Determinants of pre-hospital care non-usage for patients with emergency care needs [including commentary by Snooks H.]

Objective-To establish the demographic, health status and insurance determinants of pre-hospital ambulance non-usage for patients with emergency medical needs. Methods-Triage category, date of birth, sex, marital status, country of origin, method and time of arrival, ambulance insurance status, diagnosis, and disposal were collected for all patients who presented over a four month period (n=10 229) to the emergency department of a major provincial hospital. Data for patients with urgent (n=678) or critical care needs (n=332) who did not use pre-hospital care were analysed using Poisson regression. Results-Only a small percentage (6.6%) of the total sample were triaged as having urgent medical needs or critical care needs (3.2%). Predictors of usage for those with urgent care needs included age greater than 65 years (prevalence ratio (PR)=0.54; 95% confidence interval (CI)= 0.35 to 0.83), being admitted to intensive care or transferred to another hospital (PR=0.62; 95% CI=0.44 to 0.89) or ward (PR=0.72; 95% CI=0.56 to 0.93) and ambulance insurance status (PR=0.67; 95% CI=052 to 0.86). Sex, marital status, time of day and country of origin were not predictive of usage and non-usage. Predictors of usage for those with critical care needs included age 65 years or greater (PR=0.45; 95% CI=0.25 to 0.81) and a diagnosis of trauma (PR=0.49; 95% CI=0.26 to 0.92). A non-English speaking background was predictive of non-usage (PR=1.98; 95% CI=1.06 to 3.70). Sex, marital status, time of day, triage and ambulance insurance status were not predictive of non-usage. Conclusions-Socioeconomic and medical factors variously influence ambulance usage depending on the severity or urgency of the medical condition. Ambulance insurance status was less of an influence as severity of condition increased suggesting that, at a critical level of urgency, patients without insurance are willing to pay for a pre-hospital ambulance service.

Learning support : what do students want?

Assumptions are often made about students' needs, especially in the area of learning support. In this study 89 students were asked 8 questions relating to receiving learning support. The results are presented both qualitatively and quantitatively, and indicate that all students have individual needs that cannot be assumed. The findings reveal that the most common area of perceived need was in literacy. There were some differences between primary and middle school students' responses to withdrawal from the classroom, but the majority of students in both groups indicated a preference for withdrawal because they could concentrate better in an environment that was less noisy and because they felt they might look 'stupid' if they remained in class.

Mentoring preservice teachers in primary mathematics

A literature-based instrument gathered data about 147 final-year preservice teachers’ perceptions of their mentors’ practices related to primary mathematics teaching. Five factors characterized effective mentoring practices in primary mathematics teaching had acceptable Cronbach alphas, that is, Personal Attributes (mean scale score=3.97, SD [standard deviation]=0.81), System Requirements (mean scale score=2.98, SD=0.96), Pedagogical Knowledge (mean scale score=3.61, SD=0.89), Modelling (mean scale score=4.03, SD=0.73), and Feedback (mean scale score=3.80, SD=0.86) were .91, .74, .94, .89, and .86 respectively. Qualitative data (n=44) investigated mentors’ perceptions of mentoring these preservice teachers, including identification of successful mentoring practices and ways to enhance practices.

Understanding preservice teachers’ predispositions for teaching engineering education in Australian schools.

Engineering education is underrepresented in Australia at the primary, middle school and high school levels. Understanding preservice teachers’ preparedness to be involved in engineering will be important for developing an engineering curriculum. This study administered a literature-based survey to 36 preservice teachers, which gathered data about their perceptions of engineering and their predispositions for teaching engineering. Findings indicated that the four constructs associated with the survey had acceptable Cronbach alpha scores (i.e., personal professional attributes .88, student motivation .91, pedagogical knowledge .91, and fused curricula .89). However, there was no “disagree” or “strongly disagree” response greater than 22% for any of the 25 survey items. Generally, these preservice teachers indicated predispositions for teaching engineering in the middle school. Extensive scaffolding and support with education programs will assist preservice teachers to develop confidence in this field. Governments and education departments need to recognise the importance of engineering education, and universities must take a stronger role in developing engineering education curricula.

The appeal of the International Baccalaureate in Australia’s educational market: A curriculum of choice for mobile futures

In Australia there is growing interest in a national curriculum to replace the variety of matriculation credentials managed by State Education departments, ostensibly to address increasing population mobility. Meanwhile, the International Baccalaureate (IB) is attracting increasing interest and enrolments in State and private schools in Australia, and has been considered as one possible model for a proposed Australian Certificate of Education. This paper will review the construction of this curriculum in Australian public discourse as an alternative frame for producing citizens, and ask why this design appeals now, to whom, and how the phenomenon of its growing appeal might inform national curricular debates. The IB’s emergence is understood with reference to the larger context of neo-liberal marketization policies, neo-conservative claims on the curriculum and middle class strategy. The paper draws on public domain documents from the IB Organisation and newspaper reportage to demonstrate how the IB is constructed for public consumption in Australia.

