A national roll out of an insufficiently evaluated practice : how evidence based are our end-of-life care policies?

There has been increasing international efforts to ensure that health care policies are evidence based. One area where there is a lack of ‘effectiveness’ evidence is in the use of end-of-life care pathways (EOLCP) (1). Despite the lack of evidence supporting the efficacy of the EOCLP, their use has been endorsed in the recent national palliative care strategy document in the UK (2). In addition, a publication endorsed by the Australian Government (titled: Supporting Australians to live well at the End of Life- National Palliative Care Strategy 2010) (3), recommended a national roll out of EOLCP across all sectors (primary, acute and aged care) in Australia. According to this document, it is a measure of “appropriateness” and “effectiveness” for promoting quality end-of-life care.

Preparing students for international study : the use of technology

About 1.6 million students currently study outside their home country. Despite this, and the fact that Australia, the United States, the United Kingdom and many of the other host countries of international students are themselves extremely culturally diverse communities, business education remains essentially mono-cultural in form and Anglo American in content. Whilst it is true that these international students may want to understand the "Western" way of doing things, they may not be familiar or comfortable with the processes used to facilitate learning. This paper explores a project undertaken to create a tool that provides essential pre-orientation information and advice to students before they leave home. Where cultural adjustment is required, catching students before departure is a very effective time to introduce key information about lifestyle, culture and approaches to teaching and learning that would assist students with the complex and difficult adjustment to studying abroad, so that they could make a smoother transition to their new place of learning. Welcome to Studying Business at QUT is a Data DVD with 19 short videos capturing a student perspective on life and study. Forty percent of the content is related to living and studying and includes sections on accommodation, lifestyle, food and transport etc., and 60% takes an in-depth look at studying business, featuring students and academics talking about issues such as assessment, academic writing and working in groups. This paper outlines the process of developing the DVD and the range of issues addressed.

The effectiveness of literalism-symbolism in business-to-business advertising

A basic element in advertising strategy is the choice of an appeal. In business-to-business (B2B) marketing communication, a long-standing approach relies on literal and factual, benefit-laden messages. Given the highly complex, costly and involved processes of business purchases, such approaches are certainly understandable. This project challenges the traditional B2B approach and asks if an alternative approach—using symbolic messages that operate at a more intrinsic or emotional level—is effective in the B2B arena. As an alternative to literal (factual) messages, there is an emerging body of literature that asserts stronger, more enduring results can be achieved through symbolic messages (imagery or text) in an advertisement. The present study contributes to this stream of research. From a theoretical standpoint, the study explores differences in literal-symbolic message content in B2B advertisements. There has been much discussion—mainly in the consumer literature—on the ability of symbolic messages to motivate a prospect to process advertising information by necessitating more elaborate processing and comprehension. Business buyers are regarded as less receptive to indirect or implicit appeals because their purchase decisions are based on direct evidence of product superiority. It is argued here, that these same buyers may be equally influenced by advertising that stimulates internally-directed motivation, feelings and cognitions about the brand. Thus far, studies on the effect of literalism and symbolism are fragmented, and few focus on the B2B market. While there have been many studies about the effects of symbolism no adequate scale exists to measure the continuum of literalism-symbolism. Therefore, a first task for this study was to develop such a scale. Following scale development, content analysis of 748 B2B print advertisements was undertaken to investigate whether differences in literalism-symbolism led to higher advertising performance. Variations of time and industry were also measured. From a practical perspective, the results challenge the prevailing B2B practice of relying on literal messages. While definitive support was not established for the use of symbolic message content, literal messages also failed to predict advertising performance. If the ‘fact, benefit laden’ assumption within B2B advertising cannot be supported, then other approaches used in the business-to-consumer (B2C) sector, such as symbolic messages may be also appropriate in business markets. Further research will need to test the potential effects of such messages, thereby building a revised foundation that can help drive advances in B2B advertising. Finally, the study offers a contribution to the growing body of knowledge on symbolism in advertising. While the specific focus of the study relates to B2B advertising, the Literalism-Symbolism scale developed here provides a reliable measure to evaluate literal and symbolic message content in all print advertisements. The value of this scale to advance our understanding about message strategy may be significant in future consumer and business advertising research.

