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We evaluated a diabetic mini-clinic by assessing adherence to American Diabetes Association guidelines and changes in glycosylated haemoglobin levels. Of 1063 patients, 721 were multiple attenders. Single and multiple attenders showed no significant differences in age, sex, time since diagnosis or body mass index. Female and male multiple attenders showed significant declines in glycosylated haemoglobin levels over the first 12 and 18 months respectively. After 2 years, these levels were similar to those at entry to the clinic. The clinic’s compliance with standard measurement guidelines was high. The diabetic mini-clinic model, which is effective in industrialized countries, was equally effective in this setting.

As we slowly move towards a post-COVID-19 world, it is timely to revisit the ongoing disparity in health outcomes across Australia. Aboriginal and Torres Strait Islander people continue to experience lower life expectancy and higher morbidity than other Australians.1 Closing the Gap began in 2007, aiming to ‘close the health and life expectancy gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians … by 2030’.2 However, at the 10-year review in 2018, it was clear that the gap is not closing.2

‘Uncharted waters’ is perhaps an understatement of where we are headed at this time. The situation is fluid, with government regulations for our society changing rapidly.

The importance of physical activity as a core component of the suite of preventive measures central to improving health outcomes has been documented since the Ancient Greek period. Yet, the headline news regarding Australian physical activity trends highlights that only 15% (2.8 million) of people aged ≥18 years meet the minimum activity guidelines for physical activity and muscle strengthening.

Background Legal restrictions on alcohol availability have been used to address violence and injury in the world’s remote Indigenous communities. In Australia, alcohol management plans (AMPs) were implemented by the Queensland Government in 2002. This study reports changes in indicators of alcohol-related violence and injury in selected communities. Methods Design and setting: A longitudinal observational study was conducted in four Aboriginal and Torres Strait Islander (Indigenous) communities in Cape York, far north Queensland. All communities are similarly-isolated from population centres where alcohol is available. Data: For 2000 to 2015 inclusive: 1019 Royal Flying Doctor Service aeromedical trauma retrievals; 5641 Queensland Police Service records of unique assault occurrences, including 2936 involving alcohol; and records for 2741 unique assault victims were examined. Data analysis: Rates (per 1000 population) of trauma retrievals, assault occurrences and assault victims (per 1000 population) were compared across three policy phases. Phase 1: 2000 to 2008. Initial restrictions on possession and consumption of alcohol in ‘restricted areas’ were implemented during 2002–2003. Phase 2: 2009 to 2012. All alcohol was prohibited in three study communities and its legal availability limited in the fourth from 2009. Phase 3: 2013 to 2015. Government reviews of AMP policies in light of legal challenges and community responses characterise this phase. Results Compared with Phase 1, in Phase 2 retrieval rates declined by − 29.4%, assault occurrences by − 34.1% with less than one-third involving alcohol, and assault victims by − 21.1%, reaching historically low levels in 2010–2012. These reductions did not continue consistently. Compared with Phase 1, in Phase 3 retrieval rates, assault occurrence rates and assault victim rates declined by somewhat lesser amounts, − 13.9%, − 15.0% and − 13.4%, respectively. In Phase 3, the proportion of assault occurrences involving alcohol in communities 2, 3 and 4 rose towards pre-2008 levels. Conclusions Early successes of these controversial alcohol restrictions are jeopardised. Indicators of violence and injury appear to be rising once more in some AMP communities. Importantly, rates have not generally exceeded the highest levels seen in Phase 1. Fresh policy action is required with rigorous monitoring to prevent erosion of initial important successes.

