A randomised controlled trial to prevent hospital readmissions and loss of functional ability in high risk older adults: a study protocol

Background Older people have higher rates of hospital admission than the general population and higher rates of readmission due to complications and falls. During hospitalisation, older people experience significant functional decline which impairs their future independence and quality of life. Acute hospital services comprise the largest section of health expenditure in Australia and prevention or delay of disease is known to produce more effective use of services. Current models of discharge planning and follow-up care, however, do not address the need to prevent deconditioning or functional decline. This paper describes the protocol of a randomised controlled trial which aims to evaluate innovative transitional care strategies to reduce unplanned readmissions and improve functional status, independence, and psycho-social well-being of community-based older people at risk of readmission. Methods/Design The study is a randomised controlled trial. Within 72 hours of hospital admission, a sample of older adults fitting the inclusion/exclusion criteria (aged 65 years and over, admitted with a medical diagnosis, able to walk independently for 3 meters, and at least one risk factor for readmission) are randomised into one of four groups: 1) the usual care control group, 2) the exercise and in-home/telephone follow-up intervention group, 3) the exercise only intervention group, or 4) the in-home/telephone follow-up only intervention group. The usual care control group receive usual discharge planning provided by the health service. In addition to usual care, the exercise and in-home/telephone follow-up intervention group receive an intervention consisting of a tailored exercise program, in-home visit and 24 week telephone follow-up by a gerontic nurse. The exercise only and in-home/telephone follow-up only intervention groups, in addition to usual care receive only the exercise or gerontic nurse components of the intervention respectively. Data collection is undertaken at baseline within 72 hours of hospital admission, 4 weeks following hospital discharge, 12 weeks following hospital discharge, and 24 weeks following hospital discharge. Outcome assessors are blinded to group allocation. Primary outcomes are emergency hospital readmissions and health service use, functional status, psychosocial well-being and cost effectiveness. Discussion The acute hospital sector comprises the largest component of health care system expenditure in developed countries, and older adults are the most frequent consumers. There are few trials to demonstrate effective models of transitional care to prevent emergency readmissions, loss of functional ability and independence in this population following an acute hospital admission. This study aims to address that gap and provide information for future health service planning which meets client needs and lowers the use of acute care services.

Tracheobronchial and alveolar dose of submicrometer particles for different population age groups in Italy

Exposure to ultrafine particles (diameter less than 100 nm) is an important topic in epidemiological and toxicological studies. This study used the average particle number size distribution data obtained from our measurement survey in major micro-environments, together with the people activity pattern data obtained from the Italian Human Activity Pattern Survey to estimate the tracheobronchial and alveolar dose of submicrometer particles for different population age groups in Italy. We developed a numerical methodology based on Monte Carlo method, in order to estimate the best combination from a probabilistic point of view. More than 106 different cases were analyzed according to a purpose built sub-routine and our results showed that the daily alveolar particle number and surface area deposited for all of the age groups considered was equal to 1.5 x 1011 particles and 2.5 x 1015 m2, respectively, varying slightly for males and females living in Northern or Southern Italy. In terms of tracheobronchial deposition, the corresponding values for daily particle number and surface area for all age groups was equal to 6.5 x 1010 particles and 9.9 x 1014 m2, respectively. Overall, the highest contributions were found to come from indoor cooking (female), working time (male) and transportation (i.e. traffic derived particles) (children).

Risk of metabolic syndrome among children living in metropolitan Kuala Lumpur: A case control study

