Contextual and behavioural risk factors for sexually transmissible infections in young Aboriginal people in central Australia: a qualitative study.

Rates of sexually transmissible infections (STIs) in remote central Australian Aboriginal communities have been persistently high for over two decades, yet risk factors for STIs in these communities are not well understood. This qualitative study explored behavioural and contextual risk factors for STIs in young Aboriginal people in central Australia. The study identified that casual relationships between young people are common and that there is a strong association between travel, alcohol and casual sex, highlighting the ongoing need for comprehensive sexual health programs that are tailored to the specific social, cultural and interpersonal circumstances of young people in this setting.

Cost of best-practice primary care management of chronic disease in a remote Aboriginal community.

OBJECTIVE: To estimate the cost of completing all chronic care tasks recommended by the Central Australian Rural Practitioners Association Standard Treatment Manual (CARPA STM) for patients with type 2 diabetes and chronic kidney disease (CKD). DESIGN AND SETTING: The study was conducted at a health service in a remote Central Australian Aboriginal community between July 2010 and May 2011. The chronic care tasks required were ascertained from the CARPA STM. The clinic database was reviewed for data on disease prevalence and adherence to CARPA STM guidelines. Recommended tasks were observed in a time-and-motion study of clinicians' work. Clinicians were interviewed about systematic management and its barriers. Expenditure records were analysed for salary and administrative costs. MAIN OUTCOME MEASURES: Diabetes and CKD prevalence; time spent on chronic disease care tasks; completion of tasks recommended by the CARPA STM; barriers to systematic care identified by clinicians; and estimated costs of optimal primary care management of all residents with diabetes or CKD. RESULTS: Projected annual costs of best-practice care for diabetes and CKD for this community of 542 people were $900 792, of which $645 313 would be met directly by the local primary care service. Estimated actual expenditure for these conditions in 2009-10 was $446 585, giving a projected funding gap of $198 728 per annum, or $1733 per patient. High staff turnover, acute care workload and low health literacy also hindered optimal chronic disease care. CONCLUSION: Barriers to optimal care included inadequate funding and workforce issues. Reduction of avoidable hospital admissions and overall costs necessitates adequate funding of primary care of chronic disease in remote communities.

What stresses remote area nurses? Current knowledge and future action.

OBJECTIVE: Review and synthesise the literature identifying the stresses experienced by remote area nurses (RANs). Identify interventions implemented to address identified stresses. Explore the use of the job demands-resources (JD-R) model. METHODS: A comprehensive literature review was conducted using the meta-databases Ovid and Informit. SETTING: Remote Australian primary health care centres. RESULTS: The reported demands experienced by RANs can be grouped into four themes: (i) the remote context; (ii) workload and extended scope of practice; (iii) poor management; and (iv) violence in the workplace and community. In this high-demand, low-resource context, the JD-R model of occupational stress is particularly pertinent to examining occupational stress among RANs. The demands on RANs, such as the isolated geographical context, are immutable. However, there are key areas where resources can be enhanced to better meet the high level of need. These are: (i) adequate and appropriate education, training and orientation; (ii) appropriate funding of remote health services; and (iii) improved management practices and systems. CONCLUSION: There is a lack of empirical evidence relating to stresses experienced by RANs. The literature identifies some of the stresses experienced by RANs as unique to the remote context, while some are related to high demands coupled with a deficit of appropriate resources. Use of models, such as the JD-R model of occupational stress, might assist in identifying key areas where resources can be enhanced to better meet the high level of need and reduce RANs' levels of stress.

Near field detector for integrated surface plasmon resonance biosensor applications.

Integrated surface plasmon resonance biosensors promise to enable compact and portable biosensing at high sensitivities. To replace the far field detector traditionally used to detect surface plasmons we integrate a near field detector below a functionalized gold film. The evanescent field of a surface plasmon at the aqueous-gold interface is converted into photocurrent by a thin film organic heterojunction diode. We demonstrate that use of the near field detector is equivalent to the traditional far field measurement of reflectivity. The sensor is stable and reversible in an aqueous environment for periods of 6 hrs. For specific binding of neutravidin, the detection limit is 4 microg/cm(2). The sensitivity can be improved by reducing surface roughness of the gold layers and optimization of the device design. From simulations, we predict a maximum sensitivity that is two times lower than a comparable conventional SPR biosensor.

Expression patterns of cadherin genes in Drosophila oogenesis.

In Drosophila oogenesis, the follicular epithelium that envelops the oocyte is patterned by a small set of inductive signals and gives rise to an elaborate three-dimensional eggshell. Several eggshell structures provide sensitive readouts of the patterning signals, but the formation of these structures is still poorly understood. In other systems, epithelial morphogenesis is guided by the spatial patterning of cell adhesion and cytoskeleton genes. As a step towards developing a comprehensive description of patterning events leading to eggshell morphogenesis, we report the expression of Drosophila cadherins, calcium-dependent adhesion molecules that are repeatedly used throughout development. We found that 9/17 of Drosophila cadherins are expressed in the follicular epithelium in dynamic patterns during oogenesis. In late oogenesis, the expression patterns of cadherin genes in the main body follicle cells is summarized using a compact set of simple geometric shapes, reflecting the integration of the EGFR and DPP inductive signals. The multi-layered composite patterning of the cadherins is hypothesized to play a key role in the formation of the eggshell. Of particular note is the complex patterning of the region of the follicular epithelium that gives rise to the dorsal appendages, which are tubular structures that serve as respiratory organs for the developing embryo.

A dosimetry intercomparison phantom for intraoperative radiotherapy.

Intraoperative radiotherapy (IORT) using very low kV x-rays is a promising new treatment modality and has proven to be effective for managing breast and neurological tumours. We have treated in excess of 75 patients using four Zeiss Intrabeam x-ray sources (XRS). To date there has been no published data of any dosimetric intercomparison of this type of x-ray source used at other cancer centres worldwide. This paper describes the design of a simple dosimetry intercomparison phantom for use with these very low kV x-ray sources. A prototype polymethyl methacrylate (PMMA) phantom has been manufactured, the dimensions of which were determined by the dimensions of the XRS, the beam energy and the attenuating properties of PMMA. The phantom is used in conjunction with Gafchromic XR Type-R film (GC-XRR) and its purpose is to measure the absorbed dose at a fixed distance from the effective point source at the tip of the XRS. The utility of this phantom is further enhanced through the use of an interlock, which eliminates the need to use the mobile gantry. We have used this phantom to conduct a qualitative dosimetric intercomparison of four Zeiss Intrabeam x-ray sources with positive results. This phantom is low cost, easy to manufacture, simple to use and could be adopted as a standard method of dosimetric intercomparison for Intrabeam x-ray sources as this mode of IORT becomes more widespread.