The Mismatch between Australian Population and General Practice Medical Workforce

Aims: To review and analyse Australian general practitioner's workforce data for the 2000 to 2010 period by comparing this to Australian population trends and to make informed recommendations about GP workforce planning. Study Design: Descriptive analysis of the available Australian government data on GP workforce and the Australian population between 2000 and 2010. Place and Duration of Study: Griffith University, Australia, between April and November 2011. Methodology: Australian GP workforce data for the 2000 to 2010 period was obtained from the Australian Department of Health and Ageing (DoHA) website and population data was obtained from the Australian Bureau of Statistics website. A descriptive analysis of workforce trends using variables of interests such as overseas trained GPs, gender, age, professional services during the 11 year period was compared to population trends data. A new GP Workforce Index ratio (GPWIR = No. of GPs <35yrs 砎o. of GPs 35yrs to 64yrs of age) was derived from the data and calculated for each year of the study period. Results: The ratio of female to male GPs has increased by 35% and the percentage of overseas graduates has increased by nearly 35% in the 11 year period, an indication that the 0.12% number of GPs as a percentage of Australian population between 2000 and 2010 was only sustained by increasing the intake of foreign trained graduates. Vocationally registered GPs have increased by 20% in same period. The GP workforce index ratio (GPWIR) decreased from 0.223 in 2000 to 0.118 in 2007; this was followed by a slight increase from 0.120 in 2008 to 0.128 in 2010. Conclusion: The impact that an increase in the number of female GPs graduating from medical schools may have on the overall number of GP services available to the Australian population requires further study, since it was noted in the literature that female GPs are more likely to work part-time than male GPs. The GPWIR may be a useful indicator for evaluating the proportion of the <35yrs old GPs as a proportion of overall GP workforce. Lower GPWIR may be associated with GP workforce shortage. GPWIR increased in the last 3 years of the study corresponding with an improvement in GP supply. In this study, the GPWIR proved to be more effective in predicting overall National GP workforce shortage trend than the DoHA GP per Population ratio of 0.71:1000 (Primarily used for regional and rural workforce shortage prediction). The Department of Health and Ageing may need to keep supporting rural and remote migration of GPs and also maintain an increase in the number of students entering medical schools.Griffith Health, School of Nursing and MidwiferyFull Tex

Transforming Assessment Feedback Design: Students’ Responses to Adaptively-Released Assessment Feedback (ARAF) Strategies

The concept of Adaptively-Released Assessment Feedback (ARAF) is relatively new and, to date, has had limited application in the university sector. This article paper looks at the applications of ARAF into the assessment of courses in three different contexts across multiple disciplines at both undergraduate and postgraduate course levels. The article paper outlines the ARAF strategies and their potential for promoting a deeper learning process by enhancing student engagement with feedback. Qualitative data from students are utilized to understand student perceptions of ARAF strategies. Students reported that ARAF increased engagement with assessment feedback and, in some cases, provoked deeper reflection and encouraged them to plan their approach to future assessment tasks. Keywords: quantitative feedback, qualitative feedback, adaptively-released assessment feedback (ARAF) strategies, assessment desig

Community pharmacists' opinions of their role in administering non-prescription medicines in an emergency

Objective: To obtain community pharmacists’ opinions of their role in administering Pharmacy (S2) and Pharmacist Only (S3) Medicines in a medical emergency. These medicines can only be sold in a pharmacy and are not available for self-selection by patients. Whilst qualified pharmacy assistants can supply S2 medicines, pharmacists must be directly involved in the supply of S3 medicines. Setting: Community pharmacies in South East Queensland, Australia. Method: A survey of 151 Gold Coast and Toowoomba community pharmacists was conducted during October 2009. Main outcome measures: Pharmacists were asked their opinions as to whether the administration of S2 and S3 medicines should fall within their scope of practice, whether they had administered S2 and S3 medicines in a medical emergency in the past and if clarification of this role was required. Results: The study achieved a 30% (n = 45) response rate and demonstrated similar results regarding whether pharmacists should administer salbutamol (22/44), adrenaline (23/42), glyceryl trinitrate (22/43) and aspirin (18/36) in a medical emergency. The majority (36/43) believed that role clarification was required. Pharmacists were more likely to administer an S3 medicine in a medical emergency when they considered potential outcomes first, had no easy access to a doctor and the patient could not administer the medicine they carried with them themselves (40/45).Conclusion: Community pharmacists have direct access to S2 and S3 medicines that could be required in the management of a variety of medical emergencies. This study demonstrates that some pharmacists have administered S2 and S3 medicines in an emergency situation. However, there are currently no clear guidelines for pharmacists when faced with a medical emergency other than to act within their professional competence. To promote patient safety through the appropriate use of S2 and S3 medicines in the event of a medical emergency, additional training of pharmacists on the administration of these readily accessible medicines is needed. Clarification of the role of pharmacists in an emergency situation is required

