Tomorrow's Doctors: Review of The Australian Medical Workforce Advisory Committee (AMWAC)

The aim of this Review, prepared under the auspices of the Australian Health Ministers' Advisory Council, is to 1. Assess AMWAC's performance to date against its original terms of reference and assess to what extent have expectations been achieved? 2. Assess and make relevant recommendations on future national medical workforce planning needs, taking account of the relationship between the medical workforce and other health professionals and support staff, and AHMAC's decision to establish the Australian Health Workforce Advisory Committee (AHWAC); and the relationship between workforce and broader health systems issues. 3. Assess and make relevant recommendations on the suitability of AMWAC - including its structure and methodology - for meeting future medical workforce planning needs, taking account of access to and utilisation of evidence-based data; need for independence and access to broadly sourced advice; international experiences; and current issues, including the changing medical workforce; the implications of the application of the Trade Practices Act 1974 and competition policy; and corporatisation of medical practice. 4. Consider and recommend on appropriate financial commitment by AHMAC to medical workforce planning

Splendide Mendax: False Label Claims about High and Rising Alcohol Content of Wine

Many economists and others are interested in the phenomenon of rising alcohol content of wine and its potential causes. Has the alcohol content of wine risen—and if so, by how much, where, and when? What roles have been played by climate change and other environmental factors compared with evolving consumer preferences and expert ratings? In this paper we explore these questions using international evidence, combining time-series data on the alcohol content of wine from a large number of countries that experienced different patterns of climate change and influences of policy and demand shifts. We also examine the relationship between the actual alcohol content of wine and the alcohol content stated on the label. The systematic patterns here suggest that rising alcohol content of wine may be a nuisance by-product of producer responses to perceived market preferences for wines having riper, more-intense flavors, possibly in conjunction with evolving climate.wine grapes, alcohol percentage, climate change, labeling errors, Agricultural and Food Policy, Crop Production/Industries, Demand and Price Analysis, Food Consumption/Nutrition/Food Safety, Marketing,

A novel COL4A1 frameshift mutation in familial kidney disease: the importance of the C-terminal NC1 domain of type IV collagen

BACKGROUND: Hereditary microscopic haematuria often segregates with mutations of COL4A3, COL4A4 or COL4A5 but in half of families a gene is not identified. We investigated a Cypriot family with autosomal dominant microscopic haematuria with renal failure and kidney cysts. METHODS: We used genome-wide linkage analysis, whole exome sequencing and cosegregation analyses. RESULTS: We identified a novel frameshift mutation, c.4611_4612insG:p.T1537fs, in exon 49 of COL4A1. This mutation predicts truncation of the protein with disruption of the C-terminal part of the NC1 domain. We confirmed its presence in 20 family members, 17 with confirmed haematuria, 5 of whom also had stage 4 or 5 chronic kidney disease. Eleven family members exhibited kidney cysts (55% of those with the mutation), but muscle cramps or cerebral aneurysms were not observed and serum creatine kinase was normal in all individuals tested. CONCLUSIONS: Missense mutations of COL4A1 that encode the CB3 [IV] segment of the triple helical domain (exons 24 and 25) are associated with HANAC syndrome (hereditary angiopathy, nephropathy, aneurysms and cramps). Missense mutations of COL4A1 that disrupt the NC1 domain are associated with antenatal cerebral haemorrhage and porencephaly, but not kidney disease. Our findings extend the spectrum of COL4A1 mutations linked with renal disease and demonstrate that the highly conserved C-terminal part of the NC1 domain of the α1 chain of type IV collagen is important in the integrity of glomerular basement membrane in humans

Determinants of willingness to pay for hip and knee joint replacement surgery for osteoarthritis