Media skills for daily life : designing a journalism programme for graduates of all disciplines

This article in the journalism education field reports on the construction of a new subject as part of a postgraduate coursework degree. The subject, or unit1 will offer both Journalism students and other students an intro¬ductory experience of creating media, using common ‘new media’ tools, with exercises that will model the learning of communication principles through practice. It has been named ‘Fundamental Media Skills for the Workplace’. The conceptualisation and teaching of it will be characteristic of the Journalism academic discipline that uses the ‘inside perspective’—understanding mass media by observing from within. Proposers for the unit within the Journalism discipline have sought to extend the common teaching approach, based on training to produce start-ready recruits for media jobs, backed by a study of contexts, e.g. journalistic ethics, or media audiences. In this proposal, students would then examine the process to elicit additional knowledge about their learning. The article draws on literature of journalism and its pedagogy, and on communication generally. It also documents a ‘community of practice’ exercise conducted among practitioners as teachers for the subject, developing exercises and models of media work. A preliminary conclusion from that exercise is that it has taken a step towards enhancing skills-based learning for media work.

Scaffolding large units for small group collaborative learning : a case study.

Undergraduates working in teams can be a problematic endeavour, sometimes exacerbated for the student by poor prior experiences, a predisposition to an individual orientation of assessment, and simply the busyness that now typifies the life of a student. But effort in pedagogical design is worthwhile where team work is often a prerequisite in terms of graduate capabilities, robust learning, increased motivation, and indeed in terms of equipping individuals for emergent knowledge-age work practice, often epitomised by collaborative effort in both blended and virtual contexts. Through an iterative approach, based extensively on the established literature, we have developed a successful scaffold which is workable with a large cohort group (n >800), such that it affords students the lived experience of being a part of a learning network. Individuals within teams work together, to develop individual components that are subsequently aggregated and reified to an overall team knowledge artefact. We describe our case and propose a pedagogical model of scaffolding based on three perspectives: conceptual, rule-based and community-driven. This model provides designers with guidelines for producing and refining assessment tasks for team-based learning.

Vatkst, profit og strategisk orienteering i gazellevirksomheder (Growth, profitability and strategic orientation among gazelle firms)

Growth and profitability are often essential parts of the overall managerial goals of firms. High growth can be seen as an indicator of success and as a mean for achieving competitive advantage and higher profitability. But high growth can also lead to a number of managerial and organisational challenges, that may affect the profitability negatively. The aim of this article is to analyse the relationship between growth and profitability for Danish gazelle firms, and furthermore to investigate how the strategic orientation of the firm affects this relationship. Our study finds a clear positive relationship between growth and profitability among gazelle firms pursuing a broad market strategy. A managerial implication of this is that the growth strategy should be clearly integrated with the general strategic orientation of the firm.

The legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment : Part 1 (New South Wales)

This is the first article in a series of three that examines the legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment from adults who lack capacity. This article considers the position in New South Wales. A review of the law in this State reveals that medical professionals play significant legal roles in these decisions. However, the law is problematic in a number of respects and this is likely to impede medical professionals’ legal knowledge in this area. The article examines the level of training medical professionals receive on issues such as advance directives and substitute decision-making, and the available empirical evidence as to the state of medical professionals’ knowledge of the law at the end of life. It concludes that there are gaps in legal knowledge and that law reform is needed in New South Wales.

The legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment : Part 2 (Queensland)

This is the second article in a series of three that examines the legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment from adults who lack capacity. This article considers the position in Queensland, including the parens patriae jurisdiction of the Supreme Court. A review of the law in this State reveals that medical professionals play significant legal roles in these decisions. However, the law is problematic in a number of respects and this is likely to impede medical professionals’ legal knowledge in this area. The article examines the level of training medical professionals receive on issues such as advance health directives and substitute decision-making, and the available empirical evidence as to the state of medical professionals’ knowledge of the law at the end of life. It concludes that there are gaps in legal knowledge and that law reform is needed in Queensland.

