A stepped-wedge cluster randomised controlled trial for evaluating rates of falls among inpatients in aged care rehabilitation units receiving tailored multimedia education in addition to usual care : a trial protocol

Introduction Falls are the most frequent adverse event reported in hospitals. Approximately 30% of in-hospital falls lead to an injury and up to 2% result in a fracture. A large randomised trial found that a trained health professional providing individualised falls prevention education to older inpatients reduced falls in a cognitively intact subgroup. This study aims to investigate whether this efficacious intervention can reduce falls and be clinically useful and cost-effective when delivered in the real-life clinical environment. Methods A stepped-wedge cluster randomised trial will be used across eight subacute units (clusters) which will be randomised to one of four dates to start the intervention. Usual care on these units includes patient's screening, assessment and implementation of individualised falls prevention strategies, ongoing staff training and environmental strategies. Patients with better levels of cognition (Mini-Mental State Examination >23/30) will receive the individualised education from a trained health professional in addition to usual care while patient's feedback received during education sessions will be provided to unit staff. Unit staff will receive training to assist in intervention delivery and to enhance uptake of strategies by patients. Falls data will be collected by two methods: case note audit by research assistants and the hospital falls reporting system. Cluster-level data including patient's admissions, length of stay and diagnosis will be collected from hospital systems. Data will be analysed allowing for correlation of outcomes (clustering) within units. An economic analysis will be undertaken which includes an incremental cost-effectiveness analysis. Ethics and dissemination The study was approved by The University of Notre Dame Australia Human Research Ethics Committee and local hospital ethics committees. Results The results will be disseminated through local site networks, and future funding and delivery of falls prevention programmes within WA Health will be informed. Results will also be disseminated through peer-reviewed publications and medical conferences.

Networked identity work as project development among co-creative communities

Networked identity work is the conscious negotiation or co-creation of identity, enacted by speaking and listening across differences among multiple publics, including those real and imagined, familiar and unknown, on and offline, present and future. It is a concept I explore extensively in research with queer Digital Storytellers who share their personal stories in public places to catalyse social change (Vivienne 2013). In this article I consider distinctions between ‘story’ and ‘identity’; ‘networking’ and ‘networked identity work’ and argue that the two concepts may be usefully employed in development of co-creative community projects. Finally I consider how variable definitions of co-creativity influence project development.

WATER - a series of photographs by Louise Grayson

This body of photographic work has been created to firstly, explore a new approach to practice-led research that uses an “action genre” approach to reflective practice (Lemke) and secondly, to visually explore human interaction with the fundamental item in life - water. The first of these is based on the contention that to understand the meanings inherent in photographs we cannot look merely at the end result. It is essential to keep looking at the actions of practitioners, and the influences upon them, to determine how external influences affect the meaning potential of editorial photographs (Grayson, 2012). WATER therefore, provides an ideal platform to reflect upon the actions and influences involved in creating work within the photographic genre of photojournalism. It enables this practitioner to reflect on each stage of production to gain a better understanding of how external influences impact the narrative potential within images created. There are multi-faceted influences experienced by photographers who are creating images that, in turn, are part of constructing and presenting the narrative potential of editorial photographs. There is an important relationship between professional photographers and the technical, cultural, economic and institutional forces that impinge upon all stages of production and publication. What results is a greater understanding of technical, cultural, economic and institutional forces that impinge upon all stages of production and publication. Therefore, to understand the meanings inherent in photographs within WATER, I do not look merely at the end result. It provides a case study looking at my actions in the filed, and the influences upon me, to determine how external influences affect the meaning potential of these photographs (Grayson, 2012). As a result, this project adds to the body of scholarship around the definition of Photojournalism, how it has adapted to the current media environment and provides scope for further research into emerging new genres within editorial photography, such as citizen photojournalism. Concurrently, the photographs themselves were created to visually explore how there remains a humanistic desire to interact with the natural form of water even while living a modern cosmopolitan life around it. Taking a photojournalistic approach to exploring this phenomenon, the images were created by “capturing moments as they happened” with no posing or setting up of images. This serendipitous approach to the photographic medium provides the practitioner with at least an attempt to direct the subjectivity contained explicitly in photographs. What results is a series of images that extend the visual dialogue around the role of water within modern humanistic lifestyles and how it remains an integral part of our society’s behaviors. It captures important moments that document this relationship at this time of modern development. The resulting works were exhibited and published as part of the Head On Photo Festival, Australia's largest photo festival and the world's second largest festival in Sydney 20-24 May 2013. The WATER series of images were curated by three Magnum members; Ian Berry, Eli Reed and Chris Steele-Perkins. Magnum is a highly regarded international photographic co-operative with editorial offices in New York, London, Paris and Tokyo. There was a projection of the works as part of the official festival programme, presented to both members of the public and Sydney’s photography professionals. In addition, a sample of images from the WATER series was chosen for inclusion in the Magnum-published hardcover book. References Grayson, Louise. 2012. “Editorial photographs and patterns of practice.” Journalism Practice. Accessed: http://www.tandfonline.com/doi/abs/10.1080/17512786.2012.726836#.UbZN-L--1RQ Lemke, Jay. 1995. Textual Politics: Discourse and Social Dynamics. London: Taylor & Francis.