Objectives. To determine whether patients with osteoarthritis (OA) would be willing to pay for joint replacement and whether patient characteristics or health outcomes, including pain, physical function and health-related quality of life, were related to willingness to pay (WTP). Methods. Patients who had undergone primary total hip replacement (THR) or total knee replacement (TKR) for OA completed a disease-specific questionnaire (Western Ontario and McMaster: WOMAC index), a generic measure of health status (Medical Outcome Study Short Form-36: SF-36) and an Evaluation Questionnaire to measure WTP and satisfaction with the replacement. Results. Responses were obtained from 109 (77%) THR patients and 129 (72%) TKR patients. Mean age of respondents was 67 yr for THR (47% female) and 73 yr for TKR (60% female). Overall, 85% of patients responded to the WTP question. Of the THR patients, 71% were willing to pay something, 11% were not willing to pay anything and 18% did not answer the question. For TKR patients these figures were 70, 16 and 14% respectively. However, of those who responded to the WTP question, only 25% of the THR patients and 18% of the TKR patients indicated they would be willing to pay the actual current average cost of the operation in Australia (≥ A$15 000). A lower postoperative pain score (as measured by the WOMAC index) was a significant predictor of WTP for both THR and TKR patients. Income also significantly predicted WTP in THR patients but not in TKR patients. The other significant predictors for TKR patients were older age, having private health insurance and willingness to recommend joint replacement to others. Conclusions. Willingness to pay was a measure that was understandable and acceptable to patients, most of whom were willing to pay something. There was a high correlation between WTP, good health outcomes and patient satisfaction, pain relief being the dominant determinant

Outcomes after hip or knee replacement surgery for osteoarthritis: A prospective cohort study comparing patients quality of life before and after surgery with age-related population norms

Objective: To compare the health-related quality of life of people with osteoarthritis before and after primary total hip and knee replacement surgery with that of the general Australian population. Design: A prospective cohort study. Setting: Three Sydney hospitals, public and private. Participants: Patients with osteoarthritis undergoing primary total hip (n = 59) and knee (n = 92) joint replacement surgery. Main outcome measure: Medical Outcomes Study Short Form (SF-36) scores before and 12 months after joint replacement surgery (compared with population norms). Results: Patients in each age group showed a significant improvement in health-related quality of life after joint replacement surgery in most scales of the SF-36, particularly physical function, role physical and bodily pain. SF-36 scores for the 42 hip-replacement patients aged 55-74 years improved to equal or exceed the population norm on all scales. SF-36 scores of the 52 knee replacement patients aged 55-74 years improved, but physical function and bodily pain scores remained significantly worse than the population norm. SF-36 scores for both hip (n = 17) and knee (n= 40) replacement patients aged 75 years and over improved significantly, becoming similar to population norms for this age group. Conclusions: Total hip or knee replacement for osteoarthritis significantly improves patient health and well-being at 12 months after surgery. Age alone should not be a barrier to surgery

Attachment and conduct problems: Using the child attachment interview to examine the relationship in middle childhood and early adolescence.

This review investigates the role of attachment security in the development of later externalizing behaviour problems. 33 studies were identified which have examined this relationship and these are discussed in terms of their key findings. The majority of these studies broadly support the idea that attachment insecurity and behaviour problems are linked. Differences in the findings across studies are discussed with consideration of the level of risk of the sample, gender of the children within the sample, type of measurement of behaviour problems, specific attachment classifications and the interaction of attachment with other variables. Future research investigating the nature of the interaction of attachment with other variables, particularly environmental risk, is suggested, as is further research into the mechanisms by which attachment influences future behaviour and the role of internal working models

