How critical is fibrous cap thickness to carotid plaque stability? A flow-plaque interaction model

Background and Purpose Acute cerebral ischemic events are associated with rupture of vulnerable carotid atheroma and subsequent thrombosis. Factors such as luminal stenosis and fibrous cap thickness have been thought to be important risk factors for plaque rupture. We used a flow-structure interaction model to simulate the interaction between blood flow and atheromatous plaque to evaluate the effect of the degree of luminal stenosis and fibrous cap thickness on plaque vulnerability. Methods A coupled nonlinear time-dependent model with a flow-plaque interaction simulation was used to perform flow and stress/strain analysis in a stenotic carotid artery model. The stress distribution within the plaque and the flow conditions within the vessel were calculated for every case when varying the fibrous cap thickness from 0.1 to 2 mm and the degree of luminal stenosis from 10% to 95%. A rupture stress of 300 kPa was chosen to indicate a high risk of plaque rupture. A 1-sample t test was used to compare plaque stresses with the rupture stress. Results High stress concentrations were found in the plaques in arteries with >70% degree of stenosis. Plaque stresses in arteries with 30% to 70% stenosis increased exponentially as fibrous cap thickness decreased. A decrease of fibrous cap thickness from 0.4 to 0.2 mm resulted in an increase of plaque stress from 141 to 409 kPa in a 40% degree stenotic artery. Conclusions There is an increase in plaque stress in arteries with a thin fibrous cap. The presence of a moderate carotid stenosis (30% to 70%) with a thin fibrous cap indicates a high risk for plaque rupture. Patients in the future may be risk stratified by measuring both fibrous cap thickness and luminal stenosis.

Advancing practice in critical care: A model of knowledge integration

It could be argued that advancing practice in critical care has been superseded by the advanced practice agenda. Some would suggest that advancing practice is focused on the core attributes of an individuals practice progressing onto advanced practice status. However, advancing practice is more of a process than identifiable skills and as such is often negated when viewing the development of practitioners to the advanced practice level. For example practice development initiatives can be seen as advancing practice for the masses which ensures that practitioners are following the same level of practice. The question here is; are they developing individually.

Conceptualising the challenge of integrating digital technologies in pedagogy

The integration of digital technologies in pedagogy is positioned as an important change in education, but widespread innovative use of digital technologies is yet to be truly realised. The gap between the potential and the reality of digital technology integration is commonly attributed to a range of challenging extrinsic and intrinsic influences. Activity Theory (Engeström, 2009) is used to analyse challenges created by extrinsic influences (Nielsen, Miller, & Hoban, 2012); a complementary theory is needed to conceptualise intrinsic influences. System 1 and System 2 thinking theory (Kahneman, 2011) will be advanced as a conceptual framework for understanding conscious and unconscious aspects of teacher practice, particularly the interaction between innovation and teacher routine, attitudes and beliefs. Transformative Learning Theory (Mezirow, 2009) will be positioned to comprehend the nexus of extrinsic and intrinsic influences. This paper will propose how, when faced with extrinsic and intrinsic influences on innovative practice, educators can use these theories to conceptualise the challenge of integrating digital technologies in pedagogy.

Pedagogical tools designed to promote engagement and active learning in the biomedical sciences and allied health disciplines

