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Introduction: Simulation is commonly used in health professional education. Mask-Ed TM is a novel form of teacher-in-role methodology involving the educator wearing a purpose-made silicone mask to become the simulated patient. The simulation unfolds spontaneously and in response to the students’ or cohorts’ knowledge, skills or learning objectives. The evidence to support adoption appears limited. This is significant given the resources required to establish a Mask-Ed TM character and the changes to courses educators will likely make to embed this simulation. This scoping review aims to explore the current literature and evidence base relating to Mask-Ed TM . Methods: A scoping review was completed in September 2020 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. Five databases and Google Scholar were searched for English, peer-reviewed publications containing variants of “Mask-Ed”. Screening and data charting were completed independently by both authors and then reviewed collaboratively. A descriptive analysis was conducted reporting findings based on study design. A thematic synthesis was completed for studies containing qualitative data. Results: Eighteen studies published between 2011 and 2020 by Australian universities and health institutions were included. Twelve studies reported on 10 unique datasets drawing on survey, focus group and mixed method designs. Two studies reported case studies without data, one study was on training and a final three provided research summaries or pedagogical discussion of Mask-Ed TM . Conclusion: There is emerging evidence, self-reported by preclinical nursing students, that Mask-Ed TM supports improved engagement and confidence in formative learning activities. There is limited evidence, however, to support use in other health or medical disciplines or in individual or summative assessment.

The Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) population is at a substantially elevated risk for myriad health complications, due in large part to structural and social inequities. As such, the LGBTQ population is an important demographic to survey regarding their health. As with many populations facing inequality, the LGBTQ population is often hard to sample. In light of this challenge, several approaches may be required in order to effectively surveying this population. Specifically, advances in sampling methodologies, leveraging community partnerships, and culturally aware question design appear to increase the likelihood of a successful LGBTQ-focused health survey. The Southern LGBTQ Health Study is examined as a case study in effectively conducting a large, multi-state LBTQ health survey. They used a simple snowball sampling strategy where their online health survey was distributed through a wide network of community organizations across several states. They also employed members of the LGBTQ community as “Survey Ambassadors” to help recruit their peers to participate in the study. This case study demonstrated several successful methods. Their combined sampling methodology resulted in almost 6000 respondents. Their question for sexual orientation (“Check all that apply”) resulted in rich, easy to interpret data and was well received by the participants. However, this case study also provided valuable learning opportunities. Had they used a more formalized approach to their sampling, they would have had greater generalizability to their target population. Also, the use of an open-ended question regarding gender identity generated data that was not conducive to formal analysis without significant resources dedicated to cleaning the data.

Interconception care (ICC) is recommended to reduce maternal risk factors for poor birth outcomes between pregnancies. The IMPLICIT ICC model includes screening and brief intervention for mothers at well child visits (WCVs) for smoking, depression, multivitamin use, and family planning. Prior studies demonstrate feasibility and acceptability among providers and mothers, but not whether mothers recall receipt of targeted messages. Mothers accompanying their child at 12- and 24-month WCVs at four sites of a family medicine academic practice were surveyed pre (2012) and post (2018) ICC model implementation. Survey items assessed health history, behaviors, and report of whether their child’s physician addressed maternal depression, tobacco use, family planning, and folic acid supplementation during WCVs. Pre and post results are compared using logistic regression adjusting for demographics and insurance. Our sample included 307 distinct mothers with 108 and 199 respondents in the pre and post periods, respectively. Mothers were more likely to report discussions with their child’s doctor post-intervention for family planning (31% pre to 86% post; aOR 18.65), depression screening (63–85%; aOR 5.22), and taking a folic acid supplement (53–68%; aOR 2.54). Among mothers who smoked, the percentage that reported their child’s doctor recommended cessation increased from 56 to 75% (aOR = 3.66). The IMPLICIT ICC model resulted in increased reported health care provider discussions of four key areas of interconception health by mothers attending WCVs. This model holds promise as a primary care strategy to systematically address maternal risks associated with poor pregnancy outcomes.

