Improved rural health through a collaborative model of care – qualitative findings

INTRODUCTION Health disparity between urban and rural regions in Australia is well-documented. In the Wheatbelt catchments of Western Australia there is higher incidence and rate of avoidable hospitalisation for chronic diseases. Structured care approach to chronic illnesses is not new but the focus has been on single disease state. A recent ARC Discovery Project on general practice nurse-led chronic disease management of diabetes, hypertension and stable ischaemic heart disease reported improved communication and better medical administration.[1] In our study we investigated the sustainability of such a multi-morbidities general practice –led collaborative model of care in rural Australia. METHODS A QUAN(qual) design was utilised. Eight pairs of rural general practices were matched. Inclusion criteria used were >18 years and capable of giving informed consent, at least one identified risk factor or diagnosed with chronic conditions. Patients were excluded if deemed medically unsuitable. A comprehensive care plan was formulated by the respective general practice nurse in consultation with the treating General Practitioner (GP) and patient based on the individual’s readiness to change, and was informed by available local resource. A case management approach was utilised. Shediaz-Rizkallah and Lee’s conceptual framework on sustainability informed our evaluation.[2] Our primary outcome on measures of sustainability was reduction in avoidable hospitalisation. Secondary outcomes were patients and practitioners acceptance and satisfaction, and changes to pre-determined interim clinical and process outcomes. RESULTS The qualitative interviews highlighted the community preference for a ‘sustainable’ local hospital in addition to general practice. Costs, ease of access, low prioritisation of self chronic care, workforce turnover and perception of losing another local resource if underutilised influenced the respondents’ decision to present at local hospital for avoidable chronic diseases regardless. CONCLUSIONS Despite the pragmatic nature of rural general practice in Australia, the sustainability of chronic multi-morbidities management in general practice require efficient integration of primary-secondary health care and consideration of other social determinants of health. What this study adds: What is already known on this subject: Structured approach to chronic disease management is not new and has been shown to be effective for reducing hospitalisation. However, the focus has been on single disease state. What does this study add: Sustainability of collaborative model of multi-morbidities care require better primary-secondary integration and consideration of social determinants of health.

A history of environmental management in the field in Queensland : episodes of activity

This paper reviews a wide range of literature on environmental management in the field in Queensland, and analyzes this by period and by author. An episodic pattern of activities since European settlement is evident. Periods of exploration (pre-1950) and inventory- compilation (ca. 1950-1970) were followed by two decades of media and non-government organization campaigning (ca. 1970-1990), then an era dominated by government regulatory action (ca. 1990-2010). These eras dominated public perception of what was happening in environmental practice. They were delineated by historic ‘interventions’ (summarily, the end of World War II, the 1971 inflationary crisis, and computerization respectively).

Safety climate and injury occurrence of repair, maintenance, minor alteration and addition works : a comparison of workers, supervisors and managers

Purpose The repair, maintenance, minor alteration and addition (RMAA) sector has been expanding in many developed cities. Safety problems of the RMAA sector have attracted the attention of many governments. This study has the objectives of comparing the level of safety climate of workers, supervisors and managers in the RMAA sector; and explaining/ predicting the impact of safety climate on injury occurrence of workers, supervisors and managers. Design/methodology/approach A questionnaire survey was administered to RMAA contracting companies in Hong Kong. Findings When comparing the safety climate perception of workers, supervisors and managers in the RMAA sector, the supervisors group had the lowest mean safety climate score. Results showed that a positive workforce safety attitude and acceptance of safety rules and regulations reduced the workers’ likelihood of having injuries. A reasonable production schedule led to a lower probability of supervisors being injured. Management commitment and effective safety management reduced the probability of managers being injured. Originality/value This study revealed variations of safety climate at the different levels in the organizational hierarchy and their varying influence on safety performance of the RMAA sector. Safety of RMAA works could be improved by promulgating specific safety measures at the different hierarchy levels.

