Differences in Treatment and Management of Indigenous and Non-Indigenous Patients Presenting with Chest Pain: Results of the Heart Protection Partnership (HPP) Study

BACKGROUND: Indigenous patients with acute coronary syndromes represent a high-risk group. There are however few contemporary datasets addressing differences in the presentation and management of Indigenous and non-Indigenous patients with chest pain. METHODS: The Heart Protection Project, is a multicentre retrospective audit of consecutive medical records from patients presenting with chest pain. Patients were identified as Indigenous or non-Indigenous, and time to presentation and cardiac investigations as well as rates of cardiac investigations and procedures were compared between the two groups. RESULTS: Of the 2380 patients included, 199 (8.4%) identified as Indigenous, and 2174 (91.6%) as non-Indigenous. Indigenous patients were younger, had higher rates hyperlipidaemia, diabetes, smoking, known coronary artery disease and a lower rate of prior PCI; and were significantly less likely to have private health insurance, be admitted to an interventional facility or to have a cardiologist as primary physician. Following adjustment for difference in baseline characteristics, Indigenous patients had comparable rates of cardiac investigations and delay times to presentation and investigations. CONCLUSIONS: Although the Indigenous population was identified as a high-risk group, in this analysis of selected Australian hospitals there were no significant differences in treatment or management of Indigenous patients in comparison to non-Indigenous.

Which components of heart failure programs are effective? A meta-analysis of the outcomes of structured telephone support or telemonitoring as the primary component of heart failure management in 9,560 patients (Abridged Cochrane Review)

Aims--Telemonitoring (TM) and structured telephone support (STS) have the potential to deliver specialised management to more patients with chronic heart failure (CHF), but their efficacy is still to be proven. Objectives To review randomised controlled trials (RCTs) of TM or STS on all- cause mortality and all-cause and CHF-related hospitalisations in patients with CHF, as a non-invasive remote model of specialised disease-management intervention.--Methods and Results--Data sources:We searched 15 electronic databases and hand-searched bibliographies of relevant studies, systematic reviews, and meeting abstracts. Two reviewers independently extracted all data. Study eligibility and participants: We included any randomised controlled trials (RCT) comparing TM or STS to usual care of patients with CHF. Studies that included intensified management with additional home or clinic visits were excluded. Synthesis: Primary outcomes (mortality and hospitalisations) were analysed; secondary outcomes (cost, length of stay, quality of life) were tabulated.--Results: Thirty RCTs of STS and TM were identified (25 peer-reviewed publications (n=8,323) and five abstracts (n=1,482)). Of the 25 peer-reviewed studies, 11 evaluated TM (2,710 participants), 16 evaluated STS (5,613 participants) and two tested both interventions. TM reduced all-cause mortality (risk ratio (RR 0•66 [95% CI 0•54-0•81], p<0•0001) and STS showed similar trends (RR 0•88 [95% CI 0•76-1•01], p=0•08). Both TM (RR 0•79 [95% CI 0•67-0•94], p=0•008) and STS (RR 0•77 [95% CI 0•68-0•87], p<0•0001) reduced CHF-related hospitalisations. Both interventions improved quality of life, reduced costs, and were acceptable to patients. Improvements in prescribing, patient-knowledge and self-care, and functional class were observed.--Conclusion: TM and STS both appear effective interventions to improve outcomes in patients with CHF.

Towards a comprehensive model of driver aggression : a review of the literature and directions for the future

Driver aggression is a road safety issue of growing concern throughout most highly motorised countries, yet to date there is no comprehensive model that deals with this issue in the road safety area. This paper sets out to examine the current state of research and theory on aggressive driving with a view to incorporating useful developments in the area of human aggression from mainstream psychological research. As a first step, evidence regarding the prevalence and incidence of driver aggression, including the impact of the phenomenon on crash rates is reviewed. Inconsistencies in the definition and operationalisation of driver aggression that have hampered research in the area are noted. Existing models of driver aggression are then identified and the need to distinguish and address the role of intentionality as well as the purpose of perpetrating behaviours within both these and research efforts is highlighted. Drawing on recent findings from psychological research into general aggression, it is argued that progress in understanding driver aggression requires models that acknowledge not only the person-related and situational factors, but the cognitive and emotional appraisal processes involved in driver aggression. An effective model is expected to allow the explanation of not only the likelihood and severity of driver aggression behaviours, but also the escalation of incidents within the context of the road environment.