Purpose Tracking changes in care utilization of medication for opioid use disorder (MOUD) services before, during, and after COVID‐19‐associated changes in policy and service delivery in a mixed rural and micropolitan setting. Methods Using a retrospective, open‐cohort design, we examined visit data of MOUD patients at a family medicine clinic across three identified periods: pre‐COVID, COVID transition, and COVID. Outcome measures include the number and type of visits (in‐person or telehealth), the number of new patients entering treatment, and the number of urine drug screens performed. Distance from patient residence to clinic was calculated to assess access to care in rural areas. Goodness‐of‐Fit Chi‐Square tests and ANOVAs were used to identify differences between time periods. Findings Total MOUD visits increased during COVID (436 pre vs. 581 post, p < 0.001), while overall new patient visits remained constant (33 pre vs. 29 post, p = 0.755). The clinic's overall catchment area increased in size, with new patients coming primarily from rural areas. Length of time between urine drug screens increased (21.1 days pre vs. 43.5 days post, p < 0.001). Conclusions The patterns of MOUD care utilization during this period demonstrate the effectiveness of telehealth in this area. Policy changes allowing for MOUD to be delivered via telehealth, waiving the need for in‐person initiation of MOUD, and increased Medicaid compensation for MOUD may play a valuable role in improving access to MOUD during the COVID‐19 pandemic and beyond.

School refusal in adolescents is a growing issue and has been studied from several angles. Parental psychological control is a known risk factor for school refusal. Several individual factors have ...

Objectives. To examine the impact of North Carolina’s 2017 Strengthening Opioid Misuse Prevention (STOP) Act on opioid overdose deaths. Methods. We used quarterly data from the North Carolina Opioid Dashboard to conduct an interrupted time series analysis ranging from 2010 to 2018. Results were stratified by heroin–fentanyl deaths and other opioid deaths. Results. After the STOP Act, there was an initial rate increase of 0.60 opioid deaths per 100 000 population (95% confidence interval [CI] = 0.04, 1.15) and a decrease of 0.42 (95% CI = −0.56, −0.29) every quarter thereafter. Results differed by stratification. Conclusions. Our results suggest that North Carolina’s STOP Act was associated with a reduction in opioid deaths in the year following enactment. The changes in opioid overdose death trends coinciding with the STOP Act were similar to outcomes seen with previous opioid policies. Public Health Implications. Future policies designed to reduce the availability of opioids may benefit from encouraging and increasing the availability of evidence-based treatment of opioid use disorder.

Objective To evaluate the impact of a substance use disorder (SUD) elective curriculum on students’ perceptions of treating patients with SUDs using the Drug and Drug Problems Perceptions Questionnaire (DDPPQ). Methods In 2017, a third-year pharmacy elective, conceptualizing SUD as a chronic, relapsing brain disease with psychosocial and societal influencers, was introduced. A linked pre- and postcourse assessment using the DDPPQ was carried out for the following categories: role adequacy, role support, job satisfaction, role-related self-esteem, and role legitimacy. Results A total of 63 students were enrolled in the elective and 54 paired questionnaires were available for analysis. There was a statistically significant improvement in attitude across all 5 categories of the DDPPQ. Conclusion Students’ attitudes toward working with patients with SUD improved after completing the elective. This study indicates that teaching student pharmacists about effectively recognizing and treating SUDs may result in more willingness to work with these patients in the future.

Rates of unintended pregnancy among women with substance use disorder (SUD) are much higher than the general reproductive-age population, suggesting lower rates of contraceptive use. This study aims to determine the prevalence of contraceptive use in postpartum women with SUD and identify factors associated with its use.This retrospective cohort study using electronic health record data from 2016 to 2019 included postpartum adult women with any SUD who received care at a high-risk pregnancy clinic (n = 353). The primary outcome was contraception utilization as identified using diagnosis and procedure codes. An adjusted multivariate logistic regression was used to evaluate the relationship between postpartum contraceptive use and sample characteristics.Of the 353 postpartum women with SUD, contraceptive use was found in 128 (36.3%) women. Among the study population, the most commonly reported substance use disorders were nicotine use disorder (70.3%), opioid use disorder (51.3%), and cannabis use disorder (15.0%). Among those with opioid use disorder, 45.3% were found to be using medication for opioid use disorder (MOUD). Women who attended a postpartum visit had 2.23 times the odds of using contraception compared to women who did not (OR: 2.23, 95% CI: 1.20-4.15). Those using MOUD had 3.69 times the odds of using contraception compared to those who were not (OR: 3.69, 95% CI: 1.89-7.19). Overall, women who utilized contraception were more likely to be younger than 25, receiving MOUD, and participating in postpartum care.Postpartum women with SUD are not using contraceptive methods and this is associated with a lack of appropriate healthcare interventions in the perinatal period, which can reduce the odds of receiving effective family planning services. Specialized whole-health interventions and policies to increase access to care for women with SUD should be developed.

