Which components of heart failure programs are effective? A meta-analysis of the outcomes of structured telephone support or telemonitoring as the primary component of heart failure management in 9,560 patients (Abridged Cochrane Review)

Aims--Telemonitoring (TM) and structured telephone support (STS) have the potential to deliver specialised management to more patients with chronic heart failure (CHF), but their efficacy is still to be proven. Objectives To review randomised controlled trials (RCTs) of TM or STS on all- cause mortality and all-cause and CHF-related hospitalisations in patients with CHF, as a non-invasive remote model of specialised disease-management intervention.--Methods and Results--Data sources:We searched 15 electronic databases and hand-searched bibliographies of relevant studies, systematic reviews, and meeting abstracts. Two reviewers independently extracted all data. Study eligibility and participants: We included any randomised controlled trials (RCT) comparing TM or STS to usual care of patients with CHF. Studies that included intensified management with additional home or clinic visits were excluded. Synthesis: Primary outcomes (mortality and hospitalisations) were analysed; secondary outcomes (cost, length of stay, quality of life) were tabulated.--Results: Thirty RCTs of STS and TM were identified (25 peer-reviewed publications (n=8,323) and five abstracts (n=1,482)). Of the 25 peer-reviewed studies, 11 evaluated TM (2,710 participants), 16 evaluated STS (5,613 participants) and two tested both interventions. TM reduced all-cause mortality (risk ratio (RR 0•66 [95% CI 0•54-0•81], p<0•0001) and STS showed similar trends (RR 0•88 [95% CI 0•76-1•01], p=0•08). Both TM (RR 0•79 [95% CI 0•67-0•94], p=0•008) and STS (RR 0•77 [95% CI 0•68-0•87], p<0•0001) reduced CHF-related hospitalisations. Both interventions improved quality of life, reduced costs, and were acceptable to patients. Improvements in prescribing, patient-knowledge and self-care, and functional class were observed.--Conclusion: TM and STS both appear effective interventions to improve outcomes in patients with CHF.

Micro-family-owned businesses in hostile environment : future engine for growth?

Using panel data from the four waves of the Indonesia Family Life Survey in 1993, 1997, 2000 and 2007 we investigate the prerequisite for and contribution of micro-family-businesses to economic development. We find that family-owned firms are on average fairly profitable compared with the industrial sector profit standard. Failure rates between 1997 and 2000 are very low (about 10%), while the industrial sector experimented a massive shakeout of about 33% in the wake of the 1997 crisis (Ter Wengel & Rodriguez, 2006), with an increase in the number of family-businesses between the two years of observation. This paper contributes to the economics of entrepreneurship studies by continuing the discussion of entrepreneurship in hostile business environments (Baumol, 1990; Sobel, 2008).

Goreen Narrkwarren Ngrn-tuora : healthy family air : a literature review

This paper will focus on the literature review for Goreen Narrkwarren Ngrn-toura- Healthy Family Air, formerly known as Reducing smoking amongst pregnant Aboriginal women in Victoria: An Holistic Approach. Before we outline the findings from the literature review, we will provide some background information on the project, including why it is important and what and who are involved.

Slum free India program. Report on the findings and recommendations of QUT BEE workshop to investigate strategies to deliver better outcomes