Exploring pedestrian accessibility and walkability : insight from public place observations in inner-urban higher density Brisbane, Australia

As planners work to create more sustainable and liveable urban environments, a priority is to transition away from prioritising the automobile and towards enhancing the pedestrian experience. Thus, this research explores the experience of pedestrian accessibility in inner-urban higher-density Brisbane in Australia, drawing on findings from semi-structured in-depth interviews with 24 residents and over 100 hours of public place observations in three case-study neighbourhoods. The interviews took place in residents homes and explored their experience of higher density living and their neighbourhood, whilst observations were recorded through a combination of methods including photographs, sketch maps, recordings and field journals. Observation locations included retail and commercial space, roads, parkland and open space, with multiple observations at each location. A thematic analysis identified common themes in both interviews and the observations, with this paper focusing on residents’ lived experience in urban built environments. This analysis revealed that pedestrian accessibility is linked to access to local amenities and direct routes, aesthetics, sense of community, ownership of space and safety. In particular, observations revealed how pedestrian accessibility and route-taking works with, against or in spite of the design features of urban environments, as well as the importance of the social use of the built environment. Residents spoke about although walking quick and preferred for local amenities, the decision to walk was moderated by factors such as time of day and perceived safety. Measures to ensure and improve the pedestrian accessibility of urban areas needs to take into account the propensity for people to prefer and improvise direct routes (often to the detriment of traffic safety considerations), the importance of ongoing maintenance and upgrading of walking infrastructure and the importance of aesthetically pleasing and safe walking environments. By combining interviews and observations, this research highlights the current dominance of the automobile culture in Brisbane and the layers of meaning, experiences and complexity hidden within the pedestrian experience.

Control strategies to prevent total hip replacement-related infections : a systematic review and mixed treatment comparison

