Timed Up and Go Tests in cardiac rehabilitation : reliability and comparison with the 6-minute walk test

PURPOSE: To test the reliability of Timed Up and Go Tests (TUGTs) in cardiac rehabilitation (CR) and compare TUGTs to the 6-Minute Walk Test (6MWT) for outcome measurement. METHODS: Sixty-one of 154 consecutive community-based CR patients were prospectively recruited. Subjects undertook repeated TUGTs and 6MWTs at the start of CR (start-CR), postdischarge from CR (post-CR), and 6 months postdischarge from CR (6 months post-CR). The main outcome measurements were TUGT time (TUGTT) and 6MWT distance (6MWD). RESULTS: Mean (SD) TUGTT1 and TUGTT2 at the 3 assessments were 6.29 (1.30) and 5.94 (1.20); 5.81 (1.22) and 5.53 (1.09); and 5.39 (1.60) and 5.01 (1.28) seconds, respectively. A reduction in TUGTT occurred between each outcome point (P ≤ .002). Repeated TUGTTs were strongly correlated at each assessment, intraclass correlation (95% CI) = 0.85 (0.76–0.91), 0.84 (0.73–0.91), and 0.90 (0.83–0.94), despite a reduction between TUGTT1 and TUGTT2 of 5%, 5%, and 7%, respectively (P ≤ .006). Relative decreases in TUGTT1 (TUGTT2) occurred from start-CR to post-CR and from start-CR to 6 months post-CR of −7.5% (−6.9%) and −14.2% (−15.5%), respectively, while relative increases in 6MWD1 (6MWD2) occurred, 5.1% (7.2%) and 8.4% (10.2%), respectively (P < .001 in all cases). Pearson correlation coefficients for 6MWD1 to TUGTT1 and TUGTT2 across all times were −0.60 and −0.68 (P < .001) and the intraclass correlations (95% CI) for the speeds derived from averaged 6MWDs and TUGTTs were 0.65 (0.54, 0.73) (P < .001). CONCLUSIONS: Similar relative changes occurred for the TUGT and the 6MWT in CR. A significant correlation between the TUGTT and 6MWD was demonstrated, and we suggest that the TUGT may provide a related or a supplementary measurement of functional capacity in CR.

‘The health-location connection’: using GIS and social media on smartphones to track engagement with the Local urban environment for work, recreation, and physical activity

A technologically innovative study was undertaken across two suburbs in Brisbane, Australia, to assess socioeconomic differences in women's use of the local environment for work, recreation, and physical activity. Mothers from high and low socioeconomic suburbs were instructed to continue with usual daily routines, and to use mobile phone applications (Facebook Places, Twitter, and Foursquare) on their mobile phones to ‘check-in’ at each location and destination they reached during a one-week period. These smartphone applications are able to track travel logistics via built-in geographical information systems (GIS), which record participants’ points of latitude and longitude at each destination they reach. Location data were downloaded to Google Earth and excel for analysis. Women provided additional qualitative data via text regarding the reasons and social contexts of their travel. We analysed 2183 ‘check-ins’ for 54 women in this pilot study to gain quantitative, qualitative, and spatial data on human-environment interactions. Data was gathered on distances travelled, mode of transport, reason for travel, social context of travel, and categorised in terms of physical activity type – walking, running, sports, gym, cycling, or playing in the park. We found that the women in both suburbs had similar daily routines with the exception of physical activity. We identified 15% of ‘check-ins’ in the lower socioeconomic group as qualifying for the physical activity category, compared with 23% in the higher socioeconomic group. This was explained by more daily walking for transport (1.7kms to 0.2kms) and less car travel each week (28.km to 48.4kms) in the higher socioeconomic suburb. We ascertained insights regarding the socio-cultural influences on these differences via additional qualitative data. We discuss the benefits and limitations of using new technologies and Google Earth with implications for informing future physical and social aspects of urban design, and health promotion in socioeconomically diverse cities.

Juveniles’ contact with the criminal justice system in Australia

This report presents the first collection of data on juveniles’ contact with the criminal justice system as both alleged/convicted offenders and complainants/victims in New South Wales, the Australian Capital Territory, Victoria, Queensland, Western Australia, South Australia and the Northern Territory. Its primary objectives are to outline data from each of these jurisdictions on juveniles’ contact with the policing, courts and correctional systems and to determine what we do and do not know about juveniles’ contact with the criminal justice system.