As a result of a broad invitation extended by Professor Martin Betts, Executive Dean of the Faculty of Built Environment and Engineering, to the community of interest at QUT, a cross-disciplinary collaborative workshop was conducted to contribute ideas about responding to the Government of India’s urgent requirement to implement a program to re-house slum dwellers. This is a complex problem facing the Indian Ministry of Housing. Not only does the government aspire to eradicate existing slum conditions and to achieve tangible results within five years, but it must also ensure that slums do not form in the future. The workshop focused on technological innovation in construction to deliver transformation from the current unsanitary and overcrowded informal urban settlements to places that provide the economically weaker sections of Indian society with healthy, environmentally sustainable, economically viable mass housing that supports successful urban living. The workshop was conducted in two part process as follows: Initially, QUT academics from diverse fields shared current research and provided technical background to contextualise the challenge at a pre-workshop briefing session. This was followed by a one-day workshop during which participants worked intensively in multi-disciplinary groups through a series of exercises to develop innovative approaches to the complex problem of slum redevelopment. Dynamic, compressed work sessions, interspersed with cross-functional review and feedback by the whole group took place throughout the day. Reviews emphasised testing the concepts for their level of complexity, and likelihood of success. The two-stage workshop process achieved several objectives:  Inspired a sense of shared purpose amongst a diverse group of academics  Built participants’ knowledge of each other’s capacity  Engaged multi disciplinary team in an innovative design research process  Built participants’ confidence in the collaborative process  Demonstrated that collaborative problem solving can create solutions that represent transformative change.  Developed a framework of how workable solutions might be developed for the program through follow up workshops and charrettes of a similar nature involving stakeholders drawn from the context of the slum housing program management.

Mental health of newly arrived Burmese refugees in Australia : contributions of pre-migration and post-migration experience

Objective: This study documents the mental health status of people from Burmese refugee backgrounds, recently arrived in Australia; then examines the contributions of gender, premigration and postmigration factors in predicting mental health. Method: Structured interviews, including a demographic questionnaire, the Harvard Trauma Questionnaire, Postmigration Living Difficulties Checklist and Hopkins Symptom Checklist assessed premigration trauma, postmigration living difficulties, depression, anxiety, somatisation and traumatisation symptoms in a sample of 70 adults across five Burmese ethnic groups. Results: Substantial proportions of participants reported psychological distress in symptomatic ranges including: posttraumatic stress disorder (9%); anxiety (20%), and; depression (36%), as well as significant symptoms of somatisation (37%). Participants reported multiple and severe premigration traumas. Postmigration living difficulties of greatest concern included communication problems and worry about family not in Australia. Gender did not predict mental health. Level of exposure to traumatic events and postmigration living difficulties each made unique and relatively equal contributions to traumatisation symptoms. Postmigration living difficulties made unique contributions to depression, anxiety and somatisation symptoms. Conclusions: While exposure to traumatic events impacted on participants’ mental wellbeing, postmigration living difficulties had greater salience in predicting mental health outcomes of people from Burmese refugee backgrounds. Reported rates of posttraumatic stress disorder symptoms were consistent with a large review of adults across seven western countries. High levels of somatisation pointed to a nuanced expression of distress. Findings have implications for service provision in terms of implementing appropriate interventions to effectively meet the needs of this newly arrived group in Australia.

Children of substance-using mothers : child health engagement and child protection outcomes

Aim: Maternal substance use has been associated with a range of child risk factors. The study investigated the relationship between engagement with child health services and child protection outcomes for children of substance using mothers. ----- ----- Methods: A sample of 119 children of mothers who disclosed opiate, amphetamine or methadone use during a maternity admission between 2000 and 2003, as included in a previous matched co-hort study1, were included in the current study. Statutory child protection agency and child health engagement information for the first two years of life, was obtained. The relationship between type of maternal substance use, child health engagement and child protection outcomes was examined. ----- ----- Results: Seventy two percent of study group infants were engaged with child health services during the first two years of life. Chi square analysis showed no significant relationship between child health engagement and child protection reports. Child health engagement was associated with decreased substantiated child protection notifications for children of methadone using mothers, but not for children of illicit substance users. ----- ----- Conclusions: Almost a quarter of identified children of substance using mothers are not accessing standard child health services in their first two years of life. This study provides support for increased attention to the provision of child health services for children of methadone using mothers. Further research into effective intervention strategies for children of illicit substance using mothers is indicated.

