bluuebunny/crossref_metadata_2025 huggingface dataset:
Soundscape Elements in the Music of Denis Smalley: negotiating the abstract and the mimetic
Authors: O'Callaghan James
Published: February 2011

This paper examines the use of soundscape elements and mimetic sound-identities in the music of Denis Smalley. It attempts to reconcile these elements with the acousmatic tradition from which his music emerges, illustrating that it does not represent a contradiction, but rather a refined aesthetic where spectromorphological and soundscape concerns relate in symbiosis. A close look at key works, includingEmpty Vessels(1997),Valley Flow(1992) andPentes(1974), reveals how these elements manifest themselves in his work, and how the spectromorphological and soundscape aspects of these pieces work together toward shared goals.
The glimmering embers: Experiences of hope among cancer patients in palliative home care
Authors: Olsson Louise , Östlund Gunnel , Strang Peter , Grassman Eva Jeppsson , Friedrichsen Maria
Published: February 2011

Objective:

The experience of hope among cancer patients in palliative care is important information for healthcare providers, but research on the subject is sparse. The aim of this article was to explore how cancer patients admitted to palliative home care experienced the significance of hope and used hope during 6 weeks throughout the last phase of their life, and to assess their symptoms and hope status during 6 weeks throughout the last phase of their lives.

Method:

Eleven adult patients with cancer participated in 20 interviews and completed seven diaries. The participants were recruited from two palliative care units in the southeast of Sweden. The method used was Grounded Theory (GT), and analysis was based on the constant comparative method.

Results:

The core category, glimmering embers, was generated from four processes: (1) The creation of “convinced” hope, with a focus on positive events, formed in order to have something to look forward to; (2) The creation of “simulated hope,” including awareness of the lack of realism, but including attempts to believe in unrealistic reasons for hope; (3) The collection of and maintaining of moments of hope, expressing a wish to “seize the day” and hold on to moments of joy and pleasure; and (4) “Gradually extinct” hope, characterized by a lack of energy and a sense of time running out.

Significance of results:

The different processes of hope helped the patients to continue to live when they were close to death. Hope should be respected and understood by the professionals giving them support.
Advance care planning discussions in advanced cancer: Analysis of dialogues between patients and care planning mediators
Authors: Barnes Kelly A. , Barlow Cate A. , Harrington Jane , Ornadel Karon , Tookman Adrian , King Michael , Jones Louise
Published: February 2011

Objective:

Advance care planning (ACP) provides patients with an opportunity to consider, discuss, and plan their future care with health professionals. Numerous policy documents recommend that ACP should be available to all with life-limiting illness.

Method:

Forty patients with recurrent progressive cancer completed one or more ACP discussions with a trained planning mediator using a standardized topic guide. Fifty-two interviews were transcribed verbatim and analyzed for qualitative thematic content.

Results:

Most patients had not spoken extensively to health professionals or close persons about the future. Their concerns related to experiencing distressing symptoms or worrying how family members would cope. Some patients wished for more accurate information and were unaware of their options for care. Many felt it was doctors' responsibility to initiate such discussions, but perceived that their doctors were reluctant to do so. However, some patients felt that the time was not yet right for these conversations.

Significance of results:

This article reports on the recorded content of ACP discussions. The extent to which patients want to engage in ACP is variable, and support and training are needed for health professionals to initiate such discussions. Our findings do not fully support the current United Kingdom policy of introducing ACP early in life-threatening disease.
Social anxiety disorder as a hidden psychiatric comorbidity among cancer patients
Authors: Akechi Tatsuo , Okuyama Toru , Sagawa Ryuichi , Uchida Megumi , Nakaguchi Tomohiro , Ito Yoshinori , Furukawa Toshiaki A.
Published: February 2011

Objective:

Social anxiety disorder is one of the most popular psychiatric disorders in the general population and is also well known as a very common comorbid psychiatric disorder among patients with major depression. On the other hand, social anxiety disorder has been termed “the neglected anxiety disorder” because its diagnosis is often missed. Furthermore, the potential impact of social anxiety disorder on the psychological distress of cancer patients has not been reported.

Method:

We encountered two cancer patients with refractory depression after cancer diagnosis, in whom comorbid social anxiety disorder was unexpectedly detected during a subsequent follow-up.

Results:

To the best of our knowledge, this is the first report to discuss the potential impact of social anxiety disorder on cancer patients' distress. These two cases may help to improve our understanding of the complicated mental health problems of cancer patients and the potential influence of social anxiety disorder on patients' follow-up medical treatment.