Talking Fish : Making Connections with the Rivers of the Murray-Darling Basin

"The ongoing review of the NFS highlighted that engagement with recreational fishers and the Indigenous community, in particular, could be enhanced. This was the impetus for the Talking Fish project which acknowledged the important relationship people have with their local rivers and fish within the Murray-Darling Basin. Within these relationships a wealth of historical information about rivers and fish was held and it was recognised that this needed to be captured..."--publisher website.

Community projects : extending the community lawyering model

Law schools in Australia and the United Kingdom are increasingly adopting clinical legal education (CLE) as an important part of their curriculum. Models of CLE are emerging in those jurisdictions which draw on local experience and the strong tradition of CLE and community lawyering in the United States. The purpose of this article is to examine the pedagogy that underlies CLE and to consider how it can be applied to newly emerging models of CLE. In particular, it will evaluate a community project legal clinic in which students work on social justice projects in partnership with a range of community organisations, not limited to legal centres, with a view to determining whether pedagogical goals are being met in the way that the course is being delivered. This article argues that community project legal clinics can result in positive student learning outcomes in relation to the development of a pro bono ethos and commitment to social justice, lawyering skills including client communication, and the development of a positive professional legal identity. Part II of the article provides a brief overview of the history of CLE in Australia, the United Kingdom and the United States, noting the trend towards the development of community lawyering clinics. Part III examines the benefits of community lawyering clinics focusing on the benefits for student learning and the service-learning pedagogy applied in community lawyering clinics in the United States. Finally, part IV looks at a case study of a new community project clinic in Australia that draws upon the service-learning pedagogy of community lawyering CLE. In the community project clinic, students engage in service-learning through undertaking projects with not-for-profit community organisations. Community partners identify relevant issues and needs, and the students work in interdisciplinary teams to address these. Law students working in these teams are often exposed to a broader social problem or issue than they would experience in a traditional ‘in-person’ legal clinic. Initial evaluation suggests that this model for community clinics in law schools assists students to develop lawyering skills and a positive legal identity including awareness of and support for pro bono legal work and a sense of belonging in the legal profession.

Psychological services for asylum seekers in the community: Challenges and solutions

Objective: Given the Australian government’s current policy of placing asylum seekers into the community while their applications for asylum are being considered, it is important that mental health practitioners are able to offer culturally safe, sensitive, and competent services in this context. Method: A qualitative approach was used to interview seven practitioners, who provided services to asylum seekers at a specialist health clinic in the community. These professionals used their experience to identify the psychosocial issues faced by these asylum seekers, the challenges of providing culturally effective services to this group, and how these services can be improved. Result: Data were thematically analysed using NVivo. The findings indicated that participants perceived that clients experienced psychological, health, and cultural difficulties. The stress and uncertainty around visa applications emerged as the most severe factor impacting asylum seekers’ mental health. Working effectively with interpreters and culturally adapting assessment and treatment for these clients emerged as effective strategies. Gathering information in a conversational way and using clients’ different cultural explanatory models were methods used to identify and address mental health issues, rather than using formal measures. Interventions were eclectic and holistic, and reflected treatments that were appropriate for the clients’ cultural backgrounds. Conclusion: The study has implications for how psychological services are offered to asylum seekers in the community. Further, it identifies areas that can be incorporated in the future training of practitioners.

A study protocol: A community pharmacy-based intervention for improving the management of sleep disorders in the community settings

Background Sleep disorders are very common in the community and are estimated to affect up to 45% of the world’s population. Pharmacists are in a position to give advice and provide appropriate services to individuals who are unable to easily access medical care. The purpose of this study is to develop an intervention to improve the management of sleep disorders in the community. The aims are: (1) to evaluate the effectiveness of a community pharmacy-based intervention in managing sleep disorders; (2) to evaluate the role of actigraph as an objective measure in monitoring certain sleep disorders, and; (3) to evaluate the extended role of community pharmacists in managing sleep disorders. This intervention is developed to monitor individuals undergoing treatment and overcome the difficulties in validating self-reported feedback. Method/design This is a community-based intervention, prospective, controlled trial, with one intervention group and one control group, comparing individuals receiving a structured intervention with those receiving usual care for sleep-related disorders at community pharmacies. Discussion This study will demonstrate the utilisation and efficacy of community pharmacy-based intervention to manage sleep disorders in the community, and will assess the possibility of implementing this intervention into the community pharmacy workflow.

