried to move producers away from traditional prairie crops and cultivation methods, especially wheat production, often have been poorly designed, underfunded and limited in scope. Fundamental federal government policies for Prairie agriculture, including the Homestead Act, the Land Survey, and the Crow Rate/Western Grain Transportation Act (WGTA) have consistently pushed Prairie land use in a single direction, encouraging annual cultivation and the production of grain, especially wheat, for export at the expense of most other types of agricultural production. A precarious cyclical economy has been one result, especially in Saskatchewan. Deterioration of a significant portion of the land base has been another. The provincial land assessment and property taxation system may have institutionalized this land degradation. The "Wheat is King" tradition is still alive and well on the prairies and in the minds of policy planners. Wheat will remain a major crop. However, governments which are serious about diversification in Prairie agriculture must begin to reward early adjusters – those who innovate and respond appropriately to markets and the physical environment. Federal Government legislation for the prairie region should be enabling, not disabling legislation

Availability of difficult airway equipment to rural anaesthetists in Queensland, Australia

Introduction: Since 1990 several airway devices have become available to assist in difficult intubation. Multiple surveys have assessed difficult airway equipment availability in international anaesthetic departments and emergency departments. The practice of GP anaesthetists is unique in both its multidisciplinary nature and geographical isolation. Objectives: General practitioners performing general anaesthesia in rural and remote Queensland, Australia were surveyed to assess their access to difficult airway equipment and whether this was related to the remoteness of their location or attendance at continuing professional development activities. Methods: Design: survey. Setting: proceduralists performing general anaesthesia in hospitals categorised as Rural, Remote and Metropolitan Area (RRMA) classification 4 to 7 inclusive were surveyed. Outcome measure: data collected included demographic information, availability of airway management equipment, and attendance at continuing professional development activities. The received data was entered into a Microsoft Excel spreadsheet and analysed in Statistical Package for Social Sciences (SPSS Inc; Chicago, IL, USA) using the frequencies and crosstabs functions. The Fisher’s exact test was used. A p-value of less than 0.10 was considered noteworthy and a p-value of less than 0.05 was considered to be significant. A statistical comparison was made between the known demographics of the target population and the survey responders. The known demographics were derived from the Health Workforce Queensland database and included age, gender, practice location and practitioner type. Results: Seventy-nine surveys were distributed and 35 returned (response rate 44%). This represented 21 hospitals. There was no statistical difference between the target population and the survey responders in terms of age and gender. There was no statistical difference in terms of practice location, although the small percentage responding from RRMA 6 was notable. There was a statistically significant difference between the groups in terms of practitioner type. Hospital-based practitioners were relatively under-represented in the responder group. Eighty-two per cent of practitioners felt they had access to appropriate equipment and this was not significantly related the remoteness of their location. There was wide variation in available equipment. Simple adjuncts such as the bougie and stylet were not universally available but cricothyroidotomy sets were more common. Practitioners in the more remote locations were less likely to have attended an educational activity such as conference, workshop or skills laboratory (p=0.05). Conclusions: We suggest standardisation of difficult airway equipment for rural practitioners. This could be supported by increased availability of airway management workshops in remote areas. Such an intervention would be in line with other initiatives to standardise medical equipment in rural and remote Queensland hospitals. Familiarity with infrequently used equipment may assist practitioners and their locums. Standardisation of equipment and practice is a recognised method of improving patient safety

Vortex phases and glassy dynamics in the highly anisotropic superconductor HgBa2_{2}CuO4+δ_{4+δ}

We present an extensive study of vortex dynamics in a high-quality single crystal of HgBa$_{2}$CuO$_{4+δ}$, a highly anisotropic superconductor that is a model system for studying the effects of anisotropy. From magnetization M measurements over a wide range of temperatures T and fields H, we construct a detailed vortex phase diagram. We find that the temperature-dependent vortex penetration field H$_{p}$(T), second magnetization peak H$_{smp}$(T), and irreversibility field H$_{irr}$(T) all decay exponentially at low temperatures and exhibit an abrupt change in behavior at high temperatures T/Tc >~ 0.5. By measuring the rates of thermally activated vortex motion (creep) S(T, H) = |dlnM(T, H)/dlnt|, we reveal glassy behavior involving collective creep of bundles of 2D pancake vortices as well as temperature- and time-tuned crossovers from elastic (collective) dynamics to plastic flow. Based on the creep results, we show that the second magnetization peak coincides with the elastic-to-plastic crossover at low T, yet the mechanism changes at higher temperatures