Significance of results:

Comorbid social anxiety disorder should be considered when a cancer patient's depression is resistant to treatment and the existence of communication problems between the patient and the medical staff is suspected.
Can an unwilling horse be made drink?
Authors: CHOI YOUNG BACK
Published: February 2011

In his critique of the newer approach in economic development emphasizing institutional reforms, Ha-Joon Chang, in his article titled ‘Institutions and Economic Development: Theory, Policy and History’, equates New Institutional Economics with the program of liberal reforms for least developed countries (LDCs) and blames the former for the alleged failure of the latter. He argues with some justice that the dominant discourse in New Institutional Economics insufficiently appreciates the complexity of institutions; as a consequence, the difficulty of transplanting institutions is largely discounted. His case, however, is marred by his attempt to push down his ideological biases by marshalling inchoate, highly questionable and often contradictory ideas as facts. Going beyond a critical examination of the New Institutional Economics inspired discourse in development economics, he advocates his own version of beneficial development policies for LDCs – namely, economic democracy and industrial policies. His proposals are not only highly questionable, but they amount to adopting a double standard of exempting himself from the very criticisms he levies against New Institutional Economics – ignoring the difficulty of importing foreign institutions. Presuming to play God, like many development economists, he ignores the essential fact that an unwilling horse cannot be made to drink.
A systematic approach to assessing the sensitivity and vulnerability of water availability to climate change in Europe
Authors: Weiß Martina , Alcamo Joseph
Published: February 2011

Making use of ensemble climate modeling systems and multimodel simulations of climate projections calls for a systematic approach in impact studies. In this study the response surface method is introduced to systematically, consistently, and objectively examine impacts of climate change on water availability, subject to selected impact thresholds. The response surface hereby represents the sensitivity of water availability to a broad range of possible climatic change, onto which vulnerability thresholds are superimposed. Their exceedance is assessed by additionally superimposing climate change projections onto the surface. With this method, 18 European river basins are ranked according to their sensitivity to climate change (analyzing the response surface itself). The use of climate change projections from six regional climate models for the year 2100 under the Intergovernmental Panel on Climate Change A1B emissions scenario in combination with societal vulnerability thresholds then enables a vulnerability ranking of these basins. Overall, a strong climate sensitivity of the Nordic basins is found on the basis of their mainly snow‐dominated flow regime. When looking at the vulnerability, however, southern European basins together with some central European basins are highest in the ranking because of the violation of both low flow and water stress thresholds.
Thermochronology of the Talkeetna intraoceanic arc of Alaska: Ar/Ar, U‐Th/He, Sm‐Nd, and Lu‐Hf dating
Authors: Hacker B. R. , Kelemen Peter B. , Rioux Matthew , McWilliams Michael O. , Gans Philip B. , Reiners Peter W. , Layer Paul W. , Söderlund Ulf , Vervoort Jeffrey D.
Published: February 2011

As one of two well‐exposed intraoceanic arcs, the Talkeetna arc of Alaska affords an opportunity to understand processes deep within arcs. This study reports new Lu‐Hf and Sm‐Nd garnet ages, 40Ar/39Ar hornblende, mica and whole‐rock ages, and U‐Th/He zircon and apatite ages from the Chugach Mountains, Talkeetna Mountains, and Alaska Peninsula, which, in conjunction with existing geochronology, constrain the thermal history of the arc. Zircon U‐Pb ages establish the main period of arc magmatism as 202–181 Ma in the Chugach Mountains and 183–153 Ma in the eastern Talkeetna Mountains and Alaska Peninsula. Approximately 184 Ma Lu‐Hf and ∼182 Ma Sm‐Nd garnet ages indicate that 25–35 km deep sections of the arc remained above ∼700°C for as much as 15 Myr. The 40Ar/39Ar hornblende ages are chiefly 194–170 Ma in the Chugach Mountains and 175–150 Ma in the Talkeetna Mountains and Alaska Peninsula but differ from zircon U‐Pb ages in the same samples by as little as 0 Myr and as much as 33 Myr, documenting a spatially variable thermal history. Mica ages have a broader distribution, from ∼180 Ma to 130 Ma, suggesting local cooling and/or reheating. The oldest U‐Th/He zircon ages are ∼137 to 129 Ma, indicating no Cenozoic regional heating above ∼180°C. Although the signal is likely complicated by Cretaceous and Oligocene postarc magmatism, the aggregate thermochronology record indicates that the thermal history of the Talkeetna arc was spatially variable. One‐dimensional finite difference thermal models show that this kind of spatial variability is inherent to intraoceanic arcs with simple construction histories.
Geological Society of London Issues Statement on Climate Change
Authors: Summerhayes Colin
Published: February 2011

