Dining experience in elsewhere

Globalisation leads people getting a chance to move to a different place, to dine in a different context and to experience a different lifestyle. This paper evaluates the designs which offer dining experience in elsewhere, a changed context. A logical narrative review of literature has been conducted to clarify the patterns that restaurant practitioners, designers and social science researchers used for developing dining experience in elsewhere. The paper defines two hourglass balance pattern via food between diner and dining experience providers, as well as a set of interactive strategies in dining experience design. The former can be regarded as an example of the latter pattern. The findings indicate an empathetic setting design framework is needed in future research. This is the first paper that examines the dining experience in light of the atmosphere caused by people’s physical and psychological mobility flow in modern society. The findings provide an access to establish dining experience design framework in future research, that is, achieve various levels of diners’ needs in dining setting design by distributing the multisensory effects to activate diners’ involvement in the dining experience.

Frequency of dressing changes for central venous access devices on catheter-related infections

Background People admitted to intensive care units and those with chronic health care problems often require long-term vascular access. Central venous access devices (CVADs) are used for administering intravenous medications and blood sampling. CVADs are covered with a dressing and secured with an adhesive or adhesive tape to protect them from infection and reduce movement. Dressings are changed when they become soiled with blood or start to come away from the skin. Repeated removal and application of dressings can cause damage to the skin. The skin is an important barrier that protects the body against infection. Less frequent dressing changes may reduce skin damage, but it is unclear whether this practice affects the frequency of catheter-related infections. Objectives To assess the effect of the frequency of CVAD dressing changes on the incidence of catheter-related infections and other outcomes including pain and skin damage. Search methods In June 2015 we searched: The Cochrane Wounds Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. We also searched clinical trials registries for registered trials. There were no restrictions with respect to language, date of publication or study setting. Selection criteria All randomised controlled trials (RCTs) evaluating the effect of the frequency of CVAD dressing changes on the incidence of catheter-related infections on all patients in any healthcare setting. Data collection and analysis We used standard Cochrane review methodology. Two review authors independently assessed studies for inclusion, performed risk of bias assessment and data extraction. We undertook meta-analysis where appropriate or otherwise synthesised data descriptively when heterogeneous. Main results We included five RCTs (2277 participants) that compared different frequencies of CVAD dressing changes. The studies were all conducted in Europe and published between 1995 and 2009. Participants were recruited from the intensive care and cancer care departments of one children's and four adult hospitals. The studies used a variety of transparent dressings and compared a longer interval between dressing changes (5 to15 days; intervention) with a shorter interval between changes (2 to 5 days; control). In each study participants were followed up until the CVAD was removed or until discharge from ICU or hospital. - Confirmed catheter-related bloodstream infection (CRBSI) One trial randomised 995 people receiving central venous catheters to a longer or shorter interval between dressing changes and measured CRBSI. It is unclear whether there is a difference in the risk of CRBSI between people having long or short intervals between dressing changes (RR 1.42, 95% confidence interval (CI) 0.40 to 4.98) (low quality evidence). - Suspected catheter-related bloodstream infection Two trials randomised a total of 151 participants to longer or shorter dressing intervals and measured suspected CRBSI. It is unclear whether there is a difference in the risk of suspected CRBSI between people having long or short intervals between dressing changes (RR 0.70, 95% CI 0.23 to 2.10) (low quality evidence). - All cause mortality Three trials randomised a total of 896 participants to longer or shorter dressing intervals and measured all cause mortality. It is unclear whether there is a difference in the risk of death from any cause between people having long or short intervals between dressing changes (RR 1.06, 95% CI 0.90 to 1.25) (low quality evidence). - Catheter-site infection Two trials randomised a total of 371 participants to longer or shorter dressing intervals and measured catheter-site infection. It is unclear whether there is a difference in risk of catheter-site infection between people having long or short intervals between dressing changes (RR 1.07, 95% CI 0.71 to 1.63) (low quality evidence). - Skin damage One small trial (112 children) and three trials (1475 adults) measured skin damage. There was very low quality evidence for the effect of long intervals between dressing changes on skin damage compared with short intervals (children: RR of scoring ≥ 2 on the skin damage scale 0.33, 95% CI 0.16 to 0.68; data for adults not pooled). - Pain Two studies involving 193 participants measured pain. It is unclear if there is a difference between long and short interval dressing changes on pain during dressing removal (RR 0.80, 95% CI 0.46 to 1.38) (low quality evidence). Authors' conclusions The best available evidence is currently inconclusive regarding whether longer intervals between CVAD dressing changes are associated with more or less catheter-related infection, mortality or pain than shorter intervals.

