Melatonin synthesis : a possible indicator of intolerance to shiftwork

Hypothesis Melatonin synthesis, which is directly controlled by the central circadian pacemaker indicates the circadian phase better than rectal temperature. Methods: Thirty four men (16-32 years, 7 morning, 13 neither, 14 evening types) performed a constant routine (24-26-hr bedrest, < 30 lux, 18-20°C, hourly isocaloric diet). Salivary melatonin level was determined hourly and rectal temperature was continuously recorded. Results: The nadir of rectal temperature occurred 1.5 hr (P = 0.017), the onset of melatonin synthesis 3 hr earlier (P < 0.0001) in morning than in evening types. Morningness was not related to the quantitative but significantly to the temporal parameters, closer to those of melatonin than of rectal temperature. Conclusions: The melatonin onset is a more reliable indicator of the diurnal type than the nadir of rectal temperature. As morningness has been associated with intolerance to shiftwork, melatonin profiling provides a suitable basis for the establishment of directed preventive measures.

Application of a theoretical framework to foster a cardiac-diabetes self-management programme

AIM: This paper analyses and illustrates the application of Bandura's self-efficacy construct to an innovative self-management programme for patients with both type 2 diabetes and coronary heart disease. BACKGROUND: Using theory as a framework for any health intervention provides a solid and valid foundation for aspects of planning and delivering such an intervention; however, it is reported that many health behaviour intervention programmes are not based upon theory and are consequently limited in their applicability to different populations. The cardiac-diabetes self-management programme has been specifically developed for patients with dual conditions with the strategies for delivering the programme based upon Bandura's self-efficacy theory. This patient group is at greater risk of negative health outcomes than that with a single chronic condition and therefore requires appropriate intervention programmes with solid theoretical foundations that can address the complexity of care required. SOURCES OF EVIDENCE: The cardiac-diabetes self-management programme has been developed incorporating theory, evidence and practical strategies. DISCUSSION: This paper provides explicit knowledge of the theoretical basis and components of a cardiac-diabetes self-management programme. Such detail enhances the ability to replicate or adopt the intervention in similar or differing populations and/or cultural contexts as it provides in-depth understanding of each element within the intervention. CONCLUSION: Knowledge of the concepts alone is not sufficient to deliver a successful health programme. Supporting patients to master skills of self-care is essential in order for patients to successfully manage two complex, chronic illnesses. IMPLICATIONS FOR NURSING PRACTICE OR HEALTH POLICY: Valuable information has been provided to close the theory-practice gap for more consistent health outcomes, engaging with patients for promoting holistic care within organizational and cultural contexts.

Managing knowledge for asset management : shifting from process to relational frames

The purpose of this paper is to review existing knowledge management (KM) practices within the field of asset management, identify gaps, and propose a new approach to managing knowledge for asset management. Existing approaches to KM in the field of asset management are incomplete with the focus primarily on the application of data and information systems, for example the use of an asset register. It is contended these approaches provide access to explicit knowledge and overlook the importance of tacit knowledge acquisition, sharing and application. In doing so, current KM approaches within asset management tend to neglect the significance of relational factors; whereas studies in the knowledge management field have showed that relational modes such as social capital is imperative for ef-fective KM outcomes. In this paper, we argue that incorporating a relational ap-proach to KM is more likely to contribute to the exchange of ideas and the devel-opment of creative responses necessary to improve decision-making in asset management. This conceptual paper uses extant literature to explain knowledge management antecedents and explore its outcomes in the context of asset man-agement. KM is a component in the new Integrated Strategic Asset Management (ISAM) framework developed in conjunction with asset management industry as-sociations (AAMCoG, 2012) that improves asset management performance. In this paper we use Nahapiet and Ghoshal’s (1998) model to explain antecedents of relational approach to knowledge management. Further, we develop an argument that relational knowledge management is likely to contribute to the improvement of the ISAM framework components, such as Organisational Strategic Manage-ment, Service Planning and Delivery. The main contribution of the paper is a novel and robust approach to managing knowledge that leads to the improvement of asset management outcomes.