On 1 November the Geological Society of London (GSL) published a statement (http://www.geolsoc.org.uk/gsl/site//GSL//lang/en/climatechange) about the geological evidence relating to past climates, atmospheric carbon levels, and their interrelationships. The online version also carries a list of recommendations for further reading. The GSL's Geoscientist magazine (http://www.geolsoc.org.uk/gsl/site/GSL/lang/en/page8578.html) reported Bryan Lovell, GSL president, as saying, “Climate change is a defining issue of our time, whose full understanding needs geology's long perspective. Earth scientists can read…the geological record of changes in climate that occurred long before we were around to light so much as a camp fire, let alone burn coal, gas and oil. A dramatic global warming event 55 million years ago gives us a particularly clear indication of what happens when there is a sudden release of 1500 billion tonnes of carbon into Earth's atmosphere. It gets hot, the seas become more acid, and there is widespread extinction of life. We are a third of the way to repeating that ancient natural input of carbon through our own agency. The message from the rocks is that it would be a good idea to stop pulling that carbon trigger.”
Fred Spilhaus Receives 2010 Waldo E. Smith Medal
Authors: Harrison Christopher , Burch James , Spilhaus Fred
Published: February 2011

Fred Spilhaus was awarded the 2010 Waldo E. Smith Medal at the AGU Fall Meeting Honors Ceremony, held on 15 December 2010 in San Francisco, Calif. The medal is for “extraordinary service to geophysics.”
AMS and AGU Join Forces in Summer Policy Colloquium
Authors: Cairns Ann
Published: February 2011

Interested in developing your leadership skills? Serious about putting your science to work for societal benefit? Willing to be as disciplined in your approach to these challenges as you are in your research? The Summer Policy Colloquium may be what you're looking for. This year's program will be held 5–14 June 2011 in Washington, D. C. The American Meteorological Society (AMS) has run this unique, highly successful program for a decade. AGU is cosponsoring it for the first time this year.
Micro-nano scale ripples on metallic glass induced by laser pulse
Authors: Liu W. D. , Ye L. M. , Liu K. X.
Published: February 2011

A Zr47.7Cu31Ni9Al12.3 bulk metallic glass was irradiated directly by KrF excimer laser pulses with wavelength 248 nm and duration 10 ns. Scanning electronic microscope photographs indicated that many ripples in micro-nano scale would be generated on the edge of the irradiated area under the action of the higher intensity laser pulse. Detailed observation demonstrated that the ripples exhibited fluidity and became closer and closer out from interior. Theoretical analysis revealed the formation mechanism of the ripples, including melting, subsequent propagation of capillary waves and final solidification.
An integrated microfluidic chip with 40 MHz lead-free transducer for fluid analysis
Authors: Lee S. T. F. , Lam K. H. , Lei L. , Zhang X. M. , Chan H. L. W.
Published: February 2011

The design, fabrication, and evaluation of a high-frequency transducer made from lead-free piezoceramic for the application of microfluidic analysis is described. Barium strontium zirconate titanate [(Ba0.95Sr0.05)(Zr0.05Ti0.95)O3, abbreviated as BSZT] ceramic has been chosen to be the active element of the transducer. The center frequency and bandwidth of this high-frequency ultrasound transducer have been measured to be 43 MHz and 56.1%, respectively. The transducer was integrated into a microfluidic channel and used to measure the sound velocity and attenuation of the liquid flowing in the channel. Results suggest that lead-free high-frequency transducers could be used for in situ analysis of property of the fluid flowing through the microfluidic system.
Look before you leap: A confidence-based method for selecting species criticality while avoiding negative populations in τ-leaping
Authors: Yates Christian A. , Burrage Kevin
Published: February 2011

The stochastic simulation algorithm was introduced by Gillespie and in a different form by Kurtz. There have been many attempts at accelerating the algorithm without deviating from the behavior of the simulated system. The crux of the explicit τ-leaping procedure is the use of Poisson random variables to approximate the number of occurrences of each type of reaction event during a carefully selected time period, τ. This method is acceptable providing the leap condition, that no propensity function changes “significantly” during any time-step, is met. Using this method there is a possibility that species numbers can, artificially, become negative. Several recent papers have demonstrated methods that avoid this situation. One such method classifies, as critical, those reactions in danger of sending species populations negative. At most, one of these critical reactions is allowed to occur in the next time-step. We argue that the criticality of a reactant species and its dependent reaction channels should be related to the probability of the species number becoming negative. This way only reactions that, if fired, produce a high probability of driving a reactant population negative are labeled critical. The number of firings of more reaction channels can be approximated using Poisson random variables thus speeding up the simulation while maintaining the accuracy. In implementing this revised method of criticality selection we make use of the probability distribution from which the random variable describing the change in species number is drawn. We give several numerical examples to demonstrate the effectiveness of our new method.
Far-field plasmonic resonance enhanced nanoparticle image velocimetry within a microchannel
Authors: Zhang Zhili , Li Quanshui , Haque Sara S. , Zhang Mingjun
Published: February 2011

