Double jeopardy: hypoglycaemia and advanced hepatocellular carcinoma

Nonislet cell tumour-induced hypoglycaemia is an uncommon, but serious complication of malignancy. The aetiopathogenesis is largely as a result of tumoral overproduction of incompletely processed insulin-like growth factor-II. We describe the case of a 30-year-old black male patient who presented with recurrent hypoglycaemic episodes in the absence of diabetes or any medications known to cause hypoglycaemia. Extensive investigations revealed that the hypoglycaemia was the result of an advanced hepatocellular carcinoma.Keywords: hypoglycaemia, non-islet cell tumour-induced hypoglycaemia, insulin-like growth factor-II, hepatocellular carcinom

The Roles of ‘Conventional’ and Demand-Responsive Bus Services

Purpose - The roles of ‘conventional’ (fixed-route and fixed-timetable) bus services is examined and compared to demand-responsive services, taking rural areas in England as the basis for comparison. It adopts a ‘rural’ definition of settlements under a population of 10,000. Design/methodology/approach - Evidence from the National Travel Survey, technical press reports and academic work is brought together to examine the overall picture. Findings - Inter-urban services between towns can provide a cost-effective way of serving rural areas where smaller settlements are suitably located. The cost structures of both fixed-route and demand-responsive services indicate that staff time and cost associated with vehicle provision are the main elements. Demand-responsive services may enable larger areas to be covered, to meet planning objectives of ensuring a minimum of level of service, but experience often shows high unit cost and public expenditure per passenger trip. Economic evaluation indicates user benefits per passenger trip of similar magnitude to existing average public expenditure per trip on fixed-route services. Considerable scope exists for improvements to conventional services through better marketing and service reliability. Practical implications - The main issue in England is the level of funding for rural services in general, and the importance attached to serving those without access to cars in such areas. Social implications - The boundary between fixed-route and demand-responsive operation may lie at relatively low population densities. Originality/value - The chapter uses statistical data, academic research and operator experience of enhanced conventional bus services to provide a synthesis of outcomes in rural areas

Addressing Professional Competency Problems in Clinical Psychology Trainees

© 2017 The Australian Psychological Society Objective: Clinical psychology trainees with problems of professional competence (PPC) continue to be a challenge for courses. Despite the rapid development of competency-based training models, the impact of this shift to the identification and management of professional competency problems is unclear. This project aims to describe how clinical psychology trainees with PPC are identified and managed within the Australian and New Zealand context. Method: An online survey was distributed through Australian and New Zealand universities offering clinical psychology training programmes. Questions addressed approaches to monitoring progress on placements, identification and management of trainees determined to be underperforming on placements, and the perceived usefulness of a range of strategies such as the use of standardised-rating tools. Results: Thirty one responses were received, representing 40 clinical psychology training courses in 22 institutions across Australia and New Zealand. In all cases, at least one trainee with a PPC had been detected in the previous 5 years, most commonly attributed to psychological, behavioural, and developmental issues. Respondents reported the use of a range of preventive and remedial strategies, including the use of psychometrically validated competency evaluation rating forms to assist in the grading of placements. Conclusion: Trainees with PPC occur on a fairly regular basis in clinical psychology training courses in Australian and New Zealand. While some processes involved in the identification and management of these students have been refined and systematised, some opportunities to facilitate early identification and remediation may yet need further enhancement

Transphobia rather than education predicts provider knowledge of transgender health care

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/148342/1/medu13796.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/148342/2/medu13796_am.pd