Background Indigenous communities in Queensland (Australia) have been subject to Alcohol Management Plans since 2002/03, with significant penalties for breaching restrictions. ‘Sly grog’ and ‘homebrew’ provide access to alcohol despite restrictions. This paper describes how this alcohol is made available and the risks and impacts involved. In affected towns and communities across a large area of rural and remote Queensland, interviews and focus groups documented experiences and views of 255 long-standing community members and service providers. Using an inductive framework, transcribed interviews were analysed to identify supply mechanisms, community and service provider responses and impacts experienced. Results ‘Homebrew’ was reportedly manufactured in just a few localities, in locally-specific forms bringing locally-specific harms. However, ‘sly grog’ sourced from licensed premises located long distances from communities, is a widespread concern across the region. ‘Sly grog’ sellers circumvent retailers’ takeaway liquor license conditions, stockpile alcohol outside restricted areas, send hoax messages to divert enforcement and take extraordinary risks to avoid apprehension. Police face significant challenges to enforce restrictions. On-selling of ‘sly grog’ appears more common in remote communities with total prohibition. Despite different motives for involvement in an illicit trade ‘sly grog’ consumers and sellers receive similar penalties. Conclusions There is a need for: (a) a more sophisticated regional approach to managing takeaway alcohol sales from licensed suppliers, (b) targeted penalties for ‘sly grog’ sellers that reflect its significant community impact, (c) strategies to reduce the demand for alcohol and (d) research to assess the effects of these strategies in reducing harms.

The fact that an opinion has been widely held is no evidence whatever that it is not utterly absurd – Bertrand Russell

Skin cancer medicine is a core component of Australian general practice and is consistently in the top 10 conditions managed.1 This is not surprising as Australia has the highest incidence of melanoma in the world,2 leaving melanoma the fourth most common cancer in Australia, especially in non-metropolitan locations.3 Across the 20-year period 1995–2014, melanoma incidence in Queensland remained the highest recorded in the world (age-standardised incidence of invasive melanoma 572 per 100,000/annum [2010–2014]).4 Widespread public information campaigns have been effective; currently, approximately half of all new diagnoses of melanoma are initially noticed by the patient, who then approaches their clinician, usually their general practitioner (GP), for advice.5 This is leading to earlier detection, known to improve survival, with the incidence of in situ melanoma rising while the incidence of invasive melanoma is stable or falling in patients aged under 60 years.4 The management of melanoma continues to evolve, with the latest changes for both cutaneous and metastatic melanoma explored by Dixon et al.6,7 GPs are well positioned to play a key part in skin cancer medicine, with diagnostic acumen of similar high sensitivity and accuracy to formal skin cancer doctors.8 Overall management of skin cancer in general practice is of similar quality and effectiveness to that provided by skin cancer clinic networks.9 Similarly, despite patients with cutaneous melanoma having a high risk of recurrence and hence requiring careful follow-up, GP-led follow-up for melanoma has been shown to be as effective as hospital-based care.10

The man who uses intelligence with respect to his diet, his sleeping habits and who exercises properly, is beyond any question of doubt taking the very best preventive medicines provided so freely and abundantly by nature.

You matter because you are you, and you matter to the end of your life. We will do all that we can not only to help you die peacefully, but also to live until you die. – Cicely Saunders

Background Favourable impacts are reported from complex alcohol control strategies, known as ‘Alcohol Management Plans' (AMPs) implemented 14 years ago in 19 Aboriginal and Torres Strait Islander (Indigenous) communities in Queensland (Australia). However, it is not clear that all communities benefited and that positive impacts were sustained. Service providers, key stakeholders and community leaders provided insights about issues and impacts. Methods Participants ( N =382) were recruited from knowledgeable and experienced persons using agency lists and by recommendation across sectors which have a mandate for managing alcohol-related issues and consequences of AMP policies in communities. In semi-structured interviews, participants (51% Indigenous, 55% male and comprised of at least one-third local community residents) were asked whether they believed alcohol controls had been effective and to describe any favourable and unfavourable outcomes experienced or perceived. Inductive techniques were used for thematic analysis of the content of transcribed recorded interviews. Comments reflecting themes were assessed across service sectors, by gender, Indigenous status and remoteness. Results Participants attributed reduced violence and improved community amenity to AMPs, particularly for ‘very remote' communities. Participants' information suggests that these important achievements happened abruptly but may have become undermined over time by: the availability of illicit alcohol and an urgency to consume it; migration to larger centres to seek alcohol; criminalization; substitution of illicit drugs for alcohol; changed drinking behaviours and discrimination. Most issues were more frequently linked with ‘very remote' communities. Conclusion Alcohol restrictions in Queensland's Indigenous communities may have brought favourable changes, a significant achievement after a long period of poorly regulated alcohol availability from the 1980s up to 2002. Subsequently, over the past decade, an urgency to access and consume illicit alcohol appears to have emerged. It is not clear that relaxing restrictions would reverse the harmful impacts of AMPs without significant demand reduction, treatment and diversion efforts.

