Skill mix translation - top down or bottom up? An international comparison

Primary health care skill mix is one of the major issues now occupying the mindsets of Australian clinicians, policy makers and researchers alike. The change of Federal government in late 2007 has resulted in increased ministerial interest in the diversification of skills within primary care and led to a number of enquiries into ways this might be achieved. The APHCRI Stream Six review entitled “Optimising skill mix in the primary care workforce for the care of older Australians” identified skill mix changes that could be implemented to meet the challenges of an ageing population with a rising incidence of chronic disease and was commissioned and completed prior to the 2007 election.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

Trams, Trials and Tribulations: the development of Cathedral Square, Christchurch 1900-18

Cathedral Square Christchurch is the city's premier urban space. Yet it is without doubt the most debated and controversial two and half hectares of urban design space in the city. Set out in the shape of cross rather than a square, the last five decades of the nineteenth century saw just as much controversy over its design and use as did the entire twentieth century and on into the beginnings of the twenty-first century. Over this time its design has been the butt of jokes, the subject of constant political debate and subject of many learned articles, seminars and conference papers. The period 1900 to 1918 was one of intensive design change as Christchurch moved into the era of electric trams, motor buses and motor cars. While handsome buildings grew on the square's perimeter during this period, in 1907 a less than attractive architecturally-designed transport shelter appeared in its centre causing architect Samuel Hurst Seager, a member of the Christchurch Beautifying Society, to describe it as a public building of "… appalling ugliness." Inspired by the title "Tramway Trials and Tribulations - the saga of the tramway shelter" this paper will examine the design issues surrounding Cathedral Square during the period 1900-1918 – a period that saw the first competition to improve the aesthetic reading of this space

Unbearable wearables

As wearable devices play an increasing role in the management of health and disease, adverse skin reactions to wearables have become more common. However, the management of allergic contact dermatitis is challenging and new treatment options more compatible with wearable devices are needed. In a 40-year-old woman with contact dermatitis to a continuous glucose monitoring device, topical clobetasol propionate 0.05% spray proved to be an effective treatment that was compatible with the application of adhesive wearables. This case demonstrates that spray formulations of topical steroids are a good option for the treatment of dermatitis under wearable devices such as continuous glucose monitors or ostomy appliance

Nearly Four Million California Adults Are Victims of Intimate Partner Violence

Based on 2007 California Health Interview Survey data, analyzes the incidence and nature of physical and/or sexual intimate partner violence by gender, race/ethnicity, nativity, marital status, and sexual orientation

High prevalence of abnormal Pap smears among young women co-infected with HIV in rural South Africa - implications for cervical cancer screening policies in high HIV prevalence populations

Objective. To establish the relationship between HIV infection and cervical  dysplasia in young women in rural South Africa,Methods. This cross"sectional study was conducted at a primary health care clinic in Vulindlela, KwaZulu-Natal. Standardised questionnaires were used  to collect sociodemographic and clinical presentation data from women attending family planning and other reproductive health services. Pap  smears were done using standard methods. Pap smear data were linked to HIV serostatus.Results. Four hundred and sixty-six women were included in the study. The median age was 24.3 years (range 15 -55 years),and 80% were younger than 30 years. The HIV prevalence .rate was 24.5% (95% confidence interval: 20.7 - 28.7%) and the prevalence of abnormal Pap smears was 16.9- 6.4% ASCUS (atypical squamous cells of undetermined significance), 9.2% LGSIL (low-grade squamous intra epithelial lesions), and 1.3% HGSIL (high-grade squamous intraepitheliallesions). The association between BIV seropositivity and abnormal Pap results was statistically significant (p < 0.05).Conclusion. There is a need for more data on cervical changes in HIV  co-infected women and for review of guidelines on selective Pap smear screening in high HIV prevalence settings such as sub-Saharan Africa and  where access to antiretroviral treatment remains limited

Actin Re-Organization Induced by Chlamydia trachomatis Serovar D - Evidence for a Critical Role of the Effector Protein CT166 Targeting Rac

The intracellular bacterium Chlamydia trachomatis causes infections of urogenital tract, eyes or lungs. Alignment reveals homology of CT166, a putative effector protein of urogenital C. trachomatis serovars, with the N-terminal glucosyltransferase domain of clostridial glucosylating toxins (CGTs). CGTs contain an essential DXD-motif and mono-glucosylate GTP-binding proteins of the Rho/Ras families, the master regulators of the actin cytoskeleton. CT166 is preformed in elementary bodies of C. trachomatis D and is detected in the host-cell shortly after infection. Infection with high MOI of C. trachomatis serovar D containing the CT166 ORF induces actin re-organization resulting in cell rounding and a decreased cell diameter. A comparable phenotype was observed in HeLa cells treated with the Rho-GTPase-glucosylating Toxin B from Clostridium difficile (TcdB) or HeLa cells ectopically expressing CT166. CT166 with a mutated DXD-motif (CT166-mut) exhibited almost unchanged actin dynamics, suggesting that CT166-induced actin re-organization depends on the glucosyltransferase motif of CT166. The cytotoxic necrotizing factor 1 (CNF1) from E. coli deamidates and thereby activates Rho-GTPases and transiently protects them against TcdB-induced glucosylation. CNF1-treated cells were found to be protected from TcdB- and CT166-induced actin re-organization. CNF1 treatment as well as ectopic expression of non-glucosylable Rac1-G12V, but not RhoA-G14A, reverted CT166-induced actin re-organization, suggesting that CT166-induced actin re-organization depends on the glucosylation of Rac1. In accordance, over-expression of CT166-mut diminished TcdB induced cell rounding, suggesting shared substrates. Cell rounding induced by high MOI infection with C. trachomatis D was reduced in cells expressing CT166-mut or Rac1-G12V, and in CNF1 treated cells. These observations indicate that the cytopathic effect of C. trachomatis D is mediated by CT166 induced Rac1 glucosylation. Finally, chlamydial uptake was impaired in CT166 over-expressing cells. Our data strongly suggest CT166's participation as an effector protein during host-cell entry, ensuring a balanced uptake into host-cells by interfering with Rac-dependent cytoskeletal changes

Optimising skill-mix in the primary health care workforce for the care of older Australians: a systematic review

Australia has an ageing population resulting in demand for extensive and comprehensive care of chronic disease. This demand has required new thinking about primary health care workforce re-modelling to meet the health care needs of community dwelling older Australians. Sibbald and others have developed a model of skill-mix change to discuss workforce redesign. We conducted a systematic literature review to identify skill-mix changes needed in the primary health care workforce to successfully meet the health care needs of older Australians. Sibbald's concept that skill-mix changes could be obtained through task substitution, enhancement, delegation and innovation formed the conceptual framework for the review.The research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy