Chronic disease, geographic location and socioeconomic disadvantage as obstacles to equitable access to e-health

Despite recent public attention to e-health as a solution to rising healthcare costs and an ageingpopulation, there have been relatively few studies examining the geographical pattern of e-health usage. This paper argues for an equitable approach to e-health and attention to the way in which e-health initiatives can produce locational health inequalities, particularly in socioeconomically disadvantaged areas. In this paper, we use a case study to demonstrate geographical variation in Internet accessibility, Internet status and prevalence of chronic diseases within a small district. There are signifi cant disparities in access to health information within socioeconomically disadvantaged areas. The most vulnerable people in these areas are likely to have limited availability of, or access to Internet healthcare resources. They are also more likely to have complex chronic diseases and, therefore, be in greatest need of these resources. This case study demonstrates the importance of an equitable approach to e-health information technologies and telecommunications infrastructure.

Research for Action : Networking University and Community for Social Responsibility (Workshop)

This workshop brings together people from a diverse range of disciplines to discuss how academic researchers and community practitioners and activists can work together to explore the use of information and communication technologies, social media, augmented reality, and other forms of network technologies for research and action in pursuit of social responsibility. The aim is to connect people with ideas, ideas with research projects, and harness new media to further inquiry into socially just outcomes in our community.

Social clubs and social capital : the effect of electronic gaming machines in disadvantaged regions on the creation or destruction of community resilience

The role of particular third sector organisations, Social Clubs, in supporting gambling through the use of EGMs in venues presents as a difficult social issue. Social Clubs gain revenue from gambling activities; but also contribute to social well-being through the provision of services to communities. The revenues derived from gambling in specific geographic locales has been seen by government as a way to increase economic development particularly in deprived areas. However there are also concerns about accessibility of low-income citizens to Electronic Gaming Machines (EGMS) and the high level of gambling overall in these deprived areas. We argue that social capital can be viewed as a guard against deleterious effects of unconstrained use of EGM gambling in communities. However, it is contended that social capital may also be destroyed by gambling activity if commercial business actors are able to use EGMs without community obligations to service provision. This paper examines access to gambling through EGMs and its relationship to social capital and the consequent effect on community resilience, via an Australian case study. The results highlight the potential two-way relationship between gambling and volunteering, such that volunteering (and social capital more generally) may help protect against problems of gambling, but also that volunteering as an activity may be damaged by increased gambling activity. This suggests that, regardless of the direction of causation, it is necessary to build up social capital via volunteering and other social capital activities in areas where EGMS are concentrated. The study concludes that Social Clubs using EGMs to derive funds are uniquely positioned within the community to develop programs that foster social capital creation and build community resilience in deprived areas.

Iterative design within a local community communication fabric

Our research considers the problem designing support for local community communications. We present a description of a suburban community communication fabric as revealed through observations of long-term use of a networked community noticeboard and the introduction of tailored email digest to registered noticeboard users. The paper contributes an understanding of how iterative situated design in a user community can help us to design for participation in the use of technologies that can support growth of a community communication fabric. The different roles of the situated display and email digest are discussed.

The development of Lactococcus lactis as an antimicrobial agent

Non-pathogenic lactic acid bacteria are economically important Gram-positive bacteria used extensively in the food industry. Due to their “generally regarded as safe” status, certain species from the genera Lactobacillus and Lactococcus are also considered desirable as candidates for the production and secretion of recombinant proteins, particular those with therapeutic applications. The hypothesis examined by this thesis is that Lactococcus lactis can be modified to be an effective antimicrobial agent. Therefore, the aims of this thesis were to investigate the optimisation of the expression, secretion and/or activities of potential heterologous antimicrobial proteins by the model lactic acid bacterium, Lactococcus lactis subsp. cremoris MG1363. L. lactis strains were engineered to express and secrete the recombinant CyuC surface protein from Lactobacillus reuteri BR11, and a fusion protein consisting of CyuC and lysostaphin using the Sep promoter and secretion signal. CyuC has been characterised as a cystine-binding protein, but has also been demonstrated to have fibronectin binding activity. Lysostaphin is a bacteriolytic enzyme with specific activity against the Gram-positive pathogen, Staphylococcus aureus. These modified L. lactis strains were then investigated to see if they had the ability to inhibit the adhesion of S. aureus to host extracellular matrix (ECM) proteins. It was observed that the cell extracts of the L. lactis strain with the vector only (pGhost9:ISS1) was able to inhibit the adhesion of S. aureus to fibronectin, whilst the cell extracts of the L. lactis strain expressing lysostaphin was able to inhibit adhesion to keratin. Finally, this thesis has identified specific lactococcal genes that affect the secretion of lysostaphin through the use of random transposon mutagenesis. Ten mutants with higher lysostaphin activity contained insertions in four different genes encoding: (i) an uncharacterised putative transmembrane protein (llmg_0609), (ii) an enzyme catalysing the first step in peptidoglycan biosynthesis (murA2), (iii) a homolog of the oxidative defence regulator (trmA), and (iv) an uncharacterised putative enzyme involved in ubiquinone biosynthesis (llmg_2148). The higher lysostaphin activity observed in these mutants was found to be due to higher amounts of lysostaphin being secreted. The findings of this thesis contribute to the development of this organism as an antimicrobial agent and also to our understanding of L. lactis genetics.