eHealth-as-a-Service (eHaaS) : the industrialisation of health informatics, a practical approach

With the introduction of the Personally Controlled Health Record (PCEHR), the Australian public is being asked to accept greater responsibility for their healthcare. Although well designed, constructed and intentioned, policy and privacy concerns have resulted in an eHealth model that may impact future health information sharing requirements. Thus an opportunity to transform the beleaguered Australian PCEHR into a sustainable on-demand technology consumption model for patient safety must be explored further. Moreover, the current clerical focus of healthcare practitioners must be renegotiated to establish a shared knowledge creation landscape of action for safer patient interventions. To achieve this potential however requires a platform that will facilitate efficient and trusted unification of all health information available in real-time across the continuum of care. As a conceptual paper, the goal of the authors is to deliver insights into the antecedents of usage influencing superior patient outcomes within an eHealth-as-a-Service framework. To achieve this, the paper attempts to distil key concepts and identify common themes drawn from a preliminary literature review of eHealth and cloud computing concepts, specifically cloud service orchestration to establish a conceptual framework and a research agenda. Initial findings support the authors’ view that an eHealth-as-a-Service (eHaaS) construct will serve as a disruptive paradigm shift in the aggregation and transformation of health information for use as real-world knowledge in patient care scenarios. Moreover, the strategic value of extending the community Health Record Bank (HRB) model lies in the ability to automatically draw on a multitude of relevant data repositories and sources to create a single source of practice based evidence and to engage market forces to create financial sustainability.

Do not-for-profits need their own conceptual framework?

This paper raises the issue of whether not-for-profit (NFP) organisations require a conceptual framework that acknowledges their mission imperative and enables them to discharge their broader accountability. Relying on publicly available documentation and literature, it suggests that current conceptaul Frameworks for the for-profit and public sectors are inadequate in meeting the accountability needs of broader NFP-specific accountability and the formulation of NFP-appropriate reporting practice, including the provision of financial and non-financial reporting. The paper thus theoretically challenges existing financial reporting arrangements and investes debate on their future direction.

Stepping outside the circle : a reflective practice framework for creative facilitators

Stepping Outside the Circle was a practice-based research project focussed on creating a professional reflection framework for creative facilitators working within the community, education, corporate and health and wellbeing sectors. Underpinned by theories of critical reflection, transformative learning, reflexivity and agency, this study explored the potential benefits of multimodal inquiry processes, adapting existing reflective practice models for the unique requirements of creative facilitation contexts. Through application of the key findings from this research, synthesised in a practitioner resource, it is hoped that individual practitioners and creative organisations may develop their understanding of evaluation strategies, self- reflexivity, professional sustainability and practitioner self-care.

The security and privacy of usage policies and provenance logs in an Information Accountability Framework

The potential benefits of shared eHealth records systems are promising for the future of improved healthcare. However, the uptake of such systems is hindered by concerns over the security and privacy of patient information. The use of Information Accountability and so called Accountable-eHealth (AeH) systems has been proposed to balance the privacy concerns of patients with the information needs of healthcare professionals. However, a number of challenges remain before AeH systems can become a reality. Among these is the need to protect the information stored in the usage policies and provenance logs used by AeH systems to define appropriate use of information and hold users accountable for their actions. In this paper, we discuss the privacy and security issues surrounding these accountability mechanisms, define valid access to the information they contain, discuss solutions to protect them, and verify and model an implementation of the access requirements as part of an Information Accountability Framework.

Experimental investigations of improved dielectric condition monitoring methods on transformer oil-paper insulation system

Frequency Domain Spectroscopy (FDS) is successfully being used to assess the insulation condition of oil filled power transformers. However, it has to date only been implemented on de-energized transformers, which requires the transformers to be shut down for an extended period which can result in significant costs. To solve this issue, a method of implementing FDS under energized condition is proposed here. A chirp excitation waveform is used to replace the conventional sinusoidal waveform to reduce the measurement time in this method. Investigation of the dielectric response under the influence of a high voltage stress at power frequency is reported based on experimental results. To further understand the insulation ageing process, the geometric capacitance effect is removed to enhance the detection of the ageing signature. This enhancement enables the imaginary part of admittance to be used as a new indicator to assess the ageing status of the insulation.