Perceiving students, science students especially, as mere consumers of facts and information belies the importance of a need to engage them with the principles underlying those facts and is counter-intuitive to the facilitation of knowledge and understanding. Traditional didactic lecture approaches need a re-think if student classroom engagement and active learning are to be valued over fact memorisation and fact recall. In our undergraduate biomedical science programs across Years 1, 2 and 3 in the Faculty of Health at QUT, we have developed an authentic learning model with an embedded suite of pedagogical strategies that foster classroom engagement and allow for active learning in the sub-discipline area of medical bacteriology. The suite of pedagogical tools we have developed have been designed to enable their translation, with appropriate fine-tuning, to most biomedical and allied health discipline teaching and learning contexts. Indeed, aspects of the pedagogy have been successfully translated to the nursing microbiology study stream at QUT. The aims underpinning the pedagogy are for our students to: (1) Connect scientific theory with scientific practice in a more direct and authentic way, (2) Construct factual knowledge and facilitate a deeper understanding, and (3) Develop and refine their higher order flexible thinking and problem solving skills, both semi-independently and independently. The mindset and role of the teaching staff is critical to this approach since for the strategy to be successful tertiary teachers need to abandon traditional instructional modalities based on one-way information delivery. Face-to-face classroom interactions between students and lecturer enable realisation of pedagogical aims (1), (2) and (3). The strategy we have adopted encourages teachers to view themselves more as expert guides in what is very much a student-focused process of scientific exploration and learning. Specific pedagogical strategies embedded in the authentic learning model we have developed include: (i) interactive lecture-tutorial hybrids or lectorials featuring teacher role-plays as well as class-level question-and-answer sessions, (ii) inclusion of “dry” laboratory activities during lectorials to prepare students for the wet laboratory to follow, (iii) real-world problem-solving exercises conducted during both lectorials and wet laboratory sessions, and (iv) designing class activities and formative assessments that probe a student’s higher order flexible thinking skills. Flexible thinking in this context encompasses analytical, critical, deductive, scientific and professional thinking modes. The strategic approach outlined above is designed to provide multiple opportunities for students to apply principles flexibly according to a given situation or context, to adapt methods of inquiry strategically, to go beyond mechanical application of formulaic approaches, and to as much as possible self-appraise their own thinking and problem solving. The pedagogical tools have been developed within both workplace (real world) and theoretical frameworks. The philosophical core of the pedagogy is a coherent pathway of teaching and learning which we, and many of our students, believe is more conducive to student engagement and active learning in the classroom. Qualitative and quantitative data derived from online and hardcopy evaluations, solicited and unsolicited student and graduate feedback, anecdotal evidence as well as peer review indicate that: (i) our students are engaging with the pedagogy, (ii) a constructivist, authentic-learning approach promotes active learning, and (iii) students are better prepared for workplace transition.

From council dog catcher to critical scholar

Carol and I just missed each other in the early 1990s: Carol left Manchester for Australia in 1990, while I an·iv·ed in Manchester from Australia in 1993. Sixteen years later and on the very opposite side of the world, we found ourselves sharing an adjacent room during the 2009 Agri-Food Research Network conference in Auckland. Carol was already an accomplished sociologist; I was a newbie PhD student, presenting on a thesis topic that was only just starting to take shape...

Advancing practice in critical care : A model of knowledge integration: A Singaporean context

It could be argued that advancing practice in critical care has been superseded by the advanced practice agenda. Some would suggest that advancing practice is focused on the core attributes of an individuals practice progressing onto advanced practice status. However, advancing practice is more of a process than identifiable skills and as such is often negated when viewing the development of practitioners to the advanced practice level. For example practice development initiatives can be seen as advancing practice for the masses which ensures that practitioners are following the same level of practice. The question here is; are they developing individually. To discuss the potential development of a conceptual model of knowledge integration pertinent to critical care nursing practice. In an attempt to explore the development of leading edge critical care thinking and practice, a new model for advancing practice in critical care is proposed. This paper suggests that reflection may not be the best model for advancing practice unless the individual practitioner has a sound knowledge base both theoretically and experientially. Drawing on the contemporary literature and recent doctoral research, the knowledge integration model presented here uses multiple learning strategies that are focused in practise to develop practice, for example the use of work-based learning and clinical supervision. Ongoing knowledge acquisition and its relationship with previously held theory and experience will enable individual practitioners to advance their own practice as well as being a resource for others.