Psychosocial factors associated with controlling feeding practices of Indian and Australian-Indian mothers

This cross-sectional study examined the association between psychosocial factors (mothers’ perception of own and child weight, maternal self-efficacy in feeding and involvement of the mother-in-law in child-feeding) and controlling feeding practices (monitoring, restriction, pressure to eat and passive feeding). Participants were 531 affluent-Indian mothers in Australia and Mumbai with children aged 1-5 years. The psychosocial variables and feeding practices were measured using a combination of previously validated scales and study-developed items/scales. Multivariable regression analyses were stratified by sample (Australia and Mumbai) to investigate psychosocial factors related to the feeding practices, adjusting for covariates. Self-efficacy in feeding was associated with each of the feeding practices in at least one of the samples (β values between 0.1-0.2, p= 0.04-0.005). The greater involvement of the mother-in-law in child-feeding was related to the higher use of restriction in both samples (β values ≥0.2, p=0.02). In contrast, maternal weight perceptions were not consistently associated with feeding practices in either sample. The findings highlighted that unique (self-efficacy in feeding) and culturally-specific (involvement of the mother-in-law) variables not extensively researched within the context of child-feeding were important factors associated with Indian mothers’ feeding practices. Greater consideration of these factors may be required when tailoring child-feeding interventions for Indian mothers.

Analysis of genetically modified red-fleshed apples reveals effects on growth and consumer attributes

Consumers of whole foods, such as fruits, demand consistent high quality and seek varieties with enhanced health properties, convenience or novel taste. We have raised the polyphenolic content of apple by genetic engineering of the anthocyanin pathway using the apple transcription factor MYB10. These apples have very high concentrations of foliar, flower and fruit anthocyanins, especially in the fruit peel. Independent lines were examined for impacts on tree growth, photosynthesis and fruit characteristics. Fruit were analysed for changes in metabolite and transcript levels. Fruit were also used in taste trials to study the consumer perception of such a novel apple. No negative taste attributes were associated with the elevated anthocyanins. Modification with this one gene provides near isogenic material and allows us to examine the effects on an established cultivar, with a view to enhancing consumer appeal independently of other fruit qualities. © 2012 Society for Experimental Biology, Association of Applied Biologists and Blackwell Publishing Ltd.

Chasing the great Australian dream : definition of "an ideal home" among baby boomers

In Australia, the idea of home ownership or The Great Australian Dream is still perceived as the main achievement of every Australian’s life. Perception of an ideal home is changing over the decades. Each generation has special requirements criteria which foster their dwelling space. This research identifies and compares three generations’ (Baby Boomers, Generation X and Generation Y) demographics, special requirements and perceptions regarding their ideal home. The examination of previous research and literature into the Queensland context reveals that the Baby Boomers population of people 65 and older is currently 11.8% of the state population and is expected to grow to almost one quarter of the population by 2051. This is the highest growth rate among these three generations. Further analysis of these three generations’ status and requirements shows that aging is the most critical issue for the housing systems. This is especially the case for Baby Boomers due to their demand for support services and health care in the home. The study reveals that ‘ageing in place’, is a preferred option for the aged. This raises questions as to how well the housing system and neighbourhood environments are able to support ageing in place, and what aging factors should be taken into consideration when designing Baby boomer’s home to facilitate health and wellbeing. Therefore, this research designed a qualitative approach to investigate Australian Baby Boomers homes around Queensland, predominantly in the Brisbane area, using semi-structured interviews and observations. It aims to find out the level of satisfaction of Australian Baby Boomers with their current home and their preferences and requirements in light of their ideal home. The findings contribute new knowledge in the light of ideal home mechanisms. A set of strategies has been developed from the findings that may help improve the level of comfort, safety and satisfaction that Baby Boomers experience in their current and future homes.

