Multicultural training experiences as predictors of psychology students’ cultural competence

The psychologists in the western world, including Australia, are required to be culturally competent due to the cultural diversity of these societies. Previous studies conducted in North America and Europe have found multicultural teaching, clinical experience with culturally diverse clients, and discussion of multicultural counselling issues in supervision to be related to the practitioner’s cultural competency. The present study examined factors contributing to trainee psychologists’ perceived level of cultural competence. It was hypothesised that multicultural teaching, clinical experience and supervision would be related to students’ level of cultural competence. One hundred and twenty seven postgraduate clinical psychology students completed an online survey battery that included demographic information, a social desirability measure, and the Multicultural Mental Health Awareness Scale (Khawaja, Gomez & Turner, 2009). This hypothesis was partially supported. Clinical experience and supervision focusing on multicultural issues were found to be related to participants’ perceived cultural competence, however, multicultural teaching was not. These results provide insight into how universities around Australia can facilitate future psychologists’ competence in working with clients from different cultural backgrounds.

Engineering-based modelling experiences in the elementary classroom

Introducing engineering-based model-eliciting experiences in the elementary curriculum is a new and increasingly important domain of research by mathematics, science, technology, and engineering educators. Recent research has raised questions about the context of engineering problems that are meaningful, engaging, and inspiring for young students. In the present study an environmental engineering activity was implemented in two classes of 11-year-old students in Cyprus. The problem required students to develop a procedure for selecting among alternative countries from which to buy water. Students created a range of models that adequately solved the problem although not all models took into account all of the data provided. The models varied in the number of problem factors taken into consideration and also in the different approaches adopted in dealing with the problem factors. At least two groups of students integrated into their models the environmental aspect of the problem (energy consumption, water pollution) and further refined their models. Results indicate that engineering model-eliciting activities can be introduced effectively into the elementary curriculum, providing rich opportunities for students to deal with engineering contexts and to apply their learning in mathematics and science to solving real-world engineering problems.

A prospective cohort study of geriatric syndromes among older medical patients admitted to acute care hospitals

OBJECTIVES: To identify the prevalence of geriatric syndromes in the premorbid for all syndromes except falls (preadmission), admission, and discharge assessment periods and the incidence of new and significant worsening of existing syndromes at admission and discharge. DESIGN: Prospective cohort study. SETTING: Three acute care hospitals in Brisbane, Australia. PARTICIPANTS: Five hundred seventy-seven general medical patients aged 70 and older admitted to the hospital. MEASUREMENTS: Prevalence of syndromes in the premorbid (or preadmission for falls), admission, and discharge periods; incidence of new syndromes at admission and discharge; and significant worsening of existing syndromes at admission and discharge. RESULTS: The most frequently reported premorbid syndromes were bladder incontinence (44%), impairment in any activity of daily living (ADL) (42%). A high proportion (42%) experienced at least one fall in the 90 days before admission. Two-thirds of the participants experienced between one and five syndromes (cognitive impairment, dependence in any ADL item, bladder and bowel incontinence, pressure ulcer) before, at admission, and at discharge. A majority experienced one or two syndromes during the premorbid (49.4%), admission (57.0%), or discharge (49.0%) assessment period.The syndromes with a higher incidence of significant worsening at discharge (out of the proportion with the syndrome present premorbidly) were ADL limitation (33%), cognitive impairment (9%), and bladder incontinence (8%). Of the syndromes examined at discharge, a higher proportion of patients experienced the following new syndromes at discharge (absent premorbidly): ADL limitation (22%); and bladder incontinence (13%). CONCLUSION: Geriatric syndromes were highly prevalent. Many patients did not return to their premorbid function and acquired new syndromes.