Improved cryptanalysis of the Common Scrambling Algorithm Stream Cipher

This paper provides a fresh analysis of the widely-used Common Scrambling Algorithm Stream Cipher (CSA-SC). Firstly, a new representation of CSA-SC with a state size of only 89 bits is given, a significant reduction from the 103 bit state of a previous CSA-SC representation. Analysis of this 89-bit representation demonstrates that the basis of a previous guess-and-determine attack is flawed. Correcting this flaw increases the complexity of that attack so that it is worse than exhaustive key search. Although that attack is not feasible, the reduced state size of our representation makes it obvious that CSA-SC is vulnerable to several generic attacks, for which feasible parameters are given.

Discrepancy between human resource research and practice : comparison of industrial/organisational psychologists and human resource practitioners' beliefs

There is a large and growing body of research to show that human resource (HR) practices affect individual performance, organisational productivity and organisational performance. Academic findings about effective HR practices, however, have not readily been adopted by practitioners. A variety of theoretical and practical explanations have been advanced about the research-practice gap. Research by Rynes, Colbert, and Brown (2002) suggested that the research-practice gap is due to a lack of knowledge, but the extent to which these findings apply to the Australian context is unknown. The sample consisted of 102 industrial/organisational (I/O) psychologists and 89 HR practitioners. The main aim of the present study was to replicate and extend the work of Rynes et al. by examining and comparing the knowledge of I/O psychologists and HR practitioners. It was found that overall I/O psychologists were better informed about HR research than HR practitioners; in particular, they were more knowledgeable about management practices and recruitment and selection. In both groups, of the five content areas examined (Management Practices; General Employment Practices; Training and Development; Recruitment and Selection; and Compensation and Benefits), the greatest gaps were in Recruitment and Selection.

Faster pairings on special Weierstrass curves

This paper presents efficient formulas for computing cryptographic pairings on the curve y 2 = c x 3 + 1 over fields of large characteristic. We provide examples of pairing-friendly elliptic curves of this form which are of interest for efficient pairing implementations.

Governance issues in accounting

Purpose – The purpose of this paper is to identify some key issues for the analysis of corporate governance based on the papers within this special issue including the Guest Editor's perspectives. Design/methodology/approach – The five papers included in this special issue are summarized and their main contribution to the literature is highlighted. Findings – The paper collectively deal with the role and impact of corporate boards on the quality of information provided to capital markets. Practical implications – The theoretical and empirical research included in the special issue advance the understanding of corporate governance which provides impetus for practitioner and policy change. Originality/value – The normative concepts of best practice need to be validated by empirical testing in the context of firms and their institutional settings. This suite of papers provides evidence of the effectiveness of corporate governance in improving accounting quality

Love at first sight : Sanja Pahoki

I am a landscape architect, a non-photographer, and in reviewing this exhibition, it seems that in a critical discourse on photography the nature of the view and its relation to the observer (presumably the camera) is inevitably a key focus of creative inquiry, in an epistemological sense. In conducting such a review, of 'self-portraits' by 'female photographers' in relation to 'the landscape', one cannot help but ask what priority this critique should allocate to each of these conceptual agendas, quite apart from the simple formal quality of the individual pieces themselves. Analytically, each could form the axes of a matrix that might allow for a number of quite different permutations and therefore differently conclusive commentaries on the others: the view vs landscape; the view vs sexuality; the self-portrait vs the landscape picture. All of these would be productive in their own right and each is alluded to in the works themselves and in the narrative of the catalogue. Considering this range of possible permutations, this show is certainly rich and this richness sits well with the relative formal saturation of the images themselves.

Incomplete pregnancy and risk of ovarian cancer : results from two Australian case-control studies and systematic review

Although full-term pregnancies reduce the risk of ovarian cancer, it has not been conclusively established whether incomplete pregnancies also influence risk. We investigated the relationship between a history of incomplete pregnancy and incident epithelial ovarian cancer among over 4,500 women who participated in two large Australian population-based case-control studies in 1990-1993 and 2002-2005. They provided responses to detailed questions about their reproductive histories and other personal factors. Summary odds ratios (OR) and confidence intervals (CI) derived from each study using the same covariates were aggregated. We found no significant associations between the number of incomplete pregnancies and ovarian cancer, for parous (OR = 0.98, 95% CI: 0.89, 1.08) or nulliparous (OR = 1.06, 95% CI: 0.75, 1.48) women, nor for the number of spontaneous or induced abortions and ovarian cancer for parous women (OR = 0.95, 95% CI 0.82, 1.09; OR = 1.08, 95% CI: 0.86, 1.36) or nulliparous women (OR = 1.2, 95% CI: 0.6, 2.4; OR = 0.8, 95% CI: 0.47, 1.38), respectively. A systematic review of 37 previous studies of the topic confirmed our findings that a history of incomplete pregnancy does not influence a woman’s risk of epithelial ovarian cancer.

