The costs arising from pressure ulcers attributable to malnutrition

Aim To estimate the economic consequences of pressure ulcers attributable to malnutrition. Method Statistical models were developed to predict the number of cases of pressure ulcer, associated bed days lost and the dollar value of these losses in public hospitals in 2002/2003 in Queensland, Australia. The following input parameters were specified and appropriate probability distributions fitted • Number of at risk discharges per annum • Incidence rate for pressure ulcer • Attributable fraction of malnutrition in the development of pressure ulcer • Independent effect of pressure ulcer on length of hospital stay • Opportunity cost of hospital bed day One thousand random re-samples were made and the results expressed as (output) probabilistic distributions. Results The model predicts a mean 16060 (SD 5 671) bed days lost and corresponding mean economic cost of AU$12 968 668 (SD AU$4 924 148) (EUROS 6 925 268 SD 2 629 495; US$ 7 288 391 SD 2 767 371) of pressure ulcer attributable to malnutrition in 2002/2003 in public hospitals in Queensland, Australia. Conclusion The cost of pressure ulcer attributable to malnutrition in bed days and dollar terms are substantial. The model only considers costs of increased length of stay associated with pressure ulcer and not other factors associated with care.

Virtual mooting : using technology to enhance the mooting experience

While a range of benefits to students participating in mooting have been identified by the legal education literature, there are impediments to students participating in mooting that have been revealed by recent surveys of law students at QUT. These impediments include time, geographical location and a failure to perceive the benefits of mooting. This paper will explore the benefits of using technology to overcome these impediments, evaluate technological options to facilitate distance mooting, such as the use of Second Life, Elluminate and video conferencing, and will recommend a trial of these options.

The malnutrition screening tool is a useful tool for identifying malnutrition risk in residential aged care

Background: The Malnutrition Screening Tool (MST) is a valid nutrition screening tool in the acute hospital setting but has not been assessed in residential aged care facilities. The aim of this secondary analysis was to determine whether the MST could be a useful nutrition screening tool when compared with a full nutrition assessment by Subjective Global Assessment (SGA) in the residential aged care setting. ----- Methods: Two hundred and eighty-five residents (29% male; mean age: 84 ± 9 years) from eight residential aged care facilities in Australia participated. A secondary analysis of data collected during a nutrition intervention study was conducted. The MST consists of two questions related to recent weight loss and appetite. While the MST was not specifically applied, weight loss and appetite information was available and an estimated MST score (0-5) calculated. Nutritional status was assessed by a research assistant trained in using SGA. ----- Results: Malnutrition prevalence was 42.8% (122 malnourished out of 285 residents). Compared to the SGA, the MST was an effective predictor of nutritional risk (sensitivity = 83.6%, specificity = 65.6%, positive predictive value = 0.65, negative predictive value =0.84). ----- Conclusions: The components of the MST have acceptable sensitivity and specificity suggesting it can play a valuable role in quickly identifying malnutrition risk in the residential aged care setting. Further prospective research using the MST tool against a broader array of objective and subjective nutritional parameters is required to confirm its validity as a screening tool in aged care settings.

Can tissue engineering concepts advance tumor biology research?

Advances in tissue engineering have traditionally led to the design of scaffold- or matrix-based culture systems that better reflect the biological, physical and biochemical environment of the natural extracellular matrix. Although their clinical applications in regenerative medicine tend to receive most of the attention, it is obvious that other areas of biomedical research could be well served by the powerful tools that have already been developed in tissue engineering. In this article, we review the recent literature to demonstrate how tissue engineering platforms can enhance in vitro and in vivo models of tumorigenesis and thus hold great promise to contribute to future cancer research.