Telemonitoring or Structured Telephone Support Programmes for Patients with Chronic Heart Failure: Systematic Review and Meta-Analysis

Objective: To determine whether remote monitoring (structured telephone support or telemonitoring) without regular clinic or home visits improves outcomes for patients with chronic heart failure. Data sources: 15 electronic databases, hand searches of previous studies, and contact with authors and experts. Data extraction: Two investigators independently screened the results. Review methods: Published randomised controlled trials comparing remote monitoring programmes with usual care in patients with chronic heart failure managed within the community. Results: 14 randomised controlled trials (4264 patients) of remote monitoring met the inclusion criteria: four evaluated telemonitoring, nine evaluated structured telephone support, and one evaluated both. Remote monitoring programmes reduced the rates of admission to hospital for chronic heart failure by 21% (95% confidence interval 11% to 31%) and all cause mortality by 20% (8% to 31%); of the six trials evaluating health related quality of life three reported significant benefits with remote monitoring, and of the four studies examining healthcare costs with structured telephone support three reported reduced cost and one no effect. Conclusion: Programmes for chronic heart failure that include remote monitoring have a positive effect on clinical outcomes in community dwelling patients with chronic heart failure.

Adherence, adaptation and acceptance of elderly chronic heart failure patients to receiving healthcare via telephone-monitoring

Background: Although the potential to reduce hospitalisation and mortality in chronic heart failure (CHF) is well reported, the feasibility of receiving healthcare by structured telephone support or telemonitoring is not. Aims: To determine; adherence, adaptation and acceptability to a national nurse-coordinated telephone-monitoring CHF management strategy. The Chronic Heart Failure Assistance by Telephone Study (CHAT). Methods: Triangulation of descriptive statistics, feedback surveys and qualitative analysis of clinical notes. Cohort comprised of standard care plus intervention (SC + I) participants who completed the first year of the study. Results: 30 GPs (70% rural) randomised to SC + I recruited 79 eligible participants, of whom 60 (76%) completed the full 12 month follow-up period. During this time 3619 calls were made into the CHAT system (mean 45.81 SD ± 79.26, range 0-369), Overall there was an adherence to the study protocol of 65.8% (95% CI 0.54-0.75; p = 0.001) however, of the 60 participants who completed the 12 month follow-up period the adherence was significantly higher at 92.3% (95% CI 0.82-0.97, p ≤ 0.001). Only 3% of this elderly group (mean age 74.7 ±9.3 years) were unable to learn or competently use the technology. Participants rated CHAT with a total acceptability rate of 76.45%. Conclusion: This study shows that elderly CHF patients can adapt quickly, find telephone-monitoring an acceptable part of their healthcare routine, and are able to maintain good adherence for a least 12 months. © 2007.

[Letter to the Editor] Telemonitoring in Patients with Heart Failure

To the Editor: Chaudhry et al. suggest that enhanced support in the use of a telephone-based interactive voice-response system for patients recently discharged after worsening heart failure does not improve outcomes. This finding is broadly consistent with previous systematic reviews of telephone support1 and contrasts with the substantial effect observed with home telemonitoring of vital signs in similar populations.1 The treatment of patients in the control group was excellent, but unrepresentative of usual clinical care and not inferior to the treatment of patients receiving enhanced support. Monitoring alone is unlikely to improve outcomes but may do so when it improves prescription of or adherence to lifesaving treatments. Given enough resources, traditional methods for delivering care may render an interactive voice-response system or a home telemonitoring system ineffective. Nonetheless, there may be more cost-efficient approaches to ensuring quality care.2 Informal post hoc addition of these data to our recent meta-analysis of telephone support1 does not substantially alter the point estimates for death from any cause or heart-failure−related hospitalizations, but it does nullify the small benefit in hospitalizations for any cause, which may not be reduced by a heart-failure−focused intervention.1 Original article: Telemonitoring in Patients with Heart Failure NEJM. December 9, 2010 | S.I. Chaudhry and Others

The subjective experience of negative symptoms : characteristics of emotional withdrawal