Objective: To assess the impact on patient flow as noted by the National Emergency Access Target (NEAT), with the introduction of a new Paediatric ED (PEM ED) model of care. Methods: This longitudinal observational study was conducted at the Logan Hospital, a 344 bed public hospital in metropolitan Brisbane, which opened a physically separate, dedicated PEM ED on 14 October 2014, incorporating approximately 30% more staff, limited changes in processes and no changes in governance. De-identified data of the entire clientele from the ED Information System were compared 365 days before and after the opening of the PEM ED. Results: Although the number of children presenting to ED increased by 23% (pre 18 142, post 22 391), the median length of stay decreased substantially from 152 min to 138 min, resulting in a 7.75% rise in presentations that met the NEAT target (pre 77.41%, post 85.16%; P < 0.0001). Admission to the ED Short Stay Unit rose by 16.48% (pre 5.38%, post 21.86%; P < 0.0001), whereas final disposition to the inpatient paediatric unit fell by 2.30% (pre 11.43, post 9.13%; P < 0.0001). The clinical presentations were similar pre and post across age, sex, ethnicity, referral and arrival mode, Australasian Triage Scale category, presenting problem and discharge diagnosis. Conclusion: NEAT times improved after changing the PEM ED model of care. Further studies may assist identifying which of the specific features within the new model are most effective for improving patient flow.

Tobacco has been a pervasive part of the human experience since prehistory, with tobacco cultivation in the Americas dating back to 6000 BC.2 The dangers of tobacco smoking were clearly apparent and publicised by the mid-20th century, but formal measures to stop smoking were slow to be introduced or accepted. Looking back from our current understanding, it is hard to believe that around the time when The Royal Australian College of General Practitioners (RACGP) was established, doctors including general practitioners (GPs) were promoting smoking to patients,3 with brand preference among doctors used as a marketing strategy.4 Even a noted GP and past president of the RACGP ‘smoked Temple Bar cigarettes, sometimes while consulting’.5

As noted by Leonardo da Vinci, ‘the human foot is a masterpiece of engineering and a work of art’,2 evolving over eons with a unique design for propulsion and support.3 However, it would seem that overall we do not afford the foot great interest, adopting at an early age footwear that may not be especially supportive and restricting movement.4 When combined with the hard surfaces we regularly tread, strong and mobile feet are not the usual outcome.4

I have always been interested in the apparent dichotomy between the two arms of medical training and practice: the exploration of disease and illness through intellectual discourse versus the practical use of the clinician’s psychomotor skills and techniques to physically interact with the patient. Perhaps there is no real surprise as medicine’s two branches – the less invasive medical methods and the more invasive surgical methods – have been present since before the existence of written language.2 This duality persists in the designation of the primary medical degree in most countries as a combination of a Bachelor of Medicine with a Bachelor of Surgery.

Background In Australia, ‘Alcohol Management Plans’ (AMPs) provide the policy infrastructure for State and Commonwealth Governments to address problematic alcohol use among Aboriginal and Torres Strait Islanders. We report community residents’ experiences of AMPs in 10 of Queensland’s 15 remote Indigenous communities. Methods This cross-sectional study used a two-stage sampling strategy: N = 1211; 588 (48%) males, 623 (52%) females aged ≥18 years in 10 communities. Seven propositions about ‘favourable’ impacts and seven about ‘unfavourable’ impacts were developed from semi-structured interviews. For each proposition, one-sample tests of proportions examined participant agreement and multivariable binary logistic regressions assessed influences of gender, age (18–24, 25–44, 45–64, ≥65 years), residence (≥6 years), current drinking and Indigenous status. Confirmatory factor analyses estimated scale reliability (ρ), item loadings and covariances. Results Slim majorities agreed that: AMPs reduced violence (53%, p = 0.024); community a better place to live (54%, 0.012); and children were safer (56%, p