Interconception care (ICC) is recommended to reduce maternal risk factors for poor birth outcomes between pregnancies. The IMPLICIT ICC model includes screening and brief intervention for mothers at well child visits (WCVs) for smoking, depression, multivitamin use, and family planning. Prior studies demonstrate feasibility and acceptability among providers and mothers, but not whether mothers recall receipt of targeted messages.Mothers accompanying their child at 12- and 24-month WCVs at four sites of a family medicine academic practice were surveyed pre (2012) and post (2018) ICC model implementation. Survey items assessed health history, behaviors, and report of whether their child's physician addressed maternal depression, tobacco use, family planning, and folic acid supplementation during WCVs. Pre and post results are compared using logistic regression adjusting for demographics and insurance.Our sample included 307 distinct mothers with 108 and 199 respondents in the pre and post periods, respectively. Mothers were more likely to report discussions with their child's doctor post-intervention for family planning (31% pre to 86% post; aOR 18.65), depression screening (63-85%; aOR 5.22), and taking a folic acid supplement (53-68%; aOR 2.54). Among mothers who smoked, the percentage that reported their child's doctor recommended cessation increased from 56 to 75% (aOR = 3.66).The IMPLICIT ICC model resulted in increased reported health care provider discussions of four key areas of interconception health by mothers attending WCVs. This model holds promise as a primary care strategy to systematically address maternal risks associated with poor pregnancy outcomes.

BACKGROUND: Adverse Childhood Experiences (ACEs) have been shown to contribute to a litany of mental and physical health problems, including several chronic diseases and death, via a model known as the ACE pyramid. Many of the results of ACEs in the ACE pyramid are known contributors to poor perceived health, which has significant health implications. Despite these results, a possible link between ACEs and perceived health has not been examined to date. Based on the temporal order of the ACE pyramid, we believe any relationship between ACEs and perceived health will be mediated by other components of the model. METHODS: We conducted an analysis of the 2010 Behavioral Risk Factor Surveillance System (BRFSS) data for 4 states (Hawaii, Nevada, Vermont and Wisconsin).The Adverse Childhood Experiences Scale (11 questions) and Physical Health Days (days out of the last 30 where physical health was not good) were the primary predictor and outcome variables, respectively. The PHQ-8, a depression measure, served as a first-level mediator, while body mass index, Sleep Days (days out of the last 30 that sleep was poor) and average monthly alcohol consumption served as second-level mediators. We conducted a multiply-mediated regression using PROCESS (Hayes, 2018). RESULTS: The analysis included 6,060 respondents. ACEs were associated with an increase of 0.28 additional days of poor perceived health days per ACE through increases in depression and poor sleep. CONCLUSIONS: Adverse childhood experiences may influence perceived health through multiple intermediary factors, including depression and poor sleep quality. We discuss several theoretical and clinical implications, and future directions are proposed that take advantage of the multiply-mediated model.