According to the diagnosis of schizophrenia in the DSM-IV-TR (American Psychiatric Association, 2000), negative symptoms are those personal characteristics that are thought to be reduced from normal functioning, while positive symptoms are aspects of functioning that exist as an excess or distortion of normal functioning. Negative symptoms are generally considered to be a core feature of people diagnosed with schizophrenia. However, negative symptoms are not always present in those diagnosed, and a diagnosis can be made with only negative or only positive symptoms, or with a combination of both. Negative symptoms include an observed loss of emotional expression (affective flattening), loss of motivation or self directedness (avolition), loss of speech (alogia), and also a loss of interests and pleasures (anhedonia). Positive symptoms include the perception of things that others do not perceive (hallucinations), and extraordinary explanations for ordinary events (delusions) (American Psychiatric Association, 2000). Both negative and positive symptoms are derived from watching the patient and thus do not consider the patient’s subjective experience. However, aspects of negative symptoms, such as observed affective flattening are highly contended. Within conventional psychiatry, the absence of emotional expression is assumed to coincide with an absence of emotional experience. Contrasting research findings suggests that patients who were observed to score low on displayed emotional expression, scored high on self ratings of emotional experience. Patients were also observed to be significantly lower on emotional expression when compared with others (Aghevli, Blanchard, & Horan, 2003; Selton, van der Bosch, & Sijben, 1998). It appears that there is little correlation between emotional experience and emotional expression in patients, and that observer ratings cannot help us to understand the subjective experience of the negative symptoms. This chapter will focus on research into the subjective experiences of negative symptoms. A framework for these experiences will be used from the qualitative research findings of the primary author (Le Lievre, 2010). In this study, the primary author found that subjective experiences of the negative symptoms belonged to one of the two phases of the illness experience; “transitioning into emotional shutdown” or “recovering from emotional shutdown”. This chapter will use the six themes from the phase of “transitioning into emotional shutdown”. This phase described the experience of turning the focus of attention away from the world and onto the self and the past, thus losing contact with the world and others (emotional shutdown). Transitioning into emotional shutdown involved; “not being acknowledged”, “relational confusion”, “not being expressive”, “reliving the past”, “detachment”, and “no sense of direction” (Le Lievre, 2010). Detail will be added to this framework of experience from other qualitative research in this area. We will now review the six themes that constitute a “transition into emotional shutdown” and corresponding previous research findings.

Things just got really serious : coping in crisis

You have chosen to enter a profession that can afford you a wonderfully rich career. It is a role that has many areas of speciality and many opportunities and challenges in communicating with a vast array of people including patients, families, peers, and management. Inherent in the role are all sorts of potential stressors such as not having the equipment you need at a time you think you crucially need it, working with people you find difficult, shift work, lack of staffing, overcrowding, and the list is sometimes seemingly endless. But there are also obvious advantages to your role such as meeting a large variety of people, helping people to recover, to feel comfortable in your care and supporting families, patients and colleagues. This brings me to the two primary points to this chapter. The first point of this chapter is to understand that sometimes the challenges you may face in the health arena overwhelm your initial understanding of your capacity to cope. That is to say, there will likely be times when you feel overwhelmed or even distraught in the face of a particular situation. The second point is that these same overwhelming experiences can provide a catalyst for you to grow as a human being; to develop beyond the person you perceived yourself to be beforehand. According to Aaron Antonovsky (1985), stress is inherent in the human condition, but further to that, in your role, there is a very high possibility of traumatic experiences as well.

Information interventions for orienting patients and their carers to cancer care facilities

Background: Cancer patients experience distress and anxiety related to their diagnosis, treatment and the unfamiliar cancer centre. Strategies with the aim of orienting patients to a cancer care facility may improve patient outcomes. Although meeting patients' information needs at different stages is important, there is little agreement about the type of information and the timing for information to be given. Orientation interventions aim to address information needs at the start of a person's experience with a cancer care facility. The extent of any benefit of these interventions is unknown. Objectives: To assess the effects of information interventions which orient patients and their carers/family to a cancer care facility, and to the services available in the facility. Search Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2); MEDLINE (OvidSP) (1966 to Jun 2011), EMBASE (Ovid SP) (1966 to Jun 2011), CINAHL (EBSCO) (1982 to Jun 2011), PsycINFO (OvidSP) (1966 to Jun 2011), review articles and reference lists of relevant articles. We contacted principal investigators and experts in the field. Selection Criteria: Randomised controlled trials (RCTs), cluster RCTs and quasi-RCTs evaluating the effects of information interventions that orient patients and their carers/family to a cancer care facility. Data collection and analysis: Results of searches were reviewed against the pre-determined criteria for inclusion by two review authors. The primary outcomes were knowledge and understanding; health status and wellbeing, evaluation of care, and harms. Secondary outcomes were communication, skills acquisition, behavioural outcomes, service delivery, and health professional outcomes. We pooled results of RCTs using mean differences (MD) and 95% confidence intervals (CI). Main results: We included four RCTs involving 610 participants. All four trials aimed to investigate the effects of orientation programs for cancer patients to a cancer facility. There was high risk of bias across studies. Findings from two of the RCTs demonstrated significant benefits of the orientation intervention in relation to levels of distress (mean difference (MD) -8.96 (95% confidence interval (CI) -11.79 to -6.13), but non-significant benefits in relation to state anxiety levels (MD -9.77 (95% CI -24.96 to 5.41). Other outcomes for participants were generally positive (e.g. more knowledgeable about the cancer centre and cancer therapy, better coping abilities). No harms or adverse effects were measured or reported by any of the included studies. There were insufficient data on the other outcomes of interest. Authors conclusion: This review has demonstrated the feasibility and some potential benefits of orientation interventions. There was a low level of evidence suggesting that orientation interventions can reduce distress in patients. However, most of the other outcomes remain inconclusive (patient knowledge recall/ satisfaction). The majority of studies were subject to high risk of bias, and were likely to be insufficiently powered. Further well conducted and powered RCTs are required to provide evidence for determining the most appropriate intensity, nature, mode and resources for such interventions. Patient and carer-focused outcomes should be included.