Background With the increasing prevalence of childhood obesity, the metabolic syndrome has been studied among children in many countries but not in Malaysia. Hence, this study aimed to compare metabolic risk factors between overweight/obese and normal weight children and to determine the influence of gender and ethnicity on the metabolic syndrome among school children aged 9-12 years in Kuala Lumpur and its metropolitan suburbs. Methods A case control study was conducted among 402 children, comprising 193 normal-weight and 209 overweight/obese. Weight, height, waist circumference (WC) and body composition were measured, and WHO (2007) growth reference was used to categorise children into the two weight groups. Blood pressure (BP) was taken, and blood was drawn after an overnight fast to determine fasting blood glucose (FBG) and full lipid profile, including triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC). International Diabetes Federation (2007) criteria for children were used to identify metabolic syndrome. Results Participants comprised 60.9% (n = 245) Malay, 30.9% (n = 124) Chinese and 8.2% (n = 33) Indian. Overweight/obese children showed significantly poorer biochemical profile, higher body fat percentage and anthropometric characteristics compared to the normal-weight group. Among the metabolic risk factors, WC ≥90th percentile was found to have the highest odds (OR = 189.0; 95%CI 70.8, 504.8), followed by HDL-C≤1.03 mmol/L (OR = 5.0; 95%CI 2.4, 11.1) and high BP (OR = 4.2; 95%CI 1.3, 18.7). Metabolic syndrome was found in 5.3% of the overweight/obese children but none of the normal-weight children (p < 0.01). Overweight/obese children had higher odds (OR = 16.3; 95%CI 2.2, 461.1) of developing the metabolic syndrome compared to normal-weight children. Binary logistic regression showed no significant association between age, gender and family history of communicable diseases with the metabolic syndrome. However, for ethnicity, Indians were found to have higher odds (OR = 5.5; 95%CI 1.5, 20.5) compared to Malays, with Chinese children (OR = 0.3; 95%CI 0.0, 2.7) having the lowest odds. Conclusions We conclude that being overweight or obese poses a greater risk of developing the metabolic syndrome among children. Indian ethnicity is at higher risk compared to their counterparts of the same age. Hence, primary intervention strategies are required to prevent this problem from escalating.

Australian higher education evaluation through assurance of learning

A collaborative research project conducted by five Australian universities inquired into the philosophy and motivation for Assurance of Learning (AoL) as a process of education evaluation. Associate Deans Teaching and Learning representing Business schools from twenty-five universities across Australia participated in telephone interviews. Data was analysed using NVIVO9. Results indicated that articulated rationale for AoL was both ensuring that students had acquired the attributes and skills the universities claimed they had, and the philosophy of continuous improvement. AoL was motivated both by ritualistic objectives to satisfy accreditation requirements and virtuous agendas for quality improvement. Closing-the-loop was emphasised, but was mostly wishful thinking for next steps beyond data collection and reporting. AoL was conceptualised as one element within the larger context of quality review, but there was no evidence of comprehensive frameworks or strategic plans.

Assurance of learning – are academics and senior management singing from the same hymn sheet?

Assurance of learning (AoL) is an important process in quality education, designed to measure the accomplishment of educational aims at the core of an institution’s programs, whilst encouraging faculty to continuously develop and improve the programs and courses. This paper reports on a study of Australian business schools to investigate current AoL practices through semi structured interviews with senior faculty leaders followed by focus group interviews with groups of senior program leaders and groups of academic teaching staff. Initial findings indicate there are significant challenges in encouraging academic staff to commit to the process and recognise the benefits of assuring learning. The differences in understanding between the various leaders and the academics were highlighted through the different focus groups. Leaders’ stressed strategic issues such as staff engagement and change, while academics focussed on process issues such as teaching graduate attributes and external accreditation. Understanding the differences in the perspectives of leaders and faculty is important, as without a shared understanding between the two groups, there is likely to be limited engagement, which creates difficulties in developing effective assurance of learning processes. Findings indicate that successful strategies developed to foster shared values on assurance of learning include: strong senior leaders’ commitment; developing champions among program and unit level staff; providing professional development opportunities; promoting and celebrating success and effectiveness; and ensuring an inclusive process with academics of all levels collaborating in the development and implementation of the process.