Attack of the creationist reverberators! Or: the end of the world (as we know it)

This special issue of Popular Communication examines the impact of the global financial crisis and recession on differnt aspects of global and regional media and the cultural industries, changing practices of media production, as well as media consumption, and the interplay of economic challenges and technological change.

An analysis of the Brisbane residential property market and the global financial crisis

The period from 2007 to 2009 covered the residential property boom from early 2000, to the property recession following the Global Financial Crisis. Since late 2008, a number of residential property markets have suffered significant falls in house prices, buth this has not been consistent across all market sectors. This paper will analyze the housing market in Brisbane Australia to determine the impact, similarities and differences that the4 GFC had on range of residential sectors across a divesified property market. Data analysis will provide an overview of residential property prices, sales and listing volumes over the study period and will provide a comparison of median house price performance across the geographic and socio-economic areas of Brisbane.

Augmenting public urban spaces : the impact of the digital future on the design of public urban spaces

Social media digital and technologies surround us. We are moving into an age of ubiquitous (that is everywhere) computing. New media and information and communication technologies already impact on many aspects of everyday life including work, home and leisure. These new technologies are influencing the way that we develop social networks; understand places and location; how we navigate our cities; how we provide information about utilities and services; developing new ways to engage and participate in our communities, in planning, in governance and other decisions. This paper presents the initial findings of the impacts that digital communication technologies are having on public urban spaces. It develops a contextual review the nexus between urban planning and technological developments with examples and case studies from around the world to highlight some of the potential directions for urban planning in Queensland and Australia. It concludes with some thought provoking discussion points for urban planners, architects, designers and placemakers on the future of urban informatics and urban design, questions such as: how technology can enhance ‘place’, how technology can be used to improve public participation, and how technology will change our requirements of public places?

Characterisation of the tritrophic interactions between tobacco yellow dwarf virus, its vector and host-plants

