Study protocol : establishing good relationships between patients and health care providers while providing cardiac care. Exploring how patient-clinician engagement contributes to health disparities between indigenous and non-indigenous Australians in South Australia

Abstract Background: Studies that compare Indigenous Australian and non-Indigenous patients who experience a cardiac event or chest pain are inconclusive about the reasons for the differences in-hospital and survival rates. The advances in diagnostic accuracy, medication and specialised workforce has contributed to a lower case fatality and lengthen survival rates however this is not evident in the Indigenous Australian population. A possible driver contributing to this disparity may be the impact of patient-clinician interface during key interactions during the health care process. Methods/Design: This study will apply an Indigenous framework to describe the interaction between Indigenous patients and clinicians during the continuum of cardiac health care, i.e. from acute admission, secondary and rehabilitative care. Adopting an Indigenous framework is more aligned with Indigenous realities, knowledge, intellects, histories and experiences. A triple layered designed focus group will be employed to discuss patient-clinician engagement. Focus groups will be arranged by geographic clusters i.e. metropolitan and a regional centre. Patient informants will be identified by Indigenous status (i.e. Indigenous and non-Indigenous) and the focus groups will be convened separately. The health care provider focus groups will be convened on an organisational basis i.e. state health providers and Aboriginal Community Controlled Health Services. Yarning will be used as a research method to facilitate discussion. Yarning is in congruence with the oral traditions that are still a reality in day-to-day Indigenous lives. Discussion: This study is nestled in a larger research program that explores the drivers to the disparity of care and health outcomes for Indigenous and non-Indigenous Australians who experience an acute cardiac admission. A focus on health status, risk factors and clinical interventions may camouflage critical issues within a patient-clinician exchange. This approach may provide a way forward to reduce the appalling health disadvantage experienced within the Indigenous Australian communities. Keywords: Patient-clinician engagement, Qualitative, Cardiovascular disease, Focus groups, Indigenous

Homeostatic epistemology : reliability, coherence and coordination in a Bayesian virtue epistemology

How do agents with limited cognitive capacities flourish in informationally impoverished or unexpected circumstances? Aristotle argued that human flourishing emerged from knowing about the world and our place within it. If he is right, then the virtuous processes that produce knowledge, best explain flourishing. Influenced by Aristotle, virtue epistemology defends an analysis of knowledge where beliefs are evaluated for their truth and the intellectual virtue or competences relied on in their creation. However, human flourishing may emerge from how degrees of ignorance are managed in an uncertain world. Perhaps decision-making in the shadow of knowledge best explains human wellbeing—a Bayesian approach? In this dissertation I argue that a hybrid of virtue and Bayesian epistemologies explains human flourishing—what I term homeostatic epistemology. Homeostatic epistemology supposes that an agent has a rational credence p when p is the product of reliable processes aligned with the norms of probability theory; whereas an agent knows that p when a rational credence p is the product of reliable processes such that: 1) p meets some relevant threshold for belief (such that the agent acts as though p were true and indeed p is true), 2) p coheres with a satisficing set of relevant beliefs and, 3) the relevant set of beliefs is coordinated appropriately to meet the integrated aims of the agent. Homeostatic epistemology recognizes that justificatory relationships between beliefs are constantly changing to combat uncertainties and to take advantage of predictable circumstances. Contrary to holism, justification is built up and broken down across limited sets like the anabolic and catabolic processes that maintain homeostasis in the cells, organs and systems of the body. It is the coordination of choristic sets of reliably produced beliefs that create the greatest flourishing given the limitations inherent in the situated agent.

