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Parkinson’s disease (PD) is a prevalent neurodegenerative condition, ranking as the most common among movement disorders. People living with Parkinson’s disease benefit from the specialised skills and expertise of a dedicated Parkinson’s disease and movement disorders nurse specialist (PDMDNS) (Bramble, Carroll, & Rossiter, 2018). Access to a PD nurse embedded into the local health setting impacts the potential to avoid hospital admissions due to worsening of symptoms, improving quality of life through improved access to specialist services and reducing carer burden (Bramble et al. 2018) The World Health Organisation advocates for the tracking healthcare workforce demographics and distribution trends to ensure equity of health care services and robust economic planning to meet future needs (WHO 2016). This marks the fourth publication in an ongoing annual series examining the longitudinal trends of the PDMDNS workforce in Australia (Williams et al., 2021, 2023).

Aims: The aim of this study is to describe the demographic, presenting features and associated risk factors of ocular surface squamous neoplasia (OSSN) at a tertiary eye hospital in Johannesburg, South Africa. Methods: An interventional prospective study of patients presenting with conjunctival masses was conducted. An electronic questionnaire was completed to document demographic data, presenting history, and associated risk factors. A slit lamp examination and photos were used to document and describe the clinical features at presentation. Cases (OSSN) and controls (benign lesions) were determined by histology. Results: There were 130 cases and 45 controls. Median age was 44 years (IQR: 35–51) with an equal gender distribution in cases. The prevalence of HIV in cases was 74% and was strongly associated with OSSN (p< 0.001). Vascularisation, leukoplakia and pigmentation were clinical features that distinguished cases from controls. A fibrovascular morphology was strongly associated with a benign histology (p< 0.001), whereas leukoplakic and gelatinous morphologies were associated with OSSN. Conjunctival intra-epithelial neoplasia made up 82% of cases. Conclusion: Our study describes a sample of OSSN that is young and has no gender predisposition. The majority of cases presented with CIN lesions, rather than SCC reported in other African countries. HIV was the most significant risk factor in this study population.

This document is a collection of letters from readers of New Scientist magazine. The letters cover a range of topics, including memory retention, the energy consumption of the brain, the role of microbes in Alzheimer's disease, cannibalism, the debate over ultra-processed food, the possible evolutionary origins of ADHD, sex in space, dream engineering, string theory, and aviation's green revolution. The letters come from various locations around the world, including Australia, the UK, China, the US, and Hong Kong. [Extracted from the article]

I largely agree with Harry Lambert's observations ('The great university con', 23 August). The analogy to the frog in boiling water applies to my 30-year career as an academic, watching [...]

Living in greener areas, or close to green and blue spaces (GBS; eg, parks, lakes, or beaches), is associated with better mental health, but longitudinal evidence when GBS exposures precede outcomes is less available. We aimed to analyse the effect of living in or moving to areas with more green space or better access to GBS on subsequent adult mental health over time, while explicitly considering health inequalities.

Why was the Congo such an intense theatre in the Cold War? Providing a compelling reason in her new book, Spies in the Congo, Susan Williams provides this analysis. Eight [...]

Parkinson’s disease is a common neurological condition. Patients benefit from patient centred care provided by a Parkinson’s disease or movement disorder nurse specialist. This study is the second in a series of annually recurring publications to progressively monitor the growth and development of the PDMDNS profession in Australia. Results will firstly; provide evidence to support the PDMDNS professional body in Australia to advocate for adequate resources, sufficient training and appropriate levels of qualifications and pay grades, secondly; assist in identifying gaps in the provision of services to people living with PD.

Archives can represent a rich seam of evidence and information on the behaviour of colonial administrations. Perhaps this is why Britain is dragging its feet in returning files taken away [...]

