Are the Health of the Nation's targets attainable? Postal survey of general practitioners' views

The Health of the Nation's targets were introduced by the government in 1992 as part of a strategic approach to health.1 We aimed, in 1996, to elicit the views of general practitioners on the attainability of these targets

Does Non-Audit Service Compromise Audit Quality?

This paper investigates the relationships between non-audit services, audit fee, audit hours and accounting quality. Previous studies have not provided consistent results for how simultaneous provision of audit and non-audit services by an independent auditor to a client company affects the audit quality. In addition, further studies have identified endogeneity in research method as the primary reason. Therefore, this study analyzed audit quality comprehensively using empirical analysis on data specific to Korea. This study employs research methods contrasting with existing studies in order to present a solution for the controversy related to the endogeneity from the effects of non-audit service provided by an independent auditor on audit quality. This study used audit compensation and abnormal accruals variables simultaneously, and audit time variable includes empirical data from Korean clients for comprehensive analysis. Study results found that the non-audit service significantly affects audit service quality before controlling for endogeneity. However, after controlling for endogeneity, even when the same independent auditor provides audit and non-audit services together, it did not affect the accounting quality.

The Effect Of Auditor Change On Initial Audit Fee Discount And Non-Audit Services

The purpose of this research is to verify whether non-audit services are provided without additional fees at the initial audit as a strategy to win an external audit contract, which could give the appearance of initial audit fee discount. From the results, non-audit services are provided at the initial audit, and the initial audit fee is discounted accordingly, only when the independent auditor is changed from a Big 4 accounting firm to a non-Big 4 accounting firm. However, there is no meaningful relevance in any other types of changes. Therefore, if the auditor is changed from a Big 4 accounting firm to a non-Big 4 accounting firm, non-audit services are provided without additional fees in order to win an external audit contract, and the publication of audit fees with a division between the audit service fee and the non-audit service fee may give the appearance of a discounted audit service fee

The role of parents in children’s metacognition and self-regulation during musical learning

This thesis comprises two studies which investigated the role of parents in children’s metacognition and self-regulation during musical learning. In Study 1, 40 parents took part in an initial questionnaire study exploring trends in parental support given to children during piano practice. This was followed by a second, multi-method study involving 30 child-parent dyads, which combined questionnaires and interviews with systematic analysis of observational data of children’s instrumental practice to explore children’s metacognitive and self-regulatory processes and parental support across different contexts. Findings from this thesis indicate a significant increase in children’s use of metacognition and self-regulation during practice when supervised by parents, with parental demandingness negatively correlated with children’s musical achievement. A further negative correlation was found between children’s musical achievement and their ability to verbalise their thinking. Differences in support from parents with and without previous musical experience varied depending on the method of measurement. Although no correlation was found between reported support and parents’ previous musical experience, observational measures of parental support were positively associated with parents’ previous musical experience. Indeed, comparison of findings from multiple measures indicated complex variations in results produced by different collection methods – raising important questions about what exactly is being measured. This thesis aims to shed light on the ways in which parents support their children’s metacognition and self-regulation during musical learning, and the associations between these behaviours and children’s musical achievement. Research into the ways in which parents can mediate these internal behaviours has the potential to reinvigorate the way in which we view musical learning – not as a series of outcomes, but as a continuous process of self-understanding in which parents play a vital role. This research project hopes to make an important contribution to this exciting area of musical and psychological discourse

The effect of ephedrine on intraoperative hypothermia

BACKGROUND: Prevention of intraoperative hypothermia has become a standard of operative care. Since ephedrine has a thermogenic effect and it is frequently used to treat hypotension during anesthesia, this study was designed to determine the effect of ephedrine on intraoperative hypothermia of patients who are undergoing spine surgery. METHODS: Twenty-four patients were randomly divided to receive an ephedrine (the ephedrine group, n = 12) or normal saline (the control group, n = 12) infusion for 2 h. The esophageal temperature (the core temperature), the index finger temperature (the peripheral temperature) and the hemodynamic variables such as the mean blood pressure and heart rate were measured every 15 minutes after the intubation. RESULTS: At the end of the study period, the esophageal temperature and hemodynamic variables were significantly decreased in the control group, whereas those in the ephedrine group were stably maintained. The index finger temperature was significantly lower in the ephedrine group compared to that in the control group, suggesting the prevention of core-to-peripheral redistribution of the heat as the cause of temperature maintenance. CONCLUSIONS: An intraoperative infusion of ephedrine minimized the decrease of the core temperature and it stably maintained the hemodynamic variables during spine surgery with the patient under general anesthesia.ope

Elder Chinese Martial Art Practitioners Have Higher Radial Bone Strength, Hand-Grip Strength, and Better Standing Balance Control