A socially just rationale for an Australian curriculum? : a critical thematic policy analysis of political speeches in education (2007-2010)

In late 2007, newly elected Prime Minister Kevin Rudd placed education reform on centre stage as a key policy in the Labor Party's agenda for social reform in Australia. A major policy strategy within this 'Education Revolution' was the development of a national curriculum, the Australian Curriculum Within this political context, this study is an investigation into how social justice and equity have been used in political speeches to justify the need for, and the nature of, Australia's first official national curriculum. The aim is to provide understandings into what is said or not said; who is included or excluded, represented or misrepresented; for what purpose; and for whose benefit. The study investigates political speeches made by Education Ministers between 2008 and 201 0; that is, from the inception of the Australian Curriculum to the release of the Phase 1 F - 10 draft curriculum documents in English, mathematics, science and history. Curriculum development is defined here as an ongoing process of complex conversations. To contextualise the process of curriculum development within Australia, the thesis commences with an initial review of curriculum development in this nation over the past three decades. It then frames this review within contemporary curriculum theory; in particular it calls upon the work of William Pinar and the key notions of currere and reconceptualised curriculum. This contextualisation work is then used as a foundation to examine how social justice and equity have been represented in political speeches delivered by the respective Education Ministers Julia Gillard and Peter Garrett at key junctures of Australian Curriculum document releases. A critical thematic policy analysis is the approach used to examine selected official speech transcripts released by the ministerial media centre through the DEEWR website. This approach provides a way to enable insights and understandings of representations of social justice and equity issues in the policy agenda. Broader social implications are also discussed. The project develops an analytic framework that enables an investigation into the framing of social justice and equity issues such as inclusion, equality, quality education, sharing of resources and access to learning opportunities in political speeches aligned with the development of the Australian Curriculum Through this analysis, the study adopts a focus on constructions of educationally disadvantaged students and how the solutions of 'fixing' teachers and providing the 'right' curriculum are presented as resolutions to the perceived problem. In this way, it aims to work towards offering insights into political justifications for a national curriculum in Australia from a social justice perspective.

Improving the PLDA based speaker verification in limited microphone data conditions

A significant amount of speech data is required to develop a robust speaker verification system, but it is difficult to find enough development speech to match all expected conditions. In this paper we introduce a new approach to Gaussian probabilistic linear discriminant analysis (GPLDA) to estimate reliable model parameters as a linearly weighted model taking more input from the large volume of available telephone data and smaller proportional input from limited microphone data. In comparison to a traditional pooled training approach, where the GPLDA model is trained over both telephone and microphone speech, this linear-weighted GPLDA approach is shown to provide better EER and DCF performance in microphone and mixed conditions in both the NIST 2008 and NIST 2010 evaluation corpora. Based upon these results, we believe that linear-weighted GPLDA will provide a better approach than pooled GPLDA, allowing for the further improvement of GPLDA speaker verification in conditions with limited development data.

Bringing the real world into university learning

Introduction: As part of ongoing quality assurance, all university programs must be regularly reviewed to ensure curriculum is current, meets university and national standards, and for medical science, criteria for AIMS Accreditation. With recent developments at the national and international level also signaling change, a course design team (CDT) was assembled and tasked with developing and implementing a new four year Bachelor of Medical Laboratory Science (BMLS) course at QUT. Method: A whole-of-course approach was adopted, incorporating inverted curriculum and Capstone experience. First, course vision and desired graduate profile are defined as course learning outcomes (CLO), i.e. skills, knowledge, behaviours and attributes graduates must demonstrate. CLO are then back-mapped into introductory, developmental and expected phases from fourth to first year on a course plan and assessment map. Unit learning outcomes (ULO) are then defined, and finally, each unit (subject) designed, directly aligned with assessment. Results: The resulting BMLS course represents a deliberate program of study across four years, which from day one, focuses on the professional aspects of MLS, clinical pathology disciplines, and incrementally developing and assessing the skills, knowledge, behaviours and attributes required to undertake the Work Integrated Learning Internship (WILI) and Capstone experience in final year, and subsequently, graduate from the program. Conclusions: At the start of the year, the BMLS commenced with higher than anticipated enrolments. To date, survey data and feedback is positive, with particular emphasis on the directed nature of the course. The method of course design also ensures university/national standards, and criteria for AIMS Accreditation have been met.

The cultural impact of institutional remix : the formalisation of textual reappropriation within the ABC

In 2009, Mark Deuze proposed an updated approach to media studies to incorporate ‘media life’, a concept he suggests addresses the invisibleness of ubiquitous media. Media life provides a useful lens for researchers to understand the human condition in media and not with media. At a similar time, public service media (PSM) strategies have aligned audience participation with the so‐called Reithian trinity which suggest the PSB should inform, educate and entertain while performing its core values of public service broadcasting (Enli 2008). Remix within the PSM institution relies on audience participation, employing ‘the people formerly known as the audience’ (Rosen 2006) as cultural artifact producers, and draws on their experience from within the media. Remix as a practice then enables us to examine the shift of the core PSM values by understanding how audience participation, informed by a human condition mobilised from our existence of being in media and not merely with media. However, remix within PSM challenges the once elitist construction of meaning models with an egalitarian approach towards socially reappropriated texts, questioning its affect on the cultural landscape. This paper draws on three years of ethnographic data from within the Australian Broadcasting Corporation (ABC), exploring the remix culture of ABC Pool. ABC Pool operates under a Creative Commons licensing regime to enable remix practice under the auspices of the ABC. ABC Pool users provide a useful group of remix practitioners to examine as they had access to a vast ABC archival collection and were invited to remix those cultural artefacts, often adding cultural and fiscal value. This paper maintains a focus on the audience participation within PSM through remix culture by applying media dependency theory to remix as cultural practice and calls to expand and update the societal representation within the ABC.

Self-gifting guilt : an examination of self-gifting motivations and post-purchase regret

Purpose Self-gifting is a performative process in which consumers purchase products for themselves. The literature to date remains silent on a determination and connection between the extents of post-purchase regret resulting from self-gifting behavior. The purpose of this paper is to examine identification and connection of self-gifting antecedents, self-gifting and the effect on post purchase regret. Design/methodology/approach This study claims the two antecedents of hedonistic shopping and indulgence drive self-gifting behaviors and the attendant regret. A total of 307 shoppers responded to a series of statements concerning the relationships between antecedents of self-gifting behavior and the effect on post-purchase regret. Self-gifting is a multi-dimensional construct, consisting of therapeutic, celebratory, reward and hedonistic imports. Confirmatory factor analysis and AMOS path modeling enabled examination of relationships between the consumer traits of hedonistic shopping and indulgence and the four self-gifting concepts. Findings Hedonic and indulgent shoppers engage in self-gifting for different reasons. A strong and positive relationship was identified between hedonic shoppers and reward, hedonic, therapeutic and celebratory self-gift motivations. hedonic shoppers aligned with indulgent shoppers who also engaged the four self-gifting concepts. The only regret concerning purchase of self-gifts was evident in the therapeutic and celebratory self-gift motivations. Research limitations/implications A major limitation was the age range specification of 18 to 45 years which meant the omission of older generations of regular and experienced shoppers. This study emphasizes the importance of variations in self-gift behaviors and of post-purchase consumer regret. Originality/value This research is the first examination of an hedonic attitude to shopping and indulgent antecedents to self-gift purchasing, the concepts of self-gift motivations and their effect on post-purchase regret.

Thermal conductivity of Si nanowires with faulted stacking layers

Faulted stacking layers are ubiquitously observed during the crystal growth of semiconducting nanowires (NWs). In this paper, we employ the reverse non-equilibrium molecular dynamics simulation to elucidate the effect of various faulted stacking layers on the thermal conductivity (TC) of silicon (Si) NWs. We find that the stacking faults can greatly reduce the TC of the Si NW. Among the different stacking faults that are parallel to the NW's axis, the 9R polytype structure, the intrinsic and extrinsic stacking faults (iSFs and eSFs) exert more pronounced effects in the reduction of TC than the twin boundary (TB). However, for the perpendicularly aligned faulted stacking layers, the eSFs and 9R polytype structures are observed to induce a larger reduction to the TC of the NW than the TB and iSFs. For all considered NWs, the TC does not show a strong relation with the increasing number of faulted stacking layers. Our studies suggest the possibility of tuning the thermal properties of Si NWs by altering the crystal structure via the different faulted stacking layers.

