Transdisciplinary collaboration in wound care research

The highly complex disorder of chronic wounds is a significant problem. Information is often lacking, dynamically changing, or contradictory and thus acts to impede the progression of research and its translation into clinical care. Transdisciplinary collaboration may play an important role in chronic wound research, permitting key stakeholders with a single, central goal to take a unified approach towards addressing the problem. While transdisciplinary collaboration is not a new concept, its implementation within chronic wound research is relatively new. This is because the research area is still largely dominated by single-discipline researchers or by multiple disciplines working in isolation. Transdisciplinary research is a transcending approach, requiring a greater level of understanding between disciplines and may represent the next leap forward in wound care research. This approach necessitates a deeper understanding by all team members of the co-disciplines involved; where key stakeholders are better equipped to respond to dynamic changes and problems that arise in chronic wound research. In this paper, we illustrate what a transdisciplinary approach in wound care research may entail, with the ultimate goal of such an undertaking to improve understanding of the complexities of wound care, which could lead to potential benefits in wound management.

Turnover intentions of employees with informal eldercare responsibilities: The role of core self-evaluations and supervisor support

As longevity increases, so does the need for care of older relatives by working family members. This research examined the interactive effect of core self-evaluations and supervisor support on turnover intentions in two samples of employees with informal caregiving responsibilities. Data were obtained from 57 employees from Australia (Study 1) and 66 employees from the United States and India (Study 2). Results of Study 1 revealed a resource compensation effect, that is, an inverse relationship between core self-evaluations and turnover intentions when supervisor care support was low. Results of Study 2 extended these findings by demonstrating resource boosting effects. Specifically, there was an inverse relationship between core self-evaluations and subsequent turnover intentions for those with high supervisor work and care support. In addition, employees' satisfaction and emotional exhaustion from their work mediated the inverse relationship between core self-evaluations and subsequent turnover intentions when supervisor work support and care support were high. Overall, these findings highlight the importance of employee- and supervisor-focused intervention strategies in organizations to support informal caregivers.

Association analyses of 249,796 individuals reveal 18 new loci associated with body mass index

Obesity is globally prevalent and highly heritable, but its underlying genetic factors remain largely elusive. To identify genetic loci for obesity susceptibility, we examined associations between body mass index and approximately 2.8 million SNPs in up to 123,865 individuals with targeted follow up of 42 SNPs in up to 125,931 additional individuals. We confirmed 14 known obesity susceptibility loci and identified 18 new loci associated with body mass index (P < 5 x 10(-)(8)), one of which includes a copy number variant near GPRC5B. Some loci (at MC4R, POMC, SH2B1 and BDNF) map near key hypothalamic regulators of energy balance, and one of these loci is near GIPR, an incretin receptor. Furthermore, genes in other newly associated loci may provide new insights into human body weight regulation.

Hundreds of variants clustered in genomic loci and biological pathways affect human height

Most common human traits and diseases have a polygenic pattern of inheritance: DNA sequence variants at many genetic loci influence the phenotype. Genome-wide association (GWA) studies have identified more than 600 variants associated with human traits, but these typically explain small fractions of phenotypic variation, raising questions about the use of further studies. Here, using 183,727 individuals, we show that hundreds of genetic variants, in at least 180 loci, influence adult height, a highly heritable and classic polygenic trait. The large number of loci reveals patterns with important implications for genetic studies of common human diseases and traits. First, the 180 loci are not random, but instead are enriched for genes that are connected in biological pathways (P = 0.016) and that underlie skeletal growth defects (P < 0.001). Second, the likely causal gene is often located near the most strongly associated variant: in 13 of 21 loci containing a known skeletal growth gene, that gene was closest to the associated variant. Third, at least 19 loci have multiple independently associated variants, suggesting that allelic heterogeneity is a frequent feature of polygenic traits, that comprehensive explorations of already-discovered loci should discover additional variants and that an appreciable fraction of associated loci may have been identified. Fourth, associated variants are enriched for likely functional effects on genes, being over-represented among variants that alter amino-acid structure of proteins and expression levels of nearby genes. Our data explain approximately 10% of the phenotypic variation in height, and we estimate that unidentified common variants of similar effect sizes would increase this figure to approximately 16% of phenotypic variation (approximately 20% of heritable variation). Although additional approaches are needed to dissect the genetic architecture of polygenic human traits fully, our findings indicate that GWA studies can identify large numbers of loci that implicate biologically relevant genes and pathways.

Meta-analysis identifies 13 new loci associated with waist-hip ratio and reveals sexual dimorphism in the genetic basis of fat distribution

Waist-hip ratio (WHR) is a measure of body fat distribution and a predictor of metabolic consequences independent of overall adiposity. WHR is heritable, but few genetic variants influencing this trait have been identified. We conducted a meta-analysis of 32 genome-wide association studies for WHR adjusted for body mass index (comprising up to 77,167 participants), following up 16 loci in an additional 29 studies (comprising up to 113,636 subjects). We identified 13 new loci in or near RSPO3, VEGFA, TBX15-WARS2, NFE2L3, GRB14, DNM3-PIGC, ITPR2-SSPN, LY86, HOXC13, ADAMTS9, ZNRF3-KREMEN1, NISCH-STAB1 and CPEB4 (P = 1.9 × 10−9 to P = 1.8 × 10−40) and the known signal at LYPLAL1. Seven of these loci exhibited marked sexual dimorphism, all with a stronger effect on WHR in women than men (P for sex difference = 1.9 × 10−3 to P = 1.2 × 10−13). These findings provide evidence for multiple loci that modulate body fat distribution independent of overall adiposity and reveal strong gene-by-sex interactions.