Exploring young children's web searching and technoliteracy

Purpose – This paper aims to report findings from an exploratory study investigating the web interactions and technoliteracy of children in the early childhood years. Previous research has studied aspects of older children’s technoliteracy and web searching; however, few studies have analyzed web search data from children younger than six years of age. Design/methodology/approach – The study explored the Google web searching and technoliteracy of young children who are enrolled in a “preparatory classroom” or kindergarten (the year before young children begin compulsory schooling in Queensland, Australia). Young children were video- and audio-taped while conducting Google web searches in the classroom. The data were qualitatively analysed to understand the young children’s web search behaviour. Findings – The findings show that young children engage in complex web searches, including keyword searching and browsing, query formulation and reformulation, relevance judgments, successive searches, information multitasking and collaborative behaviours. The study results provide significant initial insights into young children’s web searching and technoliteracy. Practical implications – The use of web search engines by young children is an important research area with implications for educators and web technologies developers. Originality/value – This is the first study of young children’s interaction with a web search engine.

Maintaining nutrition in aged care residents with a train-the-trainer intervention and nutrition coordinator

Objective: To investigate the impact of a train-the-trainer program on the nutritional status of older people in residential care. ----- Design: Prospective, randomized controlled study. Setting: Eight nursing homes in Southeast Queensland, Australia. ----- Participants: A total of 352 residents participated - 245 were female (69.6%). The mean age was 84.2 years and the majority (79.4%) were classified as high dependency. ----- Intervention: Residents from four nursing homes were randomly selected for a nutrition education program coordinated by Nutrition Coordinators. Residents from the other four nursing homes (control) received usual care. ----- Measurements: The Subjective Global Assessment was used to determine prevalence of malnutrition at baseline and six months post intervention. The Resident Classification Scale measured functional dependency. Prescribed diet, fluids, oral hygiene status and allied health referrals were obtained by chart audit. ----- Results: Approximately half the residents were well nourished with 49.4% moderately or severely malnourished. Residents in the intervention group were more likely to maintain or improve their nutritional status compared with the control group who were more likely to experience a deterioration (P=0.027). The odds of the control group being malnourished post test was 1.6 times more likely compared with the intervention group but this did not reach statistical significance (P=0.1). ----- Conclusion: The results of the study encourage the implementation of a Nutrition Coordinator program to maintain nutritional status of aged care residents. Nevertheless, malnutrition rates continue to be unacceptably high. In a rapidly aging society, the aged care sector needs to confront malnutrition and provide better resources for staff to take measures against this problem.

What counts as evidence and equity?

Editorial introduction to Vol. 34 of Review of Research in Education (American Educational Research Association/Sage).

Cyber bullying in schools and the law : is there an effective means of addressing the power imbalance?

Cyber bullying – or bullying through the use of technology – is a growing phenomenon which is currently most commonly experienced by young people and the consequences manifested in schools. Cyber bullying shares many of the same attributes as face-to-face bullying such as a power imbalance and a sense of helplessness on the part of the target. Not surprisingly, targets of face-to-face bullying are increasingly turning to the law, and it is likely that targets of cyber bullying may also do so in an appropriate case. This article examines the various criminal, civil and vilification laws that may apply to cases of cyber bullying and assesses the likely effectiveness of these laws as a means of redressing that power imbalance between perpetrator and target.

Intraaortic balloon pump counterpulsation and cerebral autoregulation : an observational study

The use of Intra-aortic counterpulsation is a well established supportive therapy for patients in cardiac failure or after cardiac surgery. Blood pressure variations induced by counterpulsation are transmitted to the cerebral arteries, challenging cerebral autoregulatory mechanisms in order to maintain a stable cerebral blood flow. This study aims to assess the effects on cerebral autoregulation and variability of cerebral blood flow due to intra-aortic balloon pump and inflation ratio weaning.

Assessment of online discussion forums for law students

This paper goes beyond the existing literature and explores the innovative topic of designing criterion-referenced assessment for online discussion forums. There are several benefits of embedding online discussion forums into subjects including engaging students in collaborative learning, and encouraging deeper analysis, critical thinking and reflection. Using the assessment principles of validity, reliability and transparency, this paper offers a range of practical strategies to tutors who plan to develop criterion-referenced assessment as opposed to norm-referenced assessment for online discussion forums, applies the assessment principles in the context of an undergraduate law subject, and exemplars a rubric for an online discussion forum in a work placement subject.

