A literature review was carried out to identify the key challenges in the implementation of telehealth. This was followed by a survey of organisations in England involved in telehealth projects in order to understand the challenges they faced. Ten of the 13 health or local authority organisations surveyed had telehealth projects and three were at the planning stage. The analysis revealed seven key challenges facing implementers of telehealth in England. Based on the findings from the literature review and the survey, a model was constructed and a checklist drawn up. The model contained the following elements: identifying issues, needs and partners; producing a strategy; securing funding; implementing changes; and monitoring and evaluating a telehealth project. The checklist was validated by using key informants from the organisations originally surveyed. The checklist may be useful to guide telehealth development and implementation in the future.

This case study of an adult and community education provider based in far north Queensland describes its capacity to balance various iterations of public policy against its vision for the future of Aboriginal and Torres Straits Islanders. Community-controlled organisations wanting to contribute to economic and social development in regional/remote Australia through the use of formally recognised vocational education and training have adjusted to at least three major sociopolitical changes at the national policy level since the early 1990s. These include redefining equity, marketising the delivery of public services and increased centralisation. The contemporary orientation of vocational education and training as part of the Indigenous Advancement Strategy has become a highly prescriptive and heavily centralised mechanism for the establishment of employment outcomes. This has been framed as an obligation and right of Australian citizenship as opposed to the other wellbeing and personal development benefits of education. This registered training organisation has navigated four burdensome (re)definitions of equity that have made planning and delivery of true lifelong training objectives difficult. The provider has embraced the marketisation of the sector and navigated other policy changes in order to provide the services and knowledge set out in the college mission statement.

There is inequality in relation to obesity in primary school children in Doncaster with those in schools in the most deprived areas carrying the greatest burden. Research is needed to understand why the plateau seen nationally is not reaching the most deprived children.

Worldwide heart failure is an endemic that causes a big expenditure. One of the risk factors of coronary heart disease is smoking. WHO reported that Indonesia was one of the highest smoker populations all over the world. Clover cigarette has more nicotine, carbon monoxide, tar, and other toxic substances than the white cigarette. Smoking induces ventricle relaxation dysfunction through the imbalance production and expression of nitric oxide in the myocardium. The occurence of abundant superoxides and other reactive oxygen species causes accumulated endothelial oxidative damage. Changes of the right ventricle could be explained with the increase of tracheal, pulmonar artery, systemic, and left atrial pressures. Slight vasoconstriction occurs during smoking and then vasodilatation occurs alternately in a while. The dangerous effects of smoking caused by accumulated endothelial oxidative damage disturb the production of endogenous nitric oxide. There is no cardiac adaptation to smoking, neither the active smoker nor the passive one. Keywords: smoking, acute effect, right ventricle, heart failureAbstrak: Gagal jantung merupakan suatu endemik yang menyebabkan banyak pengeluaran besar di berbagai negara. Salah satu faktor risiko terhadap penyakit jantung koroner ialah merokok. Data WHO menunjukkan Indonesia sebagai salah satu populasi perokok terbanyak di dunia. Rokok kretek memiliki kadar nikotin, karbon monoksida, tar, dan komponen toksik lain yang lebih tinggi dibanding rokok konvensional. Merokok menginduksi gangguan relaksasi ventrikel melalui gangguan produksi dan ekspresi nitrik oksida di miokard. Selain itu banyaknya kandungan superoksida dan spesies oksigen reaktif lain menyebabkan akumulasi kerusakan oksidatif terhadap endotel. Perubahan pada ventrikel kanan dapat dijelaskan dengan meningkatnya tekanan trakeal, arteri pulmonal, sistemik, dan atrium kiri. Terjadi vasokonstriksi sesaat pada saat asap rokok memasuki alveoli paru dan kemudian berdilatasi kembali dalam waktu singkat. Efek buruk merokok disebabkan akumulasi kerusakan oksidatif pada sel endotel yang menyebabkan gangguan produksi nitrik oksigen endogen. Tidak ada adaptasi kardiak terhadap rokok bahkan pada perokok aktif. Kata kunci: merokok, efek akut, ventrikel kanan, gagal jantung