The psychosocial purpose of driving and its relationship with the risky driving behaviour of young novice drivers

Background The overrepresentation of young drivers in road crashes, injuries and fatalities around the world has resulted in a breadth of injury prevention efforts including education, enforcement, engineering, and exposure control. Despite multifaceted intervention, the young driver problem remains a challenge for injury prevention researchers, practitioners and policy-makers. The intractable nature of young driver crash risks suggests that a deeper understanding of their car use – that is, the purpose of their driving – is required to inform the design of more effective young driver countermeasures. Aims This research examined the driving purpose reported by young drivers, including the relationship with self-reported risky driving behaviours including offences. Methods Young drivers with a Learner or Provisional licence participated in three online surveys (N1 = 656, 17–20 years; N2 = 1051, 17–20 years; N3 = 351, 17–21 years) as part of a larger state-wide project in Queensland, Australia. Results A driving purpose scale was developed (the PsychoSocial Purpose Driving Scale, PSPDS), revealing that young drivers drove for psychosocial reasons such as for a sense of freedom and to feel independent. Drivers who reported the greatest psychosocial purpose for driving were more likely to be male and to report more risky driving behaviours such as speeding. Drivers who deliberately avoided on-road police presence and reported a prior driving-related offence had significantly greater PSPDS scores, and higher reporting of psychosocial driving purposes was found over time as drivers transitioned from the supervised Learner licence phase to the independent Provisional (intermediate) licence phase. Discussion and conclusions The psychosocial needs met by driving suggest that effective intervention to prevent young driver injury requires further consideration of their driving purpose. Enforcement, education, and engineering efforts which consider the psychosocial purpose of the driving are likely to be more efficacious than those which presently do not. Road safety countermeasures could reduce the young driver’s exposure to risk through such mechanisms as encouraging the use of public transport.

A novel approach to increasing inventory with the current panel: Increasing donation frequency by asking for a different blood product

BACKGROUND Ongoing shortages of blood products may be addressed through additional donations. However, donation frequency rates are typically lower than medically possible. This preliminary study aims to determine voluntary nonremunerated whole blood (WB) and plasmapheresis donors' willingness, and subsequent facilitators and barriers, to make additional donations of a different type. STUDY DESIGN AND METHODS Forty individual telephone interviews were conducted posing two additional donation pattern scenarios: first, making a single and, second, making multiple plasmapheresis donations between WB donations. Stratified purposive sampling was conducted for four samples varying in donation experience: no-plasma, new-to-both-WB-and-plasma, new-to-plasma, and plasma donors. Interviews were analyzed yielding excellent (κ values > 0.81) inter-rater reliability. RESULTS Facilitators were more endorsed than barriers for a single but not multiple plasmapheresis donation. More new-to-both donors (n = 5) were willing to make multiple plasma donations between WB donations than others (n = 1 each) and identified fewer barriers (n = 3) than those more experienced in donation (n = 8 no plasma, n = 10 new to both, n = 11 plasma). Donors in the plasma sample were concerned about the subsequent reduced time between plasma donations by adding WB donations (n = 3). The no-plasma and new-to-plasma donors were concerned about the time commitment required (n = 3). CONCLUSION Current donors are willing to add different product donations but donation history influences their willingness to change. Early introduction of multiple donation types, variation in inventory levels, and addressing barriers will provide blood collection agencies with a novel and cost-effective inventory management strategy.