In this paper, a novel far-field plasmonic resonance enhanced nanoparticle-seeded particle image velocimetry has been demonstrated to measure the velocity profile in a microchannel. Chemically synthesized silver nanoparticles have been used to seed the flow in the microchannel. By using discrete dipole approximation, plasmonic resonance enhanced light scattering has been calculated for spherical silver nanoparticles with diameters ranging from 15 to 200 nm. Optimum scattering wavelength is specified for the nanoparticles in two media: water and air. The diffraction-limited plasmonic resonance enhanced images of silver nanoparticles at different diameters have been recorded and analyzed. By using standard particle image velocimetry techniques, the velocity profile within the microchannel has been determined from the images.
Receptivity of a spatially developing jet to stochastic perturbations
Authors: Saïdi Abdelkader , Dušek Jan , David Romaric
Published: February 2011

In direct and large eddy simulations, turbulence in flows is often sustained using a random excitation. In this paper, the problem of receptivity of a linearized stable dynamical system to stochastic perturbations is reformulated in terms of the Lyapunov equation. The latter provides directly the statistical characterization of the random solution. It is shown how to describe the excitation term to obtain a time-step invariant response. The solution of the Lyapunov equation is equivalent to the spatial correlation matrix of the proper orthogonal decomposition (POD). It can thus be further post-treated to yield POD modes. The method is tested in the case of a weakly turbulent slightly heated jet by comparing the results obtained by statistical accumulation of data provided by a fully nonlinear unsteady Navier–Stokes simulation to the solution of the Lyapunov equation. The traces and POD modes are found in a very good agreement. The obtained results not only validate the method but also show that some flows may respond in an essentially linear way to random excitation and that, in this case, the direct statistical approach is more efficient and provides more reliable results than the classical Monte Carlo approach.
Deformation of a partially engulfed compound drop slowly moving in an immiscible viscous fluid
Authors: Rosenfeld L. , Lavrenteva O. M. , Spivak R. , Nir A.
Published: February 2011

Compound drops are comprised of two or more immiscible phases, one of which entirely or partially engulfs the others. In this work, we consider a partially engulfed compound drop comprised of two immiscible incompressible fluids, dispersed in an isothermal liquid, and that moved under the action of gravity and buoyancy. The contact angles between the three phases are determined by three interfacial tensions associated with the different fluids comprising the compound drop. The surfaces deform as the drop moves through the ambient fluid. If the capillary number is small (Ca⪡1), corrections to the shapes of the undeformable case (Ca=0) are constructed, making use of a perturbation technique. We report on stationary drops’ deformation for a variety of the physical parameters involved, such as volume ratio and surface tension of each interface, which determine the unperturbed configuration and the distribution of density between the two phases of the drop. Several examples of various transient behaviors of highly deformable compound drops are computed using FLUENT software and are presented as well.
Anomalous nanoparticle diffusion in polymer solutions and melts: A mode-coupling theory study
Authors: Egorov S. A.
Published: February 2011

Mode-coupling theory is employed to study diffusion of nanoparticles in polymer melts and solutions. Theoretical results are directly compared with molecular dynamics simulation data for a similar model. The theory correctly reproduces the effects of the nanoparticle size, mass, particle–polymer interaction strength, and polymer chain length on the nanoparticle diffusion coefficient. In accord with earlier experimental, simulation, and theoretical work, it is found that when the polymer radius of gyration exceeds the nanoparticle radius, the Stokes–Einstein relation underestimates the particle diffusion coefficient by as much as an order of magnitude. Within the mode-coupling theory framework, a microscopic interpretation of this phenomenon is given, whereby the total diffusion coefficient is decomposed into microscopic and hydrodynamic contributions, with the former dominant in the small particle limit, and the latter dominant in the large particle limit. This interpretation is in agreement with previous mode-coupling theory studies of anomalous diffusion of solutes in simple dense fluids.
Hole diffusivity in GaAsBi alloys measured by a picosecond transient grating technique
Authors: Nargelas S. , Jarašiūnas K. , Bertulis K. , Pačebutas V.
Published: February 2011

We applied a time-resolved transient grating technique for investigation of nonequilibrium carrier dynamics in GaAs1−xBix alloys with x=0.025–0.063. The observed decrease in carrier bipolar diffusivity with lowering temperature and its saturation below 80 K revealed a strong localization of nonequilibrium holes. Thermal activation energy ΔEa=46 meV of diffusivity and low hole mobility value μh=10–20 cm2/V s at room temperature confirmed the hybridization model of the localized Bi states with the valence band of GaAs. Nonlinear increase in carrier recombination rate with the Bi content, 1/τR∝Bi(x)3.2 indicated an increasing structural disorder in the alloy.
Numerical study of DNA-functionalized microparticles and nanoparticles: Explicit pair potentials and their implications for phase behavior
Authors: Leunissen Mirjam E. , Frenkel Daan
Published: February 2011