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Interventions to reduce suicides at suicide hotspots: a systematic review

BACKGROUND: 'Suicide hotspots' include tall structures (for example, bridges and cliffs), railway tracks, and isolated locations (for example, rural car parks) which offer direct means for suicide or seclusion that prevents intervention. METHODS: We searched Medline for studies that could inform the following question: 'What interventions are available to reduce suicides at hotspots, and are they effective?' RESULTS: There are four main approaches: (a) restricting access to means (through installation of physical barriers); (b) encouraging help-seeking (by placement of signs and telephones); (c) increasing the likelihood of intervention by a third party (through surveillance and staff training); and (d) encouraging responsible media reporting of suicide (through guidelines for journalists). There is relatively strong evidence that reducing access to means can avert suicides at hotspots without substitution effects. The evidence is weaker for the other approaches, although they show promise. CONCLUSIONS: More well-designed intervention studies are needed to strengthen this evidence base.Australian Government Department of Health and AgeingUK National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for the Southwest Peninsul

Predicting growth and curve progression in the individual patient with adolescent idiopathic scoliosis: design of a prospective longitudinal cohort study

<p>Abstract</p> <p>Background</p> <p>Scoliosis is present in 3-5% of the children in the adolescent age group, with a higher incidence in females. Treatment of adolescent idiopathic scoliosis is mainly dependent on the progression of the scoliotic curve. There is a close relationship between curve progression and rapid (spinal) growth of the patient during puberty. However, until present time no conclusive method was found for predicting the timing and magnitude of the pubertal growth spurt in total body height, or the curve progression of the idiopathic scoliosis.</p> <p>The goal of this study is to determine the predictive value of several maturity indicators that reflect growth or remaining growth potential, in order to predict timing of the peak growth velocity of total body height in the individual patient with adolescent idiopathic scoliosis. Furthermore, different parameters are evaluated for their correlation with curve progression in the individual scoliosis patient.</p> <p>Methods/design</p> <p>This prospective, longitudinal cohort study will be incorporated in the usual care of patients with adolescent idiopathic scoliosis. All new patients between 8 and 17 years with adolescent idiopathic scoliosis (Cobb angle >10 degrees) visiting the outpatient clinic of the University Medical Center Groningen are included in this study. Follow up will take place every 6 months. The present study will use a new ultra-low dose X-ray system which can make total body X-rays. Several maturity indicators are evaluated like different body length dimensions, secondary sexual characteristics, skeletal age in hand and wrist, skeletal age in the elbow, the Risser sign, the status of the triradiate cartilage, and EMG ratios of the paraspinal muscle activity.</p> <p>Correlations of all dimensions will be calculated in relationship to the timing of the pubertal growth spurt, and to the progression of the scoliotic curve. An algorithm will be made for the optimal treatment strategy in the individual patient with adolescent idiopathic scoliosis.</p> <p>Discussion</p> <p>This study will determine the value of many maturity indicators and will be useful as well for other clinicians treating children with disorders of growth. Since not all clinicians have access to the presented new 3D X-ray system or have the time to make EMG's, for example, all indicators will be correlated to the timing of the peak growth velocity of total body height and curve progression in idiopathic scoliosis. Therefore each clinician can chose which indicators can be used best in their practice.</p> <p>Trial registration number</p> <p>NTR2048</p

MYCN-targeting miRNAs are predominantly downregulated during MYCN-driven neuroblastoma tumor formation

MYCN is a transcription factor that plays key roles in both normal development and cancer. In neuroblastoma, MYCN acts as a major oncogenic driver through pleiotropic effects controlled by multiple protein encoding genes as well as microRNAs (miRNAs). MYCN activity is tightly regulated at the level of transcription and protein stability through various mechanisms. Like most genes, MYCN is further controlled by miRNAs, but the full complement of all miRNAs implicated in this process has not been determined through an unbiased approach. To elucidate the role of miRNAs in regulation of MYCN, we thus explored the MYCN-miRNA interactome to establish miRNAs controlling MYCN expression levels. We combined results from an unbiased and genome-wide high-throughput miRNA target reporter screen with miRNA and mRNA expression data from patients and a murine neuroblastoma progression model. We identified 29 miRNAs targeting MYCN, of which 12 miRNAs are inversely correlated with MYCN expression or activity in neuroblastoma tumor tissue. The majority of MYCN-targeting miRNAs in neuroblastoma showed a decrease in expression during murine MYCN-driven neuroblastoma tumor development. Therefore, we provide evidence that MYCN-targeting miRNAs are preferentially downregulated in MYCN-driven neuroblastoma, suggesting that MYCN negatively controls the expression of these miRNAs, to safeguard its expression