Turing and the Trans-Pacific Partnership: Intellectual Property, Public Health, and Access to Essential Medicines

A recent controversy in the United States over drug pricing by Turing Pharmaceuticals AG has raised larger issues in respect of intellectual property, access to medicines, and the Trans-Pacific Partnership (TPP). In August 2015, Turing Pharmaceuticals AG – a private biopharmaceutical company with offices in New York, the United States, and Zug, Switzerland - acquired the exclusive marketing rights to Daraprim in the United States from Impax Laboratories Incorporated. Martin Shkreli, Turing’s Founder and Chief Executive Officer, maintained: “The acquisition of Daraprim and our toxoplasmosis research program are significant steps along Turing’s path of bringing novel medications to patients with serious disorders, some of whom often go undiagnosed and untreated.” He emphasised: “We intend to invest in the development of new drug candidates that we hope will yield an even better clinical profile, and also plan to launch an educational effort to help raise awareness and improve diagnosis for patients with toxoplasmosis.” In September 2015, there was much public controversy over the decision of Martin Shkreli to raise the price of a 62 year old drug, Daraprim, from $US13.50 to $US750 a pill. The drug is particularly useful in respect to the treatment and prevention of malaria, and in the treatment of infections in individuals with HIV/AIDS. Daraprim is listed on the World Health Organization’s (WHO) List of Essential Medicines. In the face of much criticism, Martin Shkreli has said that he will reduce the price of Daraprim. He observed: “We've agreed to lower the price on Daraprim to a point that is more affordable and is able to allow the company to make a profit, but a very small profit.” He maintained: “We think these changes will be welcomed.” However, he has been vague and ambiguous about the nature of the commitment. Notably, the lobby group, Pharmaceutical Research and Manufacturers of America (PhARMA), disassociated itself from the claims of Turing Pharmaceuticals. The group said: “PhRMA members have a long history of drug discovery and innovation that has led to increased longevity and improved lives for millions of patients.” The group noted: “Turing Pharmaceutical is not a member of PhRMA and we do not embrace either their recent actions or the conduct of their CEO.” The biotechnology peak body Biotechnology Industry Organization also sought to distance itself from Turing Pharmaceuticals. A hot topic: United States political debate about access to affordable medicines This controversy over Daraprim is unusual – given the age of drug concerned. Daraprim is not subject to patent protection. Nonetheless, there remains a monopoly in respect of the marketplace. Drug pricing is not an isolated problem. There have been many concerns about drug pricing – particularly in respect of essential medicines for HIV/AIDS, tuberculosis, and malaria. This recent controversy is part of a larger debate about access to affordable medicines. The dispute raises larger issues about healthcare, consumer rights, competition policy, and trade. The Daraprim controversy has provided impetus for law reform in the US. US Presidential Candidate Hillary Clinton commented: “Price gouging like this in this specialty drug market is outrageous.” In response to her comments, the Nasdaq Biotechnology Index fell sharply. Hillary Clinton has announced a prescription drug reform plan to protect consumers and promote innovation – while putting an end to profiteering. On her campaign site, she has emphasised that “affordable healthcare is a basic human right.” Her rival progressive candidate, Bernie Sanders, was also concerned about the price hike. He wrote a letter to Martin Shkreli, complaining about the price increase for the drug Daraprim. Sanders said: “The enormous, overnight price increase for Daraprim is just the latest in a long list of skyrocketing price increases for certain critical medications.” He has pushed for reforms to intellectual property to make medicines affordable. The TPP and intellectual property The Daraprim controversy and political debate raises further issues about the design of the TPP. The dispute highlights the dangers of extending the rights of pharmaceutical drug companies under intellectual property, investor-state dispute settlement, and drug administration. Recently, the civil society group Knowledge Ecology International published a leaked draft of the Intellectual Property Chapter of the TPP. Knowledge Ecology International Director, James Love, was concerned the text revealed that the US “continues to be the most aggressive supporter of expanded intellectual property rights for drug companies.” He was concerned that “the proposals contained in the TPP will harm consumers and in some cases block innovation.” James Love feared: “In countless ways, the Obama Administration has sought to expand and extend drug monopolies and raise drug prices.” He maintained: “The astonishing collection of proposals pandering to big drug companies make more difficult the task of ensuring access to drugs for the treatment of cancer and other diseases and conditions.” Love called for a different approach to intellectual property and trade: “Rather than focusing on more intellectual property rights for drug companies, and a death-inducing spiral of higher prices and access barriers, the trade agreement could seek new norms to expand the funding of medical research and development (R&D) as a public good, an area where the US has an admirable track record, such as the public funding of research at the National Institutes of Health (NIH) and other federal agencies.” In addition, there has been much concern about the Investment Chapter of the TPP. The investor-state dispute settlement regime would enable foreign investors to challenge government policy making, which affected their investments. In the context of healthcare, there is a worry that pharmaceutical drug companies will deploy their investor rights to challenge public health measures – such as, for instance, initiatives to curb drug pricing and profiteering. Such concerns are not merely theoretical. Eli Lilly has brought an investor action against the Canadian Government over the rejection of its drug patents under the investor-state dispute settlement regime of the North American Free Trade Agreement (NAFTA). The Health Annex to the TPP also raises worries that pharmaceutical drug companies will able to object to regulatory procedures in respect of healthcare. It is disappointing that the TPP – in the leaks that we have seen – has only limited recognition of the importance of access to essential medicines. There is a need to ensure that there are proper safeguards to provide access to essential medicines – particularly in respect of HIV/AIDs, malaria, and tuberculosis. Moreover, there must be protection against drug profiteering and price gouging in any trade agreement. There should be strong measures against the abuse of intellectual property rights. The dispute over Turing Pharmaceuticals AG and Daraprim is an important cautionary warning in respect of some of the dangers present in the secret negotiations in respect of the TPP. There is a need to preserve consumer rights, competition policy, and public health in trade negotiations over an agreement covering the Pacific Rim.

The open access advantage for researchers: Reflections on experience and challenges

This paper focuses on the advantages of Open Access, (OA) particularly from the point of view of individual researchers, research centres and disciplines, and institutions. The advantage described by the phrase “OA advantage”, is multifaceted. The experience of Queensland University of Technology in Australia in pioneering OA as preferred practice in an institution with a growing research profile and energy, has seen evidence of the OA advantage develop in the experience of our researchers. The University has witnessed the development of practical evidence about improved recognition and impact, and this has occurred in the context of sector wide activity and policy where fresh approaches and leadership will result in even greater rewards for researchers whose outputs are “in the open”.

Engaging in online postgraduate education as means of professional learning

With enrolments in higher education becoming a competitive market, through the removal of caps in 2012, the equitable access to postgraduate education is raised. Postgraduate education, provided through higher education institutions, is an important aspect of career development for professionals. Professionals working outside of the metropolitan area are increasingly seeking postgraduate education opportunities that will be delivered online, at a distance. In this research study, data collected from the teaching profession, has culminated in a model that will ultimately improve access to professional learning. This research paper aims to highlight the important role that higher education providers play in the delivery of postgraduate education to professionals working in regional and remote areas of Australia. Although this paper focuses on the realm of education, the model of connectedness, where synchronous and asynchronous technologies are used, can be adapted and applied to any profession that requires equitable access to professional learning.

Rethinking connectedness : an investigation into the access of teacher professional learning in regional and remote Western Australia

Many teachers working in remote and regional areas have limited access to collegial support networks. This research aimed to examine the existing strategies that were being undertaken by the Department of Education in Western Australia, to provide professional learning to teachers in regional and remote areas. It was important to establish the perceptions of teachers’ access to professional learning from those working at the coalface in geographically dispersed areas. Consequently, the possible opportunity for improving the amount and variety of professional learning, through the application of both synchronous and asynchronous technologies was proposed. The study was guided by the primary research question: “In what ways might technology be used to support professional development of regional and remote teachers in Western Australia?” Generating descriptions of current practice of professional learning along with the teacher perceptions were central to this research endeavour. The study relied on a mixed method research approach in order to attend to the research question. The data were collected in phases, referred to as an explanatory mixed methods design. Quantitative data were collected from 104 participants to provide a general picture of the research problem. To further refine this general picture, qualitative data were collected through interviews and e-interviews of 10 teachers. Participants in the study included graduate teachers, teachers who had taught more than two years, senior teachers and Level Three teachers from seven teaching districts within Western Australia. An investigation into current practice was included in this phase and technologies available to support a professional learning community over distance were documented. The final phase incorporated the formulation of a conceptual framework where a model was developed to facilitate the successful implementation of a professional learning community through the application of synchronous and asynchronous technologies. The study has identified that travel time in order to access professional development is significant and impacts on teachers’ personal time. There are limited relief teachers available in these isolated areas which impacts on the opportunities to access professional development. Teachers face inequities, in terms of promotion, because professional development is explicitly linked to promotional opportunities. Importantly, it was found that professional learning communities are valued, but are often limited by small staff numbers at the geographic locality of the school. Teachers preferred to undertake professional learning in the local context of their district, school or classroom and this professional learning must be established at the need of the individual teacher in line with the school priorities. Teachers reported they were confident in using technology and accessing professional development online if required, however, much uncertainty surrounded the use of web 2.0 technologies for this purpose. The recommendations made from the study are intended to identify how a professional learning community might be enhanced through synchronous and asynchronous technologies.

Rethinking connectedness: improving access to professional learning for regional and remote teachers

Transformation of Australian education is occurring at a rapid rate through the implementation of a number of initiatives. These initiatives include the Digital Education Revolution, the move to a National Curriculum and the implementation of a National Framework for Professional Standards for Teachers and Principals. As these initiatives are rolled out to schools across Australia, the equitable access to professional learning to support all teachers, regardless of their geographical location, is in question. A number of studies have been conducted in Australia that highlight the importance of professional learning and the difficulty faced by regional and remote teachers with regard to access (Gerard Daniels, 2007; Lysons, Cooksey, Panizzon, Parnell & Pegg 2006; Ministerial Review of Schooling, 1994, Rural and Remote Education Advisory Council, 2000; Vinson, 2002). Along with access to professional learning, has been the discussion of effective modes of delivery. Face to face professional learning, in regional and metropolitan areas, is offered in isolation, or in some cases, is complimented with virtual learning environments. The need for a more sustainable approach to professional learning is highly necessary. A mixed method research approach was utilised in order to answer the primary research question "In what ways might technology be used to support professional learning of regional and remote teachers in Western Australia?" This research paper outlines the findings from the study including the significance of travel time; impact of limited relief teachers; implications for promotion and teacher registration; professional learning communities being valued but often limited by small staff numbers; professional learning conducted in the local context being preferred; professional learning established at the teacher and school level being desirable; teachers being confident in using technology and accessing PD online if required; and social cohesiveness being valued and often limited by isolation. Further, this research has culminated in the development of a "model of rethinking connectedness" that would facilitate improving the amount and variety of professional learning available to regional and remote teachers.