A novel serogenetic approach determines the community prevalence of celiac disease and informs improved diagnostic pathways

Background: Changing perspectives on the natural history of celiac disease (CD), new serology and genetic tests, and amended histological criteria for diagnosis cast doubt on past prevalence estimates for CD. We set out to establish a more accurate prevalence estimate for CD using a novel serogenetic approach.Methods: The human leukocyte antigen (HLA)-DQ genotype was determined in 356 patients with 'biopsy-confirmed' CD, and in two age-stratified, randomly selected community cohorts of 1,390 women and 1,158 men. Sera were screened for CD-specific serology.Results: Only five 'biopsy-confirmed' patients with CD did not possess the susceptibility alleles HLA-DQ2.5, DQ8, or DQ2.2, and four of these were misdiagnoses. HLA-DQ2.5, DQ8, or DQ2.2 was present in 56% of all women and men in the community cohorts. Transglutaminase (TG)-2 IgA and composite TG2/deamidated gliadin peptide (DGP) IgA/IgG were abnormal in 4.6% and 5.6%, respectively, of the community women and 6.9% and 6.9%, respectively, of the community men, but in the screen-positive group, only 71% and 75%, respectively, of women and 65% and 63%, respectively, of men possessed HLA-DQ2.5, DQ8, or DQ2.2. Medical review was possible for 41% of seropositive women and 50% of seropositive men, and led to biopsy-confirmed CD in 10 women (0.7%) and 6 men (0.5%), but based on relative risk for HLA-DQ2.5, DQ8, or DQ2.2 in all TG2 IgA or TG2/DGP IgA/IgG screen-positive subjects, CD affected 1.3% or 1.9%, respectively, of females and 1.3% or 1.2%, respectively, of men. Serogenetic data from these community cohorts indicated that testing screen positives for HLA-DQ, or carrying out HLA-DQ and further serology, could have reduced unnecessary gastroscopies due to false-positive serology by at least 40% and by over 70%, respectively.Conclusions: Screening with TG2 IgA serology and requiring biopsy confirmation caused the community prevalence of CD to be substantially underestimated. Testing for HLA-DQ genes and confirmatory serology could reduce the numbers of unnecessary gastroscopies. © 2013 Anderson et al.; licensee BioMed Central Ltd.

Traffic behaviour and compliance with the law in low and middle income countries: are we observing "pragmatic driving"?

A common theme in many accounts of road safety and road use in low and middle income countries is a widespread lack of compliance with traffic laws and related legislation. A key element of the success of road crash prevention strategies in high income countries has been the achievement of safer road user behaviour through compliance with traffic laws. Deterrence-based approaches such as speed cameras and random breath testing, which rely on drivers making an assessment that they are likely to be caught if they offend, have been very effective in this regard. However, the long term success of (for example) drink driving legislation has been supported by drivers adopting a moral approach to compliance rather than relying solely on the intensity of police operations. For low and middle income countries such morally based compliance is important, since levels of police resourcing are typically much lower than in Western countries. In the absence of morally based compliance, it is arguable that the patterns of behaviours observed in low and middle income countries can be described as "pragmatic driving": compliance only when there is a high chance of being detected and fined, or where a crash might occur. The potential characteristics of pragmatic driving in the macro-, meso- and micro-context of driving and the enforcement approach that could address it are outlined, with reference to the limited existing information available.

Enabling people to ‘see what they can be’… The Community Aspirations Program (CAP-ED)

The Community Aspirations Program in Education (CAP-ED) was delivered by CQUniversity’s Office of Indigenous Engagement to increase Aboriginal and Torres Strait Islander student participation in higher education. CAP-ED was developed through scoping studies of six individual communities within the CQuniversity footprint, including a designated Aboriginal and Torres Strait Islander community and rural and regional communities. The scoping process included developing community profiles and extensive consultation with Traditional Owners, Elders, community members and key stakeholders. This process proved to be an essential component of CAP-ED’s success, resulting in Indigenous participation in the program’s networking lunches, through to the delivery of information and workshop sessions. Moreover, it witnessed engagement with people in communities as partners in the program’s delivery and co-presenters in workshops and other events. The CAP-ED workshops focus on identity, culture, aspirations and assist participants to see that they have the potential to participate in higher education. The other essential components of the program’s success have included enabling people to ‘see what they can be’, offering opportunities for people to ask questions, voice honest concerns, and build confidence. The flexibility of delivery was paramount in accommodating the varying needs of each community and the differences in cultural protocols and community approaches, while the face to face engagement between knowledgeable and skilled staff and community members proved to be vital. Over the life of the project, CAP-ED has developed into a broad based strategy that has successfully matched community needs and university based responses through the process of community engagement.