Monocular amblyopia and higher order aberrations

This study compared the corneal and total higher order aberrations between the fellow eyes in monocular amblyopia. Nineteen amblyopic subjects (8 refractive and 11 strabismic) (mean age 30 ± 11 years) were recruited. A range of biometric and optical measurements were collected from the amblyopic and non-amblyopic eye including; axial length, corneal topography and total higher order aberrations. For a sub-group of eleven non-presbyopic subjects (6 refractive and 5 strabismic amblyopes, mean age 29 ± 10 years) total higher order aberrations were also measured during accommodation (2.5 D stimuli). Amblyopic eyes were significantly shorter and more hyperopic compared to non-amblyopic eyes and the interocular difference in axial length correlated with both the magnitude of anisometropia and amblyopia (both p < 0.01). Significant differences in higher order aberrations were observed between fellow eyes, which varied with the type of amblyopia. Refractive amblyopes displayed higher levels of 4th order corneal aberrations C(4, 0)(spherical aberration), C(4, 2)(secondary astigmatism 90°) and C(4, −2)(secondary astigmatism along 45°) in the amblyopic eye compared to the non-amblyopic eye. Strabismic amblyopes exhibited significantly higher levels of C(3, 3)(trefoil) in the amblyopic eye for both corneal and total higher order aberrations. During accommodation, the amblyopic eye displayed a significantly greater lag of accommodation compared to the non-amblyopic eye, while the changes in higher order aberrations were similar in magnitude between fellow eyes. Asymmetric visual experience during development appears to be associated with asymmetries in higher order aberrations, in some cases proportional to the magnitude of anisometropia and dependent upon the amblyogenic factor.

The increased popularity of mopeds and motor scooters : exploring usage patterns and safety outcomes