Assessing performance in critical care nursing practice using the Benner Novice to expert model: A pilot study

Background It is often believed that by ensuring the ongoing completion of competency documents and life-long learning in nursing practice guarantees quality patient care. This is probably true in most cases where it provides reassurances that the nursing team is maintaining a safe “generalised” level of practice. However, competency does not always promise quality performance. There are a number of studies that have reported differences in what practitioners know and what they actually do despite being deemed competent. Aim The aim of this study was to assess whether our current competency documentation is fit for purpose and to ascertain whether performance assessment needs to be a key component in determining competence. Method 15 nurses within a General ICU who had been on the unit <4 years agreed to participate in this project. Using participant observation and assessing performance against key indicators of the Benner Novice to Expert5 model the participants were supported and assessed over the course of a ‘normal’ nursing shift. Results The results were surprising both positively and negatively. First, the nurses felt more empowered in their clinical decision making skills; second, it identified individual learning needs and milestones in educational development. There were some key challenges identified which included 5 nurses over estimating their level of competence, practice was still very much focused on task acquisition and skill and surprisingly some nurses still felt dominated by the other health professionals within the unit. Conclusion We found that the capacity and capabilities of our nursing workforce needs continual ongoing support especially if we want to move our staff from capable task-doer to competent performers. Using the key novice to expert indicators identified the way forward for us in how we assess performance and competence in practice particularly where promotion to higher grades is based on existing documentation.

Advancing practice in critical care: A model of knowledge integration

Explore and describe a conceptual model of knowledge integration pertinent to the development of individual practitioners in critical care. Discussion of how multiple learning strategies that are embedded in practice can be beneficial in developing knowledge.

Minding the gaps: Disability culture + cultural competence in interior design

Despite the increased attention to the relationship of disability and design, this area still suffers from terminological confusion, oversimplification and a positivist bias that continues to produce ableist space. Here, I am suggesting that space is not a fixed container or a pochéd plan that needs to be ‘altered’ in order to accommodate, but that space is a fundamental element of social life and that space continually reproduces the social and cultural relations of its production. This paper serves as a critical foundation for ongoing explorations into how disability culture is situated within interior design. A shift towards disability as culture is necessary to move our understanding of how to design for those with disabilities out of the objective realm (prescriptive codes and guidelines) and into a subjective realm (the lived experience and embodied know-how of those with disabilities). By framing disability around a cultural model rather than a medical model it allows for epistemological and pedagogical shifts in our ways of knowing in interior design. In defining culture as “a way of life” it is important to look at disability as both a diverse way of living and a diverse way of knowing. Most significant, is that the everyday expertise of people with disabilities is recognized as knowledge that can inform the field of interior design. The urgency for defining disability culture is essential to our understanding of cultural competence in interior design education and practice. The aim of this paper is to challenge our current understanding of how to design for those with disabilities and to shift our ways of knowing in interior design towards a deep understanding of the lived experience, embodied know-how and culture of those with disabilities. This paper will begin by analysing the different models of disability and how interior design education and practice has shifted to reflect these different models. Defining disability culture and all of its complexities is also an essential component of this paper. Finally, this paper will present best practices and case studies of how a cultural model of disability can shape interior environments and interior design pedagogy.

Critical criminological understandings of adult pornography and woman abuse: New progressive directions in research and theory

There is a small, but growing, social scientific literature on the racist and violent nature of contemporary adult pornography. However, considerably more empirical and theoretical work needs to be done to advance a critical criminological understanding of how such hurtful sexual media contribute to various forms of woman abuse in intimate relationships. The main objective of this article is to briefly review the relevant literature and to suggest a few new progressive empirical and theoretical directions.

Why are students choosing STEM and when do they make their choice?