Structural role of the tyrosine residues of cytochrome c

The tertiary structures of horse, tuna, Neurospora crassa, horse [Hse65,Leu67]- and horse [Hse65,Leu74]-cytochromes c were studied with high-resolution 1H n.m.r. spectroscopy. The amino acid sequences of these proteins differ at position 46, which is occupied by phenylalanine in the horse proteins but by tyrosine in the remaining two, and at positions 67, 74 and 97, which are all occupied by tyrosine residues in horse and tuna cytochrome c but in the other proteins are substituted by phenylalanine or leucine, though there is only one such substitution per protein. The various aromatic-amino-acid substitutions do not seriously affect the protein structure

A Case of Emmonsiosis in an HIV-Infected Child

Opportunistic fungal infections can cause significant morbidity and mortality in immunocompromised patients. We describe a paediatric case of an unusual disseminated fungal infection. A three-year-old HIV-infected child with severe immunosuppression (CD4+ T-cell count 12 × 106/L) was admitted to hospital with pneumonia, gastroenteritis and herpes gingivostomatitis. Despite antibacterial and antiviral therapy, he experienced high fevers and developed an erythematous maculopapular rash and abdominal tenderness. The child’s condition progressively worsened during the admission. A thermally dimorphic fungus was cultured from bone marrow and identified as an Emmonsia species on DNA sequencing. The patient made a good recovery on amphotericin B deoxycholate and antiretroviral therapy. Itraconazole was continued for a minimum of 12 months, allowing for immune reconstitution to occur. This case is the first documented description of disseminated disease caused by a novel Emmonsia species in an HIV-infected child in South Africa

The p factor: genetic analyses support a general dimension of psychopathology in childhood and adolescence

Background: Diverse behaviour problems in childhood correlate phenotypically, suggesting a general dimension of psychopathology that has been called the p factor. The shared genetic architecture between childhood psychopathology traits also supports a genetic p. This study systematically investigates the manifestation of this common dimension across self‐, parent‐ and teacher‐rated measures in childhood and adolescence. / Methods: The sample included 7,026 twin pairs from the Twins Early Development Study (TEDS). First, we employed multivariate twin models to estimate common genetic and environmental influences on p based on diverse measures of behaviour problems rated by children, parents and teachers at ages 7, 9, 12 and 16 (depressive traits, emotional problems, peer problems, autism traits, hyperactivity, antisocial behaviour, conduct problems and psychopathic tendencies). Second, to assess the stability of genetic and environmental influences on p across time, we conducted longitudinal twin modelling of the first phenotypic principal components of childhood psychopathological measures across each of the four ages. Third, we created a genetic p factor in 7,026 unrelated genotyped individuals based on eight polygenic scores for psychiatric disorders to estimate how a general polygenic predisposition to mostly adult psychiatric disorders relates to childhood p. / Results: Behaviour problems were consistently correlated phenotypically and genetically across ages and raters. The p factor is substantially heritable (50%–60%) and manifests consistently across diverse ages and raters. However, residual variation in the common factor models indicates unique contributions as well. Genetic correlations of p components across childhood and adolescence suggest stability over time (49%–78%). A polygenic general psychopathology factor derived from studies of psychiatric disorders consistently predicted a general phenotypic p factor across development (0.3%–0.9%). / Conclusions: Diverse forms of psychopathology generally load on a common p factor, which is highly heritable. There are substantial genetic influences on the stability of p across childhood. Our analyses indicate genetic overlap between general risk for psychiatric disorders in adulthood and p in childhood, even as young as age 7. The p factor has far‐reaching implications for genomic research and, eventually, for diagnosis and treatment of behaviour problems.