Computational fluid dynamic analysis of intracranial aneurysmal bleb formation

Background The management of unruptured aneurysms is controversial with the decision to treat influenced by aneurysm characteristics including size and morphology. Aneurysmal bleb formation is thought to be associated with an increased risk of rupture. Objective To correlate computational fluid dynamic (CFD) indices with bleb formation. Methods Anatomical models were constructed from three-dimensional rotational angiogram (3DRA) data in 27 patients with cerebral aneurysms harbouring single blebs. Additional models representing the aneurysm before bleb formation were constructed by digitally removing the bleb. We characterised haemodynamic features of models both with and without the bleb using CFDs. Flow structure, wall shear stress (WSS), pressure and oscillatory shear index (OSI) were analysed. Results There was a statistically significant association between bleb location at or adjacent to the point of maximal WSS (74.1%, p=0.019), irrespective of rupture status. Aneurysmal blebs were related to the inflow or outflow jet in 88.9% of cases (p<0.001) whilst 11.1% were unrelated. Maximal wall pressure and OSI were not significantly related to bleb location. The bleb region attained a lower WSS following its formation in 96.3% of cases (p<0.001) and was also lower than the average aneurysm WSS in 86% of cases (p<0.001). Conclusion Cerebral aneurysm blebs generally form at or adjacent to the point of maximal WSS and are aligned with major flow structures. Wall pressure and OSI do not contribute to determining bleb location. The measurement of WSS using CFD models may potentially predict bleb formation and thus improve the assessment of rupture risk in unruptured aneurysms.

‘Time for a change in direction’ : using Indigenous knowledges as the driving force for change

We live in a time of change, of rapid change in some cases. Regardless of where we live as Indigenous peoples we see this, feel this, know this and understand this. Yet how do we manage this? At times Indigenous knowledge and Western knowledge are aligned and at other times diametrically opposed. This is also the case when examining how Indigenous knowledges are viewed, accessed and used even when politicians, governments and institutions are searching for answers and solutions for Indigenous people and for broader Australian society. Sometimes we have witnessed Indigenous knowledges too far down the back, at the bottom of the list and even disregarded. In some cases Indigenous peoples and our knowledges have been positioned as the victims of modernity. Imagine if we could draw on the strength of Indigenous knowledges as the driving force to change direction or for change. We can do this. This paper will explore some of the ways we might do this and bring about an improved society for all peoples.

Understanding the fabric of social interactions for ridesharing through mining social networking sites

The design of applications for dynamic ridesharing or carpooling is often formulated as a matching problem of connecting people with an aligned set of transport needs within a reasonable interval of time and space. This problem formulation relegates social connections to being secondary factors. Technology assisted ridesharing applications that put the matching problem first have revealed that they suffer from being unable to address the factor of social comfort, even after adding friend features or piggybacking on social networking sites. This research aims to understand the fabric of social interactions through which ridesharing happens. We take an online observation approach in order to understand the fabric of social interactions for ridesharing that is happening in highly subscribed online groups of local residents. This understanding will help researchers to identify design challenges and opportunities to support ridesharing in local communities. This paper contributes a fundamental understanding of how social interactions and social comfort precede rideshare requests in local communities.

Delineating breast cancer cell interactions with engineered bone microenvironments

The mechanisms leading to colonization of metastatic breast cancer cells (BCa) in the skeleton are still not fully understood. Here, we demonstrate that mineralized extracellular matrices secreted by primary human osteoblasts (hOBM) modulate cellular processes associated with BCa colonization of bone. A panel of four BCa cell lines of different bone-metastatic potential (T47D, SUM1315, MDA-MB-231, and the bone-seeking subline MDA-MB-231BO) was cultured on hOBM. After 3 days, the metastatic BCa cells had undergone morphological changes on hOBM and were aligned along the hOBM's collagen type I fibrils that were decorated with bone-specific proteins. In contrast, nonmetastatic BCa cells showed a random orientation on hOBM. Atomic force microscopy-based single-cell force spectroscopy revealed that the metastatic cell lines adhered more strongly to hOBM compared with nonmetastatic cells. Function-blocking experiments indicated that β1-integrins mediated cell adhesion to hOBM. In addition, metastatic BCa cells migrated directionally and invaded hOBM, which was accompanied by enhanced MMP-2 and -9 secretion. Furthermore, we observed gene expression changes associated with osteomimickry in BCa cultured on hOBM. As such, osteopontin mRNA levels were significantly increased in SUM1315 and MDA-MB-231BO cells in a β1-integrin-dependent manner after growing for 3 days on hOBM compared with tissue culture plastic. In conclusion, our results show that extracellular matrices derived from human osteoblasts represent a powerful experimental platform to dissect mechanisms underlying critical steps in the development of bone metastases.

