You\u27ve got mail: Accountability and end user attitudes to email management

In a pioneering ethnographic study of end user responses to the problem of ‘information overload’ Whittaker and Sidner (1996) found that the design of systems primarily as methods of asynchronous communication, posed significant information management problems for users. In another contemporaneous study, David Bearman (1993) extended understanding of the implications of end user email management behavior by identifying significant accountability implications for organizations arising from the use of email. Recent case studies in the United States and Australia (Leopold, 2008; Raleigh Chronicle, 2008; Strutt, and Taylor, 2007) have once again focused attention on the accountability consequences for Government of email management. Employing elements of Whittaker and Sidner’s (1996) typology, in a research design involving quantitative and case study methods, this study explores end user attitudes and behavior in email management with consequences for Australian Government accountability in an era of e-Government. The paper addresses the need of information policy makers, Chief Information Officers (CIOs) and information and records managers to be informed about current vectors in compliant email management

Public health advocacy in action: the case of unproven breast cancer screening in Australia

In recent years, nonmammographic breast imaging devices, such as thermography, electrical impedance scanning and elastography, have been promoted directly to consumers, which has captured the attention of governments, researchers and health organisations. These devices are not supported by evidence and risk undermining existing mammographic breast cancer screening services. During a 5-year period, Cancer Council Western Australia (CCWA) used strategic research combined with legal, policy and media advocacy to contest claims that these devices were proven alternatives to mammography for breast cancer screening. The campaign was successful because it had input from people with public health, academic, clinical and legal backgrounds, and took advantage of existing legal and regulatory avenues. CCWA's experience provides a useful advocacy model for public health practitioners who are concerned about unsafe consumer products, unproven medical devices, and misleading health information and advertising

Development and validation of a Food Preoccupation Questionnaire

Existing Food Preoccupation Questionnaires do not take account of food-related thoughts that have a positive emotional valence. We report on the development and validation of a questionnaire that provides independent assessments of thought frequency and emotional valence (positive, negative or neutral)

Application of infrared thermography in computer aided diagnosis

The invention of thermography, in the 1950s, posed a formidable problem to the research community: What is the relationship between disease and heat radiation captured with Infrared (IR) cameras? The research community responded with a continuous effort to find this crucial relationship. This effort was aided by advances in processing techniques, improved sensitivity and spatial resolution of thermal sensors. However, despite this progress fundamental issues with this imaging modality still remain. The main problem is that the link between disease and heat radiation is complex and in many cases even non-linear. Furthermore, the change in heat radiation as well as the change in radiation pattern, which indicate disease, is minute. On a technical level, this poses high requirements on image capturing and processing. On a more abstract level, these problems lead to inter-observer variability and on an even more abstract level they lead to a lack of trust in this imaging modality. In this review, we adopt the position that these problems can only be solved through a strict application of scientific principles and objective performance assessment. Computing machinery is inherently objective; this helps us to apply scientific principles in a transparent way and to assess the performance results. As a consequence, we aim to promote thermography based Computer-Aided Diagnosis (CAD) systems. Another benefit of CAD systems comes from the fact that the diagnostic accuracy is linked to the capability of the computing machinery and, in general, computers become ever more potent. We predict that a pervasive application of computers and networking technology in medicine will help us to overcome the shortcomings of any single imaging modality and this will pave the way for integrated health care systems which maximize the quality of patient care

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

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The regulation of non-invasive medical devices in Australia: a case study of breast cancer imaging devices marketed direct-to-consumer.