Background A pharmacist-physician covisit model in which patients see both a pharmacist and physician on the same day was established in a primary care practice. Previously, patients were seen in a referrals-based model in which providers referred patients for clinical pharmacy services on a different day. Objective To assess access to clinical pharmacy services in a pharmacist-physician covisit model compared to a referrals-based model. Methods A retrospective chart review was completed for patients who were seen by physicians on pre-specified half-days of clinic before and after implementation of the covisit model. Covisit model half-days between June 29, 2018 and September 30, 2018 and matched half-days from 2015 were included. Charts were reviewed to determine if patients scheduled to see the physician would benefit from clinical pharmacy services, including being seen for chronic disease management, eligible for a Medicare Annual Wellness Visit (AWV), prescribed medications that required counseling, had an adverse medication-related event, or had adherence concerns. Those eligible for clinical pharmacy services were further reviewed to determine if the patient interacted with a pharmacist within three months of their visit. Results Prior to implementation of the covisit model, 123 patient visits were completed on the pre-specified half-days. Of these, 61 patients (49.6%) were deemed eligible for clinical pharmacy services. In the covisit model, 149 patients were seen by the physician, of which 69 patients (46%) were eligible for clinical pharmacy services. More patients in the covisit cohort went on to interact with a pharmacist (56 patients, 81% vs. 10 patients, 16%, adjusted OR = 32.98, 95% CI [8.89–122.39]). The most common reasons patients were identified for clinical pharmacy services were eligibility for AWV, hypertension, and diabetes. Conclusions A pharmacist-physician covisit model significantly increased accessibility to clinical pharmacy services compared to a referrals-based model.

Revegetation of roadsides is an opportunity for grassland restoration, yet these habitats are prone to be colonised by invasive alien plant species (IAS). Therefore, the selection of seed mixtures for revegetation should consider potential competition with IAS present in the soil seed bank or arriving by traffic-related seed rain. We investigated whether the limiting similarity hypothesis, in terms of plant seed-size-output strategy, could be used to design native grassland communities resistant to IAS. In a greenhouse experiment, a small- or a large-seeded IAS was sown into factorial combinations of two native communities with small or large seed-size-output strategies at two sowing densities. Height and aboveground biomass of the IAS were measured after four and eight weeks, respectively. Small-seeded native communities at high density were highly effective in suppressing the small- and large-seeded IAS, mostly controlled by a density effect. Thus, limiting similarity in seed-size-output strategy only partly explained resistance to IAS, while density-driven suppression was more effective.

To the editor,Reynolds et al. [1] use descriptive methodology, examining trends in gabapentin and baclofen exposures reported to poison control and associated underlying causes. They suggest the ap...

Objective To evaluate the impact of a substance use disorder (SUD) elective curriculum on students' perceptions of treating patients with SUDs using the Drug and Drug Problems Perceptions Questionnaire (DDPPQ). Methods In 2017, a third-year pharmacy elective, conceptualizing SUD as a chronic, relapsing brain disease with psychosocial and societal influencers, was introduced. A linked pre- and postcourse assessment using the DDPPQ was carried out for the following categories: role adequacy, role support, job satisfaction, role-related self-esteem, and role legitimacy. Results A total of 63 students were enrolled in the elective and 54 paired questionnaires were available for analysis. There was a statistically significant improvement in attitude across all 5 categories of the DDPPQ. Conclusion Students' attitudes toward working with patients with SUD improved after completing the elective. This study indicates that teaching student pharmacists about effectively recognizing and treating SUDs may result in more willingness to work with these patients in the future.

Background:Clinical diagnosis of rotator cuff pathology is inaccurate. The difficulty of differentiation of supraspinatus and infraspinatus may contribute to diagnostic inaccuracy.Objective:To identify the characteristics of infraspinatus function that might isolate electromyographic activity of this muscle from that of supraspinatus, forming the basis for a clinical test for infraspinatus pathology.Methods:Key databases were searched using the single term ‘infraspinatus’. Inclusion criteria involved infraspinatus muscle activation. Two reviewers independently applied inclusion/exclusion criteria to title and abstracts. Quality of included studies was assessed. Actions involving markedly high infraspinatus electromyographic (EMG) activity and a high ratio of infraspinatus to supraspinatus activity were identified.Results:Fifty-three articles were included from an initial yield of 1175. For many movements supraspinatus was co-active with infraspinatus. Most isolated EMG activity was seen during res...