To assess the impact on patient flow as noted by the National Emergency Access Target (NEAT), with the introduction of a new Paediatric ED (PEM ED) model of care.This longitudinal observational study was conducted at the Logan Hospital, a 344 bed public hospital in metropolitan Brisbane, which opened a physically separate, dedicated PEM ED on 14 October 2014, incorporating approximately 30% more staff, limited changes in processes and no changes in governance. De-identified data of the entire clientele from the ED Information System were compared 365 days before and after the opening of the PEM ED.Although the number of children presenting to ED increased by 23% (pre 18 142, post 22 391), the median length of stay decreased substantially from 152 min to 138 min, resulting in a 7.75% rise in presentations that met the NEAT target (pre 77.41%, post 85.16%; P 0.0001). Admission to the ED Short Stay Unit rose by 16.48% (pre 5.38%, post 21.86%; P 0.0001), whereas final disposition to the inpatient paediatric unit fell by 2.30% (pre 11.43, post 9.13%; P 0.0001). The clinical presentations were similar pre and post across age, sex, ethnicity, referral and arrival mode, Australasian Triage Scale category, presenting problem and discharge diagnosis.NEAT times improved after changing the PEM ED model of care. Further studies may assist identifying which of the specific features within the new model are most effective for improving patient flow.

Paul David (in his article “Clio and the Economics of QWERTY”), Brian Arthur (in his article “Competing Technologies, Increasing Returns, and Lock-In by Historical Events”), and others introduced a “new economics” of increasing returns, alleging problems of path dependence and lock-in. These conditions were claimed to constitute market failure and were soon featured in antitrust actions, most famously in Microsoft. We challenged the empirical support for these theories and their real-world applicability (in the articles “The Fable of the Keys” and “Network Externality: An Uncommon Tragedy”). Subsequently, David and others have responded, arguing that lock-in theories require no empirical support, market failures were never an important feature of their writings, and the empirical evidence that had been put forward was never meant to be taken literally. Nevertheless, David and others claim that their theories have policy significance. Indeed, lock-in claims continue to appear as a basis for antitrust action. We now respond to the responses of David and others, review new developments in this literature, and consider antitrust implications in light of the deficiencies in lock-in theories and related empirical work.

This paper is concerned with a theoretical interpretation of an abrupt shift from the slow conductive to fast convective burning observed in the combustion of gas-permeable explosives under gradual elevation of the ambient pressure. The paper is a revision of our recent communication on the problem, and is based on the amended heat equation, which meets the requirement of the conservation of energy lacking in the previous model. It appears, however, that both formulations lead (in appropriately chosen units) to a largely similar picture of the transition. The transition is triggered by a localised autoignition in the extended resistance-induced preheat zone formed ahead of the advancing deflagration, provided the pressure difference between hot gas products and gases deep inside the pores of the unburned solid exceed a certain critical level. For moderately high activation energies the critical overpressures are comparable to those observed experimentally. In line with observations, the critical overpress...

To document rates of serious injuries in relation to government alcohol restrictions in remote Australian Indigenous communities.An ecological study using Royal Flying Doctor Service injury retrieval data, before and after changes in legal access to alcohol in four remote Australian Indigenous communities, Queensland, 1 January 1996-31 July 2010.Changes in rates of aeromedical retrievals for serious injury, and proportion of retrievals for serious injury, before and after alcohol restrictions.After alcohol restrictions were introduced in 2002-2003, retrieval rates for serious injury dropped initially, and then increased in the 2 years before further restrictions in 2008 (average increase, 2.34 per 1000 per year). This trend reversed in the 2 years after the 2008 restrictions (average decrease, 7.97 per 1000 per year). There was a statistically significant decreasing time trend in serious-injury retrieval rates in each of the four communities for the period 2 years before the 2002-2003 restrictions, 2 years before the 2008 restrictions, and the final 2 years of observations (2009-2010) (P0.001 for all four communities combined). Overall, serious-injury retrieval rates dropped from 30 per 1000 in 2008 to 14 per 1000 in 2010, and the proportions of serious-injury retrievals decreased significantly for all four communities.The absolute and the proportional rates of serious-injury retrievals fell significantly as government restrictions on legal access to alcohol increased; they are now at their lowest recorded level in 15 years.

