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Summer preview of Sydney's 18th Biennale in 2012. Preview describes the general themes of the Biennale and refers to some of the major artists in the exhibition.

General order conditions for stochastic Runge-Kutta methods for both commuting and non-commuting stochastic ordinary differential equation systems

In many modeling situations in which parameter values can only be estimated or are subject to noise, the appropriate mathematical representation is a stochastic ordinary differential equation (SODE). However, unlike the deterministic case in which there are suites of sophisticated numerical methods, numerical methods for SODEs are much less sophisticated. Until a recent paper by K. Burrage and P.M. Burrage (1996), the highest strong order of a stochastic Runge-Kutta method was one. But K. Burrage and P.M. Burrage (1996) showed that by including additional random variable terms representing approximations to the higher order Stratonovich (or Ito) integrals, higher order methods could be constructed. However, this analysis applied only to the one Wiener process case. In this paper, it will be shown that in the multiple Wiener process case all known stochastic Runge-Kutta methods can suffer a severe order reduction if there is non-commutativity between the functions associated with the Wiener processes. Importantly, however, it is also suggested how this order can be repaired if certain commutator operators are included in the Runge-Kutta formulation. (C) 1998 Elsevier Science B.V. and IMACS. All rights reserved.

What relationships exist between general self efficacy, locus of control and the nursing practice environment and caring efficacy and job satisfaction?

Research Question: What relationships exist between general self efficacy, locus of control and the nursing practice environment and caring efficacy and job satisfaction? Background: Important characteristics of current nursing practice include nurses having the ability to develop and continue therapeutic relationships with patients, nurses having autonomy and control over the practice environment and nurses having more involvement in decision making. In addition, employee satisfaction is enhanced when organisations offer access to authority. Despite this, nurses continue to complain of feeling powerless in their ability to make decisions. Sample: The study population and criteria for selection included Registered Nurses in Australia who were at the time members of an Australian professional and industrial organisation. Methods: A cross-sectional survey was undertaken. Data analysis was conducted using descriptive and bivariate statistics, and structural equation modeling. Results: The model fit the data well (χ² = 2.3594, χ²/df = 2.3594 and CFI = 0.9987). Twenty four percent of variation in caring efficacy (CE) can be accounted for by general self-efficacy (GSE); work locus of control (WLC) and practice environment (PE) and 62% of the variation in job satisfaction (JS) can be accounted for by GSE, WLC and PE. All pathways were found to be significant except PE to CE. GSE positively explained CE (β = 0.38). WLC was negatively related to CE i.e., as CE scores increased WLC scores decreased (β = -0.23). Further testing of the model found CE was positively related to GSE (βZ = 0.38, p < 0.001) and negatively related to WLC (βZ = - 0.23, p = 0.001). PE was not significantly associated with CE (βZ = - 0.01, p = 0.85). JS was explained by PE, which was positively related (βZ = 0.69, p = < 0.001); GSE which was negatively related (βZ - 0 .09, p < 0.001) and WLC, which was also negatively related (βZ = - 0.20, p < 0.001). Implications for Practice Nursing and organisational leaders should ensure the development of strategies for professional development and orientation programmes which may enhance nurses’ ability to develop caring relationships and express caring behaviours to their patients and as a result improve organisational and patient outcomes. Nursing shortages and turnover rates are associated with job satisfaction and the nursing practice environment. Improving the nursing environment can produce benefits to the health system such as better job satisfaction, improved workforce retention and better patient outcomes.

Nurse-led trials of medical devices: General principles and good practice

Aim To provide an overview of key governance matters relating to medical device trials and practical advice for nurses wishing to initiate or lead them. Background Medical device trials, which are formal research studies that examine the benefits and risks of therapeutic, non-drug treatment medical devices, have traditionally been the purview of physicians and scientists. The role of nurses in medical device trials historically has been as data collectors or co-ordinators rather than as principal investigators. Nurses more recently play an increasing role in initiating and leading medical device trials. Review Methods A review article of nurse-led trials of medical devices. Discussion Central to the quality and safety of all clinical trials is adherence to the International Conference on Harmonization Guidelines for Good Clinical Practice, which is the internationally-agreed standard for the ethically- and scientifically-sound design, conduct and monitoring of a medical device trial, as well as the analysis, reporting and verification of the data derived from that trial. Key considerations include the class of the medical device, type of medical device trial, regulatory status of the device, implementation of standard operating procedures, obligations of the trial sponsor, indemnity of relevant parties, scrutiny of the trial conduct, trial registration, and reporting and publication of the results. Conclusion Nurse-led trials of medical devices are demanding but rewarding research enterprises. As nursing practice and research increasingly embrace technical interventions, it is vital that nurse researchers contemplating such trials understand and implement the principles of Good Clinical Practice to protect both study participants and the research team.