Objectives: To identify pathogenic variants in a cohort of 23 black South African children with sporadic primary congenital glaucoma (PCG) using an exome-based approach. Methods: Children with PCG were recruited from two Paediatric Ophthalmology Clinics in Johannesburg, South Africa. Whole exome sequencing was performed on genomic DNA. Of the 23 children, 19 were male and 19 had bilateral PCG. A variant prioritization strategy was employed whereby variants in known PCG genes (CYP1B1, LTBP2and TEK) were evaluated first, followed by the identification of putative disease-causing variants in other genes related to eye diseases and phenotypes. Results: Validated pathogenic variants in the CYP1B1gene (c.1169 G>A; p.Arg390His) and TEKgene (c.922 G>A; p.Gly308Arg) were identified in one child each. No LTBP2mutations were identified in this cohort. In silicopredictions identified potentially damaging rare variants in genes previously associated with eye development phenotypes or glaucoma in a further 12 children. Conclusions: This study demonstrates the value of whole exome sequencing in identifying disease-causing variants in African children with PCG. It is the first report of a TEKdisease-causing variant in an African PCG patient. Potential causative variants detected in PCG candidate genes warrant further investigation.

Aims: The aim of the study is to assess non-invasive diagnostic modalities for ocular surface squamous neoplasia (OSSN) when compared to histology. Methods: A prospective case–control study was conducted of patients presenting with conjunctival masses at a tertiary eye hospital in Johannesburg, South Africa. Patients completed an interview and had three non-invasive diagnostic tests: optical coherence tomography, impression cytology and methylene blue stain. A biopsy with histology was performed as the gold standard to confirm the diagnosis. Results: One hundred and eighty-two conjunctival masses of 175 patients were evaluated. There were 135 lesions identified as OSSN on biopsy and 47 lesions were benign on histology. Optical coherence tomography had a sensitivity and specificity of 87.2% (95% CI: 80.0–92.5) and 75.6% (95% CI: 60.5–87.1), respectively, when an epithelial thickness cutoff of 140 um was used. Shadowing was found in 46% of cases due to leukoplakia or increased thickness of the mass. Cytology had a sensitivity of 72.4% (95% CI: 62.5–81.0) and a specificity of 74.3% (95% CI: 56.7–87.5). Twenty-seven per cent of cytology specimens were excluded from analysis due to inadequate cellularity. Methylene blue had a high sensitivity of 91.9% (95% CI: 85.9–95.9), but low specificity of 55.3% (95% CI: 40.1–69.8). Conclusion: Optical coherence tomography had a high sensitivity and specificity as a non-invasive test and liquid-based cytology performed well but had a lower sensitivity and specificity than with optical coherence tomography. Methylene blue performed well as a screening test, with a high sensitivity but low specificity.

ObjectiveMotherhood within sport has become more common with many female athletes seeking to return-to-sport (RTS) postpartum; yet few sport organisations possess policies that support female athletes to RTS postpartum. Our aim was to synthesise existing literature to identify the barriers and enablers that influence female athlete RTS postpartum to help guide the development of evidence-based policies to support postpartum athlete RTS.DesignScoping review.Data sourcesOvid-Medline, Embase, SportDiscus and Scopus were systematically searched. Reference lists of eligible studies were also searched to identify additional studies of relevance.Eligibility criteriaOriginal, empirical, peer-reviewed, English-language studies reporting on female athletes and their RTS postpartum. Reviews, book chapters and grey literature were excluded.ResultsTwenty-two studies were included in this review. Identified barriers and enablers reflected 11 categories which occurred within and/or across three domains of the socioecological model. Five key factors were found to significantly influence female athlete RTS postpartum including (1) postpartum recovery time; (2) time to manage motherhood and sport demands; (3) sport organisation policies; (4) stereotypes; and (5) social support.ConclusionVarious barriers and enablers exist that influence successful RTS postpartum. These factors present opportunities for clinicians and sport organisations to improve their support of postpartum athletes. Paid maternity leave, offering job security, travel support for carer and child and affordable and accessible childcare are critical policy inclusions to appropriately support female athletes in their RTS postpartum.

