‘It’s got to be another approach’: an Aboriginal Health Worker perspective on cardiovascular risk screening and education

This study provides a new perspective from Aboriginal Health Workers (AHWs) working in the area of heart health in the Aboriginal community of western Sydney. Discussion AHWs are well placed and keen to be a part of the team that assesses cardiovascular risk. However, lack of recognition of the AHWs’ skills and lack of access to formal training are current barriers to enhancing their role in the heart health team. Cardiovascular disease (CVD) is a major health concern in the Aboriginal population and contributes to the significant life expectancy gap between Aboriginal and non-Aboriginal Australians. Conventional risk factors alone do not account for the excess CVD mortality, which has foundations in the economic, social, physiological, psychological and educational disadvantage of the Aboriginal population. There is a lack of progress in reducing the disparities in health outcomes between Aboriginal and non-Aboriginal Australians. This may be because of a focus, to date, on acute care and patient responsibility rather than addressing underlying determinants of health such as living conditions and socioeconomic factors. In Aboriginal communities, Aboriginal Health Workers (AHWs) fulfil a variety of roles, depending on personal interests and the needs of the community. Unfortunately, a lack of understanding of the diverse expertise of AHWs persists. A universal role is that of a cultural broker through which communication between Aboriginal people and non-Aboriginal healthcare providers are enhanced, thereby increasing the effectiveness of their interaction. Recognition of AHWs as an important part of the healthcare team has been suggested as a means of delivering improved healthcare to the Aboriginal population. The aim of this study was to study the perspectives of Aboriginal health professionals (nurses and AHWs) regarding cardiovascular risk and heart health, including their understanding of cardiovascular risk assessment. Qualitative research methods can improve the understanding of perceptions of health across cultures and lead to improved health outcomes. This study was undertaken with AHWs and Aboriginal nurses from the Aboriginal Medical Service Western Sydney (AMSWS) and Western Sydney Local Health District, all of whom are working in the area of chronic disease management or heart health. AMSWS is a large Aboriginal community controlled health organisation that provides multidisciplinary primary healthcare, including cardiovascular screening, healthy lifestyle education and case management to clients with heart disease

Perceptions of shared care among survivors of colorectal cancer from non-English-speaking and English-speaking backgrounds: A qualitative study

Background: Colorectal cancer (CRC) survivors experience difficulty navigating complex care pathways. Sharing care between GPs and specialist services has been proposed to improve health outcomes in cancer survivors following hospital discharge. Culturally and Linguistically Diverse (CALD) groups are known to have poorer outcomes following cancer treatment but little is known about their perceptions of shared care following surgery for CRC. This study aimed to explore how non-English-speaking and English-speaking patients perceive care to be coordinated amongst various health practitioners. Methods: This was a qualitative study using data from face to face semi-structured interviews and one focus group in a culturally diverse area of Sydney with non-English-speaking and English-speaking CRC survivors. Participants were recruited in community settings and were interviewed in English, Spanish or Vietnamese. Interviews were recorded, transcribed, and analysed by researchers fluent in those languages. Data were coded and analysed thematically. Results: Twenty-two CRC survivors participated in the study. Participants from non-English-speaking and English-speaking groups described similar barriers to care, but non-English-speaking participants described additional communication difficulties and perceived discrimination. Non-English-speaking participants relied on family members and bilingual GPs for assistance with communication and care coordination. Factors that influenced the care pathways used by participants and how care was shared between the specialist and GP included patient and practitioner preference, accessibility, complexity of care needs, and requirements for assistance with understanding information and navigating the health system, that were particularly difficult for non-English-speaking CRC survivors. Conclusions: Both non-English-speaking and English-speaking CRC survivors described a blend of specialist-led or GP-led care depending on the complexity of care required, informational needs, and how engaged and accessible they perceived the specialist or GP to be. Findings from this study highlight the role of the bilingual GP in assisting CALD participants to understand information and to navigate their care pathways following CRC surgery

Mother Tongue Tuition in Sweden - Curriculum Analysis and Classroom Experience

The model of Mother Tongue Tuition (MTT) which has developed in Sweden since the 1970’s offers speakers of languages other than Swedish the opportunity to request tuition in their mother tongue, from kindergarten through to year 12. It is unique among the major immigrant-receiving countries of the world yet little is known about MTT and its syllabus outside of its Nordic context. This article examines the syllabus for MTT from two perspectives; firstly using the framework of Constructive Alignment, secondly from the perspective of what is hidden. The intended syllabus is revealed as well-aligned, but the hidden curriculum impedes successful enactment in many contexts. Examples from case studies in a larger on-going research project offer an alternate approach to syllabus implementation when the negative effects of the hidden curriculum are challenged. While highly context-specific, this model may represent a step in the right direction for implementation of the syllabus

Plutonic associations of North-East, Bahia

Dans le but d'illustrer une excursion géologique, les auteurs décrivent les associations plutoniques du nord-est de l'Etat de Bahia. Ils abordent le cadre géologique régional et ils présentent les caractéristiques pétrologiques et structurales à l'échelle des nombreux affleurements

Installation of internal electric fields by non-redox active cations in transition metal complexes.