De la reconstruction a l’augmentation du corps humain en medecine restaurative et en cybernetique

Aux confluences historiques et conceptuelles de la modernité, de la technologie, et de l’« humain », les textes de notre corpus négocient et interrogent de façon critique les possibilités matérielles et symboliques de la prothèse, ses aspects phénoménologiques et spéculatifs : du côté subjectiviste et conceptualiste avec une philosophie de la conscience, avec Merleau-Ponty ; et de l’autre avec les épistémologues du corps et historiens de la connaissance Canguilhem et Foucault. Le trope prometteur de la prothèse impacte sur les formations discursives et non-discursives concernant la reconstruction des corps, là où la technologie devient le corrélat de l’identité. La technologie s’humanise au contact de l’homme, et, en révélant une hybridité supérieure, elle phagocyte l’humain du même coup. Ce travail de sociologie des sciences (Latour, 1989), ou encore d’anthropologie des sciences (Hakken, 2001) ou d’anthropologie bioculturelle (Andrieu, 1993; Andrieu, 2006; Andrieu, 2007a) se propose en tant qu’exemple de la contribution potentielle que l’anthropologie biologique et culturelle peut rendre à la médecine reconstructrice et que la médecine reconstructrice peut rendre à la plastique de l’homme ; l’anthropologie biologique nous concerne dans la transformation biologique du corps humain, par l’outil de la technologie, tant dans son histoire de la reconstruction mécanique et plastique, que dans son projet d’augmentation bionique. Nous établirons une continuité archéologique, d’une terminologie foucaldienne, entre les deux pratiques. Nous questionnons les postulats au sujet des relations nature/culture, biologie/contexte social, et nous présentons une approche définitionnelle de la technologie, pierre angulaire de notre travail théorique. Le trope de la technologie, en tant qu’outil adaptatif de la culture au service de la nature, opère un glissement sémantique en se plaçant au service d’une biologie à améliorer. Une des clés de notre recherche sur l’augmentation des fonctions et de l’esthétique du corps humain réside dans la redéfinition même de ces relations ; et dans l’impact de l’interpénétration entre réalité et imaginaire dans la construction de l’objet scientifique, dans la transformation du corps humain. Afin de cerner les enjeux du discours au sujet de l’« autoévolution » des corps, les théories évolutionnistes sont abordées, bien que ne représentant pas notre spécialité. Dans le cadre de l’autoévolution, et de l’augmentation bionique de l’homme, la somation culturelle du corps s’exerce par l’usage des biotechnologies, en rupture épistémologique de la pensée darwinienne, bien que l’acte d’hybridation évolutionnaire soit toujours inscrit dans un dessein de maximisation bionique/génétique du corps humain. Nous explorons les courants de la pensée cybernétique dans leurs actions de transformation biologique du corps humain, de la performativité des mutilations. Ainsi technologie et techniques apparaissent-elles indissociables de la science, et de son constructionnisme social.

Listening to late discovery adoption and donor offspring stories : adoption, ethics and implications for contemporary donor insemination practices

