Preventative medical care in remote Aboriginal communities in the Northern Territory: a follow-up study of the impact of clinical guidelines, computerised recall and reminder systems, and audit and feedback

MIDDLESEX HOUSE,34-42 CLEVELAND ST, LONDON, ENGLAND, W1T 4L

Preventive medical care in remote Aboriginal communities in the Northern Territory: a follow-up study of the impact of clinical guidelines, computerised recall and reminder systems, and audit and feedback

Background Interventions to improve delivery of preventive medical services have been shown to be effective in North America and the UK. However, there are few studies of the extent to which the impact of such interventions has been sustained, or of the impact of such interventions in disadvantaged populations or remote settings. This paper describes the trends in delivery of preventive medical services following a multifaceted intervention in remote community health centres in the Northern Territory of Australia. Methods The intervention comprised the development and dissemination of best practice guidelines supported by an electronic client register, recall and reminder systems and associated staff training, and audit and feedback. Clinical records in seven community health centres were audited at regular intervals against best practice guidelines over a period of three years, with feedback of audit findings to health centre staff and management. Results Levels of service delivery varied between services and between communities. There was an initial improvement in service levels for most services following the intervention, but improvements were in general not fully sustained over the three year period. Conclusions Improvements in service delivery are consistent with the international experience, although baseline and follow-up levels are in many cases higher than reported for comparable studies in North America and the UK. Sustainability of improvements may be achieved by institutionalisation of relevant work practices and enhanced health centre capacity

Who bullies whom at a garden feeder? Interspecific agonistic interactions of small passerines during a cold winter

Interspecific agonistic interactions are important selective factors for maintaining ecological niches of different species, but their outcome is difficult to predict a priori. Here, we examined the direction and intensity of interspecific interactions in an assemblage of small passerines at a garden feeder, focussing on three finch species of various body sizes. We found that large and mediumsized birds usually initiated and won agonistic interactions with smaller species. Also, the frequency of fights increased with decreasing differences in body size between the participants. Finally, the probability of engaging in a fight increased with the number of birds at the feeder

Electronic dynamic Hubbard model: exact diagonalization study

A model to describe electronic correlations in energy bands is considered. The model is a generalization of the conventional Hubbard model that allows for the fact that the wavefunction for two electrons occupying the same Wannier orbital is different from the product of single electron wavefunctions. We diagonalize the Hamiltonian exactly on a four-site cluster and study its properties as function of band filling. The quasiparticle weight is found to decrease and the quasiparticle effective mass to increase as the electronic band filling increases, and spectral weight in one- and two-particle spectral functions is transfered from low to high frequencies as the band filling increases. Quasiparticles at the Fermi energy are found to be more 'dressed' when the Fermi level is in the upper half of the band (hole carriers) than when it is in the lower half of the band (electron carriers). The effective interaction between carriers is found to be strongly dependent on band filling becoming less repulsive as the band filling increases, and attractive near the top of the band in certain parameter ranges. The effective interaction is most attractive when the single hole carriers are most heavily dressed, and in the parameter regime where the effective interaction is attractive, hole carriers are found to 'undress', hence become more like electrons, when they pair. It is proposed that these are generic properties of electronic energy bands in solids that reflect a fundamental electron-hole asymmetry of condensed matter. The relation of these results to the understanding of superconductivity in solids is discussed.Comment: Small changes following referee's comment

Statistical methodologies to pool across multiple intervention studies

Combining and analyzing data from heterogeneous randomized controlled trials of complex multiple-component intervention studies, or discussing them in a systematic review, is not straightforward. The present article describes certain issues to be considered when combining data across studies, based on discussions in an NIH-sponsored workshop on pooling issues across studies in consortia (see Belle et al. in Psychol Aging, 18(3):396–405, 2003). Several statistical methodologies are described and their advantages and limitations are explored. Whether weighting the different studies data differently, or via employing random effects, one must recognize that different pooling methodologies may yield different results. Pooling can be used for comprehensive exploratory analyses of data from RCTs and should not be viewed as replacing the standard analysis plan for each study. Pooling may help to identify intervention components that may be more effective especially for subsets of participants with certain behavioral characteristics. Pooling, when supported by statistical tests, can allow exploratory investigation of potential hypotheses and for the design of future interventions

A numerical study for multiple solutions of a singular boundary value problem arising from laminar flow in a porous pipe with moving wall

This paper is concerned with multiple solutions of a singular nonlinear boundary value problem (BVP) on the interval [0,1], which arises in a study of the laminar flow in a porous pipe with an expanding or contracting wall. For the singular nonlinear BVP, the correct boundary conditions are derived to guarantee that its linearization has a unique smooth solution. Then a numerical technique is proposed to find all possible multiple solutions. For the suction driven pipe flow with the expanding wall (e.g. α=2), we find a new solution numerically and classify it as a type VI solution. The computed results agree well with what can be obtained by the bifurcation package AUTO. In addition, we also construct asymptotic solutions for a few cases of parameters, which agree well with numerical solutions. These serve as validations of our numerical results. Thus we believe that the numerical technique designed in the paper is reliable, and may be further applied to solve a variety of nonlinear equations that arise from other flow problems.</p

Graphene plasmonics

Two rich and vibrant fields of investigation, graphene physics and plasmonics, strongly overlap. Not only does graphene possess intrinsic plasmons that are tunable and adjustable, but a combination of graphene with noble-metal nanostructures promises a variety of exciting applications for conventional plasmonics. The versatility of graphene means that graphene-based plasmonics may enable the manufacture of novel optical devices working in different frequency ranges, from terahertz to the visible, with extremely high speed, low driving voltage, low power consumption and compact sizes. Here we review the field emerging at the intersection of graphene physics and plasmonics.Comment: Review article; 12 pages, 6 figures, 99 references (final version available only at publisher's web site