DNA-coated colloids have great potential for the design of complex self-assembling materials. In order to predict the structures that will form, knowledge of the interactions between DNA-functionalized particles is crucial. Here, we report results from Monte Carlo simulations of the pair-interaction between particles coated with single-stranded DNA sticky ends that are connected to the surface by relatively short and stiff surface tethers. We complement our calculations with a study of the interaction between two planar surfaces coated with the same DNA. Based on our simulations we propose analytical expressions for the interaction potentials. These analytical expressions describe the DNA-mediated interactions well for particle sizes ranging from tens of nanometers to a few micrometers and for a wide range of grafting densities. We find that important contributions to both the repulsive and attractive parts of the free energy come from purely entropic effects of the discrete tethered sticky ends. Per bond, these entropic contributions have a magnitude similar to the hybridization free energy of a free pair of sticky ends in solution and they can thus considerably change the effective sticky-end binding strength. Based on the calculated interaction potentials, we expect that stable gas–liquid separation only occurs for particles with radii smaller than a few tens of nanometers, which suggests that nanoparticles and micrometer-sized colloids will follow different routes to crystallization. Finally, we note that the natural statistical nonuniformities in the surface distribution of sticky ends lead to large variations in the binding strength. This phenomenon may compromise the reliability of tests that aim to detect specific DNA targets in diagnostics. In addition to guiding the design of novel self-assembling materials and gene-detection assays, the insights presented here could also shed more light on (multivalent) interactions in other systems with tethered binding groups, for instance in the areas of supramolecular chemistry or ligand–receptor mediated biorecognition.
Orientation dependent molecular friction on organic layer compound crystals
Authors: Fessler Gregor , Zimmermann Iwan , Glatzel Thilo , Gnecco Enrico , Steiner Pascal , Roth Raphael , Keene Tony D. , Liu Shi-Xia , Decurtins Silvio , Meyer Ernst
Published: February 2011

High resolution friction force maps of the benzylammonium terminated crystalline surface of a layer compound are presented. The lateral force map acquired with an atomic force microscope, reveals a significant contrast between different molecular orientations yielding molecular rows which differ from their neighboring ones. The single crystals are formed by stacks of copper oxalate sheets sandwiched between stereoregular organic cations, resulting in highly organized surface structures. Single molecular defects are observed at small loads. The experimental results are compared with numerical calculations which indicate a transition from an unperturbed state at small loads to a distorted state at higher loads.
Selective optical trapping based on strong plasmonic coupling between gold nanorods and slab
Authors: Zheng Y. J. , Liu H. , Wang S. M. , Li T. , Cao J. X. , Li L. , Zhu C. , Wang Y. , Zhu S. N. , Zhang X.
Published: February 2011

A resonance plasmon mode is formed between a gold nanorod and an infinite slab in infrared range, with local electric field enhancement factor over 40. A strong optical attractive force is exerted on the rod by the slab at resonance frequency. Based on Maxwell stress tensor method and numerical simulations, the optical force was calculated to be over 2.0 nN/(mW/μm2). For a fixed incident wavelength, the enhanced optical force is obtained only for the rods with particular length when the diameter is fixed. This strong optical force could be used as a possible selective optical trapping technique in the future.
On the effect of surface roughness height, wettability, and nanoporosity on Leidenfrost phenomena
Authors: Kim Hyungdae , Truong Bao , Buongiorno Jacopo , Hu Lin-Wen
Published: February 2011

In recent quenching heat transfer studies of nanofluids, it was found that deposition of nanoparticles on a surface raises its Leidenfrost point (LFP) considerably [Kim et al., Int. J. Multiphase Flow 35, 427 (2009) and Kim et al., Int. J. Heat Mass Transfer 53, 1542 (2010)]. To probe the physical mechanism underlying this observation, the effects of surface properties on LFP of water droplets were studied, using custom-fabricated surfaces for which roughness height, wettability, and porosity were controlled at the nanoscale. This approach reveals that nanoporosity is the crucial feature in efficiently increasing the LFP by initiating heterogeneous nucleation of bubbles during short-lived solid-liquid contacts, which results in disruption of the vapor film.
Fano resonance of three-dimensional spiral photonic crystals: Paradoxical transmission and polarization gap
Authors: Chen Wen-Jie , Lee Jeffrey Chi Wai , Dong Jian-Wen , Qiu Cheng-Wei , Wang He-Zhou
Published: February 2011

Extraordinary Fano resonance with right handedness is present in a right-handed polarization gap of compound spiral photonic crystals. The structure is composed of unit cells with double helices of π phase shift arranged in square lattice. Such a paradoxical phenomenon is derived from mode interferences between left-handed propagating modes along spiral axis and negative group velocity modes in extended Brillouin zone. By analyzing Fourier spectra and chirality of photonic eigenmodes, intrinsic mechanism is well understood by mode coupling theory.
Ultrafast linear kinetic inductive photoresponse of YBa2Cu3O7−δ meander-line structures by photoimpedance measurements
Authors: Atikian Haig A. , Ghamsari Behnood G. , Anlage Steven M. , Majedi A. Hamed
Published: February 2011