Proactive communication management beats hostile media exposure : training for multi-cultural community leaders in living with mass media

Proactive communication management instead of mortification in the glare of hostile media attention became the theme of a four-day training program for multi-cultural community leaders, the object of this research. The program in Brisbane from December 2009 through to February this year was conducted under auspices of a Community Media Link grant program shared by Griffith University and the Queensland Ethnic Communities Council, together with Journalism academics from the Queensland University of Technology. Twenty-eight participants from 23 organisations took part, with a team of nine facilitators from the host organisations, and guest presenters from the news media. This paper reviews the process, taking into account: its objectives, to empower participants by showing how Australian media operate and introducing participants to journalists; pedagogical thrust, where overview talks, with role play seminars with guest presenters from the media, were combined with practice in interviews and writing for media; and outcomes, assessed on the basis of participants’ responses. The research methodology is qualitative, in that the study is based on discussions to review the planning and experience of sessions, and anonymous, informal feed-back questionnaires distributed to the participants. Background literature on multiculturalism and community media was referred to in the study. The findings indicate positive outcomes for participants from this approach to protection of persons unversed in living in the Australian “mediatised” environment. Most affirmed that the “production side” perspective of the exercise had informed and motivated them effectively, such that henceforth they would venture far more into media management, in their community leadership roles.

Formalin fixation affects equilibrium partitioning of an ionic contrast agent-microcomputed tomography (EPIC-[mu]CT) imaging of osteochondral samples

Equilibrium Partitioning of an Ionic Contrast agent with microcomputed tomography (EPIC-[mu]CT) is a non-invasive technique to quantify and visualize the three-dimensional distribution of glycosaminoglycans (GAGs) in fresh cartilage tissue. However, it is unclear whether this technique is applicable to already fixed tissues. Therefore, this study aimed at investigating whether formalin fixation of bovine cartilage affects X-ray attenuation, and thus the interpretation of EPIC-[mu]CT data.Design Osteochondral samples (n = 24) were incubated with ioxaglate, an ionic contrast agent, for 22 h prior to [mu]CT scanning. The samples were scanned in both formalin-fixed and fresh conditions. GAG content was measured using a biochemical assay and normalized to wet weight, dry weight, and water content to determine potential reasons for differences in X-ray attenuation.Results The expected zonal distribution of contrast agent/GAGs was observed for both fixed and fresh cartilage specimens. However, despite no significant differences in GAG concentrations or physical properties between fixed and fresh samples, the average attenuation levels of formalin-fixed cartilage were 14.3% lower than in fresh samples.Conclusions EPIC-[mu]CT is useful for three-dimensional visualization of GAGs in formalin-fixed cartilage. However, a significant reduction in X-ray attenuation for fixed (compared to fresh) cartilage must be taken into account and adjusted for accordingly when quantifying GAG concentrations using EPIC-[mu]CT.

Leading with moral purpose : insights from community leaders

Leadership has been described as having a moral purpose. This paper argues that theoretical insights from ethical leadership theory and empowerment theory are useful for understanding the work of community leaders. Community leaders tend to be people who are known mainly to their immediate community, work in a voluntary capacity and are committed to a particular goal or cause. The paper begins by referring to Starratt’s (1996) framework that comprises three inter-related ethics: an ethic of care, critique and justice, each of which is said to constitute ethical leadership. It then explores insights from empowerment theory since it is argued that it has some strong connections to ethical leadership. Central to both perspectives is the notion of relationships and ‘power to’ where power is shared and where people work together for change. Based on interviews with nine grassroots voluntary community leaders, this paper contributes to the limited research in the community leadership field by understanding more fully their values, beliefs and leadership practices. It is argued that the insights of ethical leadership and empowerment theory are highly relevant to explain their work and practice. The paper concludes by discussing some implications for leaders in educational settings.