Immune challenge of invading macrophages at sites of infection is associated with release of TNF, which triggers a local cytokine storm as part of the normal inflammatory response. Whereas this response maybe beneficial in fighting off infections, similar responses triggered in autoimmune diseases contribute significantly to the underlying damaging pathology associated with these diseases. Here we show that Takinib, a highly discriminatory inhibitor of transforming growth factor Beta-activated kinase 1 (TAK1), selectively and potently reduces TNF production in pro-inflammatory THP-1 macrophages. A complete survey of 110 cytokines, showed robust loss of proinflammatory cytokine responsiveness to lipopolysaccharide (LPS) and interferon gamma (IFNg) challenge in response to Takinib. The mechanisms of action of Takinib was recapitulated in TAK1 KO macrophages. TAK1 KO cells showed significant loss of TNF production as well as release of IL-6 in response to LPS challenge. Furthermore, Takinib blocked the ability of exogenously added LPS to promote phosphorylation of, c-Jun, p38 protein kinases as well as downstream transcription factors regulated by nuclear factor κ-light-chain-enhancer of activated B cells (NFκB). In a mouse LPS challenge model, Takinib significantly reduced TNF serum levels. Our findings demonstrate that Takinib has utility in the treatment inflammatory disease by locally suppressing TNF production from invading macrophages.

It is difficult for surgeons to make the decision on which design or material to use given the different options available. Marketing claims and direct-to-consumer advertising certainly complicate this further. One company may claim a higher percentage of wear reduction with their bearing surfaces compared with those of another manufacturer. If the percentage of wear reduction is lower, it is unclear as to whether this creates a more effective technology for reducing wear in the clinical situation. The relative contribution and relationship of design and materials to wear performance must be considered before making that important judgment. To examine the overall influence of implant design on wear reduction, a knee simulator study was undertaken. This simulator study compared the Oxinium Genesis II system with the Triathlon Conventional and Triathlon X3 knee systems under physiologic stair-climb loading and motion profiles. This allows a similar comparison of material effect within one design but also a global comparison across designs. Test results show the Triathlon Conventional and Triathlon X3 knee systems have superior wear resistance compared with that of the Genesis II Oxinium system under stair-climbing simulation. This finding indicates that implant design plays a more significant role in knee wear reduction than material. Although material technology may improve a given knee system's ability to wear, design geometry has a first-order effect and should be addressed before materials. This study represents an effort to differentiate design effect from two different approaches to material enhancement. The results of this study support the predominance of design in knee replacement wear performance. Ultimately, only clinical evidence such as published studies or outcomes reported in the available joint registries will establish whether any material or design can achieve a 30-year outcome.

Identifying new pharmaceutical targets in cancer has been a long lasting goal of academia. Complex genomic changes coupled with a cancer cell's ability to adapt make tumors particularly difficult to target. To this end, we have identified the TAK1 kinase in the TNFα pathway as a potential mediator of cell survival or apoptosis. Here we evaluate the apoptotic effects of a novel TAK1 inhibitor, Takinib. The selectivity of Takinib was established with an IC50 of 9nm for TAK1, followed by an IC50 for IRAK4 and IRAK1 at 120nm and 390nm respectively. Treatment of MDA-MB-231 cells with Takinib on its own is not sufficient to induce consequential cell death. However, combination therapy with TNFα induces caspase 3/7 activity and subsequent cell death in a dose-dependent manner. Genetic knock out of TAK1 expression in MDA-MB-231 cells with the CRISPR/Cas9 system significantly sensitized previous resistant cells to TNFα. Furthermore, we have shown that activation of human THP-1 cells with LPS is sufficient to produce TNFα levels necessary to facilitate Takinib mediated cell death, indicating that potential immunotherapy applications may be possible. Together these findings support the idea that TAK1 may be an effective target in the TNFα pathway, shifting the cellular mechanisms from pro survival to pro apoptosis. Citation Format: Scott Scarneo, Madeline Sell, Juliane Totzke, David Carlson, Phillip Hughes, Tim Haystead. Tak-1 inhibition re-sensitizes cancer cells to TNFα [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4397.