Adaptive and maladaptive coping strategies predict posttrauma outcomes in ambulance personnel

Attending potentially dangerous and traumatic incidents is inherent in the role of emergency workers, yet there is a paucity of literature aimed at examining variables that impact on the outcomes of such exposure. Coping has been implicated in adjusting to trauma in other contexts, and this study explored the effectiveness of coping strategies in relation to positive and negative posttrauma outcomes in the emergency services environment. One hundred twenty-five paramedics completed a survey battery including the Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996), the Impact of Events Scale–Revised (IES-R; Weiss & Marmar, 1997), and the Revised-COPE (Zuckerman & Gagne, 2003). Results from the regression analysis demonstrated that specific coping strategies were differentially associated with positive and negative posttrauma outcomes. The research contributes to a more comprehensive understanding regarding the effectiveness of coping strategies employed by paramedics in managing trauma, with implications for their psychological well-being as well as the training and support services available.

Genome-wide identification and expression analysis of the NF-Y family of transcription factors in Triticum aestivum

Nuclear Factor Y (NF-Y) is a trimeric complex that binds to the CCAAT box, a ubiquitous eukaryotic promoter element. The three subunits NF-YA, NF-YB and NF-YC are represented by single genes in yeast and mammals. However, in model plant species (Arabidopsis and rice) multiple genes encode each subunit providing the impetus for the investigation of the NF-Y transcription factor family in wheat. A total of 37 NF-Y and Dr1 genes (10 NF-YA, 11 NF-YB, 14 NF-YC and 2 Dr1) in Triticum aestivum were identified in the global DNA databases by computational analysis in this study. Each of the wheat NF-Y subunit families could be further divided into 4-5 clades based on their conserved core region sequences. Several conserved motifs outside of the NF-Y core regions were also identified by comparison of NF-Y members from wheat, rice and Arabidopsis. Quantitative RT-PCR analysis revealed that some of the wheat NF-Y genes were expressed ubiquitously, while others were expressed in an organ-specific manner. In particular, each TaNF-Y subunit family had members that were expressed predominantly in the endosperm. The expression of nine NF-Y and two Dr1 genes in wheat leaves appeared to be responsive to drought stress. Three of these genes were up-regulated under drought conditions, indicating that these members of the NF-Y and Dr1 families are potentially involved in plant drought adaptation. The combined expression and phylogenetic analyses revealed that members within the same phylogenetic clade generally shared a similar expression profile. Organ-specific expression and differential response to drought indicate a plant-specific biological role for various members of this transcription factor family.

The relative impact of work-related stress, life stress and driving environment stress on driving outcomes

Previous research has shown the association between stress and crash involvement. The impact of stress on road safety may also be mediated by behaviours including cognitive lapses, errors, and intentional traffic violations. This study aimed to provide a further understanding of the impact that stress from different sources may have upon driving behaviour and road safety. It is asserted that both stress extraneous to the driving environment and stress directly elicited by driving must be considered part of a dynamic system that may have a negative impact on driving behaviours. Two hundred and forty-seven public sector employees from Queensland, Australia, completed self-report measures examining demographics, subjective work-related stress, daily hassles, and aspects of general mental health. Additionally, the Driver Behaviour Questionnaire (DBQ) and the Driver Stress Inventory (DSI) were administered. All participants drove for work purposes regularly, however the study did not specifically focus on full-time professional drivers. Confirmatory factor analysis of the predictor variables revealed three factors: DSI negative affect; DSI risk taking; and extraneous influences (daily hassles, work-related stress, and general mental health). Moderate intercorrelations were found between each of these factors confirming the ‘spillover’ effect. That is, driver stress is reciprocally related to stress in other domains including work and domestic life. Structural equation modelling (SEM) showed that the DSI negative affect factor influenced both lapses and errors, whereas the DSI risk-taking factor was the strongest influence on violations. The SEMs also confirmed that daily hassles extraneous to the driving environment may influence DBQ lapses and violations independently. Accordingly, interventions may be developed to increase driver awareness of the dangers of excessive emotional responses to both driving events and daily hassles (e.g. driving fast to ‘blow off steam’ after an argument). They may also train more effective strategies for self-regulation of emotion and coping when encountering stressful situations on the road.