Increased use of powered two-wheelers (PTWs) often underlies increases in the number of reported crashes, promoting research into PTW safety. PTW riders are overrepresented in crash and injury statistics relative to exposure and, as such, are considered vulnerable road users. PTW use has increased substantially over the last decade in many developed countries. One such country is Australia, where moped and scooter use has increased at a faster rate than motorcycle use in recent years. Increased moped use is particularly evident in the State of Queensland which is one of four Australian jurisdictions where moped riding is permitted for car licence holders and a motorcycle licence is not required. A moped is commonly a small motor scooter and is limited to a maximum design speed of 50 km/h and a maximum engine cylinder capacity of 50 cubic centimetres. Scooters exceeding either of these specifications are classed as motorcycles in all Australian jurisdictions. While an extensive body of knowledge exists on motorcycle safety, some of which is relevant to moped and scooter safety, the latter PTW types have received comparatively little focused research attention. Much of the research on moped safety to date has been conducted in Europe where they have been popular since the mid 20th century, while some studies have also been conducted in the United States. This research is of limited relevance to Australia due to socio-cultural, economic, regulatory and environmental differences. Moreover, while some studies have compared motorcycles to mopeds in terms of safety, no research to date has specifically examined the differences and similarities between mopeds and larger scooters, or between larger scooters and motorcycles. To address the need for a better understanding of moped and scooter use and safety, the current program of research involved three complementary studies designed to achieve the following aims: (1) develop better knowledge and understanding of moped and scooter usage trends and patterns; and (2) determine the factors leading to differences in moped, scooter and motorcycle safety. Study 1 involved six-monthly observations of PTW types in inner city parking areas of Queensland’s capital city, Brisbane, to monitor and quantify the types of PTW in use over a two year period. Study 2 involved an analysis of Queensland PTW crash and registration data, primarily comparing the police-reported crash involvement of mopeds, scooters and motorcycles over a five year period (N = 7,347). Study 3 employed both qualitative and quantitative methods to examine moped and scooter usage in two components: (a) four focus group discussions with Brisbane-based Queensland moped and scooter riders (N = 23); and (b) a state-wide survey of Queensland moped and scooter riders (N = 192). Study 1 found that of the PTW types parked in inner city Brisbane over the study period (N = 2,642), more than one third (36.1%) were mopeds or larger scooters. The number of PTWs observed increased at each six-monthly phase, but there were no significant changes in the proportions of PTW types observed across study phases. There were no significant differences in the proportions or numbers of PTW type observed by season. Study 2 revealed some important differences between mopeds, scooters and motorcycles in terms of safety and usage through analysis of crash and registration data. All Queensland PTW registrations doubled between 2001 and 2009, but there was an almost fifteen-fold increase in moped registrations. Mopeds subsequently increased as a proportion of Queensland registered PTWs from 1.2 percent to 8.8 percent over this nine year period. Moped and scooter crashes increased at a faster rate than motorcycle crashes over the five year study period from July 2003 to June 2008, reflecting their relatively greater increased usage. Crash rates per 10,000 registrations for the study period were only slightly higher for mopeds (133.4) than for motorcycles and scooters combined (124.8), but estimated crash rates per million vehicle kilometres travelled were higher for mopeds (6.3) than motorcycles and scooters (1.7). While the number of crashes increased for each PTW type over the study period, the rate of crashes per 10,000 registrations declined by 40 percent for mopeds compared with 22 percent for motorcycles and scooters combined. Moped and scooter crashes were generally less severe than motorcycle crashes and this was related to the particular crash characteristics of the PTW types rather than to the PTW types themselves. Compared to motorcycle and moped crashes, scooter crashes were less likely to be single vehicle crashes, to involve a speeding or impaired rider, to involve poor road conditions, or to be attributed to rider error. Scooter and moped crashes were more likely than motorcycle crashes to occur on weekdays, in lower speed zones and at intersections. Scooter riders were older on average (39) than moped (32) and motorcycle (35) riders, while moped riders were more likely to be female (36%) than scooter (22%) or motorcycle riders (7%). The licence characteristics of scooter and motorcycle riders were similar, with moped riders more likely to be licensed outside of Queensland and less likely to hold a full or open licence. The PTW type could not be identified in 15 percent of all cases, indicating a need for more complete recording of vehicle details in the registration data. The focus groups in Study 3a and the survey in Study 3b suggested that moped and scooter riders are a heterogeneous population in terms of demographic characteristics, riding experience, and knowledge and attitudes regarding safety and risk. The self-reported crash involvement of Study 3b respondents suggests that most moped and scooter crashes result in no injury or minor injury and are not reported to police. Study 3 provided some explanation for differences observed in Study 2 between mopeds and scooters in terms of crash involvement. On the whole, scooter riders were older, more experienced, more likely to have undertaken rider training and to value rider training programs. Scooter riders were also more likely to use protective clothing and to seek out safety-related information. This research has some important practical implications regarding moped and scooter use and safety. While mopeds and scooters are generally similar in terms of usage, and their usage has increased, scooter riders appear to be safer than moped riders due to some combination of superior skills and safer riding behaviour. It is reasonable to expect that mopeds and scooters will remain popular in Queensland in future and that their usage may further increase, along with that of motorcycles. Future policy and planning should consider potential options for encouraging moped riders to acquire better riding skills and greater safety awareness. While rider training and licensing appears an obvious potential countermeasure, the effectiveness of rider training has not been established and other options should also be strongly considered. Such options might include rider education and safety promotion, while interventions could also target other road users and urban infrastructure. Future research is warranted in regard to moped and scooter safety, particularly where the use of those PTWs has increased substantially from low levels. Research could address areas such as rider training and licensing (including program evaluations), the need for more detailed and reliable data (particularly crash and exposure data), protective clothing use, risks associated with lane splitting and filtering, and tourist use of mopeds. Some of this research would likely be relevant to motorcycle use and safety, as well as that of mopeds and scooters.

Multimodal and monomodal discourses of marketization in higher education : power, ideology, and the absence of the image