Monte Carlo simulations of small field output factors in solid phantoms

Introduction Total scatter factor (or output factor) in megavoltage photon dosimetry is a measure of relative dose relating a certain field size to a reference field size. The use of solid phantoms has been well established for output factor measurements, however to date these phantoms have not been tested with small fields. In this work, we evaluate the water equivalency of a number of solid phantoms for small field output factor measurements using the EGSnrc Monte Carlo code. Methods The following small square field sizes were simulated using BEAMnrc: 5, 6, 7, 8, 10 and 30 mm. Each simulated phantom geometry was created in DOSXYZnrc and consisted of a silicon diode (of length and width 1.5 mm and depth 0.5 mm) submersed in the phantom at a depth of 5 g/cm2. The source-to-detector distance was 100 cm for all simulations. The dose was scored in a single voxel at the location of the diode. Interaction probabilities and radiation transport parameters for each material were created using custom PEGS4 files. Results A comparison of the resultant output factors in the solid phantoms, compared to the same factors in a water phantom are shown in Fig. 1. The statistical uncertainty in each point was less than or equal to 0.4 %. The results in Fig. 1 show that the density of the phantoms affected the output factor results, with higher density materials (such as PMMA) resulting in higher output factors. Additionally, it was also calculated that scaling the depth for equivalent path length had negligible effect on the output factor results at these field sizes. Discussion and conclusions Electron stopping power and photon mass energy absorption change minimally with small field size [1]. Also, it can be seen from Fig. 1 that the difference from water decreases with increasing field size. Therefore, the most likely cause for the observed discrepancies in output factors is differing electron disequilibrium as a function of phantom density. When measuring small field output factors in a solid phantom, it is important that the density is very close to that of water.

Ozone-Induced Dissociation on a Modified Tandem Linear Ion-Trap : Observations of Different Reactivity for Isomeric Lipids

Ozone-induced dissociation (OzID) exploits the gas-phase reaction between mass-selected lipid ions and ozone vapor to determine the position(s) of unsaturation In this contribution, we describe the modification of a tandem linear ion-trap mass spectrometer specifically for OzID analyses wherein ozone vapor is supplied to the collision cell This instrumental configuration provides spatial separation between mass-selection, the ozonolysis reaction, and mass-analysis steps in the OzID process and thus delivers significant enhancements in speed and sensitivity (ca 30-fold) These improvements allow spectra revealing the double-bond position(s) within unsaturated lipids to be acquired within 1 s significantly enhancing the utility of OzID in high-throughput lipidomic protocols The stable ozone concentration afforded by this modified instrument also allows direct comparison of relative reactivity of isomeric lipids and reveals reactivity trends related to (1) double-bond position, (2) substitution position on the glycerol backbone, and (3) stereochemistry For cis- and trans-isomers, differences were also observed in the branching ratio of product ions arising from the gas-phase ozonolysis reaction, suggesting that relative ion abundances could be exploited as markers for double-bond geometry Additional activation energy applied to mass-selected lipid ions during injection into the collision cell (with ozone present) was found to yield spectra containing both OzID and classical-CID fragment ions This combination CID-OzID acquisition on an ostensibly simple monounsaturated phosphatidylcholine within a cow brain lipid extract provided evidence for up to four structurally distinct phospholipids differing in both double-bond position and sn-substitution U Am Soc Mass Spectrom 2010, 21, 1989-1999) (C) 2010 American Society for Mass Spectrometry

Australia lawyer well-being : workplace demands, resources and the impact of time-billing targets

The purpose of the present study was to examine the types of workplace demands and resources experienced by full-time Australian lawyers, and the prevalence of a range of psychological outcomes. The study further focussed on the impact of time-billing targets on lawyers’ experience of these variables. Participants were 384 full-time Australian lawyers who completed an online questionnaire distributed by their Australian State or Territory Law Society. Analysis revealed that emphasis on profits within the workplace was the highest perceived demand, and the perception of social value in their work was the highest available resource. The results indicated that 37% of participants displayed Moderate to Extremely Severe depressive symptoms, and 35% were a positive screen for hazardous or harmful drinking. A series of three multivariate analyses of variance revealed significant differences between non-billers, low-to-moderate billers and high billers, with high billers experiencing greater demands, fewer resources and poorer psychological outcomes. The practical applications of these results for the legal profession are discussed.

