Challenging endoscopy reprocessing guidelines: a prospective study investigating the safe shelf life of flexible endoscopes in a tertiary gastroenterology unit.

Professional prac− tice guidelines for endoscope reprocessing re− commend reprocessing endoscopes between each case and proper storage following repro− cessing after the last case of the list. There is lim− ited empirical evidence to support the efficacy of endoscope reprocessing prior to use in the first case of the day; however, internationally, many guidelines continue to recommend this practice. The aim of this study is to estimate a safe shelf life for flexible endoscopes in a high−turnover gastroenterology unit. Materials and methods: In a prospective obser− vational study, all flexible endoscopes in active service during the 3−week study period were mi− crobiologically sampled prior to reprocessing be− fore the first case of the day (n = 200). The main outcome variables were culture status, organism cultured, and shelf life. Results: Among the total number of useable samples (n = 194), the overall contamination rate was 15.5 %, with a pathogenic contamination rate of 0.5 %. Mean time between last case one day and reprocessing before the first case on the next day (that is, shelf life) was 37.62 h (SD 36.47). Median shelf life was 18.8 h (range 5.27± 165.35 h). The most frequently identified organ− ism was coagulase−negative Staphylococcus, an environmental nonpathogenic organism. Conclusions: When processed according to es− tablished guidelines, flexible endoscopes remain free from pathogenic organisms between last case and next day first case use. Significant re− ductions in the expenditure of time and resources on reprocessing endoscopes have the potential to reduce the restraints experienced by high−turnover endoscopy units and improve ser− vice delivery.

The use of narrative text for injury surveillance research : a systematic review

Objective: To summarise the extent to which narrative text fields in administrative health data are used to gather information about the event resulting in presentation to a health care provider for treatment of an injury, and to highlight best practise approaches to conducting narrative text interrogation for injury surveillance purposes.----- Design: Systematic review----- Data sources: Electronic databases searched included CINAHL, Google Scholar, Medline, Proquest, PubMed and PubMed Central.. Snowballing strategies were employed by searching the bibliographies of retrieved references to identify relevant associated articles.----- Selection criteria: Papers were selected if the study used a health-related database and if the study objectives were to a) use text field to identify injury cases or use text fields to extract additional information on injury circumstances not available from coded data or b) use text fields to assess accuracy of coded data fields for injury-related cases or c) describe methods/approaches for extracting injury information from text fields.----- Methods: The papers identified through the search were independently screened by two authors for inclusion, resulting in 41 papers selected for review. Due to heterogeneity between studies metaanalysis was not performed.----- Results: The majority of papers reviewed focused on describing injury epidemiology trends using coded data and text fields to supplement coded data (28 papers), with these studies demonstrating the value of text data for providing more specific information beyond what had been coded to enable case selection or provide circumstantial information. Caveats were expressed in terms of the consistency and completeness of recording of text information resulting in underestimates when using these data. Four coding validation papers were reviewed with these studies showing the utility of text data for validating and checking the accuracy of coded data. Seven studies (9 papers) described methods for interrogating injury text fields for systematic extraction of information, with a combination of manual and semi-automated methods used to refine and develop algorithms for extraction and classification of coded data from text. Quality assurance approaches to assessing the robustness of the methods for extracting text data was only discussed in 8 of the epidemiology papers, and 1 of the coding validation papers. All of the text interrogation methodology papers described systematic approaches to ensuring the quality of the approach.----- Conclusions: Manual review and coding approaches, text search methods, and statistical tools have been utilised to extract data from narrative text and translate it into useable, detailed injury event information. These techniques can and have been applied to administrative datasets to identify specific injury types and add value to previously coded injury datasets. Only a few studies thoroughly described the methods which were used for text mining and less than half of the studies which were reviewed used/described quality assurance methods for ensuring the robustness of the approach. New techniques utilising semi-automated computerised approaches and Bayesian/clustering statistical methods offer the potential to further develop and standardise the analysis of narrative text for injury surveillance.

Undressing Kellerman, Uncovering Broadhurst : the modern woman and "un-Australia"

This article explores the contributions of two unique Australian women, Annette Kellerman and Florence Broadhurst, to global fashion and aesthetics through subverting and challenging female gender roles of the early twentieth century. These two women are brought together here as a means of highlighting their markedly contrasting social tactics: undressing versus layering. Kellerman's body became an instrument in her quest for global fame, engaging in daring public "undress" in swimming and diving performances around the world that served to show case her innovative swimwear design. In contrast, Broadhurst, through repeated reconstructions of her persona and constant relayering of identities, concocted versions of herself in order to pass through Shanghai, London, and Sydney societies. Their lives exist as binaristic parallels, expressing contrasting values of un-Australianness - the disavowal of national identity; and Australianness - the promotion of national identity. Both Kellerman and Broadhurst tested the limits of body, dress and national identity as vehicles for global recognition. The recent interest in their historical roles is evidenced in the films "The original Mermaid"( 2004) and "Unfolding Florence" (2005) in addition to numerous books and journal articles. Despite this resurgent public recognition of their lives and achievements, scholarly analysis of their legacies in the fields of fashion and design are still relatively neglected. This article explores their contributions to celebrity and modernity, fashion and gender as modern un-Australian women.

Patterning fashion : drafting a visual framework

Christine Schmidt uses swimwear to illustrate that the methodological practice of the assemblage of pattern pieces is inherent to the intellectual construction that underpins fashion's cultural and historical discourses. She argues that these common threads are woven together to shape the finished 'global' garment.