We report the experimental demonstration of the linear kinetic-inductive photoresponse of thin-film YBa2Cu3O7−δ meander line structures, where the photoresponse amplitude, full-width-half-maximum, and rise time are bilinear in the incident optical power and bias current. This bilinear behavior reveals a trade-off between obtaining high responsivity and high speed photodetection. We also report a rise time as short as 29 ps in our photoimpedance measurements.
Views of GPs and practice nurses on support needed to respond to pandemic influenza: a qualitative study
Authors: Pearce Christopher , Shearer Marianne , Phillips Christine , Hall Sally , Kljakovic Marjan , Glasgow Nicholas J. , Dugdale Paul , Patel Mahomed
Published: February 2011

Introduction. Five years ago Australia, and the world, placed itself on heightened alert for pandemic influenza, based on concerns about the potential spread of the avian influenza virus. This prompted a flurry of preparation activity involving general practice, with information from various sources; government, colleges and divisions of general practice. Method. To assess how general practitioners and practice nurses perceive this information, practice nurses and general practitioners were interviewed as part of a larger project exploring the role of the Australian general practice sector in an influenza pandemic. Results were validated by two focus groups and scenario sessions. Findings. Participants perceived that non-government organisations rarely gave useful information during a pandemic outbreak. Local divisions were perceived as having a practical and useful role, providing hands-on support to practices during a pandemic outbreak. Our participants did not perceive any coordination in the delivery of information sent by all the organisations involved in a pandemic response and therefore rejected our second hypothesis. Conclusions. More planning needs to go into the coordinated response of the general practice sector to a pandemic, and such a response should include the support of local Divisions, both as a conduit for information and to assist practices to develop response plans. What is known about the topic? Response to a pandemic will require a coordinated response between primary and secondary care, public and private sectors. What does this paper add? Outlines the support needs for general practice to respond effectively, in particular highlighting the important role Divisions can play. What are the implications for practitioners? Planning for a pandemic should include Divisions of general practice as an integral element of the response, both as a conduit for information and to assist practices to develop response plans.
Indigenous women's expectations of clinical care during treatment for a gynaecological cancer: rural and remote differences in expectations
Authors: Willis Eileen M. , Dwyer Judith , Owada Kei , Couzner Leah , King Debra , Wainer Jo
Published: February 2011

Objectives. To report on differences in Indigenous women’s expectations of clinical care during treatment for a gynaecological cancer in rural and remote regions. Design. Qualitative interviews were conducted in New South Wales, Victoria, South Australia and the Northern Territory in 2008 with 37 clinicians working in gynaecological cancer and 24 women with a gynaecological cancer. Three of the participants were Indigenous women living in large rural towns (others were non-Indigenous), whereas six of the 37 clinicians interviewed worked closely with Indigenous women in remote settings. Indigenous women were contacted through an Indigenous researcher. Interviews were analysed for emerging themes, then compared with each other and with the research literature for similarities and differences. Results. There is considerable variation between clinician observations of the expectations of Indigenous women in remote regions, and the views of Aboriginal women in rural settings. Conclusion. Indigenous women in rural settings have specific views about quality medical care. These include expectations of timely and culturally appropriate care, and strong ties to family and kin, but do not accord with other research findings that suggest Aboriginal women must receive care from same sex clinicians or that care is often delayed. The paper alerts practitioners to the fact that culturally appropriate care will vary from group to group, particularly between remote, rural and urban populations. What is known about this topic? Cross-cultural health care research recognises that health professionals need to be attuned to the cultural preferences and needs of Indigenous patients. What does this paper add? This study warns against assuming all Indigenous people are the same, or have the same expectations about quality health care. It notes that little guidance is offered to clinicians on how Indigenous responses to Western bio-medical care might differ across the country. The paper identifies some differences and proposes strategies for understanding local preferences. What are the implications for practitioners? This paper alerts practitioners to the fact that although Indigenous patients share many cultural similarities, clinicians should not make assumptions about what is appropriate culturally safe care. Culturally appropriate care will vary from group to group, particularly between remote, rural and urban populations in terms of timely access, culturally appropriate care and educational materials, the role of family and Aboriginal Health Workers, and sex preferences.
A 'snap shot' of the health of homeless people in inner Sydney: St Vincent's Hospital
Authors: Chin Caroline N. , Sullivan Kate , Wilson Stephen F.
Published: February 2011