OBJECTIVE: To synthesise the available evidence and estimate the comparative efficacy of control strategies to prevent total hip replacement (THR)-related surgical site infections (SSIs) using a mixed treatment comparison. DESIGN: Systematic review and mixed treatment comparison. SETTING: Hospital and other healthcare settings. PARTICIPANTS: Patients undergoing THR. PRIMARY AND SECONDARY OUTCOME MEASURES: The number of THR-related SSIs occurring following the surgical operation. RESULTS: 12 studies involving 123 788 THRs and 9 infection control strategies were identified. The strategy of 'systemic antibiotics+antibiotic-impregnated cement+conventional ventilation' significantly reduced the risk of THR-related SSI compared with the referent strategy (no systemic antibiotics+plain cement+conventional ventilation), OR 0.13 (95% credible interval (CrI) 0.03-0.35), and had the highest probability (47-64%) and highest median rank of being the most effective strategy. There was some evidence to suggest that 'systemic antibiotics+antibiotic-impregnated cement+laminar airflow' could potentially increase infection risk compared with 'systemic antibiotics+antibiotic-impregnated cement+conventional ventilation', 1.96 (95% CrI 0.52-5.37). There was no high-quality evidence that antibiotic-impregnated cement without systemic antibiotic prophylaxis was effective in reducing infection compared with plain cement with systemic antibiotics, 1.28 (95% CrI 0.38-3.38). CONCLUSIONS: We found no convincing evidence in favour of the use of laminar airflow over conventional ventilation for prevention of THR-related SSIs, yet laminar airflow is costly and widely used. Antibiotic-impregnated cement without systemic antibiotics may not be effective in reducing THR-related SSIs. The combination with the highest confidence for reducing SSIs was 'systemic antibiotics+antibiotic-impregnated cement+conventional ventilation'. Our evidence synthesis underscores the need to review current guidelines based on the available evidence, and to conduct further high-quality double-blind randomised controlled trials to better inform the current clinical guidelines and practice for prevention of THR-related SSIs.

The idea of women : representations of power in the work of Charles Bukowski

This thesis is a comparative textual analysis of Charles Bukowski's representations of power in relation to the idea of women. The exegesis explores Bukowski's idea of women and power as exemplified by the representational differences between his short stories for Hustler Magazine and his novel Women. The creative piece, a novel, "Many a Broken Hearted Woman" informed and was informed by this research.

Spatial metaphor as spatial technique in the work of Michel Foucault

This essay argues that the deployment of spatial metaphor in the writing of Michel Foucault is indivisible from his spatial politics. Beginning with his 1967 essay "Of Other Spaces," the development of Foucault's spatial politics and his growing awareness of the importance to his work of spatial (particularly geographic) metaphors can be charted. The focus here is not the concretisation of Foucault's early spatial obsessions—particularly with regard to the concept of "heterotopia"—into a theory or model. Rather, I am concerned with the way in which those obsessions inform Foucault's major works, in particular The Archaeology of Knowledge and Discipline and Punish. These works, I argue, do not develop a theory of space, but instead perform, through their rhetoric, a kind of spatial praxis. In this sense, Foucault's metaphors become "spatial techniques" for the practice and production of power–knowledge.

Climate change and children’s health : a call for research on what works to protect children

Climate change is affecting and will increasingly influence human health and wellbeing. Children are particularly vulnerable to the impact of climate change. An extensive literature review regarding the impact of climate change on children’s health was conducted in April 2012 by searching electronic databases PubMed, Scopus, ProQuest, ScienceDirect, and Web of Science, as well as relevant websites, such as IPCC and WHO. Climate change affects children’s health through increased air pollution, more weather-related disasters, more frequent and intense heat waves, decreased water quality and quantity, food shortage and greater exposure to toxicants. As a result, children experience greater risk of mental disorders, malnutrition, infectious diseases, allergic diseases and respiratory diseases. Mitigation measures like reducing carbon pollution emissions, and adaptation measures such as early warning systems and post-disaster counseling are strongly needed. Future health research directions should focus on: (1) identifying whether climate change impacts on children will be modified by gender, age and socioeconomic status; (2) refining outcome measures of children’s vulnerability to climate change; (3) projecting children’s disease burden under climate change scenarios; (4) exploring children’s disease burden related to climate change in low-income countries, and ; (5) identifying the most cost-effective mitigation and adaptation actions from a children’s health perspective.