For most of the 20th Century a ‘closed’ system of adoption was practised throughout Australia and other modern Western societies. This ‘closed’ system was characterised by sealed records; amended birth certificates to conceal the adoption, and prohibited contact with all biological family. Despite claims that these measures protected these children from the taint of illegitimacy the central motivations were far more complex, involving a desire to protect couples from the stigma of infertility and to provide a socially acceptable family structure (Triseliotis, Feast, & Kyle, 2005; Marshall & McDonald, 2001). From the 1960s significant evidence began to emerge that many adopted children and adults were experiencing higher incidences of psychological difficulties, characterised by problems with psychological adjustment, building self-esteem and forming a secure personal identity. These difficulties became grouped under the term ‘genealogical bewilderment’. As a result, new policies and practices were introduced to try to place the best interests of the child at the forefront. These changes reflected new understandings of adoption; as not only an individual process but also as a social and relational process that continues throughout life. Secrecy and the withholding of birth information are now prohibited in the overwhelming majority of all domestic adoptions processed in Australia (Marshall & McDonald, 2001). One little known consequence of this ‘closed’ system of adoption was the significant number of children who were never told of their adoptive status. As a consequence, some have discovered or had this information disclosed to them, as adults. The first study that looked at the late discovery of genetic origins experiences was conducted by the Post Adoption Resource Centre in New South Wales in 1999. This report found that the participants in their study expressed feelings of disbelief, confusion, anger, sorrow and loss. Further, the majority of participants continued to struggle with issues arising from this intentional concealment of their genetic origins (Perl & Markham, 1999). A second and more recent study (Passmore, Feeney & Foulstone, 2007) looked at the issue of secrecy in adoptive families as part of a broader study of 144 adult adoptees. This study found that secrecy and/or lies or misinformation on the part of adoptive parents had negative effects on both personal identity and relationships with others. The authors noted that those adoptees who found out about their adoption as adults were ‘especially likely to feel a sense of betrayal’ (p.4). Over recent years, stories of secrecy and late discovery have also started to emerge from sperm donor conceived adults (Spencer, 2007; Turner & Coyle, 2000). Current research evidence shows that although a majority of couples during the donor assisted conception process indicate that they intend to tell the offspring about their origins, as many as two-thirds or more of couples continue to withhold this information from their children (Akker, 2006; Gottlieb, A. McWhinnie, 2001; Salter-Ling, Hunter, & Glover, 2001). Why do they keep this secret? Infertility involves a range of complex factors that are often left unresolved or poorly understood by those choosing insemination by donor as a form of family building (Schaffer, J. A., & Diamond, R., 1993). These factors may only impact after the child is born, when resemblance talk becomes most pronounced. Resemblance talk is an accepted form of public discourse and a social convention that legitimises the child as part of the family and is part of the process of constructing the child’s identity within the family. Couples tend to become focused on resemblance as this is where they feel most vulnerable, and the lack of resemblance to the parenting father may trigger his sense of loss (Becker, Butler, & Nachtigall, 2005).

The mechanical response of the ovine lumbar anulus fibrosus to uniaxial, biaxial and shear loads

Analytical and computational models of the intervertebral disc (IVD) are commonly employed to enhance understanding of the biomechanics of the human spine and spinal motion segments. The accuracy of these models in predicting physiological behaviour of the spine is intrinsically reliant on the accuracy of the material constitutive representations employed to represent the spinal tissues. There is a paucity of detailed mechanical data describing the material response of the reinforced­ground matrix in the anulus fibrosus of the IVD. In the present study, the ‘reinforced­ground matrix’ was defined as the matrix with the collagen fibres embedded but not actively bearing axial load, thus incorporating the contribution of the fibre-fibre and fibre-matrix interactions. To determine mechanical parameters for the anulus ground matrix, mechanical tests were carried out on specimens of ovine anulus, under unconfined uniaxial compression, simple shear and biaxial compression. Test specimens of ovine anulus fibrosus were obtained with an adjacent layer of vertebral bone/cartilage on the superior and inferior specimen surface. Specimen geometry was such that there were no continuous collagen fibres coupling the two endplates. Samples were subdivided according to disc region - anterior, lateral and posterior - to determine the regional inhomogeneity in the anulus mechanical response. Specimens were loaded at a strain rate sufficient to avoid fluid outflow from the tissue and typical stress-strain responses under the initial load application and under repeated loading were determined for each of the three loading types. The response of the anulus tissue to the initial and repeated load cycles was significantly different for all load types, except biaxial compression in the anterior anulus. Since the maximum applied strain exceeded the damage strain for the tissue, experimental results for repeated loading reflected the mechanical ability of the tissue to carry load, subsequent to the initiation of damage. To our knowledge, this is the first study to provide experimental data describing the response of the ‘reinforced­ground matrix’ to biaxial compression. Additionally, it is novel in defining a study objective to determine the regionally inhomogeneous response of the ‘reinforced­ground matrix’ under an extensive range of loading conditions suitable for mechanical characterisation of the tissue. The results presented facilitate the development of more detailed and comprehensive constitutive descriptions for the large strain nonlinear elastic or hyperelastic response of the anulus ground matrix.