A quantitative-trait genome-wide association study of alcoholism risk in the community: findings and implications

BACKGROUND Given moderately strong genetic contributions to variation in alcoholism and heaviness of drinking (50% to 60% heritability) with high correlation of genetic influences, we have conducted a quantitative trait genome-wide association study (GWAS) for phenotypes related to alcohol use and dependence. METHODS Diagnostic interview and blood/buccal samples were obtained from sibships ascertained through the Australian Twin Registry. Genome-wide single nucleotide polymorphism (SNP) genotyping was performed with 8754 individuals (2062 alcohol-dependent cases) selected for informativeness for alcohol use disorder and associated quantitative traits. Family-based association tests were performed for alcohol dependence, dependence factor score, and heaviness of drinking factor score, with confirmatory case-population control comparisons using an unassessed population control series of 3393 Australians with genome-wide SNP data. RESULTS No findings reached genome-wide significance (p = 8.4 x 10(-8) for this study), with lowest p value for primary phenotypes of 1.2 x 10(-7). Convergent findings for quantitative consumption and diagnostic and quantitative dependence measures suggest possible roles for a transmembrane protein gene (TMEM108) and for ANKS1A. The major finding, however, was small effect sizes estimated for individual SNPs, suggesting that hundreds of genetic variants make modest contributions (1/4% of variance or less) to alcohol dependence risk. CONCLUSIONS We conclude that: - 1) meta-analyses of consumption data may contribute usefully to gene discovery; - 2) translation of human alcoholism GWAS results to drug discovery or clinically useful prediction of risk will be challenging, and; - 3) through accumulation across studies, GWAS data may become valuable for improved genetic risk differentiation in research in biological psychiatry (e.g., prospective high-risk or resilience studies).

A review of project evaluation methodologies to address net impacts and risks of toll road projects to the community

Project evaluation is a process of measuring costs, benefits, risks and uncertainties for the purpose of decision-making by estimating and assessing impacts of the project to the community. The effects of impacts of toll roads are similar but different from the general non-tolled roads. Project evaluation methodologies are extensively studied and applied to various transport infrastructure projects. However, there is no definitive methodology to evaluate toll roads. This review discusses the impacts of toll roads then reviews the limitations of existing project evaluation methodologies when evaluating toll road impacts. The review identified gaps of knowledge of toll evaluations. First, the treatment of toll in project evaluation, particularly in Cost-Benefit Analysis requires further study to explore the appropriate methodology. Secondly, the project evaluation methodology needs to place strong emphasis on empirically based risk and uncertainty assessment. Addressing the limitations of the existing project evaluation methodologies leads to improvements of the methodology in practical level as well as fills the gap of knowledge of project evaluation for toll roads with respect to net impacts to the community.

The impact of the public library as a creative place in the community: A contextual review

This review examines recent literature on the public library as a creative place and the ways in which socio-cultural impact is being measured in assessments of cultural value. Inputs such as funding and staffing are frequently measured against outputs such as visitor numbers and lending frequencies, but qualitative measures (outcomes and impacts) are minimal in the literature because of the lack of persuasive evaluative frameworks and the difficulty of designing and facilitating the evaluations at local and national levels. Nevertheless, when combined with data about outputs and outcomes, the impact on individuals and their communities can be measured effectively and reported persuasively (Poll 2012, p.124). This contextual review provides an overview of current thinking about public libraries and creative spaces with particular attention paid to the rise of so-called makerspaces and Fab Labs. This includes discussion on the types of creative activities that are occurring in the public library context, and an outline of the rhetoric and reality of the public library as a community space. These outlines are reconsidered in a discussion of the evaluative frameworks that have been employed by libraries in the past, followed by an account of some prominent creative spaces that have been formally evaluated. The existence of creative spaces in public libraries is in a state of constant flux, and the development and redevelopment of evaluative frameworks will ensure that published reports will continue to appear throughout 2015 and beyond. This review provides a brief snapshot of the state of the field as it is in the first quarter of 2015.