Background. Previous research has mainly targeted older people with high risk of falling. The effectiveness of exercise interventions in older people with mild levels of balance dysfunction remains unexplored. Objective. This study evaluated the effectiveness of a home balance and strength exercise intervention in older people systematically screened as having mild balance dysfunction. Design. This was a community-based, randomized controlled trial with assessors blinded to group allocation. Participants. Study participants were older people who reported concerns about their balance but remained community ambulant (n=225). After a comprehensive balance assessment, those classified as having mild balance dysfunction (n= 165) were randomized into the trial. Intervention. Participants in the intervention group (n=83) received a 6-month physical therapist-prescribed balance and strength home exercise program, based on the Otago Exercise Program and the Visual Health Information Balance and Vestibular Exercise Kit. Participants in the control group (n=82) continued with their usual activities. Outcome Measures. Laboratory and clinical measures of balance, mobility, and strength were assessed at baseline and at a 6-month reassessment. Results. After 6 months, the intervention group (n=59) significantly improved relative to the control group (n=62) for: the Functional Reach Test (mean difference=2.95 cm, 95% confidence interval [CI]=1.75 to 4.15), the Step Test (2.10 steps/15 seconds, 95% CI= 1.17 to 5.02), hip abductor strength (0.02, 95% CI=0.01 to 0.03), and gait step width (2.17 cm, 95% CI=1.23 to 3.11). There were nonsignificant trends for improvement on most other measures. Fourteen participants in the intervention group (23.7%) achieved balance performance within the normative range following the exercise program, compared with 3 participants (4.8%) in the control group. Limitations. Loss to follow-up (26.6%) was slightly higher than in some similar studies but was unlikely to have biased the results. Conclusions. A physical therapist-prescribed home exercise program targeting balance and strength was effective in improving a number of balance and related outcomes in older people with mild balance impairment., Balance is defined as the ability to maintain the projection of the body's center of mass within limits of the base of support, as in standing or sitting, or in [...]

On 18 September 1961, the second UN secretary general, Dag Hammarskjold, was killed in a mysterious plane crash in the Zambian town of Ndola. He was on a mission to [...]

Ed's and Seana's papers together present a powerful argument for the idea that autonomy is a fundamental value underlying the protection of free speech. As I have written elsewhere, I [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.cor.2005.07.023 Byline: Susan K. Williams (a), Michael J. Magazine (b) Abstract: The goal of the printed circuit board job-batching problem is to minimize the total manufacturing time required to process a set of printed circuit board jobs on an insertion machine. We have developed four families of heuristics to solve this problem: the clustering family, the bin-packing family, a family of sequencing genetic algorithms, and a grouping genetic algorithm. Within each family of heuristics, we developed several variations. Some of the variations use techniques from the literature and some of the techniques we developed specifically for this problem. We test the variations and select a good performer from each family. Author Affiliation: (a) College of Business Administration, Northern Arizona University, PO Box 15066, Flagstaff, AZ 86011, USA (b) College of Business, University of Cincinnati, PO Box 210020, Cincinnati, OH 45221-0020, USA

States have shown creativity and adaptability in developing outreach strategies to promote State Children's Health Insurance Program (SCHIP) enrollment. As the program has matured and the fiscal environment has tightened, States have learned what efforts are successful and have tailored their approaches accordingly. This article reviews the evolution of State outreach strategies under SCHIP, using qualitative information from all 50 States and the District of Columbia. Early campaigns were aimed at building broad awareness of SCHIP. Over time, States have adapted their outreach campaigns to close the gaps in enrolling hard-to-reach populations, by modifying their target populations, messages, methods, organizational strategies, and emphasis., INTRODUCTION Since the initiation of SCHIP in 1997, States have recognized the importance of outreach in raising awareness and facilitating enrollment in the program. States have shown creativity and adaptability [...]

When one considers the milestones in the application of seismic methods to further oil and gas exploration over the last 20 years, one usually thinks first of the progression from [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ijinfomgt.2005.11.004 Byline: Susan P. Williams, Paul A. Scifleet, Catherine A. Hardy Keywords: Business information management; Online business reporting; Socio-technical change; Metadata; Extensible Business Reporting Language (XBRL) Abstract: Online business reporting and the benefits thereof are widely reported in the academic and practitioner literatures. Much is made of its potential to transform information supply and demand and the dominant focus of the current discourse is on the automation and publishing aspects of online business reporting. These we argue are necessary aspects but present a narrow conception of the role of business information in organisations. Current research lacks an information management perspective, which focuses attention on the design, management and intellectual organisation of business information. Drawing on a preliminary study of the adoption and implementation of business reporting markup languages (in particular XBRL) in the Australian financial sector we draw out the issues for research and practice. We present a complementary perspective that makes information and information work visible and takes into account the complex inter-relationships between the activities of humans and the information itself. Author Affiliation: Discipline of Business Information Systems School of Business, University of Sydney, Sydney, NSW, Australia

A study is carried to develop a means of assessing the impact of global information technology applications. This provided better understandings of the factors that should be considered when assessing the impact of global IT applications.