Non-invasive assessment of tear film surface quality

The tear film plays an important role preserving the health of the ocular surface and maintaining the optimal refractive power of the cornea. Moreover dry eye syndrome is one of the most commonly reported eye health problems. This syndrome is caused by abnormalities in the properties of the tear film. Current clinical tools to assess the tear film properties have shown certain limitations. The traditional invasive methods for the assessment of tear film quality, which are used by most clinicians, have been criticized for the lack of reliability and/or repeatability. A range of non-invasive methods of tear assessment have been investigated, but also present limitations. Hence no “gold standard” test is currently available to assess the tear film integrity. Therefore, improving techniques for the assessment of the tear film quality is of clinical significance and the main motivation for the work described in this thesis. In this study the tear film surface quality (TFSQ) changes were investigated by means of high-speed videokeratoscopy (HSV). In this technique, a set of concentric rings formed in an illuminated cone or a bowl is projected on the anterior cornea and their reflection from the ocular surface imaged on a charge-coupled device (CCD). The reflection of the light is produced in the outer most layer of the cornea, the tear film. Hence, when the tear film is smooth the reflected image presents a well structure pattern. In contrast, when the tear film surface presents irregularities, the pattern also becomes irregular due to the light scatter and deviation of the reflected light. The videokeratoscope provides an estimate of the corneal topography associated with each Placido disk image. Topographical estimates, which have been used in the past to quantify tear film changes, may not always be suitable for the evaluation of all the dynamic phases of the tear film. However the Placido disk image itself, which contains the reflected pattern, may be more appropriate to assess the tear film dynamics. A set of novel routines have been purposely developed to quantify the changes of the reflected pattern and to extract a time series estimate of the TFSQ from the video recording. The routine extracts from each frame of the video recording a maximized area of analysis. In this area a metric of the TFSQ is calculated. Initially two metrics based on the Gabor filter and Gaussian gradient-based techniques, were used to quantify the consistency of the pattern’s local orientation as a metric of TFSQ. These metrics have helped to demonstrate the applicability of HSV to assess the tear film, and the influence of contact lens wear on TFSQ. The results suggest that the dynamic-area analysis method of HSV was able to distinguish and quantify the subtle, but systematic degradation of tear film surface quality in the inter-blink interval in contact lens wear. It was also able to clearly show a difference between bare eye and contact lens wearing conditions. Thus, the HSV method appears to be a useful technique for quantitatively investigating the effects of contact lens wear on the TFSQ. Subsequently a larger clinical study was conducted to perform a comparison between HSV and two other non-invasive techniques, lateral shearing interferometry (LSI) and dynamic wavefront sensing (DWS). Of these non-invasive techniques, the HSV appeared to be the most precise method for measuring TFSQ, by virtue of its lower coefficient of variation. While the LSI appears to be the most sensitive method for analyzing the tear build-up time (TBUT). The capability of each of the non-invasive methods to discriminate dry eye from normal subjects was also investigated. The receiver operating characteristic (ROC) curves were calculated to assess the ability of each method to predict dry eye syndrome. The LSI technique gave the best results under both natural blinking conditions and in suppressed blinking conditions, which was closely followed by HSV. The DWS did not perform as well as LSI or HSV. The main limitation of the HSV technique, which was identified during the former clinical study, was the lack of the sensitivity to quantify the build-up/formation phase of the tear film cycle. For that reason an extra metric based on image transformation and block processing was proposed. In this metric, the area of analysis was transformed from Cartesian to Polar coordinates, converting the concentric circles pattern into a quasi-straight lines image in which a block statistics value was extracted. This metric has shown better sensitivity under low pattern disturbance as well as has improved the performance of the ROC curves. Additionally a theoretical study, based on ray-tracing techniques and topographical models of the tear film, was proposed to fully comprehend the HSV measurement and the instrument’s potential limitations. Of special interested was the assessment of the instrument’s sensitivity under subtle topographic changes. The theoretical simulations have helped to provide some understanding on the tear film dynamics, for instance the model extracted for the build-up phase has helped to provide some insight into the dynamics during this initial phase. Finally some aspects of the mathematical modeling of TFSQ time series have been reported in this thesis. Over the years, different functions have been used to model the time series as well as to extract the key clinical parameters (i.e., timing). Unfortunately those techniques to model the tear film time series do not simultaneously consider the underlying physiological mechanism and the parameter extraction methods. A set of guidelines are proposed to meet both criteria. Special attention was given to a commonly used fit, the polynomial function, and considerations to select the appropriate model order to ensure the true derivative of the signal is accurately represented. The work described in this thesis has shown the potential of using high-speed videokeratoscopy to assess tear film surface quality. A set of novel image and signal processing techniques have been proposed to quantify different aspects of the tear film assessment, analysis and modeling. The dynamic-area HSV has shown good performance in a broad range of conditions (i.e., contact lens, normal and dry eye subjects). As a result, this technique could be a useful clinical tool to assess tear film surface quality in the future.

