Carers\u27 preferences for the delivery of therapy services for people with disability in rural Australia: Evidence from a discrete choice experiment

Background: The implementation of the Australian National Disability Insurance Scheme (NDIS) is expected to generate a responsive, person-centred system that will empower people with disability to choose the services and support they receive. However little attention has been paid to examine how users of the NDIS will choose and spend their individual budgets. This study aimed to determine quantitatively the relative importance that carers of people with a disability living in rural Australia place on different therapy service delivery characteristics. Methods: A stated preference discrete choice experiment (DCE) was incorporated into a survey of carers of people with disability living in rural Australia. Carers chose between therapy delivery services differing in attributes such as travel time to receive therapy, sector providing the service (i.e. Government, not-for-profit, private), out-of-pocket costs, person who delivers the therapy (therapist or other staff) and waiting time. Results: A total of 133 carers completed the DCE. The majority of respondents cared for a child with a disability (84%), the average age of the person they cared for was 17 years (SD 14.25). Participants expressed strong preferences for a short waiting time (0-3 months) to receive therapy services; services delivered by a therapist, no out of pocket cost and travelling up to 4 hours to receive a therapy session (p Conclusion: Carers of people with a disability in rural Australia exhibited strongest preferences for short waiting times (0-3 months). Therapy services that are delivered by therapy assistants or support workers will require careful introduction to achieve uptake and acceptability

Should I stay or should I go? Exploring the job preferences of allied health professionals working with people with disability in rural Australia

Introduction: The uneven distribution of allied health professionals (AHPs) in rural and remote Australia and other countries is well documented. In Australia, like elsewhere, service delivery to rural and remote communities is complicated because relatively small numbers of clients are dispersed over large geographic areas. This uneven distribution of AHPs impacts significantly on the provision of services particularly in areas of special need such as mental health, aged care and disability services. Objective: This study aimed to determine the relative importance that AHPs (physiotherapists, occupational therapists, speech pathologists and psychologists – “therapists”) living in a rural area of Australia and working with people with disability, place on different job characteristics and how these may affect their retention. Methods: A cross-sectional survey was conducted using an online questionnaire distributed to AHPs working with people with disability in a rural area of Australia over a 3-month period. Information was sought about various aspects of the AHPs’ current job, and their workforce preferences were explored using a best–worst scaling discrete choice experiment (BWSDCE). Conditional logistic and latent class regression models were used to determine AHPs’ relative preferences for six different job attributes. Results: One hundred ninety-nine AHPs completed the survey; response rate was 51 %. Of those, 165 completed the BWSDCE task. For this group of AHPs, “high autonomy of practice” is the most valued attribute level, followed by “travel BWSDCE arrangements: one or less nights away per month”, “travel arrangements: two or three nights away per month” and “adequate access to professional development”. On the other hand, the least valued attribute levels were “travel arrangements: four or more nights per month”, “limited autonomy of practice” and “minimal access to professional development”. Except for “some job flexibility”, all other attributes had a statistical influence on AHPs’ job preference. Preferences differed according to age, marital status and having dependent children. Conclusions: This study allowed the identification of factors that contribute to AHPs’ employment decisions about staying and working in a rural area. This information can improve job designs in rural areas to increase retention

Observables in the Decays of B to Two Vector Mesons

In general there are nine observables in the decay of a B meson to two vector mesons defined in terms of polarization correlations of these mesons. Only six of these can be detected via the subsequent decay angular distributions because of parity conservation in those decays. The remaining three require the measurement of the spin polarization of one of the decay products.Comment: 12 pages, no figur

Formation of Random Dark Envelope Solitons from Incoherent Waves

This letter reports experimental results on a new type of soliton: the random temporal dark soliton. One excites an incoherent large-amplitude propagating spin-wave packet in a ferromagnetic film strip with a repulsive, instantaneous nonlinearity. One then observes the random formation of dark solitons from this wave packet. The solitons appear randomly in time and in position relative to the entire wave packet. They can be gray or black. For wide and/or very strong spin-wave packets, one also observes multiple dark solitons. In spite of the randomness of the initial wave packets and the random formation processes, the solitons show signatures that are found for conventional coherent dark solitons.Comment: 10 pages, 4 figures, double-spaced preprint forma

