On resilience and acceptance in the transition to palliative care at the end of life

Specialist palliative care is a prominent and expanding site of health service delivery, providing highly specialised care to people at the end of life. Its focus on the delivery of specialised life-enhancing care stands in contrast to biomedicine's general tendency towards life-prolonging intervention. This philosophical departure from curative or life-prolonging care means that transitioning patients can be problematic, with recent work suggesting a wide range of potential emotional, communication and relational difficulties for patients, families and health professionals. Yet, we know little about terminally ill patients' lived experiences of this complex transition. Here, through interviews with 40 inpatients in the last few weeks of life, we explore their embodied and relational experiences of the transition to inpatient care, including their accounts of an ethic of resilience in pre-palliative care and an ethic of acceptance as they move towards specialist palliative care. Exploring the relationship between resilience and acceptance reveals the opportunities, as well as the limitations, embedded in the normative constructs that inflect individual experience of this transition. This highlights a contradictory dynamic whereby participants' experiences were characterised by talk of initiating change, while also acquiescing to the terminal progression of their illness.

Growth factors in induction of epithelial-mesenchymal transition and metastasis

Epithelial to mesenchymal transition (EMT) has gained widespread acceptance over recent years as a mechanism by which normally sessile epithelial tumour cells can move away from the primary tumour and metastasize. This review article examines the role of a number of growth factors in inducing EMT, and the reverse process mesenchymal to epithelial transition. Unique and common intracellular signalling pathways are highlighted. A comprehensive understanding of the regulation of EMT will be critical in manipulating this process to develop novel anti-metastasis therapies.

An evidence-based program to improve analgesic practice and pain outcomes in residential aged care facilities

Pain is common in individuals living in residential aged care facilities (RACFs), and a number of obstacles have been identified as recurring barriers to adequate pain management. To address this, the Australian Pain Society developed 27 recommendations for comprehensive good practice in the identification, assessment, and management of pain. This study reviewed preexisting pain management practice at five Australian RACFs and identified changes needed to implement the recommendations and then implemented an evidence-based program that aimed to facilitate better pain management. The program involved staff training and education and revised in-house pain-management procedures. Reviews occurred before and after the program and included the assessment of 282 residents for analgesic use and pain status. Analgesic use improved after the program (P<.001), with a decrease in residents receiving no analgesics (from 15% to 6%) and an increase in residents receiving around-the-clock plus as-needed analgesics (from 24% to 43%). There were improvements in pain relief for residents with scores indicative of pain, with Abbey pain scale (P=.005), Pain Assessment in Advanced Dementia Scale (P=.001), and Non-communicative Patient's Pain Assessment Instrument scale (P<.001) scores all improving. Although physical function declined as expected, Medical Outcomes Study 36-item Short-Form Survey bodily pain scores also showed improvement (P=.001). Better evidence-based practice and outcomes in RACFs can be achieved with appropriate training and education. Investing resources in the aged care workforce using this program improved analgesic practice and pain relief in participating sites. Further attention to the continued targeted pain management training of aged care staff is likely to improve pain-focused care for residents.

Case Study 4: Education Doctoral Student - "An Exploratory Study of Online Social Networking within a Doctorate of Education Program"

Introduction The professional doctorate is specifically designed for professionals investigating real-world problems and relevant issues for a profession, industry, and/or the community. The focus is scholarly research into professional practices. The research programme bridges academia and the professions, and offers doctoral candidates the opportunity to investigate issues relevant to their own practices and to apply these understandings to their professional contexts. The study on which this article is based sought to track the scholarly skill development of a cohort of professional doctoral students who commenced the course in January 2008 at an Australian university. Because they hold positions of responsibility and are time-poor, many doctoral students have difficulty transitioning from professional practitioner to researcher and scholar. The struggle many experience is in the development of a theoretical or conceptual standpoint for argumentation (Lesham, 2007; Weese et al., 1999). It was thought that the use of a scaffolded learning environment that drew upon a blended learning approach incorporating face to face intensive blocks and collaborative knowledge-building tools such as wikis would provide a data source for understanding the development of scholarly skills. Wikis, weblogs and similar social networking software have the potential to support communities to share, learn, create and collaborate. The development of a wiki page by each candidate in the 2008 cohort was encouraged to provide the participants and the teaching team members with textual indicators of progress. Learning tasks were scaffolded with the expectation that the candidates would complete these tasks via the wikis. The expectation was that cohort members would comment on each other’s work, together with the supervisor and/or teaching team member who was allocated to each candidate. The supervisor is responsible for supervising the candidate’s work through to submission of the thesis for examination and the teaching team member provides support to both the supervisor and the candidate through to confirmation. This paper reports on the learning journey of a cohort of doctoral students during the first seven months of their professional doctoral programme to determine if there had been any qualitative shifts in understandings, expectations and perceptions regarding their developing knowledge and skills. The paper is grounded in the literature pertaining to doctoral studies and examines the structure of the professional doctoral programme. Following this is a discussion of the qualitative study that helped to unearth key themes regarding the participants’ learning journey.