A novel approach to assessing road-curve crash severity

Curves are a common feature of road infrastructure; however crashes on road curves are associated with increased risk of injury and fatality to vehicle occupants. Countermeasures require the identification of contributing factors. However, current approaches to identifying contributors use traditional statistical methods and have not used self-reported narrative claim to identify factors related to the driver, vehicle and environment in a systemic way. Text mining of 3434 road-curve crash claim records filed between 1 January 2003 and 31 December 2005 at a major insurer in Queensland, Australia, was undertaken to identify risk levels and contributing factors. Rough set analysis was used on insurance claim narratives to identify significant contributing factors to crashes and their associated severity. New contributing factors unique to curve crashes were identified (e.g., tree, phone, over-steer) in addition to those previously identified via traditional statistical analysis of Police and licensing authority records. Text mining is a novel methodology to improve knowledge related to risk and contributing factors to road-curve crash severity. Future road-curve crash countermeasures should more fully consider the interrelationships between environment, the road, the driver and the vehicle, and education campaigns in particular could highlight the increased risk of crash on road-curves.

Influences on novice drivers' speed selection - a systematic review: Application and limitations of theory and methodology

Background Excessive speed is a primary contributing factor to young novice road trauma, including intentional and unintentional speeds above posted limits or too fast for conditions. The objective of this research was to conduct a systematic review of recent investigations into novice drivers’ speed selection, with particular attention to applications and limitations of theory and methodology. Method Systematic searches of peer-reviewed and grey literature were conducted during September 2014. Abstract reviews identified 71 references potentially meeting selection criteria of investigations since the year 2000 into factors that influence (directly or indirectly) actual speed (i.e., behaviour or performance) of young (age <25 years) and/or novice (recently-licensed) drivers. Results Full paper reviews resulted in 30 final references: 15 focused on intentional speeding and 15 on broader speed selection investigations. Both sets identified a range of individual (e.g., beliefs, personality) and social (e.g., peer, adult) influences, were predominantly theory-driven and applied cross-sectional designs. Intentional speed investigations largely utilised self-reports while other investigations more often included actual driving (simulated or ‘real world’). The latter also identified cognitive workload and external environment influences, as well as targeted interventions. Discussion and implications Applications of theory have shifted the novice speed-related literature beyond a simplistic focus on intentional speeding as human error. The potential to develop a ‘grand theory’ of intentional speeding emerged and to fill gaps to understand broader speed selection influences. This includes need for future investigations of vehicle-related and physical environment-related influences and methodologies that move beyond cross-sectional designs and rely less on self-reports.

Employee green behavior: A theoretical framework, multilevel review, and future research agenda

We propose a conceptual model based on person–environment interaction, job performance, and motivational theories to structure a multilevel review of the employee green behavior (EGB) literature and agenda for future research. We differentiate between required EGB prescribed by the organization and voluntary EGB performed at the employees’ discretion. The review investigates institutional-, organizational-, leader-, team-, and employee-level antecedents and outcomes of EGB and factors that mediate and moderate these relationships. We offer suggestions to facilitate the development of the field, and call for future research to adopt a multilevel perspective and to investigate the outcomes of EGB.

Micro-breaks matter: A diary study on the effects of energy management strategies on occupational well-being

Organizational researchers and practitioners are increasingly interested in self-regulatory strategies employees can use at work to sustain or improve their occupational well-being. A recent cross-sectional study on energy management strategies suggested that many work-related strategies (e.g., setting a new goal) are positively related to occupational well-being, whereas many micro-breaks (e.g., listening to music) are negatively related to occupational well-being. We used a diary study design to take a closer look at the effects of these energy management strategies on fatigue and vitality. Based on conservation of resources theory, we hypothesized that both types of energy management strategies negatively predict fatigue and positively predict vitality. Employees (N = 124) responded to a baseline survey and to hourly surveys across one work day (6.7 times on average). Consistent with previous research, between-person differences in the use of work-related strategies were positively associated with between-person differences in vitality. However, results of multilevel analyses of the hourly diary data showed that only micro-breaks negatively predicted fatigue and positively predicted vitality. These findings suggest that taking micro-breaks during the work day may have short-term effects on occupational well-being, whereas using work-related strategies may have long-term effects.