Objective: To examine the cost benefits of a heat health warning system (HHWS) in South Australia. Methods: Information from key agencies was used to estimate the costs associated with the South Australian HHWS, including for three targeted public health interventions. Health cost savings were estimated based on previously reported HHWS‐attributable reductions in hospital and emergency department (ED) admissions and ambulance callouts. Results: The estimated cost for a one‐week activation of the HHWS was AU$593,000. Activation costs compare favourably with the potential costs averted through HHWS‐attributable reductions in hospital admissions and ambulance callouts with an estimated benefit‐cost ratio of 2.0–3.3. Conclusions: On the basis of estimated cost benefit, the South Australian HHWS is a no‐regret public health response to heatwaves. Implications for public health: As global temperatures rise there are likely to be significant health impacts from more frequent and intense heatwaves. This study indicates that HHWSs incorporating targeted supports for vulnerable groups are likely to be cost‐effective public health interventions.

Summary points Demands on emergency services and inappropriate requests for emergency ambulances are increasing Ambulance services must respond to calls immediately by sending vehicles with flashing lights and sirens, staffed [...]

BackgroundExposure to extreme temperatures is associated with increased emergency department (ED) presentations. The resulting burden on health service costs and the potential impact of climate change is largely unknown. This study examines the temperature-EDs/cost relationships in Adelaide, South Australia and how this may be impacted by increasing temperatures.MethodsA time series analysis using a distributed lag nonlinear model was used to explore the exposure–response relationships. The net-attributable, cold-attributable and heat-attributable ED presentations for temperature-related diseases and costs were calculated for the baseline (2014–2017) and future periods (2034–2037 and 2054–2057) under three climate representative concentration pathways (RCPs).ResultsThe baseline heat-attributable ED presentations were estimated to be 3600 (95% empirical CI (eCI) 700 to 6500) with associated cost of $A4.7 million (95% eCI 1.8 to 7.5). Heat-attributable ED presentations and costs were projected to increase during 2030s and 2050s with no change in the cold-attributable burden. Under RCP8.5 and population growth, the increase in heat-attributable burden would be 1.9% (95% eCI 0.8% to 3.0%) for ED presentations and 2.5% (95% eCI 1.3% to 3.7%) for ED costs during 2030s. Under the same conditions, the heat effect is expected to increase by 3.7% (95% eCI 1.7% to 5.6%) for ED presentations and 5.0% (95% eCI 2.6% to 7.1%) for ED costs during 2050s.ConclusionsProjected climate change is likely to increase heat-attributable emergency presentations and the associated costs in Adelaide. Planning health service resources to meet these changes will be necessary as part of broader risk mitigation strategies and public health adaptation actions.