Relational regulation theory and the role of social support and organisational fairness for nurses in a general acute context

Aims and objectives. To present a novel approach to nurse stress by exploring the demand–control–support model with organisational justice through the lens of relational regulation theory. Background. Nursing is often stressful due to high demands and dissatisfaction with pay, which impacts the mental well-being and productivity of nurses. Design. A cross-sectional design. Methods. A validated questionnaire was sent to the work addresses of all nursing and midwifery staff in a medium-sized general acute hospital in Australia. A total of 190 nurses and midwives returned completed questionnaires for the analyses. Results. The multiple regression analyses demonstrated that the model applies to the prototypical context of a general acute hospital and that job control, supervisor support and outside work support improve the job satisfaction and mental health of nurses. Conclusions. Most importantly, supervisor support was found to buffer the impact of excessive work demands. Fairness of procedures, distribution of resources and the quality and consistency of information are also beneficial. Relational regulation theory is applied to these findings as a novel way to conceptualise the mechanisms of support and fairness in nursing. Relevance to clinical practice. The importance of nurses’ well-being and job satisfaction is a priority for improving clinical outcomes. Practically, this means nurse managers should be encouraging nurses in the pursuit of diverse relational activities both at work and outside work.

Lying in all honesty : capturing truth in women’s confessional memoir

This paper explores the slippery nature of illness and diagnosis in Lauren Slater’s memoir, Lying: a Metaphorical Memoir (2000). Speaking from the shadowy intersection of childhood and adolescence, Slater’s narrator, Lauren, uses the metaphor of epilepsy to describe her own predilection for exaggeration. In exploiting the fallibility of the first-person narrator, Slater insists on the legitimacy of metaphor in accounts of childhood illness that are more concerned with narrative truth than historical accuracy. The result of this playfulness and general misrule is that Slater writes herself into a double bind: on one side, she is the child narrator who inadvertently misrepresents events and misdirects readers, and on the other side, she is the untrustworthy author who employs metaphor as a licence to lie.

The once-and-for-all withdrawal of the Liverpool Care Pathway in the UK : what are the implications for Australia?

This Perspective reflects on the withdrawal of the Liverpool Care Pathway in the UK, and its implications for Australia. Integrated care pathways are documents which outline the essential steps of multidisciplinary care in addressing a specific clinical problem. They can be used to introduce best clinical practice, to ensure that the most appropriate management occurs at the most appropriate time and that it is provided by the most appropriate health professional. By providing clear instructions, decision support and a framework for clinician-patient interactions, care pathways guide the systematic provision of best evidence-based care. The Liverpool Care Pathway (LCP) is an example of an integrated care pathway, designed in the 1990s to guide care for people with cancer who are in their last days of life and are expected to die in hospital. This pathway evolved out of a recognised local need to better support non-specialist palliative care providers’ care for patients dying of cancer within their inpatient units. Historically, despite the large number of people in acute care settings whose treatment intent is palliative, dying patients receiving general hospital acute care tended to lack sufficient attention from senior medical staff and nursing staff. The quality of end-of-life care was considered inadequate, therefore much could be learned from the way patients were cared for by palliative care services. The LCP was a strategy developed to improve end-of-life care in cancer patients and was based on the care received by those dying in the palliative care setting.