How small business advisory program delivery methods (collective learning, tailored, and practice-based approaches) affect learning and innovation

Past studies relate small business advisory program effectiveness to advisory characteristics such as advisory intensity and scope. We contribute to existing literature by seeking to identify the impact of different advisory program methods of delivery on learning and subsequent firm innovation behavior. Our research is based on a survey of 257 Australian firms completing small business advisory programs in the three years preceding the research. We explore the range of small business advisory program delivery methods in which our surveyed firms participated and, with reference to the literature on organizational learning and innovation, we analyze predictors of firms' learning ability and innovativeness based on the identified delivery methods. First, we found that business advisory programs that involved high levels of collective learning and tailored approaches enhanced firms' perceptions of their learning of critical skills or capabilities. We also found that small business advisory programs that were delivered by using practice-based approaches enhanced firms' subsequent organizational innovation. We verified this finding by testing whether firms that have participated in small business advisory services subsequently demonstrate improved behavior in terms of organizational innovativeness, when compared with matched firms that have not participated in an advisory program.

Adaptive estimation of HMM transition probabilities

This paper presents new schemes for recursive estimation of the state transition probabilities for hidden Markov models (HMM's) via extended least squares (ELS) and recursive state prediction error (RSPE) methods. Local convergence analysis for the proposed RSPE algorithm is shown using the ordinary differential equation (ODE) approach developed for the more familiar recursive output prediction error (RPE) methods. The presented scheme converges and is relatively well conditioned compared with the ...

Adaptive estimation of hidden semi-Markov chains with parameterised transition probabilities and exponential decaying states

This paper develops maximum likelihood (ML) estimation schemes for finite-state semi-Markov chains in white Gaussian noise. We assume that the semi-Markov chain is characterised by transition probabilities of known parametric from with unknown parameters. We reformulate this hidden semi-Markov model (HSM) problem in the scalar case as a two-vector homogeneous hidden Markov model (HMM) problem in which the state consist of the signal augmented by the time to last transition. With this reformulation we apply the expectation Maximumisation (EM ) algorithm to obtain ML estimates of the transition probabilities parameters, Markov state levels and noise variance. To demonstrate our proposed schemes, motivated by neuro-biological applications, we use a damped sinusoidal parameterised function for the transition probabilities.

Developing emerging leaders in the library profession : program content, self-efficacy and leadership

This thesis used experimental and qualitative methods to determine that a typical, formal library leadership development intervention significantly enhanced the leadership self-efficacy of participants. The investigation also ascertained what program content and attributes affected leadership self-efficacy and how these elements either deterred or enhanced leadership self-efficacy development. Self-efficacy is critical to leadership emergence and effectiveness. Leadership succession has been identified as an issue in the library profession and society as a whole. The research confirmed that leadership development interventions with appropriate structure and content can be an effective mechanism to foster the emergence of leaders.

The impact of transformative learning in a critical service-learning program on teacher development: Building a foundation for inclusive teaching

With international and national policies requiring teachers to adopt inclusive practices worldwide, this paper examines the impact of transformational learning in a critical service-learning program on final-year pre-service teachers’ approaches to inclusive teaching. Data from emailed questionnaires and focus group interviews are analysed through a social, critical framework. The results indicate that the critical service-learning program provided the students with an opportunity to consider diversity and inclusion in selecting teaching strategies, and to enact values suitable to inclusive practices and appreciation of diversity in schools. In this paper we argue that transformative learning experiences about inclusivity and diversity are needed if pre-service teachers are to be challenged to adopt inclusive values and practice in schools. A critical service-learning program for pre-service teachers provides a solid foundation on which to develop or build on the ability to think and teach inclusively.

Modeling conditional correlations of asset returns : a smooth transition approach

In this paper we propose a new multivariate GARCH model with time-varying conditional correlation structure. The time-varying conditional correlations change smoothly between two extreme states of constant correlations according to a predetermined or exogenous transition variable. An LM–test is derived to test the constancy of correlations and LM- and Wald tests to test the hypothesis of partially constant correlations. Analytical expressions for the test statistics and the required derivatives are provided to make computations feasible. An empirical example based on daily return series of five frequently traded stocks in the S&P 500 stock index completes the paper.

Designing for collaborative learning spaces : an academic staff development pilot program

To prepare for the delivery of new Bachelor of Science units in collaborative learning spaces, academic and professional staff at Queensland University of Technology piloted an academic development program over the period of a semester. The program was informed by Rogers’ theory of innovation and diffusion (2003) and structured according to Wilson’s framework for faculty development (2007). Through a series of workshops and group mentoring activities, the program modelled inquiry-based learning in a collaborative learning space, and the participants designed and practiced the delivery of teaching activities. This paper provides a preliminary evaluation of the effectiveness of the pilot based on survey responses from participants, notes from the development team who coordinated the program and audience feedback from the final showcase session. The design and structure of the program is discussed as well as possible future directions.