Young people’s aspirations for education, work, family and leisure

Young people are arguably facing more ‘complex and contested’ transitions to adulthood and an increasing array of ‘non-linear’ paths. Education and training have been extended, identity is increasingly shaped through leisure and consumerism and youth must navigate their life trajectories in highly individualised ways. The study utilises 819 short essays compiled by students aged 14–16 years from 19 schools in Australia. It examines how young people understand their own unique positions and the possibilities open to them through their aspirations and future orientations to employment and family life. These young people do not anticipate postponing work identities, but rather embrace post-school options such as gaining qualifications, work experience and achieving financial security. Boys expected a distant involvement in family life secondary to participation in paid work. In contrast, around half the girls simultaneously expected a future involving primary care-giving and an autonomous, independent career, suggesting attempts to remake gendered inequalities

Increased traffic exposure and negative birth outcomes : a prospective cohort in Australia

Background: Pregnant women exposed to traffic pollution have an increased risk of negative birth outcomes. We aimed to investigate the size of this risk using a prospective cohort of 970 mothers and newborns in Logan, Queensland. ----- ----- Methods: We examined two measures of traffic: distance to nearest road and number of roads around the home. To examine the effect of distance we used the number of roads around the home in radii from 50 to 500 metres. We examined three road types: freeways, highways and main roads.----- ----- Results: There were no associations with distance to road. A greater number of freeways and main roads around the home were associated with a shorter gestation time. There were no negative impacts on birth weight, birth length or head circumference after adjusting for gestation. The negative effects on gestation were largely due to main roads within 400 metres of the home. For every 10 extra main roads within 400 metres of the home, gestation time was reduced by 1.1% (95% CI: -1.7, -0.5; p-value = 0.001).----- ----- Conclusions: Our results add weight to the association between exposure to traffic and reduced gestation time. This effect may be due to the chemical toxins in traffic pollutants, or because of disturbed sleep due to traffic noise.

A new family of Marx generators based on commutation circuits

This paper presents a novel topology for the generation of high voltage pulses that uses both slow and fast solid-state power switches. This topology includes diode-capacitor units in parallel with commutation circuits connected to a positive buck-boost converter. This enables the generation of a range of high output voltages with a given number of capacitors. The advantages of this topology are the use of slow switches and a reduced number of diodes in comparison with conventional Marx generator. Simulations performed for single and repetitive pulse generation and experimental tests of a prototype hardware verify the proposed topology.

Translating competency statements into desired outcomes : a representational model for conceptualising the competency acquisition process

The need to develop effective and efficient training programs has been recognised by all sectors engaged in training. In responding to the above need, focus has been directed to developing good competency statements and performance indicators to measure the outcomes. Very little has been done to understand how the competency statements get translated into good performance. To conceptualise this translation process, a representational model based on an information processing paradigm is proposed and discussed. It is argued that learners’ prior knowledge and the effectiveness of the instructional material are two variables that have significant bearing on how effectively the competency knowledge is translated into outcomes. To contextualise the model examples from apprentice training are used.

Role demands and work-family balance experience in Malaysia : the different moderating effects of collectivism and gender role identity among diverse ethnic groups