Promoting physical activity to older adults in general practice

This study aimed to assess the efficacy of a general practice based intervention to increase physical activity (PA) levels among 50-70 year old adults. One hundred and thirty-six inactive patients (50-70 years) were randomised into three groups. All participants received brief advice and a written prescription from a GP. Group one received this 'usual care' only (GP, n=46); group two received individualised counselling and follow-up contact from an Exercise Scientist (ES, n=45); group three received a pedometer to supplement the ES counselling (PED, n=45). The Active Australia Survey was administered at baseline, after the 12- week intervention and at a 24-week follow-up. One-way ANOVA showed no significant group differences at baseline in self-reported PA. Average time spent walking increased in all three groups at the 24-week follow-up (GP, 68158min/wk, p=0.006; ES, 83160min/wk, p=0.001; PED, 87132min/wk, p<0.001). Total time in PA (weighted min/wk) also increased significantly in all three groups (GP, 98 213min/wk, p=0.003; ES, 108 182min/wk, p<0.001; PED, 158 229min/wk, p<0.001 ). The proportion of participants who initially did not meet National PA Guidelines (150 minutes and 5 sessions/week) but who met the Guidelines at the 12 and 24-week follow-up was 15% (12 weeks) and 20% (24 weeks) in the GP group compared with 36% and 24% in the ES group and 20% and 42% in the PED group. All three intervention strategies were effective in increasing PA, but the ES intervention resulted in a higher proportion of active participants after 12 weeks and the PED group resulted in a higher proportion of active participants after 24 weeks.

Promoting physical activity to older adults through general practice

This study aimed to assess the efficacy of a general practice based intervention to increase physical activity (PA) levels among 50-70 year old adults. One hundred and thirty-six inactive patients (50-70 years) were randomised into three groups. All participants received brief advice and a written prescription from a GP. Group one received this 'usual care' only (GP, n=46); group two received individualised counselling and follow-up contact from an Exercise Scientist (ES, n=45); group three received a pedometer to supplement the ES counselling (PED, n=45). The Active Australia Survey was administered at baseline, after the 12- week intervention and at a 24-week follow-up. One-way ANOVA showed no significant group differences at baseline in self-reported PA. Average time spent walking increased in all three groups at the 24-week follow-up (GP, 68158min/wk, p=0.006; ES, 83160min/wk, p=0.001; PED, 87132min/wk, p<0.001). Total time in PA (weighted min/wk) also increased significantly in all three groups (GP, 98 213min/wk, p=0.003; ES, 108 182min/wk, p<0.001; PED, 158 229min/wk, p<0.001 ). The proportion of participants who initially did not meet National PA Guidelines (150 minutes and 5 sessions/week) but who met the Guidelines at the 12 and 24-week follow-up was 15% (12 weeks) and 20% (24 weeks) in the GP group compared with 36% and 24% in the ES group and 20% and 42% in the PED group. All three intervention strategies were effective in increasing PA, but the ES intervention resulted in a higher proportion of active participants after 12 weeks and the PED group resulted in a higher proportion of active participants after 24 weeks.

Building macroscale models from microscale probabilistic models : a general probabilistic approach for nonlinear diffusion and multispecies phenomena

A discrete agent-based model on a periodic lattice of arbitrary dimension is considered. Agents move to nearest-neighbor sites by a motility mechanism accounting for general interactions, which may include volume exclusion. The partial differential equation describing the average occupancy of the agent population is derived systematically. A diffusion equation arises for all types of interactions and is nonlinear except for the simplest interactions. In addition, multiple species of interacting subpopulations give rise to an advection-diffusion equation for each subpopulation. This work extends and generalizes previous specific results, providing a construction method for determining the transport coefficients in terms of a single conditional transition probability, which depends on the occupancy of sites in an influence region. These coefficients characterize the diffusion of agents in a crowded environment in biological and physical processes.

A contextualised general systems theory

A system is something that can be separated from its surrounds, but this definition leaves much scope for refinement. Starting with the notion of measurement, we explore increasingly contextual system behaviour, and identify three major forms of contextuality that might be exhibited by a system: (a) between components; (b) between system and experimental method, and; (c) between a system and its environment. Quantum Theory is shown to provide a highly useful formalism from which all three forms of contextuality can be analysed, offering numerous tests for contextual behaviour, as well as modelling possibilities for systems that do indeed display it. I conclude with the introduction of a Contextualised General Systems Theory based upon an extension of this formalism.

Can’t we all just get along? A qualitative investigation of the cognitive processes motivating driver aggression.