How childcare providers interpret "reasonable suspicion" of child abuse

- Background Childcare providers are often “first responders” for suspected child abuse, and how they understand the concept of “reasonable suspicion” will influence their decisions regarding which warning signs warrant reporting. - Objective The purpose of this study was to investigate how childcare providers interpret the threshold for reporting suspected abuse, and to consider the implications of these findings for professional training and development. - Method A convenience sample of 355 childcare providers completed the Reasonable Suspicion of Child Abuse survey to quantify what likelihood of child abuse constitutes “reasonable suspicion.” Responses were examined for internal consistency, evidence of a group standard, and associations with professional and personal demographics. - Results On a Rank Order Scale, responses for what constitutes “reasonable suspicion” ranged from requiring that abuse be “the” most likely cause (8 %) of an injury, to the second most likely (9 %), third (18 %), fourth (18 %), to even the seventh (8 %) or eighth (5 %) most likely cause of an injury. On a numerical probability scale, 21 % of respondents indicated that “abuse” would need to be ≥83 % likely before reasonable suspicion existed; 40 % stated that a likelihood between 53–82 % was needed; 27 % identified the necessary likelihood between 33–52 %; and 12 % set a threshold between 1–32 %. - Conclusions The present finding that no consensus exists for interpreting “reasonable suspicion” suggests that a broadly accepted interpretive framework is needed in order to help prepare childcare providers to know when to report suspected abuse.

Market access and welfare: Is there a conflict?

Well known tariff reform rules that are guaranteed to increase welfare will not necessarily increase market access, while rules that are guaranteed to increase market access will not necessarily increase welfare. The present paper proposes a new set of tariff reforms that can achieve both objectives at the same time.

Tariff-tax reforms and market access

Reducing tariffs and increasing consumption taxes is a standard IMF advice to countries that want to open up their economy without hurting government finances. Indeed, theoretical analysis of such a tariff–tax reform shows an unambiguous increase in welfare and government revenues. The present paper examines whether the country that implements such a reform ends up opening up its markets to international trade, i.e. whether its market access improves. It is shown that this is not necessarily so. We also show that, comparing to the reform of only tariffs, the tariff–tax reform is a less efficient proposal to follow both as far as it concerns market access and welfare.

Knowledge unlatched : A global library consortium model for funding Open Access scholarly books

Specialist scholarly books, including monographs, allow researchers to present their work, pose questions and to test and extend areas of theory through long-form writing. In spite of the fact that research communities all over the world value monographs and depend heavily on them as a requirement of tenure and promotion in many disciplines, sales of this kind of book are in free fall, with some estimates suggesting declines of as much as 90% over twenty years (Willinsky 2006). Cashstrapped monograph publishers have found themselves caught in a negative cycle of increasing prices and falling sales, with few resources left to support experimentation, business model innovation or engagement with digital technology and Open Access (OA). This chapter considers an important attempt to tackle failing markets for scholarly monographs, and to enable the wider adoption of OA licenses for book-length works: the 2012 – 2014 Knowledge Unlatched pilot. Knowledge Unlatched is a bold attempt to reconfigure the market for specialist scholarly books: moving it beyond the sale of ‘content’ towards a model that supports the services valued by scholarly and wider communities in the context of digital possibility. Its success has powerful implications for the way we understand copyright’s role in the creative industries, and the potential for established institutions and infrastructure to support the open and networked dynamics of a digital age.