Tobacco yellow dwarf virus (TbYDV, family Geminiviridae, genus Mastrevirus) is an economically important pathogen causing summer death and yellow dwarf disease in bean (Phaseolus vulgaris L.) and tobacco (Nicotiana tabacum L.), respectively. Prior to the commencement of this project, little was known about the epidemiology of TbYDV, its vector and host-plant range. As a result, disease control strategies have been restricted to regular poorly timed insecticide applications which are largely ineffective, environmentally hazardous and expensive. In an effort to address this problem, this PhD project was carried out in order to better understand the epidemiology of TbYDV, to identify its host-plant and vectors as well as to characterise the population dynamics and feeding physiology of the main insect vector and other possible vectors. The host-plants and possible leafhopper vectors of TbYDV were assessed over three consecutive growing seasons at seven field sites in the Ovens Valley, Northeastern Victoria, in commercial tobacco and bean growing properties. Leafhoppers and plants were collected and tested for the presence of TbYDV by PCR. Using sweep nets, twenty-three leafhopper species were identified at the seven sites with Orosius orientalis the predominant leafhopper. Of the 23 leafhopper species screened for TbYDV, only Orosius orientalis and Anzygina zealandica tested positive. Forty-two different plant species were also identified at the seven sites and tested. Of these, TbYDV was only detected in four dicotyledonous species, Amaranthus retroflexus, Phaseolus vulgaris, Nicotiana tabacum and Raphanus raphanistrum. Using a quadrat survey, the temporal distribution and diversity of vegetation at four of the field sites was monitored in order to assess the presence of, and changes in, potential host-plants for the leafhopper vector(s) and the virus. These surveys showed that plant composition and the climatic conditions at each site were the major influences on vector numbers, virus presence and the subsequent occurrence of tobacco yellow dwarf and bean summer death diseases. Forty-two plant species were identified from all sites and it was found that sites with the lowest incidence of disease had the highest proportion of monocotyledonous plants that are non hosts for both vector and the virus. In contrast, the sites with the highest disease incidence had more host-plant species for both vector and virus, and experienced higher temperatures and less rainfall. It is likely that these climatic conditions forced the leafhopper to move into the irrigated commercial tobacco and bean crop resulting in disease. In an attempt to understand leafhopper species diversity and abundance, in and around the field borders of commercially grown tobacco crops, leafhoppers were collected from four field sites using three different sampling techniques, namely pan trap, sticky trap and sweep net. Over 51000 leafhopper samples were collected, which comprised 57 species from 11 subfamilies and 19 tribes. Twentythree leafhopper species were recorded for the first time in Victoria in addition to several economically important pest species of crops other than tobacco and bean. The highest number and greatest diversity of leafhoppers were collected in yellow pan traps follow by sticky trap and sweep nets. Orosius orientalis was found to be the most abundant leafhopper collected from all sites with greatest numbers of this leafhopper also caught using the yellow pan trap. Using the three sampling methods mentioned above, the seasonal distribution and population dynamics of O. orientalis was studied at four field sites over three successive growing seasons. The population dynamics of the leafhopper was characterised by trimodal peaks of activity, occurring in the spring and summer months. Although O. orientalis was present in large numbers early in the growing season (September-October), TbYDV was only detected in these leafhoppers between late November and the end of January. The peak in the detection of TbYDV in O. orientalis correlated with the observation of disease symptoms in tobacco and bean and was also associated with warmer temperatures and lower rainfall. To understand the feeding requirements of Orosius orientalis and to enable screening of potential control agents, a chemically-defined artificial diet (designated PT-07) and feeding system was developed. This novel diet formulation allowed survival for O. orientalis for up to 46 days including complete development from first instar through to adulthood. The effect of three selected plant derived proteins, cowpea trypsin inhibitor (CpTi), Galanthus nivalis agglutinin (GNA) and wheat germ agglutinin (WGA), on leafhopper survival and development was assessed. Both GNA and WGA were shown to reduce leafhopper survival and development significantly when incorporated at a 0.1% (w/v) concentration. In contrast, CpTi at the same concentration did not exhibit significant antimetabolic properties. Based on these results, GNA and WGA are potentially useful antimetabolic agents for expression in genetically modified crops to improve the management of O. orientalis, TbYDV and the other pathogens it vectors. Finally, an electrical penetration graph (EPG) was used to study the feeding behaviour of O. orientalis to provide insights into TbYDV acquisition and transmission. Waveforms representing different feeding activity were acquired by EPG from adult O. orientalis feeding on two plant species, Phaseolus vulgaris and Nicotiana tabacum and a simple sucrose-based artificial diet. Five waveforms (designated O1-O5) were observed when O. orientalis fed on P. vulgaris, while only four (O1-O4) and three (O1-O3) waveforms were observed during feeding on N. tabacum and the artificial diet, respectively. The mean duration of each waveform and the waveform type differed markedly depending on the food source. This is the first detailed study on the tritrophic interactions between TbYDV, its leafhopper vector, O. orientalis, and host-plants. The results of this research have provided important fundamental information which can be used to develop more effective control strategies not only for O. orientalis, but also for TbYDV and other pathogens vectored by the leafhopper.

Psychometric validation of the growth and empowerment measure (GEM) applied with Indigenous Australians

Objective: Empowerment is a complex process of psychological, social, organizational and structural change. It allows individuals and groups to achieve positive growth and effectively address the social and psychological impacts of historical oppression, marginalization and disadvantage. The Growth and Empowerment Measure (GEM) was developed to measure change in dimensions of empowerment as defi ned and described by Aboriginal Australians who participated in the Family Well Being programme.---------- Method: The GEM has two components: a 14-item Emotional Empowerment Scale (EES14) and 12 Scenarios (12S). It is accompanied by the Kessler 6 Psychological Distress Scale (K6), supplemented by two questions assessing frequency of happy and angry feelings. For validation, the measure was applied with 184 Indigenous Australian participants involved in personal and/or organizational social health activities.---------- Results: Psychometric analyses of the new instruments support their validity and reliability and indicate two-component structures for both the EES (Self-capacity; Inner peace) and the 12S (Healing and enabling growth, Connection and purpose). Strong correlations were observed across the scales and subscales. Participants who scored higher on the newly developed scales showed lower distress on the K6, particularly when the two additional questions were included. However, exploratory factor analyses demonstrated that GEM subscales are separable from the Kessler distress measure.---------- Conclusion: The GEM shows promise in enabling measurement and enhancing understanding of both process and outcome of psychological and social empowerment within an Australian Indigenous context.