The purpose of this thesis is to examine the influence of ethnic cultural values on the relationship of role demands and the work-family balance (WFB) experience. Past studies have found that the demands from work and family roles have a different impact on the work-family experience in people of different ethnicity. Researchers attribute these results to the cultural differences across the groups. However, there has been no empirical support for these assumptions because most past studies did not explicitly measure the cultural dimension in their design. Therefore, although studies have found ethnic differences in work-family experience, as cultural variables were not measured, it cannot be determined whether these differences were due to the differing ethnic groups’ cultural styles. The present thesis is set up to address this limitation in the literature, employing the Malay and Chinese ethnic groups in Malaysia as the study samples. The investigation consisted of pilot interviews and two survey studies. The interviews were carried out to establish the perception of WFB by target participants of a non-western nation. The first survey served to identify whether the Malay and Chinese ethnic groups residing under the same economic and social systems vary in their perceptions of work and family roles. The second survey tests the research model empirically, that is, whether cultural values moderate the relationship between role demands and WFB and if these moderation effects vary across ethnic groups. From the interviews, the results indicated that work-family experience is not a universal experience, but is partly culture-specific. Specifically, in the case of Malaysia, WFB is very much observed from the role obligation perspective. In particular, balance is perceived when work duties and household affairs are both adequately fulfilled. On the other hand, the conceptualisation of WFB in terms of role satisfaction and role interference also emerged in the interviews, suggesting the universality of these constructs across cultures. The findings from Survey One indicated that participants of different ethnicities in this study do not differ greatly in their perceptions regarding their participation in work and family roles. Generally, these participants revealed the less traditional attitudes towards women’s participation in work and family roles. However, variations were observed between the two groups in terms of reasons for working, spouses’ preferences towards their employment, and the extent to which their work role is perceived to impede their normative role performance in the household. Despite these differences, the Malay and Chinese ethnic groups showed more similarities than differences in their perceptions of work and family. The findings from Survey Two, which tested the research model, produced mixed results. On the whole, the results showed that the cultural dimensions examined in this study (i.e. collectivism, work identity and family identity) did influence the relationship between role demands and WFB experience, thus providing empirical evidence for the assumption in the literature that the relationship between role demand and work-family experience is moderated by cultural values. Most importantly, support was found for the proposition that these moderation effects vary between the Malay and Chinese ethnic groups. Moreover, this study also found evidence that Malays and Chinese differ significantly on collectivism and work identity cultural dimensions where Malays are found to be more collectivist than the Chinese, while work identity is stronger in the Chinese than in the Malays. There is no difference in the levels of family identity between the two groups. Of all the three moderators, work identity was deemed the most important because many of the supported hypotheses pertained to the work identity moderating effects. In contrast, family identity does not seem to have much moderating influence on role demand-WFB relationships, while the results for the collectivism moderator are mixed. As such, although not conclusive, it can be deduced that variations in the effects of role demand on work-family experience across ethnicity are a result of the groups’ cultural differences, thereby supporting the assumption in the literature.

Children’s food and activity patterns following a six-month child weight management program

Objective To describe the impact of a parent-led, family focused child weight management program on the food intake and activity patterns of pre-pubertal children. Methods n assessor-blinded, randomized controlled trial involving 111 (64% female) overweight, pre-pubertal children 6 to 9 years of age randomly assigned to parenting-skills training plus intensive lifestyle education, parenting-skills training alone, or a 12-month wait-listed control. Study outcomes were assessed at baseline, 6 months, and 12 months. This paper presents data on food intake assessed via a validated 54-item parent completed dietary questionnaire and activity behaviours assessed via a parent-report 20-item activity questionnaire. Results Intake of energy-dense nutrient poor foods was lower in both intervention groups at 6 months (mean difference, P+DA -1.5 serves [CI -2.0;-1.0]; P -1.0 serves [-2.0;-0.5]) and 12 months (mean difference P+DA -1.0 serves [CI -2.0;-0.5]; P -1.0 serves [-1.5; 0.0]) compared to baseline. Intake of vegetables, fruit, breads and cereals, meat and alternatives and dairy foods remained unchanged. Regardless of study group there were significant reductions over time in the reported time spent engaged in small screen activities and an increase in the time reported spent in active play. Conclusion Child weight management intervention that promotes food intake in line with national dietary guidelines achieves a reduction in children’s intake of energy dense, nutrient poor foods. This was achieved without compromising intake of nutrient-rich food and changes in were maintained even once the intervention ceased.