The OnTrack Diabetes web-based program for type 2 diabetes and dysphoria self-management: A randomized controlled trial protocol

Background: The prevalence of type 2 diabetes is rising with the majority of patients practicing inadequate disease self-management. Depression, anxiety, and diabetes-specific distress present motivational challenges to adequate self-care. Health systems globally struggle to deliver routine services that are accessible to the entire population, in particular in rural areas. Web-based diabetes self-management interventions can provide frequent, accessible support regardless of time and location Objective: This paper describes the protocol of an Australian national randomized controlled trial (RCT) of the OnTrack Diabetes program, an automated, interactive, self-guided Web program aimed to improve glycemic control, diabetes self-care, and dysphoria symptoms in type 2 diabetes patients. Methods: A small pilot trial is conducted that primarily tests program functionality, efficacy, and user acceptability and satisfaction. This is followed by the main RCT, which compares 3 treatments: (1) delayed program access: usual diabetes care for 3 months postbaseline followed by access to the full OnTrack Diabetes program; (2) immediate program: full access to the self-guided program from baseline onward; and (3) immediate program plus therapist support via Functional Imagery Training (FIT). Measures are administered at baseline and at 3, 6, and 12 months postbaseline. Primary outcomes are diabetes self-care behaviors (physical activity participation, diet, medication adherence, and blood glucose monitoring), glycated hemoglobin A1c (HbA1c) level, and diabetes-specific distress. Secondary outcomes are depression, anxiety, self-efficacy and adherence, and quality of life. Exposure data in terms of program uptake, use, time on each page, and program completion, as well as implementation feasibility will be conducted. Results: This trial is currently underway with funding support from the Wesley Research Institute in Brisbane, Australia. Conclusions: This is the first known trial of an automated, self-guided, Web-based support program that uses a holistic approach in targeting both type 2 diabetes self-management and dysphoria. Findings will inform the feasibility of implementing such a program on an ongoing basis, including in rural and regional locations.

Development of the OnTrack Diabetes program

Background: Type 2 diabetes affects an estimated 347 million people worldwide and often leads to serious complications including blindness, kidney disease, and limb amputation. Comorbid dysphoria is common and is an independent risk factor for poor glycaemic control. Professional support for diabetes self-management and dysphoria has limited availability and involves high costs, especially after regular hours, and in rural and remote areas. Web-based cognitive behavior therapy offers highly accessible, acceptable, and cost-effective support for people with diabetes. This paper describes the development of OnTrack Diabetes, a self-guided, Web-based program to promote improved physical and emotional self-management in people with Type 2 diabetes. Objective: The objective of the study is to describe the development of the OnTrack Diabetes program, which is a self-guided, Web-based program aimed to promote euthymia and improved disease self-management in people with Type 2 diabetes. Methods: Semistructured interviews with 12 general practitioners and 13 patients with Type 2 diabetes identified enablers of and barriers to effective diabetes self-management, requirements for additional support, and potential program elements. Existing resources and research data informed the development of content, and consultants from relevant disciplines provided feedback on draft segments and reviewed the program before release. Using a self-guided delivery format contained costs, in addition to adapting program features and modules from an existing OnTrack program. Results: A separate paper describes the protocol for a randomized controlled trial to provide this required evaluation. Conclusions: Development of the OnTrack Diabetes program demonstrates strategies that help ensure that a program is acceptable to users. The next stages involve testing users’ experiences and examining the program’s effectiveness and cost-effectiveness in randomized controlled trials.

Best practice in peer-led curriculum content : informing an interactive program to improve passenger safety among high school seniors

Despite ongoing improvements in behaviour change strategies, licensing models and road law enforcement measures young drivers remain significantly over-represented in fatal and non-fatal road related crashes. This paper focuses on the safety of those approaching driving age and identifies both high priority road safety messages and relevant peer-led strategies to guide the development school programs. It summarises the review in a program logic model built around the messages and identified curriculum elements, as they may be best operationalised within the licensing and school contexts in Victoria. This paper summarises a review of common deliberate risk-taking and non-deliberate unsafe driving behaviours among novice drivers, highlighting risks associated with speeding, driving while fatigued, driving while impaired and carrying passengers. Common beliefs of young people that predict risky driving were reviewed, particularly with consideration of those beliefs that can be operationalised in a behaviour change school program. Key components of adolescent risk behaviour change programs were also reviewed, which identified a number of strategies for incorporation in a school based behaviour change program, including: a well-structured theoretical design and delivery, thoughtfully considered peer-selected processes, adequate training and supervision of peer facilitators, a process for monitoring and sustainability, and interactive delivery and participant discussions. The research base is then summarised in a program logic model with further discussion about the quality of the current state of knowledge of evaluation of behaviour change programs and the need for considerable development in program evaluation.