Narratives of possession : reading for saga authorship

The aim of this thesis is to show how character analysis can be used to approach conceptions of saga authorship in medieval Iceland. The idea of possession is a metaphor that is adopted early in the thesis, and is used to describe Icelandic sagas as works in which traditional material is subtly interpreted by medieval authors. For example, we can say that if authors claim greater possession of the sagas, they interpret, and not merely record, the sagas' historical information. On the other hand, tradition holds onto its possession of the narrative whenever it is not possible for an author to develop his own creative and historical interests. The metaphor of possession also underpins the character analysis in the thesis, which is based on the idea that saga authors used characters as a vehicle by which to possess saga narratives and so develop their own historical interests. The idea of possession signals the kinds of problems of authorship study which are addressed here, in particular, the question of the authors' sense of saga writing as an act either of preservation or of creation. While, in that sense, the thesis represents an additional voice in a long-standing debate about the saga writers' relation to their source materials, I argue against a clear-cut distinction between creative and non-creative authors, and focus instead on the wide variation in authorial control over saga materials. This variation suggests that saga authorship is a multi-functional activity, or one which co-exists with tradition. Further, by emphasising characterisation as a method, I am adding to the weight of scholarship that seeks to understand the sagas in terms of their literary effects. The Introduction and chapter one lay out the theoretical scope of this thesis. My aim in these first two sections is to inform the reader of the type of critical questions that arise when authorship is approached in relation to characterisation, and to suggest an interpretive framework with which to approach these questions. In the Introduction this aim manifests as a brief discussion of the application of the term "authorship" to the medieval Icelandic corpus, a definition of the scope of this study, and an introduction to the connections, made throughout this thesis, between saga authors, the sagas' narrative style, and the style of characterisation in the sagas. Chapter one is a far more detailed discussion of our ability to make these connections. In particular, the chapter develops the definition of the analytical term "secondary authorship" that I introduce in order to delineate the type of characterisation that is of most interest in this thesis. "Secondary authorship" is a literary term that aims to sharpen our approach to saga authors' relationship to their characters by focusing on characters who make representations about the events of the saga. The term refers to any instance in which characters behave in a manner that resembles the creativity, interpretation, and understanding associated with authorship more generally. Character analysis cannot, however, be divorced from socio-historical approaches to the saga corpus. Most importantly, the sagas themselves are socio-historical representations that claim some degree of truth value. This claim that the sagas make by implication about their historicity is the starting point of a discussion of authorship in medieval Iceland. Therefore, at the beginning of chapter one I discuss some of the approaches to the social context of saga writing. This discussion serves as an introduction to both the culture of saga writing in medieval Iceland and to the nature of the sagas' historical perspective, and reflects my sense that literary interpretations of the sagas cannot be isolated from the historical discourses that frame them. The chapter also discusses possession, which, as I note above, is used alongside the concept of secondary authorship to describe the saga authors' relationship with the stories and characters of the past. At the close of chapter one, I offer a preliminary list the various functions of saga authorship, and give some examples of secondary authorship. From this point I am able to tie my argument about secondary authorship to specific examples from the sagas. Chapter two examines the effect of family obligations and domestic points of view in the depiction of characters' choices and conception of themselves. The examples that are given in that chapter - from Gisla saga Súrssonar and Íslendinga saga - are the first of a number of textual analyses that demonstrate the application of the concepts of secondary authorship and possession of saga narratives. The relationship between narratives about national and domestic matters shows how authorial creativity in the area of kinship obligation provides the basis for the saga's development of historical themes. Thus, the two major case studies given in chapter two tie authorial engagement with characters to the most influential social institution in early and medieval Iceland, the family. The remaining chapters represent similar attempts to relate authorial possession of saga characters to central socio-historical themes in the sagas, such as the settlement process in early Iceland and its influence on the development of regional political life (chapter three). Likewise, the strong authorial interest in an Icelander's journey to Norway in Heimskringla is presented as evidence of the author's use of a saga character to express an Icelandic interpretation of Norwegian history and to promote a sense that Iceland shared the ownership of regal history with Norway (chapter four). In that authorial engagement with the Icelander abroad, we witness saga characterisation being used as a basis for historical interpretation and the means by which foreign traditions and influence, not least the narratives of royal lives and of the Christianisation, are claimed as part of medieval Icelanders' self-conception. While saga authors observe the conventions of saga narration, characters are often subtly positioned as the authors' interpretive mirrors, especially clear than when they act as secondary authors. Nowhere is this more apparent than in Brennu- Njáls saga, which contains many characters who voice the author's claim to interpret the past. Even Hrútr Herjólfsson, through his remarkable perception of events and his conspicuous comments about them, acts as a secondary author by enabling the author to emphasise the importance of the disposition of characters. In Laxdœla saga and Þorgils saga ok Hafliða, authorial interest in characters' perception is matched by the thematising of learning, from the inception of knowledge as prophecy or advice to complete understanding by saga characters (chapter six). In Þorgils saga skarða, a character's inner development from an excessively ambitious and politically ruthless youth to a Christian leader killed by his kinsman allows the author to shape a political life into a lesson about leadership and the community's ability to moderate and contain the behaviour of extraordinary individuals. The portrayal draws on methods of characterisation that we can identify in Grettis saga Ásmundarson, Fóstbrœðra saga, and Orkneyinga saga. A comparison of the characterisation of figures with intense political or military ambitions suggests that saga authors were interested in the community's ability to balance their strength and ability with a degree of social moderation. The discussion of these sagas shows that character study can be used to analyse how the saga authors added their own voice to the voices passed down to medieval Icelanders in traditional narratives. Authorial engagement with characters allowed inherited traditions about early Norway and Iceland and records of thirteenth century events to be transformed into sophisticated historical works with highly creative elements. Through secondary authorship, saga authors took joint-possession of narratives and contested the power of tradition in setting the interpretive framework of a saga.