BACKGROUND OR CONTEXT The higher education sector plays an important role in encouraging students into the STEM pipeline through fostering partnerships with schools, building on universities long tradition in engagement and outreach to secondary schools. Numerous activities focus on integrated STEM learning experiences aimed at developing conceptual scientific and mathematical knowledge with opportunities for students to show and develop skills in working with each other and actively engaging in discussion, decision making and collaborative problem solving. (NAS, 2013; AIG, 2015; OCS, 2014). This highlights the importance of the development and delivery of engaging integrated STEM activities connected to the curriculum to inspire the next generation of scientists and engineers and generally preparing students for post-secondary success. The broad research objective is to gain insight into which engagement activities and to what level they influence secondary school students’ selection of STEM-related career choices at universities. PURPOSE OR GOAL To evaluate and determine the effectiveness of STEM engagement activities impacting student decision making in choosing a STEM-related degree choice at university. APPROACH A survey was conducted with first-year domestic students studying STEM-related fieldswithin the Science and Engineering Faculty at Queensland University of Technology. Of the domestic students commencing in 2015, 29% responded to the survey. The survey was conducted using Survey Monkey and included a variety of questions ranging from academic performance at school to inspiration for choosing a STEM degree. Responses were analysed on a range of factors to evaluate the influence on students’ decisions to study STEM and whether STEM high school engagement activities impacted these decisions. To achieve this the timing of decision making for students choice in study area, degree, and university is compared with the timing of STEM engagement activities. DISCUSSION Statistical analysis using SPSS was carried out on survey data looking at reasons for choosing STEM degrees in terms of gender, academic performance and major influencers in their decision making. It was found that students choose their university courses based on what subjects they enjoyed and exceled at in school. These results found a high correlation between enjoyment of a school subject and their interest in pursuing this subject at university and beyond. Survey results indicated students are heavily influenced by their subject teachers and parents in their choice of STEM-related disciplines. In terms of career choice and when students make their decision, 60% have decided on a broad area of study by year 10, whilst only 15% had decided on a specific course and 10% had decided on which university. The timing of secondary STEM engagement activities is seen as a critical influence on choosing STEM disciplines or selection of senior school subjects with 80% deciding on specific degree between year 11 and 12 and 73% making a decision on which university in year 12. RECOMMENDATIONS/IMPLICATIONS/CONCLUSION Although the data does not support that STEM engagement activities increase the likelihood of STEM-related degree choice, the evidence suggests the students who have participated in STEM activities associate their experiences with their choice to pursue a STEM-related course. It is important for universities to continue to provide quality engaging and inspirational learning experiences in STEM, to identify and build on students’ early interest and engagement, increase STEM knowledge and awareness, engage them in interdisciplinary project-based STEM practices, and provide them with real-world application experiences to sustain their interest.

Reflective perspectives: Negotiations at and within the borders of cultural difference: A post-qualitative inquiry of cultural hybridity within third space enunciations

This research explores the in-between space of intercultural collaboration between Aboriginal and Torres Strait Islander peoples and non-Indigenous peoples in Australia. Using critical and third space theories and a post-qualitative inquiry, I examine negotiations of cultural difference through articulated moments of intercultural collaboration in order to inform intercultural pedagogical practices. This research also explores how ideology, imbued through discourse, has the power to enforce or challenge cultural and social domination. This in turn creates cultural hegemony, a process whereby a particular social and cultural group has the power to influence the thoughts, expectations and behaviours of a particular society.

Australian innovation ecosystem: A critical review of the national innovation support mechanisms

Innovation is understood as the combination of existing ideas or the generation of new ideas into new processes, products and services, and widely viewed as the main driver of growth in contemporary economies. In the age of the knowledge economy, successful economic development is intimately linked to a country’s capacity to generate, acquire, absorb, disseminate, and apply innovation towards advanced technology products and services. This development approach is labelled as knowledge-based economic development and highly associated with a capacity embodied in a country’s national innovation ecosystem. The research reported in this paper aims to critically review the Australian innovation ecosystem in order to provide a better understanding on the potential impacts of policy and support mechanisms on the innovation and knowledge generation capacity. The investigation places Australia’s innovation system and national-level innovation support mechanisms under the microscope. The methodology of the study is twofold. Firstly, it undertakes a critical review of the literature and government policy documents to better understand the innovation policy and support mechanisms in the country. It, then, conducts a survey to capture Australian innovation companies’ perceptions on the role and effectiveness of the existing innovation incentive programs. The paper concludes with a discussion on the key insights and findings and potential policy and support directions of the country to achieve a flourishing knowledge economy.

"It makes you think anything is possible”: Representing diversity in music theory pedagogy

This paper critiques a traditional approach to music theory pedagogy. It argues that music theory courses should draw on pedagogies that reflect the diversity and pluralism inherent in 21st century music making. It presents the findings of an action research project investigating the experiences of undergraduate students undertaking an innovative contemporary art music theory course. It describes the students’ struggle in coming to terms with a course that integrated composing, performing, listening and analysing coupled with what for many was their first exposure to the diversity of contemporary art music. The paper concludes with suggesting that the approach could be adopted more widely throughout music programs.