The impact of funding deadlines on personal workloads, stress and family relationships : a qualitative study of Australian researchers

Objective To examine the impact of applying for funding on personal workloads, stress and family relationships. Design Qualitative study of researchers preparing grant proposals. Setting Web-based survey on applying for the annual National Health and Medical Research Council (NHMRC) Project Grant scheme. Participants Australian researchers (n=215). Results Almost all agreed that preparing their proposals always took top priority over other work (97%) and personal (87%) commitments. Almost all researchers agreed that they became stressed by the workload (93%) and restricted their holidays during the grant writing season (88%). Most researchers agreed that they submitted proposals because chance is involved in being successful (75%), due to performance requirements at their institution (60%) and pressure from their colleagues to submit proposals (53%). Almost all researchers supported changes to the current processes to submit proposals (95%) and peer review (90%). Most researchers (59%) provided extensive comments on the impact of writing proposals on their work life and home life. Six major work life themes were: (1) top priority; (2) career development; (3) stress at work; (4) benefits at work; (5) time spent at work and (6) pressure from colleagues. Six major home life themes were: (1) restricting family holidays; (2) time spent on work at home; (3) impact on children; (4) stress at home; (5) impact on family and friends and (6) impact on partner. Additional impacts on the mental health and well-being of researchers were identified. Conclusions The process of preparing grant proposals for a single annual deadline is stressful, time consuming and conflicts with family responsibilities. The timing of the funding cycle could be shifted to minimise applicant burden, give Australian researchers more time to work on actual research and to be with their families.

A threshold concepts focus to curriculum design: supporting student learning through application of variation theory

This project develops and evaluates a model of curriculum design that aims to assist student learning of foundational disciplinary ‘Threshold Concepts’. The project uses phenomenographic action research, cross-institutional peer collaboration and the Variation Theory of Learning to develop and trial the model. Two contrasting disciplines (Physics and Law) and four institutions (two research-intensive and two universities of technology) were involved in the project, to ensure broad applicability of the model across different disciplines and contexts. The Threshold Concepts that were selected for curriculum design attention were measurement uncertainty in Physics and legal reasoning in Law. Threshold Concepts are key disciplinary concepts that are inherently troublesome, transformative and integrative in nature. Once understood, such concepts transform students’ views of the discipline because they enable students to coherently integrate what were previously seen as unrelated aspects of the subject, providing new ways of thinking about it (Meyer & Land 2003, 2005, 2006; Land et al. 2008). However, the integrative and transformative nature of such threshold concepts make them inherently difficult for students to learn, with resulting misunderstandings of concepts being prevalent...

Free-riding, cooperation, and 'peaceful revolutions' in copyright

Modern copyright law is based on the inescapable assumption that users, given the choice, will free-ride rather than pay for access. In fact, many consumers of cultural works – music, books, films, games, and other works – fundamentally want to support their production. It turns out that humans are motivated to support cultural production not only by extrinsic incentives, but also by social norms of fairness and reciprocity. This article explains how producers across the creative industries have used this insight to develop increasingly sophisticated business models that rely on voluntary payments (including pay-what-you-want schemes) to fund their costs of production. The recognition that users are not always free-riders suggests that current policy approaches to copyright are fundamentally flawed. Because social norms are so important in consumer motivations, the perceived unfairness of the current copyright system undermines the willingness of people to pay for access to cultural goods. While recent copyright reform debate has focused on creating stronger deterrence through enforcement, increasing the perceived fairness and legitimacy of copyright law is likely to be much more effective. The fact that users will sometimes willingly support cultural production also challenges the economic raison d'être of copyright law. This article demonstrates how 'peaceful revolutions' are flipping conventional copyright models and encouraging free-riding through combining incentives and prosocial norms. Because they provide a means to support production without limiting the dissemination of knowledge and culture, there is good reason to believe that these commons-based systems of cultural production can be more efficient, more fair, and more conducive to human flourishing than conventional copyright systems. This article explains what we know about free-riding so far and what work remains to be done to understand the viability and importance of cooperative systems in funding cultural production.