Objectives. The poor health profile of people who are homeless results in a disproportionate use of health resources by these people. An in-hospital count of demographic and health data of homeless patients was conducted on two occasions at St Vincent’s Hospital in Sydney as an indicator of health resource utilisation for the Sydney region. Methods. Two in-hospital counts were conducted of homeless patients within the boundaries of St Vincent’s Hospital to coincide with the inaugural City of Sydney homeless street counts in winter 2008 and summer 2009. Data collected included level of homelessness, principal diagnosis, triage category, bed occupancy and linkages to services post hospital discharge. Results. Homeless patients at St Vincent’s utilised over four times the number of acute ward beds when compared with the state average. This corresponds to a high burden of mental health, substance use and physical health comorbidities in homeless people. There was high utilisation of mental health and drug and alcohol services by homeless people, and high levels of linkages with these services post-discharge. There were relatively low rates of linkage with general practitioner and ambulatory care services. Conclusion. Increasing knowledge of the health needs of the homeless community will assist in future planning and allocation of health services. What is known about the topic? The poor health status of people who are homeless has been previously noted in the USA, Canada and Scotland. What does this paper add? Homeless people living in Sydney also have a poor health profile and a disproportionate use of health resources when compared to people in the general population. What are the implications for practitioners? Health services for homeless people should be equipped to deal with mental health, substance use and physical health comorbidities.
The global financial crisis and Australian general practice
Authors: McRae Ian S. , Paolucci Francesco
Published: February 2011

Objective. To explore the potential effects of the global financial crisis (GFC) on the market for general practitioner (GP) services in Australia. Design. We estimate the impact of changes in unemployment rates on demand for GP services and the impact of lost asset values on GP retirement plans and work patterns. Combining these supply and demand effects, we estimate the potential effect of the GFC on the market for GP services under various scenarios. Results. If deferral of retirement increases GP availability by 2%, and historic trends to reduce GP working hours are halved, at the current level of ~5.2% unemployment average fees would decline by $0.23 per GP consultation and volumes of GP services would rise by 2.53% with almost no change in average GP gross earnings over what would otherwise have occurred. With 8.5% unemployment, as initially predicted by Treasury, GP fees would increase by $0.91 and GP income by nearly 3%. Conclusions. The GFC is likely to increase activity in the GP market and potentially to reduce fee levels relative to the pre-GFC trends. Net effects on average GP incomes are likely to be small at current unemployment levels. What is known about the topic? Although the broad directions of the impact of the global financial crisis on the demand for and supply of GP services have been the subject of public discussion, the overall impact on the GP market has not been formally assessed. What does this paper add? Drawing on existing supply and demand models, we estimate the likely effect of the global financial crisis on GP activity levels, GP earnings, and the fees to be faced by patients. What are the implications for practitioners? Practitioners on average are likely to work harder to recover losses in the investments they have made for their retirements. They may face lower fees than would have been the case due to the increasing supply of GPs as some defer retirement, but average incomes are likely to be minimally affected.
Audit of emergency department assessment and management of patients presenting with community-acquired needle stick injuries
Authors: Celenza Antonio , D'Orsogna Lloyd J. , Tosif Shervin H. , Bateman Samantha M. , O'Brien Debra , French Martyn A. , Martinez O. Patricia
Published: February 2011

Objectives. To describe characteristics and management of people with community acquired needle stick injuries (CANSI) attending urban emergency departments; and suggest a guideline to improve assessment, management, and documentation. Methods. A retrospective analysis of cases with CANSI attending emergency departments in two tertiary hospitals between 2001 and 2005 using medical record review with follow up phone and written survey. Results. Thirty-nine cases met the criteria for CANSI. Persons younger than 30 years sustained 48.72% of all injuries. Source serology was available for only five cases (12.82%). Thirty-one of thirty-nine patients (79.49%) were classed as not immune to hepatitis B but only four of these (12.90%) received both hepatitis B vaccination and hepatitis B immunoglobulin. Six patients (15.38%) received HIV prophylaxis; of which two (33.33%) did not receive baseline HIV testing. Of ten patients referred to immunology clinic for follow up only two (20.00%) attended at 6 months. Conclusion. We have identified groups that are at high risk of CANSI, including young males, security workers and cleaners. In the majority of cases protection against hepatitis B was inadequately provided, and a substantial proportion had inadequate baseline assessment and documentation. A guideline is suggested that may be used to improve these deficits. What is known about this topic? Occupationally acquired needle stick injury guidelines are well established, but no guidelines currently exist for community acquired needle stick injuries (CANSI) which may require different risk stratification, assessment and management. Management of CANSI in Emergency Departments has not been well described. What does this paper add? An audit of Emergency Department management of community acquired needle stick injuries demonstrates deficits in risk assessment, documentation and use of post-exposure immunisation and prophylaxis. A guideline is suggested that may be used to improve these deficits. What are the implications for practitioners? Practitioners need to perform and document a risk assessment of the injury, perform baseline serology, and provide tetanus and hepatitis B immunisation. Use of HIV post-exposure prophylaxis is determined by local prevalence of disease, injury risk assessment, source serology if known, and time since injury.
Increasing utilisation of emergency ambulances
Authors: Lowthian Judy A. , Cameron Peter A. , Stoelwinder Johannes U. , Curtis Andrea , Currell Alex , Cooke Matthew W. , McNeil John J.
Published: February 2011