Information systems development outsourcing : the role of control configurations

The Control Theory has provided a useful theoretical foundation for Information Systems development outsourcing (ISD-outsourcing) to examine the co-ordination between the client and the vendor. Recent research identified two control mechanisms: structural (structure of the control mode) and process (the process through which the control mode is enacted). Yet, the Control Theory research to-date does not describe the ways in which the two control mechanisms can be combined to ensure project success. Grounded in case study data of eight ISD-outsourcing projects, we derive three ‘control configurations’; i) aligned, ii) negotiated, and 3) self-managed, which describe the combinative patterns of structural and process control mechanisms within and across control modes.

How accurate is the identification of serious traffic injuries by Police? The concordance between Police and hospital reported traffic injuries

Police reported crash data are the primary source of crash information in most jurisdictions. However, the definition of serious injury within police-reported data is not consistent across jurisdictions and may not be accurate. With the Australian National Road Safety Strategy targeting the reduction of serious injuries, there is a greater need to assess the accuracy of the methods used to identify these injuries. A possible source of more accurate information relating to injury severity is hospital data. While other studies have compared police and hospital data to highlight the under-reporting in police-reported data, little attention has been given to the accuracy of the methods used by police to identify serious injuries. The current study aimed to assess how accurate the identification of serious injuries is in police-reported crash data, by comparing the profiles of transport-related injuries in the Queensland Road Crash Database with an aligned sample of data from the Queensland Hospital Admitted Patients Data Collection. Results showed that, while a similar number of traffic injuries were recorded in both data sets, the profile of these injuries was different based on gender, age, location, and road user. The results suggest that the ‘hospitalisation’ severity category used by police may not reflect true hospitalisations in all cases. Further, it highlights the wide variety of severity levels within hospitalised cases that are not captured by the current police-reported definitions. While a data linkage study is required to confirm these results, they highlight that a reliance on police-reported serious traffic injury data alone could result in inaccurate estimates of the impact and cost of crashes and lead to a misallocation of valuable resources.

Cyclic mechanical strain guides capillary-like morphology in vitro

Introduction Stretching of tissue stimulates angiogenesis but increased motion at a fracture site hinders revascularisation. In vitro studies have indicated that mechanical stimuli promote angiogenic responses in endothelial cells, but can either inhibit or enhance responses when applied directly to angiogenesis assays. We anticipated that cyclic tension applied during endothelial network assembly would increase vascular structure formation up to a certain threshold. Methods Fibroblast/HUVEC co-cultures were subjected to cyclic equibiaxial strain (1 Hz; 6 h/day; 7 days) using the FlexerCell FX-4000T system and limiting rings for simultaneous application of multiple strain magnitudes (0–13%). Cells were labelled using anti-PECAM-1, and image analysis provided measures of endothelial network length and numbers of junctions. Results Cyclic stretching had no significant effect on the total length of endothelial networks (P > 0.2) but resulted in a strain-dependent decrease in branching and localised alignments of endothelial structures, which were in turn aligned with the supporting fibroblastic construct. Conclusion The organisation of endothelial networks under cyclic strain is dominated by structural adaptation to the supporting construct. It may be that, in fracture healing, the formation and integrity of the granulation tissue and callus is ultimately critical in revascularisation and its failure under severe strain conditions.