Background: We previously reviewed evidence published from 1992 to 2001 concerning early experience for healthcare undergraduates (Dornan T, Littlewood S, Margolis S, Scherpbier A, Spencer J, Ypinazar V. 2006. How can experience in clinical and community settings contribute to early medical education? A BEME systematic review. Med Teach 28: 3-18). This subsequent study reviews evidence published from 2002 to 2008. Aims: Identify changes in the evidence base; determine the value of re-reviewing; set a future research agenda. Methods: The same search strategy as in the original review was repeated. Newly identified publications were critically appraised against the same benchmarks of strength and educational importance. Results: Twenty-four new empirical studies of early authentic experience in education of health professionals met our inclusion criteria, yielding 96 outcomes. Sixty five outcomes (from 22 studies) were both educationally important and based on strong evidence. A new significant theme was found: the use of early experience to help students understand and align themselves with patient and community perspectives on illness and healthcare. More publications were now from outside Europe and North America. Conclusions: In addition to supporting the findings of our original review, this update shows an expansion in research sources, and a shift in research content focus. There are still questions, however, about how early authentic experience leads to particular learning outcomes and what will make it most educationally effective.

Background: The Royal Flying Doctor Service (RFDS) has been providing emergency aeromedical retrieval services in Queensland, Australia since 1928. Study Objectives: This article details service and delivery structure plus a description of 12 years of experience managing patients with critical clinical conditions. Methods: This study is a retrospective longitudinal analysis of the demographics and diagnostic classification of all cases of critical clinical severity conducted March 1, 1994 through February 28, 2006. Results: There were a total of 72,054 retrievals, with trauma the single most common clinical diagnosis. There were 4259 retrievals for patients with critical clinical conditions (6%). The most common categories of clinical diagnosis were: trauma with 1493 (35.1%), respiratory diseases 1386 (32.5%), and circulatory diseases 908 (21.3%). Trauma accounted for 69 of the 90 (77%) primary retrievals from locations without health care facilities. The death rate in transport was 1%, with most of these involving males from locations with minimal health facilities. Conclusion: The RFDS in Queensland is an effective provider of fixed-wing aeromedical retrieval services, operating in an unusual environment with vast distances, low population density, and a high number of Indigenous people.

This paper examines the economic logic underlying bundles and tie-in sales and uses the lessons learned from that examination to analyze seven specific instances of bundling that have been the subject of antitrust scrutiny or other policy initiatives. We are particularly interested in products that are non-rivalrous in consumption, making all-you-can-eat pricing a viable candidate for efficiency. Our main economic points are the following: A la carte pricing may populate economic models but most products are bundles; they are bundles because bundles are generally more efficient. Tie-in sales are much less common and, we believe, not properly understood in textbook discussions. Market foreclosure, the principal efficiency concern with tying and bundling, is likely to be exceedingly rare. The seven instances of bundling (ties) examined are: cable television; patent pools; blanket licenses; iPods and iTunes; telephones; music albums and songs; and operating systems and component programs.

Aims: To assess the impact of supply reduction through Alcohol Management Plans (AMP) on the rate of serious injuries in four indigenous communities in remote Australia. Methods: An ecological study used the database of the Royal Flying Doctor Service (RFDS) to calculate trauma retrieval rates for 8 years pre- and 2 years post-AMP in four remote communities covering a period from 1 January 1995 to 24 November 2005. All serious injuries in these communities required aero-medical retrieval. Results: Serious injury resulted in a total of 798 retrievals during the observation period. One-sided analysis of variance for repeated measurements over the 10 years demonstrated a significant (P = 0.021) decrease of injury retrieval rates after the introduction of the AMP. Similarly, a comparison of linear trends of injury retrieval rates pre- and post-AMP also resulted in a significant decrease (P = 0.022; one-sided paired t-test). Comparisons of injury retrieval rates of just the 2 years pre- and post-AMP also revealed a significant reduction (P = 0.001; paired t-test), with an averaged 52% decline. Identical comparisons of retrieval rates for causes other than injury revealed no significant changes. Conclusion: This impact evaluation provides evidence that AMP was effective in reducing serious injury in the assessed indigenous communities.