Plagiarism in Take-home Exams: Help-seeking, Collaboration, and Systematic Cheating

Due to the increased enrollments in Computer Science education programs, institutions have sought ways to automate and streamline parts of course assessment in order to be able to invest more time in guiding students' work. This article presents a study of plagiarism behavior in an introductory programming course, where a traditional pen-and-paper exam was replaced with multiple take-home exams. The students who took the take-home exam enabled a software plugin that recorded their programming process. During an analysis of the students' submissions, potential plagiarism cases were highlighted, and students were invited to interviews. The interviews with the candidates for plagiarism highlighted three types of plagiarism behaviors: help-seeking, collaboration, and systematic cheating. Analysis of programming process traces indicates that parts of such behavior are detectable directly from programming process data.Peer reviewe

Late-night simulation: Opinions of fourth- and fifth-year medical students at the University of the Free State, Bloemfontein, South Africa

Background. Sleep deprivation is a problem for medical students and practitioners due to long and late working hours, which may result in a decline in their performance in practising medicine. Objectives. To investigate whether educational practices require altering with regard to the time at which simulation classes are presented, or identify any other possible suggestions for improving the preparation of students for shift work in their profession as medical doctors as a potential solution to reduce sleep-deprivation-related adverse outcomes. Methods. In this quantitative cross-sectional study, an anonymous questionnaire was distributed to 111 fourth-year and 141 fifth-year medical students at the Faculty of Health Sciences, University of the Free State (UFS), Bloemfontein, South Africa, during the second half of 2018. The researchers interpreted the responses and the Department of Biostatistics, UFS, analysed the data. Results. The majority of the fourth-year (88.6%) and fifth-year (90.4%) student groups responded that late-night simulation classes between 01h00 and 04h00 would not be beneficial to their preparation for shift work. The motivation for negative responses was that it might worsen sleep deprivation due to time constraints in an already demanding course. The fourth-year (61.4%) and fifth-year (80.5%) student groups did not regard simulation as realistic and felt that late-night simulation training sessions would not prepare them better for future shift work. However, both groups believed ‘practice makes perfect’ and, as such, their confidence with procedures would improve as they practise more during simulation. Conclusion. The majority of students were negative towards the idea of late-night simulation classes, because of the effect it would have on their already full programme. Students are familiar with the effects of sleep deprivation and felt that late-night simulation classes would add pressure to their busy lives and worsen their sleep deprivation. Further investigation and practical testing would be required to conclude the impact of late-night simulation classes in preparation for shift work of medical doctors and the resultant effect on clinical performance

Can a pharmacy intervention improve the metabolic risks of mental health patients? Evaluation of a novel collaborative service

Background: The pressure on healthcare services worldwide has driven the incorporation of disease state management services within community pharmacies in developed countries. Pharmacists are recognised as the most accessible healthcare professionals, and the incorporation of these services facilitates patient care. In Australia, the opportunity to manage pharmacy patients with mental illness has been underutilised, despite the existence of service models for other chronic conditions. This paper is an independent evaluation of a novel service developed by a community pharmacy in Perth, Western Australia. The service represents collaboration between a nurse practitioner and community pharmacy staff in the management of mental health patients with metabolic risks. Methods: We applied practice service standards for Australian community pharmacies to develop an evaluation framework for this novel service. This was followed by semi -structured interviews with staff members at the study pharmacy to explore service processes and procedures. Descriptive analysis of interviews was supplemented with analysis of patients’ biometric data. All data were evaluated against the developed framework. Results: The evaluation framework comprised 13 process, 5 out comes, and 11 quality indicators. Interview data from eight staff members and biometric data from 20 community-dwelling mental health patients taking antipsychotics were evaluated against the framework. Predominantly, patients were managed by the pharmacy’s nurse practitioner, with medication management provided by pharmacists. Patients’ biometric measurements comprised weight, blood pressure, blood glucose levels, lipid profiles and management of obesity, smoking, hypertension and diabetes. Positive outcomes observed in the patient data included weight loss, smoking cessation, and improved blood pressure, blood glucose and lipid levels. Conclusions: The developed framework allowed effective evaluation of the service, and may be applicable to other pharmacy services. The metabolic clinic met key process, quality and outcomes indicators. The positive patient outcomes may assist in securing further funding

Mutations in GPAA1, Encoding a GPI Transamidase Complex Protein, Cause Developmental Delay, Epilepsy, Cerebellar Atrophy, and Osteopenia.