Evolutionary biology of Gondwanan non-biting midges (Diptera: Chironomidae)

The potential restriction to effective dispersal and gene flow caused by habitat fragmentation can apply to multiple levels of evolutionary scale; from the fragmentation of ancient supercontinents driving diversification and speciation on disjunct landmasses, to the isolation of proximate populations as a result of their inability to cross intervening unsuitable habitat. Investigating the role of habitat fragmentation in driving diversity within and among taxa can thus include inferences of phylogenetic relationships among taxa, assessments of intraspecific phylogeographic structure and analyses of gene flow among neighbouring populations. The proposed Gondwanan clade within the chironomid (non-biting midge) subfamily Orthocladiinae (Diptera: Chironomidae) represents a model system for investigating the role that population fragmentation and isolation has played at different evolutionary scales. A pilot study by Krosch et al (2009) indentified several highly divergent lineages restricted to ancient rainforest refugia and limited gene flow among proximate sites within a refuge for one member of this clade, Echinocladius martini Cranston. This study provided a framework for investigating the evolutionary history of this taxon and its relatives more thoroughly. Populations of E. martini were sampled in the Paluma bioregion of northeast Queensland to investigate patterns of fine-scale within- and among-stream dispersal and gene flow within a refuge more rigorously. Data was incorporated from Krosch et al (2009) and additional sites were sampled up- and downstream of the original sites. Analyses of genetic structure revealed strong natal site fidelity and high genetic structure among geographically proximate streams. Little evidence was found for regular headwater exchange among upstream sites, but there was distinct evidence for rare adult flight among sites on separate stream reaches. Overall, however, the distribution of shared haplotypes implied that both larval and adult dispersal was largely limited to the natal stream channel. Patterns of regional phylogeographic structure were examined in two related austral orthoclad taxa – Naonella forsythi Boothroyd from New Zealand and Ferringtonia patagonica Sæther and Andersen from southern South America – to provide a comparison with patterns revealed in their close relative E. martini. Both taxa inhabit tectonically active areas of the southern hemisphere that have also experienced several glaciation events throughout the Plio-Pleistocene that are thought to have affected population structure dramatically in many taxa. Four highly divergent lineages estimated to have diverged since the late Miocene were revealed in each taxon, mirroring patterns in E. martini; however, there was no evidence for local geographical endemism, implying substantial range expansion post-diversification. The differences in pattern evident among the three related taxa were suggested to have been influenced by variation in the responses of closed forest habitat to climatic fluctuations during interglacial periods across the three landmasses. Phylogeographic structure in E. martini was resolved at a continental scale by expanding upon the sampling design of Krosch et al (2009) to encompass populations in southeast Queensland, New South Wales and Victoria. Patterns of phylogeographic structure were consistent with expectations and several previously unrecognised lineages were revealed from central- and southern Australia that were geographically endemic to closed forest refugia. Estimated divergence times were congruent with the timing of Plio-Pleistocene rainforest contractions across the east coast of Australia. This suggested that dispersal and gene flow of E. martini among isolated refugia was highly restricted and that this taxon was susceptible to the impacts of habitat change. Broader phylogenetic relationships among taxa considered to be members of this Gondwanan orthoclad group were resolved in order to test expected patterns of evolutionary affinities across the austral continents. The inferred phylogeny and estimated divergence times did not accord with expected patterns based on the geological sequence of break-up of the Gondwanan supercontinent and implied instead several transoceanic dispersal events post-vicariance. Difficulties in appropriate taxonomic sampling and accurate calibration of molecular phylogenies notwithstanding, the sampling regime implemented in the current study has been the most intensive yet performed for austral members of the Orthocladiinae and unsurprisingly has revealed both novel taxa and phylogenetic relationships within and among described genera. Several novel associations between life stages are made here for both described and previously unknown taxa. Investigating evolutionary relationships within and among members of this clade of proposed Gondwanan orthoclad taxa has demonstrated that a complex interaction between historical population fragmentation and dispersal at several levels of evolutionary scale has been important in driving diversification in this group. While interruptions to migration, colonisation and gene flow driven by population fragmentation have clearly contributed to the development and maintenance of much of the diversity present in this group, long-distance dispersal has also played a role in influencing diversification of continental biotas and facilitating gene flow among disjunct populations.