Design for creative activity : a framework for analyzing the creative potential of computer games

This paper describes a design framework intended to conceptually map the influence that game design has on the creative activity people engage in during gameplay. The framework builds on behavioral and verbal analysis of people playing puzzle games. The analysis was designed to better understand the extent to which gameplay activities within different games facilitate creative problem solving. We have used an expert review process to evaluate these games in terms of their game design elements and have taken a cognitive action approach to this process to investigate how particular elements produce the potential for creative activity. This paper proposes guidelines that build upon our understanding of the relationship between the creative processes that players undertake during a game and the components of the game that allow these processes to occur. These guidelines may be used in the game design process to better facilitate creative gameplay activity.

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.

Medical negligence, causation and liability for non-disclosure of risk : a post-wallace framework and critique

Through an examination of Wallace v Kam, this article considers and evaluates the law of causation in the specific context of a medical practitioner’s duty to provide information to patients concerning material risks of treatment. To supply a contextual background for the analysis which follows, Part II summarises the basic principles of causation law, while Part III provides an overview of the case and the reasoning adopted in the decisions at first instance and on appeal. With particular emphasis upon the reasoning in the courts of appeal, Part IV then examines the implications of the case in the context of other jurisprudence in this field and, in so doing, provides a framework for a structured consideration of causation issues in future non-disclosure cases under the Australian civil liability legislation. As will become clear, Wallace was fundamentally decided on the basis of policy reasoning centred upon the purpose behind the legal duty violated. Although the plurality in Rogers v Whitaker rejected the utility of expressions such as ‘the patient’s right of self-determination’ in this context, some Australian jurisprudence may be thought to frame the practitioner’s duty to warn in terms of promoting a patient’s autonomy, or right to decide whether to submit to treatment proposed. Accordingly, the impact of Wallace upon the protection of this right, and the interrelation between it and the duty to warn’s purpose, is investigated. The analysis in Part IV also evaluates the courts’ reasoning in Wallace by questioning the extent to which Wallace’s approach to liability and causal connection in non-disclosure of risk cases: depends upon the nature and classification of the risk(s) in question; and can be reconciled with the way in which patients make decisions. Finally, Part V adopts a comparative approach by considering whether the same decision might be reached if Wallace was determined according to English law.

A framework for people capability enhancement to support sustainable facility management practices

Spanning over a considerable length of time, facility management is a key phase in the development cycle of built assets. Therefore facility managers are in a commanding position to maximise the potential of sustainability through the operation, maintenance and upgrade of built facilities leading to decommission and deconstruction. Sustainability endeavours in facility management practices will not only contribute to reducing energy consumption, waste and running costs, but also help improve organisational productivity, financial returns and community standing of the organisation. At the forefront facing sustainability challenge, facility manager should be empowered with the necessary knowledge and capabilities. However, literature studies show a gap between the current level of awareness and the specific knowledge and necessary skills required to pursue sustainability in the profession. People capability is considered as the key enabler in managing the sustainability agenda as well as being central to the improvement of competency and innovation in an organization. This paper aims to identify the critical factors for enhancing people capabilities in promoting the sustainability agenda in facility management practices. Starting with a total of 60 factors identified through literature review, the authors conducted a questionnaire survey to assess the perceived importance of these factors. The findings reveal 23 critical factors as significantly important. They form the basis of a mechanism framework developed to equip facility managers with the right knowledge, to continue education and training and to develop new mind-sets to enhance the implementation of sustainability measures in FM practices.

Critical reflection

Critical reflection is a necessary component of professionalism in early childhood education. Evidence of critical reflection within a service draws attention to the intellectual work of early childhood educators and highlights professional capacities beyond the care of young children.