Approximately one in every 200 mammalian proteins is anchored to the cell membrane through a glycosylphosphatidylinositol (GPI) anchor. These proteins play important roles notably in neurological development and function. To date, more than 20 genes have been implicated in the biogenesis of GPI-anchored proteins. GPAA1 (glycosylphosphatidylinositol anchor attachment 1) is an essential component of the transamidase complex along with PIGK, PIGS, PIGT, and PIGU (phosphatidylinositol-glycan biosynthesis classes K, S, T, and U, respectively). This complex orchestrates the attachment of the GPI anchor to the C terminus of precursor proteins in the endoplasmic reticulum. Here, we report bi-allelic mutations in GPAA1 in ten individuals from five families. Using whole-exome sequencing, we identified two frameshift mutations (c.981_993del [p.Gln327Hisfs∗102] and c.920delG [p.Gly307Alafs∗11]), one intronic splicing mutation (c.1164+5C>T), and six missense mutations (c.152C>T [p.Ser51Leu], c.160_161delinsAA [p.Ala54Asn], c.527G>C [p.Trp176Ser], c.869T>C [p.Leu290Pro], c.872T>C [p.Leu291Pro], and c.1165G>C [p.Ala389Pro]). Most individuals presented with global developmental delay, hypotonia, early-onset seizures, cerebellar atrophy, and osteopenia. The splicing mutation was found to decrease GPAA1 mRNA. Moreover, flow-cytometry analysis of five available individual samples showed that several GPI-anchored proteins had decreased cell-surface abundance in leukocytes (FLAER, CD16, and CD59) or fibroblasts (CD73 and CD109). Transduction of fibroblasts with a lentivirus encoding the wild-type protein partially rescued the deficiency of GPI-anchored proteins. These findings highlight the role of the transamidase complex in the development and function of the cerebellum and the skeletal system

TRY plant trait database - enhanced coverage and open access

Plant traits-the morphological, anatomical, physiological, biochemical and phenological characteristics of plants-determine how plants respond to environmental factors, affect other trophic levels, and influence ecosystem properties and their benefits and detriments to people. Plant trait data thus represent the basis for a vast area of research spanning from evolutionary biology, community and functional ecology, to biodiversity conservation, ecosystem and landscape management, restoration, biogeography and earth system modelling. Since its foundation in 2007, the TRY database of plant traits has grown continuously. It now provides unprecedented data coverage under an open access data policy and is the main plant trait database used by the research community worldwide. Increasingly, the TRY database also supports new frontiers of trait-based plant research, including the identification of data gaps and the subsequent mobilization or measurement of new data. To support this development, in this article we evaluate the extent of the trait data compiled in TRY and analyse emerging patterns of data coverage and representativeness. Best species coverage is achieved for categorical traits-almost complete coverage for 'plant growth form'. However, most traits relevant for ecology and vegetation modelling are characterized by continuous intraspecific variation and trait-environmental relationships. These traits have to be measured on individual plants in their respective environment. Despite unprecedented data coverage, we observe a humbling lack of completeness and representativeness of these continuous traits in many aspects. We, therefore, conclude that reducing data gaps and biases in the TRY database remains a key challenge and requires a coordinated approach to data mobilization and trait measurements. This can only be achieved in collaboration with other initiatives

Some Reflections on the Proposed Revisions to the OECD Model and Commentaries, and on the Multilateral Instrument, with Respect to Fiscally Transparent Entities

This material was first published by Sweet &amp; Maxwell Limited in Angelo Nikolakakis, Stephane Austry, John Avery Jones, Philip Baker, Peter Blessing, Robert Danon, Shefali Goradia, Johann Hattingh, Koichi Inoue, Juergen Luedicke, Guglielmo Maisto, Toshio Miyatake, Kees van Raad, Richard Vann and Bertil Wiman, “Some Reflections on the Proposed Revisions to the OECD Model and Commentaries, and on the Multilateral Instrument, With Respect to Fiscally Transparent Entities”, British Tax Review, Vol. 2017, No. 3, pp. 295-373, 2017 and is reproduced by agreement with the Publishers. This article sets out some reflections of the authors on those aspects of the OECD’s October 2015 final report on Neutralising the Effects of Hybrid Mismatch Arrangements (the Hybrids Report) that relate to revisions to the OECD Model to add a specific provision on fiscally transparent entities (as a new Article 1(2)), and to build on the Commentaries already in place in this regard (the HR Proposals). It also considers the similar and related provisions contained in the multilateral instrument to implement the tax treaty related BEPS measures (the MLI) that was released on 24 November 2016. The authors conduct an extensive review of the issues and raise a number of interpretive and technical questions, as well as policy considerations. This review is set against the backdrop of an examination of similar provisions (or provisions with similar purposes) in the US Models and in various existing bilateral treaties, as well as under domestic laws, of the countries represented by the authors. The authors also provide some observations with respect to potential scope and drafting or implementation of alternatives, with a view to contributing to the ongoing international debate and reform project