Validity of the previous day physical activity recall (PDPAR) in fifth-grade children

This study evaluated the validity of the Previous Day Physical Activity Recall (PDPAR) self-report instrument in quantifying after-school physical activity behavior in fifth-grade children. Thirty-eight fifth-grade students (mean age, 10.8 +/- 0.1; 52.6% female; 26.3% African American) from two urban elementary schools completed the PDPAR after wearing a CSA WAM 7164 accelerometer for a day. The mean within-subject correlation between self-reported MET level and total counts for each 30-min block was 0.57 (95% C.I., 0.51-0.62). Self-reported mean MET level during the after-school period and the number of 30-min blocks with activity rated at greater than or equal to 6 METs were significantly correlated with the CSA outcome variables. Validity coefficients for these variables ranged from 0.35 to 0.43 (p <.05). Correlations between the number of 30-min blocks with activity rated at greater than or equal to 3 METs and the CSA variables were positive but failed to reach statistical significance (r = 0.19-0.23). The PDPAR provides moderately valid estimates of relative participation in vigorous activity and mean MET level in fifth-grade children. Caution should be exercised when using the PDPAR to quantify moderate physical activity in preadolescent children.

A prospective study of the determinants of physical activity in rural fifth-grade children

Background Understanding the factors that influence physical activity behavior is important in the design of intervention programs targeted at youth. Methods A prospective study design was used to identify the predictors of vigorous physical activity (VPA) (greater than or equal to 6 METs) and moderate and vigorous physical activity (MVPA) (greater than or equal to 3 METs) among 202 rural, predominantly African-American children. Selected social-cognitive determinants of physical activity were assessed via questionnaire in the fifth grade. Participation in VPA and MVPA was assessed via the previous day physical activity recall 1 year later in the sixth grade. Results For girls, participation in community sports, self-efficacy in overcoming barriers, enjoyment of school physical education, race (white > black), and perception of mother's activity level (active vs inactive) were significant predictors of VPA. For MVPA, participation in community sports and self-efficacy in overcoming barriers were significant predictors. For boys, self-efficacy in overcoming barriers was the only significant predictor of VPA, while beliefs regarding activity outcomes and participation in community sports were significant predictors of MVPA. Conclusion Social-cognitive constructs such as physical activity self-efficacy, access to community physical activity outlets, and positive beliefs regarding physical activity outcomes are important predictors of future physical activity behavior among rural, predominantly African-American children.