The ubiquity of multimodality in hypermedia environments is undeniable. Bezemer and Kress (2008) have argued that writing has been displaced by image as the central mode for representation. Given the current technical affordances of digital technology and user-friendly interfaces that enable the ease of multimodal design, the conspicuous absence of images in certain domains of cyberspace is deserving of critical analysis. In this presentation, I examine the politics of discourses implicit within hypertextual spaces, drawing textual examples from a higher education website. I critically examine the role of writing and other modes of production used in what Fairclough (1993) refers to as discourses of marketisation in higher education, tracing four pervasive discourses of teaching and learning in the current economy: i) materialization, ii) personalization, iii) technologisation, and iv) commodification (Fairclough, 1999). Each of these arguments is supported by the critical analysis of multimodal texts. The first is a podcast highlighting the new architectonic features of a university learning space. The second is a podcast and transcript of a university Open Day interview with prospective students. The third is a time-lapse video showing the construction of a new science and engineering precinct. These three multimodal texts contrast a final web-based text that exhibits a predominance of writing and the powerful absence or silencing of the image. I connect the weightiness of words and the function of monomodality in the commodification of discourses, and its resistance to the multimodal affordances of web-based technologies, and how this is used to establish particular sets of subject positions and ideologies through which readers are constrained to occupy. Applying principles of critical language study by theorists that include Fairclough, Kress, Lemke, and others whose semiotic analysis of texts focuses on the connections between language, power, and ideology, I demonstrate how the denial of image and the privileging of written words in the multimodality of cyberspace is an ideological effect to accentuate the dominance of the institution.

An exploratory study of ethical dilemmas faced by academic leaders in three Australian universities

Being an academic in universities today is characterised by change and increasing complexity in response to a multitude of factors impacting on the university sector. Among the consequences of such changes are that many academics, and academic leaders in particular, are subjected to both increasing stress and scrutiny in many of the decisions they make. Some of these decisions require critical choices that involve contestation of values (including personal, professional, institutional, and community), resulting in ethical dilemmas for the decisionmakers. This article reports on an exploratory study into ethical dilemmas faced by middle-level academic leaders, drawing on the results of an on-line survey distributed to relevant academics in three universities in Australia. Here, middle-level academic leaders are defined as those holding course coordination roles, locating them between senior university staff and other academics on the one hand, and students on the other hand. As a consequence, these diverse groups of staff and students potentially have an array of conflicting interests in, and expectations on, middle-level academics’ decision-making processes. The findings of the study are clear: ethical dilemmas are evident, and commonly so, for many middle-level academic leaders. While exploratory in nature, the findings of this study suggest that much more attention to ethics and ethical dilemmas is needed in our universities.

Pathways for developing a 'smart' workforce : does the achievement of formal workplace qualifications encourage participation in higher education?

The purpose of this paper is to investigate a public workforce education initiative in the context of State and agency policies designed to enhance employee capabilities to adapt to a volatile and changing environment. In particular, we are concerned with public employees’ experience of a higher educational pathway that resulted in their obtaining a Diploma level qualification. In addition to understanding the employees’ experience of this pathway we were interested in whether the experience contributed to their openness to the prospect of university level education. We conducted telephone interviews with a sample of participants from the program. Employees reported very positive experience of the program; in particular employees reported enhanced efficacy beliefs, a strong sense of achievement, and a feeling of recognition. This experience is explained by four main factors; (1) a program design that was well aligned with the employees learning needs, (2) strong support by organisational staff who delivered and assessed participants on capability criteria, (3) strong management support for employees’ participation, (4) an academic ceremony that provided participants with public recognition of their achievement by valued others. Participants’ motivation to participate was primarily intrinsic rather than extrinsic. Participants in the study reported that their experience in this educational pathway gave them the confidence to consider the possibility of university level education. The paper also discusses the practitioner-academic collaboration that led to the development of this paper.

Higher education policy in China 1992-2010 : a genealogical analysis of the enterprise university

In the context of globalisation and the knowledge economy, universities worldwide are undertaking profound restructuring. Following these pressures for reform, the entity of the "enterprise university" has emerged internationally. Characteristics of this new form of educational institution can be summarised as deploying corporate styles of governance and management in order to enhance economic competitiveness and academic prestige. The higher education sector in China is no different, as it has undergone extensive reforms particularly since the "socialist market economy" was introduced in 1992. Hence, this study aims to investigate the emergence of the enterprise university in a Chinese context. The research question is: How have discourses of globalisation manifested and constituted new forms of social and educational governance within China's higher education sector during the period 1992 to 2010? Following this research question, the study uses a genealogical methodology to conduct a critical analysis of reforms in Chinese higher education (1992 -2010). At a national level, China's higher education policy is examined using the analytical framework of governmentality. This discloses the underlying rationalities and technologies of Chinese political authorities as they seek to refashion higher education policy and practice. At a local level, a case study of a particular university in China is conducted in order to facilitate understanding of reform at the national level. The aim is to uncover the kinds of educational subjects and spaces that have been constituted in the university's efforts to reconfigure itself within the context of national higher education reform. The study found that the concept of the enterprise university in China has features shared by the one that has emerged internationally. However, the analysis showed that the emergence of the enterprise university in China has specific social, economic, political, and cultural environments which impact on local educational practices. The study is significant because it is one of the few examples where the framework of governmentality.a research approach or perspective employed largely to examine Western society.is applied in a Chinese context, which is a non-Western and non-liberal democratic site.