The life-history and relationships of ‘Orthocladius’ pictipennis Freeman (Diptera: Chironomidae)

The previously unknown larva and pupa of ‘Orthocladius’ pictipennis Freeman have been found, and associated by molecular means. Pharate pupae (males within pupae) allow the link to the described adult. We describe the larva and pupa, and provide short notes on the adult. The taxon is unrelated to Orthocladius – no members of this Holarctic genus are present in New Zealand – and therefore we provide a new generic name, Paulfreemania Cranston and Krosch gen. n. as well as a short discussion of relationships amongst austral Orthocladiinae.

Interactional competence in a paired speaking test : features salient to raters

Paired speaking tests are now commonly used in both high-stakes testing and classroom assessment contexts. The co-construction of discourse by candidates is regarded as a strength of paired speaking tests, as candidates have the opportunity to display a wider range of interactional competencies, including turn taking, initiating topics and engaging in extended discourse with a partner, rather than an examiner. However, the impact of the interlocutor in such jointly negotiated discourse and the implications for assessing interactional competence are areas of concern. This article reports on the features of interactional competence that were salient to four trained raters of 12 paired speaking tests through the analysis of rater notes, stimulated verbal recalls and rater discussions. Findings enabled the identification of features of the performance noted by raters when awarding scores for interactional competence, and the particular features associated with higher and lower scores. A number of these features were seen by the raters as mutual achievements, which raises the issue of the extent to which it is possible to assess individual contributions to the co-constructed performance. The findings have implications for defining the construct of interactional competence in paired speaking tests and operationalising this in rating scales.

The legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment : part 3 (Victoria)

This is the final article in a series of three that examines the legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment from adults who lack capacity. This article considers the position in Victoria. A review of the law in this State reveals that medical professionals play significant legal roles in these decisions. However, the law is problematic in a number of respects and this is likely to impede medical professionals’ legal knowledge in this area. The article examines the level of training that medical professionals receive on issues such as refusal of treatment certificates and substitute decision-making, and the available empirical evidence as to the state of medical professionals’ knowledge of the law at the end of life. It concludes that there are gaps in legal knowledge and that law reform is needed in Victoria. The article also draws together themes from the series as a whole, including conclusions about the need for more and better medical education and about law reform generally.

Development and pilot test of a peer-support based Cardiac-Diabetes Self-Management program : a study protocol

Background: People with cardiac disease and type 2 diabetes have higher hospital readmission rates (22%)compared to those without diabetes (6%). Self-management is an effective approach to achieve better health outcomes; however there is a lack of specifically designed programs for patients with these dual conditions. This project aims to extend the development and pilot test of a Cardiac-Diabetes Self-Management Program incorporating user-friendly technologies and the preparation of lay personnel to provide follow-up support. Methods/Design: A randomised controlled trial will be used to explore the feasibility and acceptability of the Cardiac-Diabetes Self-Management Program incorporating DVD case studies and trained peers to provide follow-up support by telephone and text-messaging. A total of 30 cardiac patients with type 2 diabetes will be randomised, either to the usual care group, or to the intervention group. Participants in the intervention group will received the Cardiac-Diabetes Self-Management Program in addition to their usual care. The intervention consists of three faceto- face sessions as well as telephone and text-messaging follow up. The face-to-face sessions will be provided by a trained Research Nurse, commencing in the Coronary Care Unit, and continuing after discharge by trained peers. Peers will follow up patients for up to one month after discharge using text messages and telephone support. Data collection will be conducted at baseline (Time 1) and at one month (Time 2). The primary outcomes include self-efficacy, self-care behaviour and knowledge, measured by well established reliable tools. Discussion: This paper presents the study protocol of a randomised controlled trial to pilot evaluates a Cardiac- Diabetes Self-Management program, and the feasibility of incorporating peers in the follow-ups. Results of this study will provide directions for using such mode in delivering a self-management program for patients with both cardiac condition and diabetes. Furthermore, it will provide valuable information of refinement of the intervention program.

HyperCard test engine using Rasch Analysis

This paper will focus on the development of an interactive test engine using Rasch analysis of item responses for question selection and reporting of results. The Rasch analysis is used to determine student ability and question difficulty. This model is widely used in the preparation of paper-based tests and has been the subject of particular use and development at the Australian Council for Education Research (ACER). This paper presents an overview of an interactive implementation of the Rasch analysis model in HyperCard, where student ability estimates are generated 'on the fly' and question difficulty values updated from time to time. The student ability estimates are used to determine question selection and are the basis of scoring and reporting schemes.