Reactions to changes in work control: Implications for self-determined and non-self-determined individuals

We investigate the extent to which individuals’ global motivation (self-determined and non-self-determined types) influences adjustment (anxiety, positive reappraisal) and engagement (intrinsic motivation, task performance) in reaction to changes to the level of work control available during a work simulation. Participants (N = 156) completed 2 trials of an inbox activity under conditions of low or high work control—with the ordering of these levels varied to create an increase, decrease, or no change in work control. In support of the hypotheses, results revealed that for more self-determined individuals, high work control led to the increased use of positive reappraisal. Follow-up moderated mediation analyses revealed that the increases in positive reappraisal observed for self-determined individuals in the conditions in which work control was high by Trial 2 consequently increased their intrinsic motivation toward the task. For more non-self-determined individuals, high work control (as well as changes in work control) led to elevated anxiety. Follow-up moderated mediation analyses revealed that the increases in anxiety observed for non-self-determined individuals in the high-to-high work control condition consequently reduced their task performance. It is concluded that adjustment to a demanding work task depends on a fit between individuals’ global motivation and the work control available, which has consequences for engagement with demanding work.

Doctors’ perspectives on law and life-sustaining treatment: Survey design and recruitment strategies for a challenging cohort

- Background Palliative medicine and other specialists play significant legal roles in decisions to withhold and withdraw life-sustaining treatment at the end of life. Yet little is known about their knowledge of or attitudes to the law, and the role they think it should play in medical practice. Consideration of doctors’ views is critical to optimizing patient outcomes at the end of life. However, doctors are difficult to engage as participants in empirical research, presenting challenges for researchers seeking to understand doctors’ experiences and perspectives. - Aims To determine how to engage doctors involved in end-of-life care in empirical research about knowledge of the law and the role it plays in medical practice at the end of life. - Methods Postal survey of all specialists in palliative medicine, emergency medicine, geriatric medicine, intensive care, medical oncology, renal medicine, and respiratory medicine in three Australian states: New South Wales, Victoria, and Queensland. The survey was sent in hard copy with two reminders and a follow up reminder letter was also sent to the directors of hospital emergency departments. Awareness was further promoted through engagement with the relevant medical colleges and publications in professional journals; various incentives to respond were also used. The key measure is the response rate of doctors to the survey. - Results Thirty-two percent of doctors in the main study completed their survey with response rate by specialty ranging from 52% (palliative care) to 24% (medical oncology). This overall response rate was twice that of the reweighted pilot study (16%). - Conclusions Doctors remain a difficult cohort to engage in survey research but strategic recruitment efforts can be effective in increasing response rate. Collaboration with doctors and their professional bodies in both the development of the survey instrument and recruitment of participants is essential.

Evaluation of haemoglobin in blister fluid as an indicator of paediatric burn wound depth

The early and accurate assessment of burns is essential to inform patient treatment regimens; however, this first critical step in clinical practice remains a challenge for specialist burns clinicians worldwide. In this regard, protein biomarkers are a potential adjunct diagnostic tool to assist experienced clinical judgement. Free circulating haemoglobin has previously shown some promise as an indicator of burn depth in a murine animal model. Using blister fluid collected from paediatric burn patients, haemoglobin abundance was measured using semi-quantitative Western blot and immunoassays. Although a trend was observed in which haemoglobin abundance increased with burn wound severity, several patient samples deviated significantly from this trend. Further, it was found that haemoglobin concentration decreased significantly when whole cells, cell debris and fibrinous matrix was removed from the blister fluid by centrifugation; although the relationship to depth was still present. Statistical analyses showed that haemoglobin abundance in the fluid was more strongly related to the time between injury and sample collection and the time taken for spontaneous re-epithelialisation. We hypothesise that prolonged exposure to the blister fluid microenvironment may result in an increased haemoglobin abundance due to erythrocyte lysis, and delayed wound healing

The impact of Indigenous Community sports programs: The case of surfing

The objective of this research project was to consider the social impact of sport and physical activity on the lives of Indigenous Australians and their communities. There has been strong research interest in the links between sport and recreation programs and various health and social outcomes and a well-established body of literature exists on the use of sport to address social issues in mainstream society (A Thomson, Darcy and Pearce 2010). The consensus is that physical activity is an important contributor to health for all people (Nelson, Abbott and Macdonald 2010). While there is strong research interest, what remains unclear is the value and impact of sport and physical activity on Indigenous communities (Cairnduff 2001). Nelson (2009) drawing on the work of Jonas and Langton (1994) indicates that an ‘Aboriginal person is a descendant of an Indigenous inhabitant of Australia, identifi es as an Aboriginal, and is recognised as Aboriginal by members of the community in which he or she lives’ (p. 97). Even this defi nition has the potential to be politically charged. At a general level, the collective terms ‘Indigenous’ (capitalised) and ‘Aboriginal and Torres Strait Islander’ people (title capitalised) appear to be broadly acceptable terms. Indigenous groups cannot be considered to be homogenous as there is much diversity between and within groups (Nelson et al. 2010; Parker et al. 2006). It is therefore important this report is not viewed as taking an essentialist view of who Indigenous people are and how they develop. Rather, this paper attempts to describe and discuss the experiences of some individuals and their communities in site-specifi c surfi ng programs.