Comprehensive geriatric assessment (CGA), supported by e-health, was provided to 89 frail veterans aged 70 years or older who were admitted to medical, surgical or orthopaedic units at two private hospitals in rural Queensland. Patients were screened and assessed by trained nurses using the interRAl-Acute Care tools. Data entry, validation, reporting and geriatrician comment were facilitated by an online, secure database and reporting system. The process was evaluated based on its utilization and staff satisfaction. The response to the project was generally very positive, but there were also some problems: (1) lack of staff, staff time and resources to successfully complete the assessments; (2) limited referrals from general practitioners (GPs) and difficulty with developing a sustainable communication and referral system between GPs and the hospital; (3) significant variations in caseloads between the study sites; and (4) the unfamiliarity of sufficient staff at the trial sites with the CGA process. Despite these challenges, the use of e-health-supported strategies in geriatric medicine certainly appears achievable and deserve further study.

Deflagrations in porous solid propellants are often affected by an increasing pressure difference, or overpressure, between the burned-gas region and the gas deep within the pores of the material. As a result, there appears to be a relatively rapid change in the burning-rate response over a certain range of overpressures in which the sensitivity, or slope, of the propagation speed as a function of overpressure transitions from relatively small to large values. This is often referred to as a transition from “conductive” to “convective” burning, corresponding to the increased role played by convective gas transport relative to thermal diffusion in determining the propagation speed of the deflagration. In the present work, we consider the analysis of a two-temperature model in which finite-rate interphase heat-transfer effects also play an important role in determining the burning-rate eigenvalue. In particular, we revisit a physically relevant scenario in which the first effects of temperature nonequilibriu...

Health professionals need to be cognizant of the varying perceptions of health shared by people from different religious, sociocultural, and linguistic backgrounds to deliver culturally sensitive health care. In this qualitative study, the authors used semistructured interviews to provide insight into how 10 older Arabian Gulf Muslim persons understand and perceive health and illness with emphasis on the role of Islam in formulating health behaviors. Participants' views were strongly influenced by their religious convictions. Good health was equated with the absence of visible disease, with participants demonstrating limited understanding of silent or insidious disease. They attended doctors for treatment of visible disease rather than seeking preventive health care for diseases such as hypertension, diabetes, and hyperlipidemia. Building on the results from this study could help inform both health service planners and providers to improve the appropriateness, relevancy, and effectiveness of aged care services for these individuals.

A critical first step in responding to an airborne chemical or biological attack is determining the location of the source of the toxin. We have formulated the mathematical description of source location as an inverse problem constrained by the partial differential equation (PDE) that describes the toxin's transport. This transport is advection-dominated, but takes place in a flow field that in realistic settings will be turbulent, thereby inducing an effective diffusivity tensor in the transport model. We model the turbulent flow using a Reynolds-averaged Navier--Stokes (RANS) approach, which can be solved offline for an arbitrary building of interest. The inversion problem then consists of finding the (regularized) source distribution that best reproduces a set of sensor measurements, subject to the transport model constraint relating the source to the concentration at the sensor positions. Though individual toxin sources are likely to be point sources, we cannot make any assumptions about the number of such sources. Hence, because multiple sources are a possibility, we assume a spatially continuous source distribution, thus eliminiating any need to impose assumptions about the number and nature of the sources. The operational context for this problem implies certain practical requirements. In particular, it is critical to reduce the time for inversion and the number of sensors required for an accurate determination of the source field. A particular focus of this paper is the exploration of the degree to which we can economize on computational effort through adaptive mesh coarsening tailored to preserve the essential features of the flow field. We have found that location of multiple sources is well accommodated by this method, and have shown that it is possible to reduce significantly the computational time through flow-tailored mesh adaptation without adverse impact on the accuracy of the source location. Finally, we have done a preliminary study of the number of sensors required for useful inversion. These conclusions will be of considerable use in developing sensor deployment strategies.