Multi-disciplinary field investigations were undertaken in 1972–7 and 1998–9 at Kuk Swamp in the upper Wahgi Valley in the Highlands of Papua New Guinea. Multi-period finds dating from the early Holocene to the recent past and interpreted to represent human manipulation of a wetland margin for plant exploitation were documented. The archaeological remains dating from the early to mid-Holocene have partially grounded contested claims for the emergence of early and independent agricultural practices on the island of New Guinea. In this paper, the early to mid- Holocene archaeological remains at the site (ie, those allocated to Phases 1, 2, and 3) are reported in detail. The authors of this paper all agree that plant exploitation began at Kuk at c. 10,000 cal BP, however they hold different interpretations of the archaeological evidence from the swamp, which have in turn led to diverse claims for the antiquity of agriculture in New Guinea by at least c. 10,000 cal BP (Golson and Hughes), or by at least 6950–6440 cal BP (Denham). Divergent readings of the archaeological remains are presented at length in order to clarify the evidential bases for the varying claims and to promote future discussion.

A study of four teacher samples, surveyed between 1991 and 1998, has investigated similarities and differences in teaching styles, classroom behaviours and reactions to changes between teachers nominated by their students as influential on study decisions and non-nominated classroom teachers. Differences and similarities in response of teachers over a decade marked by significant changes in policy and practice have also been examined, especially with regard to the conflict between economic rationalist/instrumental and humanistic/ affective ideologies evident in education which has intensified in recent years. Similarities between the 'exemplary' and broadly representative classroom teachers in terms of classroom ideals, constructs of teaching competencies and teaching styles are observed, along with the persisting commitment to student-centred repertoires, despite external organisational pressures. Complex responses to change are noted, including a slight reduction in stress of most recent teacher cohorts...

The Asia-Pacific region has made substantial but uneven advances in education, particularly over the past two decades. The region’s countries must share information on successful and unsuccessful approaches to solving educational problems and join forces to explore topics about which educators and policy-makers know little or nothing. On the basis of a history of successful co-operation and a commitment to respecting cultural difference, they can and must collaborate both to improve their own education systems and to contribute to the development of secondary education around the world.

Darwin Harbour is one of the largest bays along the Northern Territory coastline. Some shell mounds around the Harbour are renowned as the creations of the scrub-fowl Megapodius reinvardt (Stone 1989). However, the abundant archaeological middens that exist within the region have received little attention. While this failure to explore the archaeology of Darwin Harbour is being remedied in the regional study by Bums (1999), there is still a need for specific studies of site patteming within the region. In particular investigations of chronological and morphological variation in anthropogenic shell deposits and their environmental contexts will assist the evaluation of land-use models. Shell structures in Darwin Harbour exist within a geomorphic context underrepresented in studies of archaeological mounds in the "Top End". Shell mounds studied elsewhere in northern Australia by archaeologists are generally on near-flat depositional surfaces produced by coastal progradation and composed entirely of alluvium or coastal sediments, and the interpretation of these sites is tied to the growth of coastal plains (eg. Bailey 1975 ; Baker 1981; Beaton 1985; Woodroffe et al. 1988). In contrast, Darwin Harbour consists of a flooded valley that has had relatively little sediment infilling, leaving a coastline that consists of bedrock and steep colluvial slopes that terminate below the high tide limit. Middens in Darwin Harbour, located on these steep rocky surfaces, are subject to different geomorphic conditions and reflect an environmental history different from mounds in regions such as Kakadu or Princess Charlotte Bay. Â In this paper we describe deposits of shell identified in one portion of Darwin Harbour, and document not only mound structures but also rings of shell. Our purpose is to provide an initial account of the diversity and chronology of these two kinds of archaeological shell deposits around Darwin Harbour and to discuss prehistoric settlement systems in that area of northern Australia. Our investigations focus on Haycock Reach, a small portion of the Harbour coastline which demonstrates a rich archaeological record. Â

(2000). Division and discord: British policy, Indochina, and the origins of the Vietnam war, 1954–56. The Journal of Imperial and Commonwealth History: Vol. 28, International Diplomacy and Colonial Retreat, pp. 94-112.