Open access and soft power: Chinese voices in international scholarship

Networked digital technologies and Open Access (OA) are transforming the processes and institutions of research, knowledge creation and dissemination globally: enabling new forms of collaboration, allowing researchers to be seen and heard in new ways and reshaping relationships between stakeholders across the global academic publishing system. This article draws on Joseph Nye’s concept of ‘Soft Power’ to explore the role that OA is playing in helping to reshape academic publishing in China. It focusses on two important areas of OA development: OA journals and national-level repositories. OA is being supported at the highest levels, and there is potential for it to play an important role in increasing the status and impact of Chinese scholarship. Investments in OA also have the potential to help China to re-position itself within international copyright discourses: moving beyond criticism for failure to enforce the rights of foreign copyright owners and progressing an agenda that places greater emphasis on equality of access to the resources needed to foster innovation. However, the potential for OA to help China to build and project its soft power is being limited by the legacies of the print era, as well as the challenges of efficiently governing the national research and innovation systems.

A journey access tool to facilitate mobility-related access for people with disabilities in low and middle income countries

People with disabilities (PWD) experience difficulties in accessing the transport system (including both infrastructure and services) to meet their needs for health care, employment and other activities. Our research shows that lack of access to the journeys needed for these purposes is a more significant barrier in low and middle income countries than in high income countries, and results in inadequate health care, rehabilitation and access to education and employment. At the same time, the existing transport system in low and middle income countries presents much higher road crash risks than in high income countries. By combining the principles and methods of Road Safety Audit and disability access, and adapting these Western approaches to a low/middle income country context, we have worked with Handicap International Cambodia to develop a Journey Access Tool (JAT) for use by disabled peoples’ organisations (DPOs), people with a disability and other key stakeholders. A key element of the approach is that it involves the participation of PWD on the journeys that they need to take, and it identifies infrastructure and service improvements that should be prioritised in order to facilitate access to these journeys. The JAT has been piloted in Cambodia with a range of PWD. This presentation will outline the design of the JAT and the results of the pilot studies. The information gained thus far strongly suggests that the JAT is a valuable and cost-effective approach that can be used by DPOs and professionals to identify barriers to access and prioritise the steps needed to address them.

HealthMap: A cluster randomised trial of interactive health plans and self-management support to prevent coronary heart disease in people with HIV

Background The leading causes of morbidity and mortality for people in high-income countries living with HIV are now non-AIDS malignancies, cardiovascular disease and other non-communicable diseases associated with ageing. This protocol describes the trial of HealthMap, a model of care for people with HIV (PWHIV) that includes use of an interactive shared health record and self-management support. The aims of the HealthMap trial are to evaluate engagement of PWHIV and healthcare providers with the model, and its effectiveness for reducing coronary heart disease risk, enhancing self-management, and improving mental health and quality of life of PWHIV. Methods/Design The study is a two-arm cluster randomised trial involving HIV clinical sites in several states in Australia. Doctors will be randomised to the HealthMap model (immediate arm) or to proceed with usual care (deferred arm). People with HIV whose doctors are randomised to the immediate arm receive 1) new opportunities to discuss their health status and goals with their HIV doctor using a HealthMap shared health record; 2) access to their own health record from home; 3) access to health coaching delivered by telephone and online; and 4) access to a peer moderated online group chat programme. Data will be collected from participating PWHIV (n = 710) at baseline, 6 months, and 12 months and from participating doctors (n = 60) at baseline and 12 months. The control arm will be offered the HealthMap intervention at the end of the trial. The primary study outcomes, measured at 12 months, are 1) 10-year risk of non-fatal acute myocardial infarction or coronary heart disease death as estimated by a Framingham Heart Study risk equation; and 2) Positive and Active Engagement in Life Scale from the Health Education Impact Questionnaire (heiQ). Discussion The study will determine the viability and utility of a novel technology-supported model of care for maintaining the health and wellbeing of people with HIV. If shown to be effective, the HealthMap model may provide a generalisable, scalable and sustainable system for supporting the care needs of people with HIV, addressing issues of equity of access. Trial registration Universal Trial Number (UTN) U111111506489; ClinicalTrial.gov Id NCT02178930 submitted 29 June 2014