There, yet not there : human relationships with technology

There is a “reality” to being online which we know to be false. We are simultaneously “there” but “not there” as we talk, work and play with others in online spaces. We move between physical and virtual spaces in ways that realise the predictions made for computers in the mid-20th Century and enact scenarios from science fiction. We are left wondering if our thoughts - through our disembodied selves - have become a “second self” or if we have become part of the machine itself. Information and communication technology (ICT) have brought differing human and technological agencies to all aspects of contemporary life including teaching and learning. This paper attempts to identify and categorise these agencies through the genres of technics and to illustrate them – and our relationships with technology - through reference to philosophy, fiction and reality. It also stands as an introduction to this special issue on the agency of technology.

Matching intention with agency : lessons from practice

The research project described in this paper was designed to explore the potential of a wiki to facilitate collaboration and to reduce the isolation of postgraduate students enrolled in a professional doctoral program at a Queensland university. It was also intended to foster a community of practice for reviewing and commenting on one another’s work despite the small number of students and their disparate topics. The students were interviewed and surveyed at the beginning and during the face-to-face sessions of the course and their wikis were examined over the year to monitor, analyse and evaluate the extent to which the agency of the technology (wiki) mediated their development of scholarly skills. The study showed that students paradoxically eschewed use of the structured wiki and formed their own informal networks. This paper will contend that this paradox arose from a mismatch between the agency of technology and its intended purpose.

Identifying work related injuries : comparison of methods for interrogating text fields

Background: Work-related injuries in Australia are estimated to cost around $57.5 billion annually, however there are currently insufficient surveillance data available to support an evidence-based public health response. Emergency departments (ED) in Australia are a potential source of information on work-related injuries though most ED’s do not have an ‘Activity Code’ to identify work-related cases with information about the presenting problem recorded in a short free text field. This study compared methods for interrogating text fields for identifying work-related injuries presenting at emergency departments to inform approaches to surveillance of work-related injury.---------- Methods: Three approaches were used to interrogate an injury description text field to classify cases as work-related: keyword search, index search, and content analytic text mining. Sensitivity and specificity were examined by comparing cases flagged by each approach to cases coded with an Activity code during triage. Methods to improve the sensitivity and/or specificity of each approach were explored by adjusting the classification techniques within each broad approach.---------- Results: The basic keyword search detected 58% of cases (Specificity 0.99), an index search detected 62% of cases (Specificity 0.87), and the content analytic text mining (using adjusted probabilities) approach detected 77% of cases (Specificity 0.95).---------- Conclusions The findings of this study provide strong support for continued development of text searching methods to obtain information from routine emergency department data, to improve the capacity for comprehensive injury surveillance.

Validation of the impact of Health Information Technology (I-HIT) scale : an international collaborative

In 2005, the Healthcare Information Management Systems Society (HIMSS) Nursing Informatics Community developed a survey to measure the impact of health information technology (HIT), the IHIT Scale, on the role of nurses and interdisciplinary communication in hospital settings. In 2007, nursing informatics colleagues from Australia, England, Finland, Ireland, New Zealand, Scotland and the United States formed a research collaborative to validate the IHIT across countries. All teams have completed construct and face validation in their countries. Five out of six teams have initiated reliability testing by practicing nurses. This paper reports the international collaborative’s validation of the IHIT Scale completed to date.

The contribution of different androgen receptor domains to receptor dimerization and signaling

The androgen receptor (AR) is a ligand-activated transcription factor of the nuclear receptor superfamily that plays a critical role in male physiology and pathology. Activated by binding of the native androgens testosterone and 5-dihydrotestosterone, the AR regulates transcription of genes involved in the development and maintenance of male phenotype and male reproductive function as well as other tissues such as bone and muscle. Deregulation of AR signaling can cause a diverse range of clinical conditions, including the X-linked androgen insensitivity syndrome, a form of motor neuron disease known as Kennedy’s disease, and male infertility. In addition, there is now compelling evidence that the AR is involved in all stages of prostate tumorigenesis including initiation, progression, and treatment resistance. To better understand the role of AR signaling in the pathogenesis of these conditions, it is important to have a comprehensive understanding of the key determinants of AR structure and function. Binding of androgens to the AR induces receptor dimerization, facilitating DNA binding and the recruitment of cofactors and transcriptional machinery to regulate expression of target genes. Various models of dimerization have been described for the AR, the most well characterized interaction being DNA-binding domain- mediated dimerization, which is essential for the AR to bind DNA and regulate transcription. Additional AR interactions with potential to contribute to receptor dimerization include the intermolecular interaction between the AR amino terminal domain and ligand-binding domain known as the N-terminal/C-terminal interaction, and ligand-binding domain dimerization. In this review, we discuss each form of dimerization utilized by the AR to achieve transcriptional competence and highlight that dimerization through multiple domains is necessary for optimal AR signaling.

On Gloves

This article explores the historical symbolic meanings of gloves.

Thinking critically about critical thinking in higher education

The literature on critical thinking in higher education is constructed around the fundamental assumption that, while regarded as essential, is neither clearly or commonly understood. There is elsewhere evidence that academics and students have differing perceptions of what happens in university classrooms, particularly in regard to higher order thinking. This paper reports on a small-scale investigation in a Faculty of Education at an Australian University into academic and student definitions and understandings of critical thinking. Our particular interest lay in the consistencies and disconnections assumed to exist between academic staff and students. The presumption might therefore be that staff and students perceive critical thinking in different ways and that this may limit its achievement as a critical graduate attribute. The key finding from this study, contrary to extant findings, is that academics and students did share substantively similar definitions and understandings of critical thinking.