Objectives Existing clinical tests for infraspinatus lack accuracy and differentiation from supraspinatus is difficult. We aimed to find a position that isolated infraspinatus contraction from supraspinatus and to analyse the contraction characteristics of lower (oblique) and upper (transverse) parts of infraspinatus. Design Within-participant, repeated measures experimental study. Methods Intramuscular electromyography was used to measure the level of activation (electromyographic amplitude as a percentage of maximal voluntary contraction) of infraspinatus and supraspinatus on 15 healthy participants. Participants produced an isometric external rotation force at the shoulder, against manual resistance in shoulder positions of neutral, flexion, abduction and extension. Longitudinal force along the humeral axis was also applied. Results The two parts of infraspinatus demonstrated different patterns of electromyographic activation. The oblique part of infraspinatus was “markedly active” in all positions while the transverse part was mostly “moderately active”. Comparing supraspinatus with infraspinatus, it was found that infraspinatus was significantly more active than supraspinatus from the positions of shoulder flexion and neutral with the highest ratios observed in the position of shoulder flexion. Longitudinal humeral force was not an important factor. Conclusions If isometric external rotation of the shoulder is performed against resistance, the oblique part of infraspinatus will be working harder than the transverse part, irrespective of shoulder position. If differentiation of infraspinatus contraction from supraspinatus is desired, external rotation should be performed from a position of shoulder flexion or neutral. Resisted external rotation in shoulder flexion may form the basis of the development of a more accurate clinical test for infraspinatus.

The curriculum scene in Australia has many similarities together with some differences from what is happening in England. The similarities spring from common social changes which are influencing mo...

This chapter reviews developments in education and training since World War II, suggesting that education will have to change is it is going to be effective in such a changed and changing world. It looks at the goal of education for all (EFA), which has been a priority for decades. The author contends that it is now urgent for institutions such as UNESCO to find the means of achieving that goal or to change the priorities of EFA, given that for millions of people the achievement of EFA offers their major hope of release from exclusion, repression and deprivation. EFA should thus be seen as a strategy and process which aims to achieve poverty eradication and greater equity and justice in societies. A broader concept of EFA to include all the varied forms of technical and vocational education and training (TVET) provides new possibilities.

We can all identify teachers who made an impact on us, good or bad. But exactly what is it that makes for a good one? It's a question that got Phillip Hughes thinking about the teachers who influenced him.

Editor: We read with interest the article by Dr Sabharwal and colleagues in the September 2002 issue of Radiology (1) on their experience with balloon dilation for achalasia of the cardia in 76 patients. We agree with the authors regarding incremental dilation. We note that in patients undergoing balloon dilation for the first time, however, 15-mm balloon dilation was used initially and then progressed to 20-, 30-, and 35-mm balloons. Their results, however, showed that no patient required only 15-mm dilation. Only five patients had initial dilation to 20 mm (7%), and of these, four (80%) had poor results, with improvement in symptoms lasting less than 2 months. The solitary patient who did benefit from 20-mm dilation for 10 months subsequently required 30-mm dilation and has remained asymptomatic for a further 30 months. We also note from the results that 55 of 76 (72%) patients were dilated to 30 mm at the initial procedure. Our center’s experience from May 1998 to November 2002 involves 56 balloon dilations in 32 patients with achalasia of the cardia. We perform balloon dilations as a day case procedure in the interventional radiology suite with use of fluoroscopy and intravenous sedoanalgesia (2–10 mg midazolam, Hypnovel, Roche Products, High Wycombe, England and 25–100 g fentanyl, Sublimaze, Janssen-Cilag, High Wycombe, England). All patients are followed up in the clinic by a gastroenterologist or an esophageal surgeon at 3 and 6 months and then annually. Initial dilations are performed with a 30-mm balloon and then 35-mm balloons are used, depending on the response. A good response to balloon dilation is based on obliteration of the wasting seen at screening and blood on the balloon surface at withdrawal. If symptoms fail to resolve or recur, further dilations with up to 40-mm balloons are performed. Our results show that 26 patients (81%) had a single dilation to 30 mm, and six patients (19%) required dilation to 35 mm at the initial procedure. Overall, 56% of patients required repeat dilations. Thirteen patients (50%) in the 30-mm group required further dilation to 35 mm at 1–2 years, and of these, 10 patients (77%) required further dilation to 40 mm at 3–4 years of follow-up. In the initial 35-mm group, five patients (83%) required a second dilation to 40 mm at 1–2 years of follow-up. We have had no major complications. On the basis of our data, we suggest that incremental balloon dilation from 30 to 35 mm and then to 40 mm may be more cost-effective with reduced balloon and/or sterilization costs.