Effects of augmented exercise therapy time after stroke: a meta-analysis

<p><b>Background and Purpose:</b> To present a systematic review of studies that addresses the effects of intensity of augmented exercise therapy time (AETT) on activities of daily living (ADL), walking, and dexterity in patients with stroke.</p> <p><b>Summary of Review:</b> A database of articles published from 1966 to November 2003 was compiled from MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, PEDro, DARE, and PiCarta using combinations of the following key words: stroke, cerebrovascular disorders, physical therapy, physiotherapy, occupational therapy, exercise therapy, rehabilitation, intensity, dose–response relationship, effectiveness, and randomized controlled trial. References presented in relevant publications were examined as well as abstracts in proceedings. Studies that satisfied the following selection criteria were included: (1) patients had a diagnosis of stroke; (2) effects of intensity of exercise training were investigated; and (3) design of the study was a randomized controlled trial (RCT). For each outcome measure, the estimated effect size (ES) and the summary effect size (SES) expressed in standard deviation units (SDU) were calculated for ADL, walking speed, and dexterity using fixed and random effect models. Correlation coefficients were calculated between observed individual effect sizes on ADL of each study, additional time spent on exercise training, and methodological quality. Cumulative meta-analyses (random effects model) adjusted for the difference in treatment intensity in each study was used for the trials evaluating the effects of AETT provided. Twenty of the 31 candidate studies, involving 2686 stroke patients, were included in the synthesis. The methodological quality ranged from 2 to 10 out of the maximum score of 14 points. The meta-analysis resulted in a small but statistically significant SES with regard to ADL measured at the end of the intervention phase. Further analysis showed a significant homogeneous SES for 17 studies that investigated effects of increased exercise intensity within the first 6 months after stroke. No significant SES was observed for the 3 studies conducted in the chronic phase. Cumulative meta-analysis strongly suggests that at least a 16-hour difference in treatment time between experimental and control groups provided in the first 6 months after stroke is needed to obtain significant differences in ADL. A significant SES supporting a higher intensity was also observed for instrumental ADL and walking speed, whereas no significant SES was found for dexterity.</p> <p><b>Conclusion:</b> The results of the present research synthesis support the hypothesis that augmented exercise therapy has a small but favorable effect on ADL, particularly if therapy input is augmented at least 16 hours within the first 6 months after stroke. This meta-analysis also suggests that clinically relevant treatment effects may be achieved on instrumental ADL and gait speed.</p&gt

Proper Motion of Water Masers Associated with IRAS 21391+5802: Bipolar Outflow and an AU-Scale Dusty Circumstellar Shell

We present VLBA observations of water maser emission associated with the star-forming region IRAS 21391+5802, which is embedded in a bright rimmed cometary globule in IC1396. The angular resolution of the maps is about 0.8 mas, corresponding to a spatial resolution of about 0.6 AU, at an estimated distance of 750 pc. Proper motions are derived for 10 maser features identified consistently over three epochs, which were separated by intervals of about one month. The masers appear in four groups, which are aligned linearly on the sky, roughly along a northeast-southwest direction, with a total separation of about 520 AU (about 0.7 arcseconds). The 3-D velocities of the masers have a maximum value of about 42 km/s (about 9 AU/yr). The average error on the derived proper motions is about 4 km/s. The overall pattern of proper motions is indicative of a bipolar outflow. Proper motions of the masers in a central cluster, with a projected extent of about 20 AU, show systematic deviations from a radial outflow. However, we find no evidence of Keplerian rotation, as has been claimed elsewhere. A nearly circular loop of masers lies near the middle of the cluster. The radius of this loop is 1 AU and the line-of-sight velocities of the masers in the loop are within 2 km/s of the systemic velocity of the region. These masers presumably exist at the radial distance where significant dust condensation occurs in the outflow emanating from the star.Comment: 15 pages, 4 figures. Accepted for publication in the Astrophysical Journal. Version 2.12.00: Astrometric coordinates of maser revise

Cosmic ray tests of the D0 preshower detector

The D0 preshower detector consists of scintillator strips with embedded wavelength-shifting fibers, and a readout using Visible Light Photon Counters. The response to minimum ionizing particles has been tested with cosmic ray muons. We report results on the gain calibration and light-yield distributions. The spatial resolution is investigated taking into account the light sharing between strips, the effects of multiple scattering and various systematic uncertainties. The detection efficiency and noise contamination are also investigated.Comment: 27 pages, 24 figures, submitted to NIM

Ancestral TSH mechanism signals summer in a photoperiodic mammal

SummaryIn mammals, day-length-sensitive (photoperiodic) seasonal breeding cycles depend on the pineal hormone melatonin, which modulates secretion of reproductive hormones by the anterior pituitary gland [1]. It is thought that melatonin acts in the hypothalamus to control reproduction through the release of neurosecretory signals into the pituitary portal blood supply, where they act on pituitary endocrine cells [2]. Contrastingly, we show here that during the reproductive response of Soay sheep exposed to summer day lengths, the reverse applies: Melatonin acts directly on anterior-pituitary cells, and these then relay the photoperiodic message back into the hypothalamus to control neuroendocrine output. The switch to long days causes melatonin-responsive cells in the pars tuberalis (PT) of the anterior pituitary to increase production of thyrotrophin (TSH). This acts locally on TSH-receptor-expressing cells in the adjacent mediobasal hypothalamus, leading to increased expression of type II thyroid hormone deiodinase (DIO2). DIO2 initiates the summer response by increasing hypothalamic tri-iodothyronine (T3) levels. These data and recent findings in quail [3] indicate that the TSH-expressing cells of the PT play an ancestral role in seasonal reproductive control in vertebrates. In mammals this provides the missing link between the pineal melatonin signal and thyroid-dependent seasonal biology

Observation of Spin Wave Soliton Fractals in Magnetic Film Active Feedback Rings

The manifestation of fractals in soliton dynamics has been observed for the first time. The experiment utilized self-generated spin wave envelope solitons in a magnetic film based active feedback ring. At high ring gain, the soliton that circulates in the ring breathes in a fractal pattern. The corresponding power frequency spectrum shows a comb structure, with each peak in the comb having its own comb, and so on, to finer and finer scales.Comment: 4 pages, 4 figure