A genealogy of hacking

Hacking is now a widely discussed and known phenomenon, but remains difficult to define and empirically identify because it has come to refer to many different, sometimes incompatible, material practices. This paper proposes genealogy as a framework for understanding hacking by briefly revisiting Foucault’s concept of genealogy and interpreting its perspectival stance through the feminist materialist concept of the situated observer. Using genealogy as a theoretical frame a history of hacking will be proposed in four phases. The first phase is the ‘pre-history’ of hacking in which four core practices were developed. The second phase is the ‘golden age of cracking’ in which hacking becomes a self-conscious identity and community and is for many identified with breaking into computers, even while non-cracking practices such as free software mature. The third phase sees hacking divide into a number of new practices even while old practices continue, including the rise of serious cybercrime, hacktivism, the division of Open Source and Free Software and hacking as an ethic of business and work. The final phase sees broad consciousness of state-sponsored hacking, the re-rise of hardware hacking in maker labs and hack spaces and the diffusion of hacking into a broad ‘clever’ practice. In conclusion it will be argued that hacking consists across all the practices surveyed of an interrogation of the rationality of information techno-cultures enacted by each hacker practice situating itself within a particular techno-culture and then using that techno-culture to change itself, both in changing potential actions that can be taken and changing the nature of the techno-culture itself

Demostración de resultado económico: percepción del comando da aeronáutica de Brasil

No ano de 2010, uma alteração no quadro normativo brasileiro introduziu a Demonstração do Resultado Econômico (DRE) para o setor público, que busca comparar custos internos de produção com valores de mercado, segundo o conceito de custo de oportunidade. Este estudo procura analisar as possíveis respostas estratégicas dos gestores , buscando perceber se a cultura contábil existente no País permite a aceitação do novo instrumento. Por meio das percepções dos agentes públicos do Comando da Aeronáutica (Comaer), no Brasil, conclui-se que a resposta estratégica dos entrevistados tende para a atitude de aceitação da nova rotina, demonstrando traços de menor conservadorismo e maior interesse pela evidenciação de resultados.In 2010, a change in the Brazilian accounting regulatory framework introduced the Demonstração do Resultado Econômico (DRE) [Economic Income Statement] for the public sector, which seeks to compare the internal costs of production to market values, according to the concept of opportunity cost. This study aims to analyse the possible strategic responses of managers and tries to understand if the existing accounting culture in Brazil facilitates the introduction of the new statement. By means of perceptions of officials of the Aeronautical Command (Comaer), in Brazil, it is possible to conclude that the strategic response of respondents is closer to acceptance of the new routine, showing traces of less conservatism and greater interest for displaying results.En el año 2010, una modificación del cuadro normativo brasileño introdujo la Demostración del Resultado Económico (DRE) para el sector público, que busca comparar los costos internos de producción con los valores del mercado, según el concepto de costo de oportunidad. Este estudio tiene como objetivo analizar las posibles respuestas estratégicas de los gestores, con el fin de percibir si la cultura contable existente en el país permite la aceptación del nuevo instrumento. Por medio de las percepciones de los agentes públicos del Comando da Aeronáutica (Comaer), en Brasil, se concluyó que la respuesta estratégica de los entrevistados tiende a aceptar la nueva rutina, mostrando rasgos de menos conservadurismo y más interés por la manifestación de resultados.Fundação para a Ciência e a Tecnologia (FCT

Examining mindfulness and its relation to self-differentiation and alexithymia

Published online first in 10 July 2013Research supports the association between mindfulness, emotion regulation, stress reduction, and interpersonal/relational wellness. The present study evaluated the potential effect of mindfulness on some indicators of psychological imbalance such as low self-differentiation and alexithymia. In this cross-sectional study, a sample of 168 undergraduates (72 % women) completed measures of perceived mindfulness (CAMS-R and PHLMS), self-differentiation (SIPI), and alexithymia (TAS-20). Results revealed positive correlations between the different dimensions of mindfulness and negative correlations between those dimensions, selfdifferentiation, and alexithymia. The dimensions of quality of mindfulness and acceptance were mediators in the relationship between self-differentiation and alexithymia. A nonsignificant interaction between gender and alexithymia was found. All mindfulness dimensions, but self-differentiation, contributed to explain the allocation of the non-alexithymic group. These results indicate that mindfulness seems to be a construct with great therapeutic and research potential at different levels, suggesting that some aspects of mindfulness seem to promote a better self-differentiation and prevent alexithymia