Combustion processes in energetic materials are often modeled by a surface gasification reaction followed by a distributed gaseous flame. However, under confinement, deflagrations in porous or granular propellants are generally accompanied by an increasing pressure difference, or overpressure, between the burned-gas region and the unburned reactants deep within the pores of the material. As the overpressure and/or the solid-phase reaction rate become sufficiently large, the gaseous and solid reaction zones tend to merge into a single multiphase reaction region. Furthermore, in certain parameter regimes, the gas flame penetrates into the porous solid, resulting in subsurface gaseous combustion. When the activation energies of the gaseous and solid-phase reactions are of the same order of magnitude and/or the overpressure becomes significant, gasification reactions may also become active within the solid, thus eliminating a distinct propellant surface and forming a distributed multiphase reaction layer. A large activation-energy analysis of this scenario is presented to study the effects of distributed solid reactions on the deflagration structure and the burning-rate response. The burning-rate eigenvalue is obtained from a numerical solution of the reaction-zone problem, and the results are calculated for various overpressures as well as different gas-to-solid activation-energy and thermal conductivity ratios. It is observed that increasing overpressure results in a more spatially distributed solid-phase reaction and a rapidly increasing flame-propagation speed.

Aim: To compare the quality of aged care provided by two different models of primary health care services in the United Arab Emirates. Methods: Cross sectional survey by chart review of 200 consecutive people aged 65 years and over attending two primary health care centers located in adjacent suburbs and serving populations with similar characteristics; a resource intensive center (RIC) and the other a resource thrifty center (RTC). Quality indicators were blood pressure levels in hypertensives and glycosylated hemoglobin (HbA1c) levels in diabetics. Results: There was no variation in age, sex or number of visits per year between the clinics. Osteoarthritis, hypertension, and diabetes were the most common diagnoses at both. The people attending the RIC had a substantially higher level of comorbidity (RIC=1.19±1.18, RTC=0.63 ± 0.68, p < 0.001), the average systolic and diastolic blood pressure for those diagnosed with hypertension was in the normal range at the RIC (138.5 ± 19.8/77.1 ± 9.9), whereas it was significantly higher and in the elevated range at the RTC (149.5 ± 17.7/85.2 ± 9.1, p < 0.001) and the HbA1c was significantly lower at the RIC (7.7 ± 1.4) than at the RTC (9.5 ± 2.0, p < 0.001). Conclusions:The quality of health outcomes for the two chronic diseases, hypertension and diabetes, appeared significantly higher at the RIC, when compared with the RTC. However, there may have been significant selection bias. Further studies are needed to determine if the RIC improves quality measures in other aspects of chronic disease care and provides a more cost effective health care service.

The combustion of porous energetic materials under confinement is generally characterized by a relatively rapid increase in the flame-propagation speed as the pressure difference, or overpressure, between the burned gases in the product region and the unburned gases deep within the pores of the unburned solid increases. The structure of the deflagration wave during this transition from "conductive" to "convective" burning is likely to correspond to a previously identified intrusive regime associated with higher overpressures. In this intrusive limit, the distributed gas-phase reactions proceed in the vicinity of the solid/gas interface, where surface reactions representing sublimation and pyrolysis occur. In this merged-flame regime, gaseous combustion can then either be confined to the purely gas-phase region beyond the solid surface or, depending on a number of factors, can penetrate inside the unburned porous material. A large-activation-energy analysis of the latter scenario is presented in this work ...

Changes in use by the elderly of the emergency department of a major hospital in Al-Ain in the years 1989 and 1999 were examined. All patients aged 65 years or older who attended the emergency room were included in this cross-sectional survey. Patient numbers rose from 321 in 1989 to 1347 in 1999 with no significant change in the female to male ratio of 0.78 or the mean age of the elderly attendees 72.9 +/- 7.4 years. Attendance rose 5.4 fold while non-urgent attendance rose 14.7 fold, demonstrating rising use but falling illness severity over time.