Ecological sustainable development: a study of the obstacles in Australia's construction industry

Ecological sustainable development (ESD), defined as that which meets the needs of the present without compromising the ability of future generations to meet their own needs, has much to offer in enhancing the quality of life of people and maintaining the environment for future generations by reducing the pollution of water, air and land, minimizing the destruction of irreplaceable ecosystems and cutting down the amount of toxic materials released. However, there is still much to do to achieve full implementation world-wide. This paper reports on three factors-design, attitudes and financial constraints - that are likely barriers to the implementation of ESD within the built environment in Australian industry. A postal questionnaire survey is described aimed at soliciting views on detailed aspects of the factors. This shows that ESD in the Australian built environment has also not been successfully implemented. The main reason is found to be due to the perceived costs involved - the cost of using environmental materials being a predominant factor. The design of ESD, being more sophisticated, also is perceived as involving stakeholders in more expense. There also appears to be a lack of knowledge and a lack of specialised and interdisciplinary design teams available in the Australian context.

Raman spectroscopic study of the mineral thorikosite Pb3(OH)(SbO3,AsO3)Cl2 : a mineral of archaeological significance

The mineral thorikosite Pb3(OH)(SbO3,AsO3)Cl2 is named after the ancient city of Thorikos, in the region of Attica, where the ancient mine sites dating back to the bronze ages are found. Raman spectra of the antimonate bearing mineral thorikosite Pb3(OH)(SbO3,AsO3)Cl2 were studied, and related to the structure of the mineral. Two intense Raman peaks are observed at 596 and 730 cm-1 and are assigned to the Sb3+O3 and As3+O3 stretching vibrations. A peak at 1085 cm-1 is assigned to the Sb3+OH deformation mode. Raman band at 325 cm-1 is assigned to an OAsO bending vibration of the As3+O3 units and the bands at 269 and 275 cm-1 are attributed to the OSbO bending modes of the Sb3+O3 units. The intense Raman bands at 112 and 133 cm-1 are associated with PbCl stretching modes. Minerals such as nealite and thorikosite are minerals of archaeological significance. Yet no spectroscopic studies of these minerals have been undertaken.

Assessment of the influence of cultural barriers to HDR supervision of non-English speaking background (NESD) students in engineering and information technology (IT) disciplines

The paper details the results of the first phase of an on-going research into the sociocultural factors that influence the supervision of higher degrees research (HDR) engineering students in the Faculty of Built Environment and Engineering (BEE) and Faculty of Science and Technology (FaST) at Queensland University of Technology. A quantitative analysis was performed on the results from an online survey that was administered to 179 engineering students. The study reveals that cultural barriers impact their progression and developing confidence in their research programs. We argue that in order to assist international and non-English speaking background (NESB) research students to triumph over such culturally embedded challenges in engineering research, it is important for supervisors to understand this cohort's unique pedagogical needs and develop intercultural sensitivity in their pedagogical practice in postgraduate research supervision. To facilitate this, the governing body (Office of Research) can play a vital role in not only creating the required support structures but also their uniform implementation across the board.

Order and disorder in the structures of two crystal polymorphs of the adduct bis(quinolinium-2-carboxylate) DL-malic acid

The structures of two polymorphs of the anhydrous cocrystal adduct of bis(quinolinium-2-carboxylate) DL-malic acid, one triclinic the other monoclinic and disordered, have been determined at 200 K. Crystals of the triclinic polymorph 1 have space group P-1, with Z = 1 in a cell with dimensions a = 4.4854(4), b = 9.8914(7), c = 12.4670(8)Å, α = 79.671(5), β = 83.094(6), γ = 88.745(6)deg. Crystals of the monoclinic polymorph 2 have space group P21/c, with Z = 2 in a cell with dimensions a = 13.3640(4), b = 4.4237(12), c = 18.4182(5)Å, β = 100.782(3)deg. Both structures comprise centrosymmetric cyclic hydrogen-bonded quinolinic acid zwitterion dimers [graph set R2/2(10)] and 50% disordered malic acid molecules which lie across crystallographic inversion centres. However, the oxygen atoms of the malic acid carboxylic groups in 2 are 50% rotationally disordered whereas in 1 these are ordered. There are similar primary malic acid carboxyl O-H...quinaldic acid hydrogen-bonding chain interactions in each polymorph, extended into two-dimensional structures but in l this involves centrosymmetric cyclic head-to-head malic acid hydroxyl-carboxyl O-H...O interactions [graph set R2/2(10)] whereas in 2 the links are through single hydroxy-carboxyl hydrogen bonds.