Local electric fields contribute to the high selectivity and catalytic activity in enzyme active sites and confined reaction centers in zeolites by modifying the relative energy of transition states, intermediates and/or products. Proximal charged functionalities can generate equivalent internal electric fields in molecular systems but the magnitude of their effect and impact on electronic structure has been minimally explored. To generate quantitative insight into installing internal fields in synthetic systems, we report an experimental and computational study using transition metal (M1) Schiff base complexes functionalized with a crown ether unit containing a mono- or dicationic alkali or alkaline earth metal ion (M2). The synthesis and characterization of the complexes M1 = Ni(ii) and M2 = Na+ or Ba2+ are reported. The electronic absorption spectra and density functional theory (DFT) calculations establish that the cations generate a robust electric field at the metal, which stabilizes the Ni-based molecular orbitals without significantly changing their relative energies. The stabilization is also reflected in the experimental Ni(ii/i) reduction potentials, which are shifted 0.12 V and 0.34 V positive for M2 = Na+ and Ba2+, respectively, compared to a complex lacking a proximal cation. To compare with the cationic Ni complexes, we also synthesized a series of Ni(salen) complexes modified in the 5' position with electron-donating and -withdrawing functionalities (-CF3, -Cl, -H, -tBu, and -OCH3). Data from this series of compounds provides further evidence that the reduction potential shifts observed in the cationic complexes are not due to inductive ligand effects. DFT studies were also performed on the previously reported monocationic and dicatonic Fe(ii)(CH3CN) and Fe(iii)Cl analogues of this system to analyze the impact of an anionic chloride on the electrostatic potential and electronic structure of the Fe site

Inequalities in ventilation tube insertion procedures between Aboriginal and non-Aboriginal children in New South Wales, Australia: a data linkage study

OBJECTIVES Australian Aboriginal children experience earlier, more frequent and more severe otitis media, particularly in remote communities, than non-Aboriginal children. Insertion of ventilation tubes is the main surgical procedure for otitis media. Our aim was to quantify inequalities in ventilation tube insertion (VTI) procedures between Australian Aboriginal and non-Aboriginal children, and to explore the influence of birth characteristics, socioeconomic background and geographical remoteness on this inequality. DESIGN Retrospective cohort study using linked hospital and mortality data from July 2000 to December 2008. SETTING AND PARTICIPANTS A whole-of-population cohort of 653 550 children (16 831 Aboriginal and 636 719 non-Aboriginal) born in a New South Wales hospital between 1 July 2000 and 31 December 2007 was included in the analysis. OUTCOME MEASURE First VTI procedure. RESULTS VTI rates were lower in Aboriginal compared with non-Aboriginal children (incidence rate (IR), 4.3/1000 person-years; 95% CI 3.8 to 4.8 vs IR 5.8/1000 person-years; 95% CI 5.7 to 5.8). Overall, Aboriginal children were 28% less likely than non-Aboriginal children to have ventilation tubes inserted (age-adjusted and sex-adjusted rate ratios (RRs) 0.72; 95% CI 0.64 to 0.80). After adjusting additionally for geographical remoteness, Aboriginal children were 19% less likely to have ventilation tubes inserted (age-adjusted and sex-adjusted RR 0.81; 95% CI 0.73 to 0.91). After adjusting separately for private patient/health insurance status and area socioeconomic status, there was no significant difference (age-adjusted and sex-adjusted RR 0.96; 95% CI 0.86 to 1.08 and RR 0.93; 95% CI 0.83 to 1.04, respectively). In the fully adjusted model, there were no significant differences in VTI rates between Aboriginal and non-Aboriginal children (RR 1.06; 95% CI 0.94 to 1.19). CONCLUSIONS Despite a much higher prevalence of otitis media, Aboriginal children were less likely to receive VTI procedures than their non-Aboriginal counterparts; this inequality was largely explained by differences in socioeconomic status and geographical remoteness.This work was supported by the National Health and Medical Research Council (NHMRC; grant number 573113). KF was supported by an NHMRC Early Career Fellowship (#1016475) and an NHMRC capacity building grant (#573122). EB was supported by an NHMRC Senior Research Fellowship (#1042717)

Design Fluxgate Magnetometer (Fiuxgate Sensor)

Fluxgate magnetometers have been used by robotic space probes to analyze, map and monitor the magnetic fields of the earth and other planets. They are also used in geological prospecting, aerospace navigation, underwater navigation, land navigation and submarine detection. The objective of this project is to build fluxgate sensor for measuring a magnetic field, The flux gate sensor has two ferromagnetic core, a primary, electrically conducting coil arranged around the core for periodical magnetization of the core into magnetic saturation by an alternating electric current through the primary coil, and a secondary, electrically conducting coil arranged around two ferromagnetic core. The Methodology of the project has been carry out with precise decision in order to find a way to reduce the size, power consumption and cost, hence the author use low saturation flux density materials. The design and testing of a fluxgate sensor, which is totally embedded in printed circuit board, has been presented. The sensor is suitable for sensing currents in the printed circuit board traces. The sensitivity has been measured at 150 m VI A for 50 kHz excitation. The power dissipation has been measured at approximately 1.44 W for a sinusoidal excitation. The power dissipation can almost certainly be reduced by using pulse excitation, or perhaps by using a saturable inductor in the excitation circuit. It is also possible to improve the sensitivity and reduce the power consumption by use of an improved magnetic material. In particular a material with lower saturation flux density and higher permeability should be possible. Future work will focus on further characterization of the sensor in terms of bandwidth, noise level, and minimum current detection level

Fichte's Creuzer Review and the Transformation of the of Free Will Problem

Fichte’s early review of C. A. L. Creuzer’s neglected and idiosyncratic skeptical book on free will posed a serious challenge to what at the time was emerging as a consensus Kantian position on the role of free choice (Willkür) in the generation of imputable action. Fichte’s review was directed as much against Reinhold’s important (and only recently published) letter on freedom of the will as it was against Creuzer himself. In the course of his brief review, Fichte suggests an important recasting of the strategy of the Kantian postulates of rational faith; he poses a dilemma for the Reinholdian understanding of the relationship among an autonomous practical will, a free power of choice, and the actions of natural human organisms; and he hints at a radical reappropriation of the rationalist doctrine of pre-established harmony in re-orienting the search for a defensible reconstruction of a broadly Kantian position on the problem of free will