Designing and evaluating mobile multimedia user experiences in public urban places : Making sense of the field

The majority of the world’s population now lives in cities (United Nations, 2008) resulting in an urban densification requiring people to live in closer proximity and share urban infrastructure such as streets, public transport, and parks within cities. However, “physical closeness does not mean social closeness” (Wellman, 2001, p. 234). Whereas it is a common practice to greet and chat with people you cross paths with in smaller villages, urban life is mainly anonymous and does not automatically come with a sense of community per se. Wellman (2001, p. 228) defines community “as networks of interpersonal ties that provide sociability, support, information, a sense of belonging and social identity.” While on the move or during leisure time, urban dwellers use their interactive information communication technology (ICT) devices to connect to their spatially distributed community while in an anonymous space. Putnam (1995) argues that available technology privatises and individualises the leisure time of urban dwellers. Furthermore, ICT is sometimes used to build a “cocoon” while in public to avoid direct contact with collocated people (Mainwaring et al., 2005; Bassoli et al., 2007; Crawford, 2008). Instead of using ICT devices to seclude oneself from the surrounding urban environment and the collocated people within, such devices could also be utilised to engage urban dwellers more with the urban environment and the urban dwellers within. Urban sociologists found that “what attracts people most, it would appear, is other people” (Whyte, 1980, p. 19) and “people and human activity are the greatest object of attention and interest” (Gehl, 1987, p. 31). On the other hand, sociologist Erving Goffman describes the concept of civil inattention, acknowledging strangers’ presence while in public but not interacting with them (Goffman, 1966). With this in mind, it appears that there is a contradiction between how people are using ICT in urban public places and for what reasons and how people use public urban places and how they behave and react to other collocated people. On the other hand there is an opportunity to employ ICT to create and influence experiences of people collocated in public urban places. The widespread use of location aware mobile devices equipped with Internet access is creating networked localities, a digital layer of geo-coded information on top of the physical world (Gordon & de Souza e Silva, 2011). Foursquare.com is an example of a location based 118 Mobile Multimedia – User and Technology Perspectives social network (LBSN) that enables urban dwellers to virtually check-in into places at which they are physically present in an urban space. Users compete over ‘mayorships’ of places with Foursquare friends as well as strangers and can share recommendations about the space. The research field of Urban Informatics is interested in these kinds of digital urban multimedia augmentations and how such augmentations, mediated through technology, can create or influence the UX of public urban places. “Urban informatics is the study, design, and practice of urban experiences across different urban contexts that are created by new opportunities of real-time, ubiquitous technology and the augmentation that mediates the physical and digital layers of people networks and urban infrastructures” (Foth et al., 2011, p. 4). One possibility to augment the urban space is to enable citizens to digitally interact with spaces and urban dwellers collocated in the past, present, and future. “Adding digital layer to the existing physical and social layers could facilitate new forms of interaction that reshape urban life” (Kjeldskov & Paay, 2006, p. 60). This methodological chapter investigates how the design of UX through such digital placebased mobile multimedia augmentations can be guided and evaluated. First, we describe three different applications that aim to create and influence the urban UX through mobile mediated interactions. Based on a review of literature, we describe how our integrated framework for designing and evaluating urban informatics experiences has been constructed. We conclude the chapter with a reflective discussion on the proposed framework.