Building an Australian user community for VIVO

The Australian National Data Service (ANDS) was established in 2008 and aims to: influence national policy in the area of data management in the Australian research community; inform best practice for the curation of data, and, transform the disparate collections of research data around Australia into a cohesive collection of research resources One high profile ANDS activity is to establish the population of Research Data Australia, a set of web pages describing data collections produced by or relevant to Australian researchers. It is designed to promote visibility of research data collections in search engines, in order to encourage their re-use. As part of activities associated with the Australian National Data Service, an increasing number of Australian Universities are choosing to implement VIVO, not as a platform to profile information about researchers, but as a 'metadata store' platform to profile information about institutional research data sets, both locally and as part of a national data commons. To date, the University of Melbourne, Griffith University, the Queensland University of Technology, and the University of Western Australia have all chosen to implement VIVO, with interest from other Universities growing.

Effectiveness of nurse-led preoperative assessment services for elective surgery : a systematic review

Background--The admission and assessment of patients for elective procedures is a task faced by all healthcare organisations that provide elective surgical services. Several different strategies have been used to facilitate the management of these tasks. Nurse-led preadmission clinics or services have been implemented in many health services as one of these management strategies; however their effectiveness has not been established. Objectives--The objective of this review was to examine the available research on the effectiveness of nurse-led elective surgery preoperative assessment clinics or services on patient outcomes.--Results--Of the 19 included articles, there were 10 audits of patient and hospital data, 3 surveys or questionnaires, 3 descriptive studies, 1 action research design, 1 prospective observational study and 1 RCT. Five of ten studies reporting data on cancellations rates found that nurse-led preadmission services reduced the number of day-of-surgery cancellations. Non-attendance for surgery was also reduced, with nine studies reporting decreases in the number of patients failing to attend. Eight studies reporting data on patient or parent satisfaction found high levels of satisfaction with nurse-led preadmission services. Three of four studies investigating the effect of the nurse-led preadmission service on patient anxiety found a reduction in reported anxiety levels. Three studies found that preoperative preparation was enhanced by the use of a nurse-led preadmission service.--Conclusions--While all included studies reported evidence of effectiveness for nurse-led preadmission services on a wide range of outcomes for elective surgery patients, the lack of experimental trials means that the level of evidence is low, and further research is needed.--Implications for practice--Nurse-led preadmission services may be an effective strategy for reducing procedural cancellations, failure to attend for procedures, and patient anxiety, however currently the evidence level is low.

Using economic data to reduce healthcare-acquired infection

In this issue Burns et al. report an estimate of the economic loss to Auckland City Hospital from cases of healthcare-associated bloodstream infection. They show that patients with infection stay longer in hospital and this must impose an opportunity cost because beds are blocked. Harder to measure costs fall on patients, their families and non-acute health services. Patients face some risk of dying from the infection.

Finding the remote: Immersive learning in an outback community

Real-world design education projects present particular challenges when in a place remote from and distinctively different to students’ familiar territory. The teaching challenge is to assist students to translate the skills they learn at university into an entirely new context, facilitating a project they will learn from, and the community will value. In 2008 QUT design and engineering students undertook a project called Linking Karumba for this remote Queensland town. They engaged with a landscape, climate and community dramatically different from their base in urban Brisbane, and in a fortnight produced locally responsive strategic planning options. The theoretical approach to this was twofold: they needed to make a rapid shift along a continuum from being “outsiders” towards becoming “insiders” (Relph 1976), and to create designs responsive to local distinctiveness (Cumberlidge and Musgrave 2007). This paper outlines Linking Karumba’s teaching strategy via an analogy with the “immersion” method in bilingual education. Three teaching methods were adopted. Firstly, the overall framework drew on Brockbank and McGill (1998), and Thomas’ (2006a) approaches to student reflective practice. Within this, Girot’s “Four Trace Concepts” (1999) inspired exercises for finding Karumba and moving toward insideness; and a program of community engagement sought immersion in local distinctiveness, and “conversation” between the differing forms of knowledge and capacities embedded within the community and students (Armstrong 1999, Thomas 2006). The responsiveness of the student work to the character of Karumba’s culture and environment indicated remarkable levels of immersion, and the community highly valued the project outcomes: four strategic planning options which attracted $830 000 in state government funding for implementation.

'Radiant with possibility': involving young people in creating a vision for the future of their community

This paper argues that young people need to be given the opportunity to recognise the interaction between their own understandings of the world as it is now and the vision of what it might become. To support this argument, we discuss an urban planning project, known as the Lower Mill Site Project, which involved active participation of high school students from the local community. The outcomes of this project demonstrate the positive contributions young people can make to the process of urban redevelopment, the advantages of using a participatory design approach, and the utopian possibilities that can emerge when young people are invited to be part of an intergenerational community project.