Byline: Susan Williams, Jeremy Dale, Edward Glucksman Abstract: Study objective: We investigated the types of patient presentations that cause senior house officers (SHOs) most difficulty during their tenure in emergency departments and report the extent to which such difficulties are related to SHOs' communication problems, stress, or perceived lack of skills or knowledge. Methods: We conducted a questionnaire survey of 171 newly appointed SHOs employed in 27 EDs in the South Thames region of England. Subjects were asked to describe the presentation that gave them greatest difficulty during three subsequent shifts at the end of the first and fourth months of their ED appointment. Results: A total of 132 (77%) and 110 (64%) respondents returned questionnaires at the end of the first and fourth months, respectively; 61% (105) responded to both questionnaires. The respondents described 537 of a possible total of 726 cases (74%). Communication problems caused difficulty in 406 (76%) cases, SHOs' experience of stress in 352 (66%) cases, and a perceived lack of knowledge or skills in 281 (52%) cases. Communication problems and the experience of stress occurred in 141 (26%) cases. Patients presenting with mental or behavioral disorders and symptoms most frequently gave rise to communication problems, perceived lack of skills, and the experience of stress. The difficulties described at the two time periods were very similar indicating that experience alone had little effect on these problems. Conclusion: ED SHOs may benefit from communication skills training, the opportunity to review difficult case presentations, and the alleviation of organizational stress factors. [Williams S, Dale J, Glucksman E: Emergency department senior house officers' consultation difficulties: Implications for training. Ann Emerg Med March 1998;31:358-363.] Article History: Received 24 March 1997; Revised 12 August 1997; Accepted 15 August 1997 Article Note: (footnote) [star] From the Department of General Practice and Primary Care, King's College School of Medicine and Dentistry, Weston Education Centre, London,* the School of Postgraduate Medical Education, University of Warwick, Coventry,a and the Department of Accident and Emergency Medicine, King's College Hospital, London,As. England., [star][star] Supported by the Primary Care Development Fund, South Thames Region, NHSE, London., a Address for reprints: Susan Williams, MSc, Kings College, Weston Education Centre, Cutcombe Road, Bessemer Road, London SE5 9PJ, England, aa Reprint no. 47/1/87769

A relationship exists between patients' feeling that nurses care and their satisfaction with nursing care. The patient characteristics of age, gender and degree of pain influence their perceptions of nurse caring. A study including 94 hospitalized medical patients at two rural, southeastern US hospitals found the patients not to have a high degree of satisfaction with their nursing care. This result raises questions about communication and trust between nurse and patient. Holistic nurse caring is a significant factor in patient outcomes.

Patient-focused care appears to be successful in reducing patients' perceptions of anxiety. Ninety-four hospitalized patients reported their perceptions of their nurses' overall concern for them and their immediate and general perceptions of anxiety. Patients reported that overall caring was evident. Those patients who felt more evidence of care tended to report less immediate anxiety, while patients in more pain tended to report more immediate anxiety. There was a significant correlation between overall and immediate anxiety.

Introduction Stress affecting junior doctors is receiving increasing attention.[1-8] It has been reported that excessive levels of stress may lead to dissatisfaction, lower morale, and poorer work performance.[5] Although it [...]

Nursing teaching strategies must expand beyond having students gather information because this is not enough to produce competent nurses. Strategies that encourage critical thinking include incorporating the experience and background of the individual students into clinical teaching, critical incident cards with decision trees, preceptorships and mentorships, simulations to teach skills, student-selected clinical experiences, participation in nursing rounds, and concept mapping.

Aging gracefully is a challenge in its own right. However, for parents of children with serious mental illness, the challenges of growing older present a unique set of circumstances. This [...]

One of the first things I was told when I came to McClellanville, South Carolina, was that 'nobody' used the public schools. For a white person to express interest in [...]

Ocular surface squamous neoplasia (OSSN) is the most common ocular tumour with an incidence ranging from 0.03 to 1.9 per 100,000 persons/year. The diagnosis is made on clinical suspicion and confirmed with anterior-segment optical coherence tomography (AS-OCT), cytology, or histology. The purpose of this review is to provide an overview of the management options available for OSSN and review their success and recurrence rates. Surgery is the gold standard for the management of small OSSN lesions. With the increased use of less invasive diagnostic modalities such as AS-OCT and cytology, there has been a move to use topical therapies for the management of OSSN. The most commonly used agents are interferon-α2b (IFN), mitomycin-C (MMC) and 5-fluorouracil (5FU). They have been shown to have similar resolution and recurrence rates but differ in cost and side effect profile. IFN has the lowest side effect profile, but is also the most expensive, whereas MMC has the greatest surface toxicity and is priced midway between the three. 5FU is the cheapest of the three topical agents with less surface toxicity than MMC. Radiotherapy is mostly employed as adjuvant therapy. Newer novel therapies are available but have not been widely adopted as mainstream therapy due to cost and lack of clinical evidence. OSSN has the benefit of many management options. No single modality has been shown to superior and some patients will need the use of combination therapy to achieve an optimal clinical outcome.

Over half a century after Dag Hammarskjold's mysterious plane crash at Ndola, the UN reopened the investigation into his death. But reluctance from the US and UK governments is holding [...]