Background: The premarket assessment of medical devices by an independent regulator is necessary to ensure that devices are safe and effective before they are made available to consumers in Australia. This responsibility is further necessitated by the practice of direct-to-consumer advertising (DtCA), whereby devices can be promoted to, and accessed by consumers without the involvement of a registered healthcare practitioner. An increase in the number of complaints against medical device advertising in Australia has raised questions around the effectiveness of the current regulations at ensuring that devices and their advertising material are adequately supported by evidence. Aims: The aim of this thesis is to explore the relationship between scientific evidence and DtCA in the policy context of medical device regulation in Australia. This aim is investigated using a case study of three emerging breast cancer imaging devices: digital infrared thermal imaging (DITI), electronic impedance scanning (EIS) and electronic palpation imaging (EPI). In this thesis, the evidence supporting the safety and effectiveness of these devices is evaluated, the nature and frequency of claims presented in online advertisements for these devices are assessed and compared against the available evidence, and stakeholders are engaged in a discussion around options to reform the regulation of medical devices and medical device advertising. Methods: A mixed methods approach was undertaken, involving three interrelated studies. The first study presents a systematic review of the available evidence for the safety and effectiveness of DITI, EIS and EPI. Following the systematic review, a quantitative content analysis was used to investigate the evidentiary basis of advertising claims made on websites that promote DITI, EIS and EPI in Australia. Finally, the results of the first two studies were used to inform stakeholder engagement around options to reform the regulation of medical devices and medical device advertising. Thematic analysis was used to synthesise stakeholder preferences in relation to a series of reform options proposed by Australia’s principal therapeutic goods regulator, the Therapeutic Goods Administration (TGA). Results: Study 1 As no direct effectiveness data were identified, the surrogate outcome measure of diagnostic accuracy became the primary focus of the systematic review. Significant heterogeneity was present among all three device classes, limiting the potential for meta-analyses. There was insufficient evidence to support the use of DITI, EIS or EPI for breast cancer screening, and the reported estimates of the sensitivity and specificity in symptomatic populations varied greatly for DITI (Sens 0.25-0.97, Spec 0.12-0.85) and EIS (Sens 0.26- 0.98, Spec 0.08-0.81), while only two poor quality studies were identified for EPI. Study 2 Thirty-nine Australian websites promoting DITI, EIS or EPI were identified. Despite a lack of primary evidence identified in the prior systematic review, the devices were advertised for diagnosis (n = 22 websites), screening (n = 20), prevention (n = 13) and risk factor identification for breast cancer (n = 13). Similarly, advertising claims of diagnostic accuracy (Sens 0.78-0.99, Spec 0.44-0.91) did not reflect the evidence base. Direct comparisons with conventional imaging were highly prominent (n = 31), and one third of websites explicitly promoted their device as a suitable alternative to conventional imaging (n = 12). Study 3 Sixteen stakeholders representing breast cancer research, patient advocacy and screening provided input into reforms to premarket medical device regulation and advertising proposed by the TGA. Participants highlighted important benefits and limitations of the proposed options. Differences between the TGA’s options for reform and stakeholder views indicated a need to update the current model for regulation that allows consumer choice and supports innovation, but within a more tightly regulated, safety-oriented framework. Conclusion: Online advertising claims made for DITI, EIS and EPI extend the indications and efficacy of these devices beyond the available research evidence. This disconnect suggests the regulatory framework tasked with ensuring the safety and efficacy of these devices and their promotion is in need of reform. Extending the current regulations for advertising preapproval to include medical devices, assessing diagnostic imaging devices for efficacy prior to market, and monitoring the use of a device in practice compared to its approved use on the Australian Register of Therapeutic Goods (ARTG) will help close the gap between DtCA and the evidence for emerging breast imaging devices.Thesis (Ph.D.) -- University of Adelaide, School of Population Health, 201

Proteoglycan changes in carcinogen (4WQ0)-Treated tongue mucosa

The purpose of this study was to undertake preliminary analyses of the extracellular proteoglycans in carcinogen [4-nitroquinoline N-oxide (4NQO)]-treated rat tongue mucosa. Experimental rats were exposed to twice-weekly applications of 4NQO in propylene glycol for six months, after which the animals were killed. Control and 4NQO-treated tissues were subjected to sequential aqueous extractions of proteoglycans under associative and dissociative conditions, followed by alkaline cleavage of protein-glycosaminoglycan linkages to yield a glycosaminoglycan residue. Tissues subjected to 4NQO applications contained smaller proportions of proteoglycans which were readily soluble under associative and dissociative conditions. Proportionately more proteoglycan remained strongly associated with other intercellular tissue components, being released only by alkaline cleavage. These biochemical alterations in preinvasive 4NQO-treated epithelium and connective tissues, together with an observed associated change in water retention by the connective tissue, occurred prior to actual neoplastic invasion and suggest differences in macromolecular conformation and orderliness. We hypothesize that these changes are related to the phenomenon of neoplastic epithelial invasion