Developing agency in the creative career : a design-based framework for work integrated learning

Research shows that approximately half of creative practitioners operate as embedded creatives by securing gainful employment within organisations located in the field beyond their core discipline. This foregrounds the significance of having the skills necessary to successfully cross the disciplinary boundaries in order to negotiate a professional role. The multiple implications of such reframing for emerging creative practitioners who navigate uncertain professional boundaries include developing a skill of identifying and successfully targeting the shifting professional and industry coordinates while remaining responsive to changes. A further implication involves creative practitioners engaging in a continuous cycle of re-negotiation of their professional identity making the management of multiple professional selves - along with creating and recreating a meaningful frame of references such as the language around their emerging practice - a necessary skill. This chapter presents a case study of a set of Work Integrated Learning subjects designed to develop in creative industries practitioners the skills to manage their emerging professional identities in response to the shifts in the professional world.

Creative Work Beyond the Creative Industries: An Introduction

Creative occupations exist across the entire economy. The creative worker’s habitus cannot be discovered by looking only in film studios, games companies or artist’s garrets. Work practices, evolved through the traditions of the creative and performing arts, are now deployed to create new services and products across all sectors, to develop process innovations, and to change the distribution thereof. Yet the bulk of academic study of creative work (both functionalist and critical), as well as the content of higher/further professional education programs and everyday understanding of creative workers, focuses on one subset of the Creative Industries: those involved in the production of cultural goods or services (film, television, music etc.) for consumption by the general public. And further, the bulk of existing academic work focuses on those creative workers employed in cultural production industries. However, as recent work has shown, this focus misses both the large (and increasing) number of creative workers embedded in industries beyond the core Creative Industries (for example, manufacturing, banking, mining) and those creative workers and firms that supply services to business as well as to the general public, such as architects, technical writers, and graphic designers (see Cunningham 2013; Potts and Cunningham 2008; Potts, Cunningham, Hartley and Omerod 2008). This book focuses on this subset of very important, and yet under-recognized creative workers: embedded creative workers and providers of creative services into other sectors of the economy, as indicated in the following taxonomy (Figure 1.1), which juxtaposes occupation and industry sector...

Viability of Pseudomonas aeruginosa in cough aerosols generated by persons with cystic fibrosis

Background Person-to-person transmission of respiratory pathogens, including Pseudomonas aeruginosa, is a challenge facing many cystic fibrosis (CF) centres. Viable P aeruginosa are contained in aerosols produced during coughing, raising the possibility of airborne transmission. Methods Using purpose-built equipment, we measured viable P aeruginosa in cough aerosols at 1, 2 and 4 m from the subject (distance) and after allowing aerosols to age for 5, 15 and 45 min in a slowly rotating drum to minimise gravitational settling and inertial impaction (duration). Aerosol particles were captured and sized employing an Anderson Impactor and cultured using conventional microbiology. Sputum was also cultured and lung function and respiratory muscle strength measured. Results Nineteen patients with CF, mean age 25.8 (SD 9.2) years, chronically infected with P aeruginosa, and 10 healthy controls, 26.5 (8.7) years, participated. Viable P aeruginosa were detected in cough aerosols from all patients with CF, but not from controls; travelling 4 m in 17/18 (94%) and persisting for 45 min in 14/18 (78%) of the CF group. Marked inter-subject heterogeneity of P aeruginosa aerosol colony counts was seen and correlated strongly (r=0.73–0.90) with sputum bacterial loads. Modelling decay of viable P aeruginosa in a clinic room suggested that at the recommended ventilation rate of two air changes per hour almost 50 min were required for 90% to be removed after an infected patient left the room. Conclusions Viable P aeruginosa in cough aerosols travel further and last longer than recognised previously, providing additional evidence of airborne transmission between patients with CF.

Domestic ecologies : gender and domesticity in Harold Pinter's Rooms

Harold Pinter's work opens the walls to the relatively closed rooms of domesticity. The room of the love affair, the unpredictable liaison, the cramped cluttered rooms of poverty and the disaffected. This study uses Pinter's rooms to analyse existing ideologies of gender, territory, power and domesticity. Pinter's rooms are more often than not reflections of familiar domestic spaces. This research investigates Pinter's rooms through a case study of a theatre set for one of his plays and textual analysis of selected works, developing an understanding of how Pinter's characters reflect behaviours within the domestic environment, mimicking while subverting domestic ecologies.