Categorising emotional experiences with portable interactive devices

This paper reports on a six month longitudinal study exploring people’s emotional experience with two categories of portable interactive devices (PIDs); media and health related PIDs. The focus is on emotions and how PIDs mediate these experiences in everyday contexts. Previous findings presented by the authors (Gomez 2009, 2010) revealed that people’s emotional experiences with PIDs over time are influenced by whether interactions were at a personal or social level. This paper presents four categories of activities identified and their relationship to emotional experiences with PIDs that have been developed through further analysis of the data. It concludes with a discussion of the findings and their implications to the field of Design on the design of future PIDs.

Identification of early-stage colorectal cancer patients at risk of relapse post-resection by immunobead reverse transcription-PCR analysis of peritoneal lavage fluid for malignant cells

Purpose: Colorectal cancer patients diagnosed with stage I or II disease are not routinely offered adjuvant chemotherapy following resection of the primary tumor. However, up to 10% of stage I and 30% of stage II patients relapse within 5 years of surgery from recurrent or metastatic disease. The aim of this study was to determine if tumor-associated markers could detect disseminated malignant cells and so identify a subgroup of patients with early-stage colorectal cancer that were at risk of relapse. Experimental Design: We recruited consecutive patients undergoing curative resection for early-stage colorectal cancer. Immunobead reverse transcription-PCR of five tumor-associated markers (carcinoembryonic antigen, laminin γ2, ephrin B4, matrilysin, and cytokeratin 20) was used to detect the presence of colon tumor cells in peripheral blood and within the peritoneal cavity of colon cancer patients perioperatively. Clinicopathologic variables were tested for their effect on survival outcomes in univariate analyses using the Kaplan-Meier method. A multivariate Cox proportional hazards regression analysis was done to determine whether detection of tumor cells was an independent prognostic marker for disease relapse. Results: Overall, 41 of 125 (32.8%) early-stage patients were positive for disseminated tumor cells. Patients who were marker positive for disseminated cells in post-resection lavage samples showed a significantly poorer prognosis (hazard ratio, 6.2; 95% confidence interval, 1.9-19.6; P = 0.002), and this was independent of other risk factors. Conclusion: The markers used in this study identified a subgroup of early-stage patients at increased risk of relapse post-resection for primary colorectal cancer. This method may be considered as a new diagnostic tool to improve the staging and management of colorectal cancer. © 2006 American Association for Cancer Research.

Using cost-effective multimedia to create engaging learning experiences in law and other disciplines

This is the final report of an Australian Learning and Teaching Council Teaching Fellowship which addressed the needs of two separate groups of learners: (1) final year law students studying ethics and (2) law academics and other interested educators in higher education wishing to use information and communication technologies (ICT) to create engaging learning environments for their students but lacking the capacity to do so. The Fellowship resulted in final year law students being infused with an improved appreciation of ethical practice than they receive from traditional lecture/tutorial means by the development of an integrated program of blended learning including an online program entitled "Entry into Valhalla". This "ethics capstone‟ utilises multimedia produced using cost effective resources (including the "Second Life" virtual environment) to create engaging, contextualised learning experiences. The Fellowship also constructed the knowledge of producing cost-effective multimedia projects in other law academics and other educators in higher education by staff development activities comprising workshops, conference presentations and an interactive website using the "Entry into Valhalla" program as a case study exemplar.

Teen content creators : experiences of using information to learn

As access to networked digital communities increases, a growing number of teens participate in digital communities by creating and sharing a variety of content. The affordances of social media - ease of use, ubiquitous access, and communal nature - have made creating and sharing content an appealing process for teens. Teens primarily learn the practices of encountering and using information through social interaction and participation within digital communities. This article adopts the position that information literacy is the experience of using information to learn. It reports on an investigation into teens experiences in the United States, as they use information to learn how to create content and participate within the context of social media. Teens that participate in sharing art on sites such as DeiviantArt, website creation, blogging, and/or posting edited videos via YouTube and Vimeo, were interviewed. The interviews explored teens' information experiences within particular social and digital contexts. Teens discussed the information they used, how information was gathered and accessed, and explored the process of using that information to participate in the communities.