Bone tissue engineering : reconstruction of critical sized segmental bone defects in the ovine tibia

Well-established therapies for bone defects are restricted to bone grafts which face significant disadvantages (limited availability, donor site morbidity, insufficient integration). Therefore, the objective was to develop an alternative approach investigating the regenerative potential of medical grade polycaprolactone-tricalcium phosphate (mPCL-TCP) and silk-hydroxyapatite (silk-HA) scaffolds. Critical sized ovine tibial defects were created and stabilized. Defects were left untreated, reconstructed with autologous bone grafts (ABG) and mPCL-TCP or silk-HA scaffolds. Animals were observed for 12 weeks. X-ray analysis, torsion testing and quantitative computed tomography (CT) analyses were performed. Radiological analysis confirmed the critical nature of the defects. Full defect bridging occurred in the autograft and partial bridging in the mPCL-TCP group. Only little bone formation was observed with silk-HA scaffolds. Biomechanical testing revealed a higher torsional moment/stiffness (p < 0.05) and CT analysis a significantly higher amount of bone formation for the ABG group when compared to the silk-HA group. No significant difference was determined between the ABG and mPCL-TCP groups. The results of this study suggest that mPCL-TCP scaffolds combined can serve as an alternative to autologous bone grafting in long bone defect regeneration. The combination of mPCL-TCP with osteogenic cells or growth factors represents an attractive means to further enhance bone formation.

The effectiveness of a four layer compression bandage system in comparison to Class 3 compression hosiery on healing and quality of life for patients with venous leg ulcers : a randomised controlled trial

There are an increasing number of compression systems available for treatment of venous leg ulcers and limited evidence on the relative effectiveness of these systems. The purpose of this study was to conduct a randomised controlled trial to compare the effectiveness of a 4-layer compression bandage system with Class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers. Data were collected from 103 participants on demographics, health, ulcer status, treatments, pain, depression and quality of life for 24 weeks. After 24 weeks, 86% of the 4-layer bandage group and 77% of the hosiery group were healed (p=0.24). Median time to healing for the bandage group was 10 weeks, in comparison to 14 weeks for the hosiery group (p=0.018). Cox proportional hazards regression found participants in the 4-layer system were 2.1 times (95% CI 1.2–3.5) more likely to heal than those in hosiery, while longer ulcer duration, larger ulcer area and higher depression scores significantly delayed healing. No differences between groups were found in quality of life or pain measures. Findings indicate these systems were equally effective in healing patients by 24 weeks, however a 4-layer system may produce a more rapid response.

Cultural impact on e-service use in Saudi Arabia : results from focus groups

This paper reports the results of focus groups obtained as part of a full study that uses a mixed method approach to answer the following question: what are the cultural values that impact on e-service use in Saudi Arabia? In order to answer this question we reviewed culture theories, dimensions, and models that have been identified in the literature. Four focus groups interviewing experts and general users (customers) of online services in Saudi Arabia have been completed aiming at the end to identify the uncovered elements of Saudi culture in the literature, which hopefully will result in developing a framework of cultural values that affect e-service use in Saudi context. This paper will firstly, introduce the importance of culture and define the aspects of Saudi culture. It will then describe the method used, and finally discussing the findings of the focus groups. Findings revealed four factors that have not been covered in the literature and need to be investigated namely: nepotism, the lack of human interaction, services oriented culture, and the career path.