Background. Increased ambulance utilisation is closely linked with Emergency Department (ED) attendances. Pressures on hospital systems are widely acknowledged with ED overcrowding reported regularly in the media and peer-reviewed literature. Strains on ambulance services are less well-documented or studied. Aims. To review the literature to determine the trends in utilisation of emergency ambulances throughout the developed world and to discuss the major underlying drivers perceived as contributing to this increase. Method. A search of online databases, search engines, peer-reviewed journals and audit reports was undertaken. Findings. Ambulance utilisation has increased in many developed countries over the past 20 years. Annual growth rates throughout Australia and the United Kingdom are similar. Population ageing, changes in social support, accessibility and pricing, and increasing community health awareness have been proposed as associated factors. As the extent of their contribution has not yet been established these factors were reviewed. Conclusion. The continued rise in utilisation of emergency ambulances is placing increasing demands on ambulance services and the wider health system, potentially compromising access, quality, safety and outcomes. A variety of factors may contribute to this increase and targeted strategies to reduce utilisation will require an accurate identification of the major drivers of demand. What is known about the topic? Ambulance utilisation is increasing annually throughout the developed world, with previous research suggesting numerous underlying factors. What does this paper add? These factors have not been previously synthesised in the international literature. This narrative review clearly articulates the underlying problems. What are the implications for practitioners? This paper outlines the need for further research of the causes of increased emergency ambulance utilisation, to enable the development of appropriate strategies to manage demand in the future.
Evaluating new roles for the support workforce in community rehabilitation settings in Queensland
Authors: Wood Angela J. , Schuurs Sarita B. , Amsters Delena I.
Published: February 2011

Introduction.
Alternative workforce models need to be explored to adequately meet the future health care needs of the Australian population. A new role for the support workforce, to optimise their contribution in community rehabilitation in Queensland – the advanced community rehabilitation assistant (ACRA) – was developed on the basis of service activity mapping and gap analysis.

Objectives.
Evaluation of a trial of the new ACRA role at six pilot sites in Queensland.

Participants.
ACRAs, health professionals and rehabilitation clients.

Methods.
Transcripts of semistructured telephone interviews conducted with ACRAs, health professionals and rehabilitation clients were thematically analysed. The nature of the role as well as perceived strengths and weaknesses were explored.

Results.
The presence of an ACRA was generally seen to diversify and expand local service capacity. The major challenge was the initial intensity of instruction that was required from supervising health professionals.

Conclusions.
ACRAs have potential to be valuable resources in the provision of community rehabilitation services. The challenge of meeting each new ACRA’s preliminary training needs requires further consideration. A critical mass of people trained to this role may be required to ensure sustainability. Further trial and evaluation is needed to investigate the role more thoroughly over time and in different settings.

What is known about the topic?
It is evident that support workers such as allied health assistants and assistants in nursing make a valuable contribution to healthcare provision. Emerging alternative health workforce models incorporate support workers in a range of capacities including generic health workers through to advanced support roles.

What does this paper add?
By presenting an evaluation of a trial of an ACRA role, this paper highlights potential benefits and challenges of such a role.

What are the implications for practitioners?
The trial of the ACRA’s role, as presented in this paper, demonstrates how practitioners can be personally involved in shaping workforce solutions at a service level. The attitude of health professionals to an expanded role for the support workforce and their ability to provide the necessary support for the role will influence its potential as a component of an alternative workforce model.
Extra‐credential experiences and social closure: Working‐class students at university
Authors: Lehmann Wolfgang
Published: February 2011

Human capital theorists perceive of educational expansion as beneficial to individuals, corporations and national economies, while social closure theorists have claimed that inflation of credential requirements maintains traditional status inequalities. In this paper I argue that status inequalities are not only maintained by credential inflation, but also the inflation of extra‐credential experiences. As undergraduate degrees become more common, access to employment and further education opportunities increasingly depend on extra‐curricular and ‘enriching’ educational experiences. Using qualitative data from a longitudinal study of working‐class university students in Canada, I will address the mechanisms by which they have gained or were denied access to such experiences. The data suggest that working‐class students’ relative lack of financial resources and social networks are barriers to the development of extra‐credential experiences, which in turn leads to the change of educational and career plans for some.
Disengaged and disaffected young people: Surviving the system
Authors: Lumby Jacky
Published: February 2011

There are counter‐narratives of youth as at risk and as buoyant and agentive. The article maps the conceptual terrain concerning resilience, well‐being, buoyancy, enjoyment and happiness and selects factors related to the successful navigation of schooling. It analyses data from a subset of a national data set, from 65 young people considered to be disaffected or disengaged by their school or college. It explores the perceptions of young people that the difficulties they encounter are in part a result of their own behaviour and in part a product of the system. Hirschman's theory of exit, voice, loyalty is used to explore their choices. The article concludes that schools act to maintain homeostasis and that a substantial minority of young people are at long‐term risk due to organisational and national unwillingness to decouple economic benefit from maintenance of the existing system.