Early detection : a strategy to reduce risk and severity?

Despite changes in surgical techniques, radiotherapy targeting and the apparent earlier detection of cancers, secondary lymphoedema is still a significant problem for about 20–30% of those who receive treatment for cancer, although the incidence and prevalence does seem to be falling. The figures above generally relate to detection of an enlarged limb or other area, but it seems that about 60% of all patients also suffer other problems with how the limb feels, what can or cannot be done with it and a range of social or psychological issues. Often these ‘subjective’ changes occur before the objective ones, such as a change in arm volume or circumference. For most of those treated for cancer lymphoedema does not develop immediately, and, while about 60–70% develop it in the first few years, some do not develop lymphoedema for up to 15 or 20 years. Those who will develop clinically manifest lymphoedema in the future are, for some time, in a latent or hidden phase of lymphoedema. There also seems to be some risk factors which are indicators for a higher likelihood of lymphoedema post treatment, including oedema at the surgical site, arm dominance, age, skin conditions, and body mass index (BMI).

The prognostic significance of quality of life following breast cancer [Conference Abstract]

Introduction: Evidence suggests a positive association between quality of life (QOL). and overall survival(OS). among metastatic breast cancer (BC). patients, although the relationship in early-stage BC is unclear. This work examines the association between QOL and OS following a diagnosis of early-stage BC. ----- Methods: A population-based sample of Queensland women (n=287). with early-stage, invasive, unilateral BC, were prospectively observed for a median of 6.6 years. QOL was assessed at six and 18 months post-diagnosis using the Functional Assessment of Cancer Therapy, Breast FACT-B+4. questionnaire. Raw scores for the FACT-B+4 scales were computed and individuals were categorised according to whether QOL declined, remained stable or improved over time. OS was measured from the date of diagnosis to the date of death or was censored at the date of last follow-up. Risk ratios (RR) and 95% confidence intervals (CI). for the association between QOL and OS were obtained using Cox proportional hazards survival models adjusted for confounding characteristics. ----- Results: A total of 27 (9.4%). women died during the follow-up period. Three baseline QOL scales (emotional, general and overall QOL) were significantly associated with OS, with RRs ranging between 0.89 95% CI: 0.81, 0.98; P=0.01. and 0.98 (95% CI: 0.96, 0.99; P=0.03),indicating a 2%-11% reduced risk of death for every one unit increase in QOL. When QOL was categorised according to changes between six and 18 months post-diagnosis, analyses showed that for those who experienced declines in functional and physical QOL, risk of death increased by two- (95% CI: 1.43, 12.52; P<0.01) and four-fold (95% CI: 1.15, 7.19; P=0.02), respectively. Conclusions: This work indicates that specific QOL scales at six months post-diagnosis, and changes in certain QOL scales over the subsequent 12-month period (as measured by the FACT-B+4), are associated with overall survival in women with early-stage breast cancer.

Cough-generated aerosols of Pseudomonas aeruginosa and other Gram Negative Bacteria from cystic fibrosis patients.

Background: Pseudomonas aeruginosa is the most common bacterial pathogen in cystic fibrosis (CF) patients. Current infection control guidelines aim to prevent transmission via contact and respiratory droplet routes and do not consider the possibility of airborne transmission. We hypothesized that with coughing, CF subjects produce viable, respirable bacterial aerosols. Methods: Cross-sectional study of 15 children and 13 adults with CF, 26 chronically infected with P. aeruginosa. A cough aerosol sampling system enabled fractioning of respiratory particles of different size, and culture of viable Gram negative non-fermentative bacteria. We collected cough aerosols during 5 minutes voluntary coughing and during a sputum induction procedure when tolerated. Standardized quantitative culture and genotyping techniques were used. Results: P. aeruginosa was isolated in cough aerosols of 25 (89%) subjects of whom 22 produced sputum samples. P. aeruginosa from sputum and paired cough aerosols were indistinguishable by molecular typing. In 4 cases the same genotype was isolated from ambient room air. Approximately 70% of viable aerosols collected during voluntary coughing were of particles ≤ 3.3 microns aerodynamic diameter. P. aeruginosa, Burkholderia cenocepacia Stenotrophomonas maltophilia and Achromobacter xylosoxidans were cultivated from respiratory particles in this size range. Positive room air samples were associated with high total counts in cough aerosols (P=0.003). The magnitude of cough aerosols were associated with higher FEV1 (r=0.45, P=0.02) and higher quantitative sputum culture results (r=0.58, P=0.008). Conclusion: During coughing, CF patients produce viable aerosols of P. aeruginosa and other Gram negative bacteria of respirable size range, suggesting the potential for airborne transmission.