Associations between physical activity and other health behaviors in a representative sample of US adolescents

OBJECTIVES This study examined the associations between physical activity and other health behaviors in a representative sample of US adolescents. METHODS In the 1990 Youth Risk Behavior Survey, 11631 high school students provided information on physical activity; diet; substance use; and other negative health behaviors. Logistic regression analyses examined associations between physical activity and other health behaviors in a subset of 2652 high-active and 1641 low-active students. RESULTS Low activity was associated with cigarette smoking, marijuana use, lower fruit and vegetable consumption, greater television watching, failure to wear a seat belt, and low perception of academic performance. For consumption of fruit, television watching, and alcohol consumption, significant interactions were found with race/ethnicity or sex, suggesting that sociocultural factors may affect the relationships between physical activity and some health behaviors. CONCLUSIONS Low physical activity was associated with several other negative health behaviors in teenagers. Future studies should examine whether interventions for increasing physical activity in youth can be effective in reducing negative health behaviors.

The use of phospholipid fatty acid analysis to measure impact of acid rock drainage on microbial communities in sediments

The impact of acid rock drainage (ARD) and eutrophication on microbial communities in stream sediments above and below an abandoned mine site in the Adelaide Hills, South Australia, was quantified by PLFA analysis. Multivariate analysis of water quality parameters, including anions, soluble heavy metals, pH, and conductivity, as well as total extractable metal concentrations in sediments, produced clustering of sample sites into three distinct groups. These groups corresponded with levels of nutrient enrichment and/or concentration of pollutants associated with ARD. Total PLFA concentration, which is indicative of microbial biomass, was reduced by >70% at sites along the stream between the mine site and as far as 18 km downstream. Further downstream, however, recovery of the microbial abundance was apparent, possibly reflecting dilution effect by downstream tributaries. Total PLFA was >40% higher at, and immediately below, the mine site (0-0.1 km), compared with sites further downstream (2.5-18 km), even after accounting for differences in specific surface area of different sediment samples. The increased microbial population in the proximity of the mine source may be associated with the presence of a thriving iron-oxidizing bacteria community as a consequence of optimal conditions for these organisms while the lower microbial population further downstream corresponded with greater sediments' metal concentrations. PCA of relative abundance revealed a number of PLFAs which were most influential in discriminating between ARD-polluted sites and the rest of the sites. These PLFA included the hydroxy fatty acids: 2OH12:0, 3OH12:0, 2OH16:0; the fungal marker: 18:2ω6; the sulfate-reducing bacteria marker 10Me16:1ω7; and the saturated fatty acids 12:0, 16:0, 18:0. Partial constrained ordination revealed that the environmental parameters with the greatest bearing on the PLFA profiles included pH, soluble aluminum, total extractable iron, and zinc. The study demonstrated the successful application of PLFA analysis to rapidly assess the toxicity of ARD-affected waters and sediments and to differentiate this response from the effects of other pollutants, such as increased nutrients and salinity.

Intrinsic frames of reference in haptic spatial learning

It has been proposed that spatial reference frames with which object locations are specified in memory are intrinsic to a to-be-remembered spatial layout (intrinsic reference theory). Although this theory has been supported by accumulating evidence, it has only been collected from paradigms in which the entire spatial layout was simultaneously visible to observers. The present study was designed to examine the generality of the theory by investigating whether the geometric structure of a spatial layout (bilateral symmetry) influences selection of spatial reference frames when object locations are sequentially learned through haptic exploration. In two experiments, participants learned the spatial layout solely by touch and performed judgments of relative direction among objects using their spatial memories. Results indicated that the geometric structure can provide a spatial cue for establishing reference frames as long as it is accentuated by explicit instructions (Experiment 1) or alignment with an egocentric orientation (Experiment 2). These results are entirely consistent with those from previous studies in which spatial information was encoded through simultaneous viewing of all object locations, suggesting that the intrinsic reference theory is not specific to a type of spatial memory acquired by the particular learning method but instead generalizes to spatial memories learned through a variety of encoding conditions. In particular, the present findings suggest that spatial memories that follow the intrinsic reference theory function equivalently regardless of the modality in which spatial information is encoded.