Although driver aggression has been identified as contributing to crashes, current understanding of the fundamental causes of the behaviour is poor. Two key reasons for this are evident. Firstly, existing research has been largely atheoretical, with no unifying conceptual framework guiding investigation. Secondly, emphasis on observable behaviours has resulted in limited knowledge of the underlying thought processes that motivate behaviour. Since driving is fundamentally a social situation, requiring drivers to interpret on-road events, insight regarding these perception and appraisal processes is paramount in advancing understanding of the underlying causes. Thus, the current study aimed to explore the cognitive appraisal processes involved in driver aggression, using a conceptual model founded on the General Aggression Model (Anderson & Bushman, 2002). The present results reflect the first of several studies testing this model. Participants completed 3 structured driving diaries to explore perceptions and cognitions. Thematic analysis of diaries identified several cognitive themes. The first, ‘driving etiquette’ concerned an implied code of awareness and consideration for other motorists, breaches of which were strongly associated with reports of anger and frustration. Such breaches were considered intentional; attributed to dispositional traits of another driver, and precipitated the second theme, ‘justified retaliation’. This theme showed that drivers view their aggressive behaviour as warranted, to convey criticism towards another motorist’s etiquette violation. However, the third theme, ‘superiority’ suggested that those refraining from an aggressive response were motivated by a desire to perceive themselves as ‘better’ than the offending motorists. Collectively, the themes indicate deep-seated and complex thought patterns underlying driver aggression, and suggest the behaviour will be challenging to modify. Implications of these themes in relation to the proposed model will be discussed, and continued research will explore these cognitive processes further, to examine their interaction with person-related factors.

Global, regional, and national age–sex specifi c all-cause and cause-specifi c mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Background Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries. Methods We estimated age-sex-specific all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specific causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions. Findings Global life expectancy for both sexes increased from 65·3 years (UI 65·0–65·6) in 1990, to 71·5 years (UI 71·0–71·9) in 2013, while the number of deaths increased from 47·5 million (UI 46·8–48·2) to 54·9 million (UI 53·6–56·3) over the same interval. Global progress masked variation by age and sex: for children, average absolute differences between countries decreased but relative differences increased. For women aged 25–39 years and older than 75 years and for men aged 20–49 years and 65 years and older, both absolute and relative differences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10·7%, from 4·3 million deaths in 1990 to 4·8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100 000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions. Interpretation For most countries, the general pattern of reductions in age-sex specific mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade.

General practice coordinated chronic disease management to reduce avoidable hospital admission

Chronic disease accounts for about 80 per cent of the total disease burden in Australia, and its management accounts for 70 per cent of all current health expenditure.1 Effective prevention and management of chronic disease requires a coordinated approach between primary health care, acute care services, and the patients.2 However, what is not clear is whether improvements in primary healthcare management can have a clear benefit in the cost of care of patients with chronic disease. We recently completed a pilot study in rural Western Australia to ascertain the feasibility of a coordinated general practice-based approach to managing chronic respiratory and cardiovascular conditions, and to determine the direct cost savings to the public insurer through reduction in avoidable hospital admission. The aim of this correspondence is to share our preliminary findings and encourage debate on how such a project may be scaled up or adapted to other primary healthcare settings.

The Australian litigation landscape - Oral and Maxillofacial Surgery and general dentistry (oral surgery procedures): An analysis of litigation cases

Background: There are persistent concerns about litigation in the dental and medical professions. These concerns arise in a setting where general dentists are more frequently undertaking a wider range of oral surgery procedures, potentially increasing legal risk. Methods: Judicial cases dealing with medical negligence in the fields of general dentistry (oral surgery procedure) and Oral and Maxillofacial Surgery were located using the three main legal databases. Relevant cases were analysed to determine the procedures involved, the patients’ claims of injury, findings of negligence, and damages awarded. A thematic analysis of the cases was undertaken to determine trends. Results: Fifteen cases over a twenty-year period were located across almost all Australian jurisdictions (eight cases involved general dentists; seven cases involved Oral and Maxillofacial Surgeons). Eleven of the fifteen cases involved determinations of whether or not the practitioner had failed in their duty of care; negligence was found in six cases. Eleven of the fifteen cases related to molar extractions (eight specifically to third molar). Conclusions: Dental and medical practitioners wanting to manage legal risk should have regard to circumstances arising in judicial cases. Adequate warning of risks is critical, as is offering referral in appropriate cases. Pre-operative radiographs, good medical records, and processes to ensure appropriate follow-up are also important.