Autonomy versus futility? Barriers to good clinical practice in end-of-life care : a Queensland case

Findings from a Queensland coronial inquest highlight the complex clinical, ethical and legal issues that arise in end-of-life care when clinicians and family members disagree about a diagnosis of clinical futility. The tension between the law and best medical practice is highlighted in this case, as doctors are compelled to seek family consent to not commence a futile intervention. Good communication between doctors and families, as well as community and professional education, is essential to resolve tensions that can arise when there is disagreement about treatment at the end of life.

E-learning : aging workforce versus technology-savvy generation

Purpose – The purpose of this paper is to provide description and analysis of how a traditional industry is currently using e-learning, and to identify how the potential of e-learning can be realised whilst acknowledging the technological divide between younger and older workers. Design/methodology/approach – An exploratory qualitative methodology was employed to analyse three key questions: How is the Australian rail industry currently using e-learning? Are there age-related issues with the current use of e-learning in the rail industry? How could e-learning be used in future to engage different generations of learners in the rail industry? Data were collected in five case organisations from across the Australian rail industry. Findings – Of the rail organisations interviewed, none believed they were using e-learning to its full potential. The younger, more technologically literate employees are not having their expectations met and therefore retention of younger workers has become an issue. The challenge for learning and development practitioners is balancing the preferences of an aging workforce with these younger, more “technology-savvy”, learners and the findings highlight some potential ways to begin addressing this balance. Practical implications – The findings identified the potential for organisations (even those in a traditional industry such as rail) to better utilise e-learning to attract and retain younger workers but also warns against making assumptions about technological competency based on age. Originality/value – Data were gathered across an industry, and thus this paper takes an industry approach to considering the potential age-related issues with e-learning and the ways it may be used to meet the needs of different generations in the workplace.

Perceptions of physical versus virtual design studio education

While the studio environment has been promoted as an ideal educational setting for project-based disciplines associated with the art and design, few qualitative studies have been undertaken in a comprehensive way, with even fewer giving emphasis to the teachers and students and how they feel about changing their environment. This situation is problematic given the changes and challenges facing higher education, including those associated with new technologies such as online learning. In response, this paper describes a comparative study employing grounded theory to identify and describe teachers’ and students’ perceptions of the physical design studio (PDS) as well as the virtual design studio (VDS) of architectural students in an Australian university. The findings give significance to aspects of design education activities and their role in the development of integrated hybrid learning environments.

A double-blind randomised controlled trial of a natural oil-based emulsion containing allantoin versus aqueous cream for managing radiation-induced skin reactions in patients with cancer

Background: Radiation-induced skin reaction (RISR) is one of the most common and distressing side effects of radiotherapy in patients with cancer. It is featured with swelling, redness, itching, pain, breaks in skin, discomfort, and a burning sensation. There is a lack of convincing evidence supporting any single practice in the prevention or management of RISR. Methods/Designs: This double-blinded randomised controlled trial aims to investigate the effects of a natural oil-based emulsion containing allantoin (as known as Moogoo Udder Cream®) versus aqueous cream in reducing RISR, improving pain, itching and quality of life in this patient group. One group will receive Moogoo Udder Cream®. Another group will receive aqueous cream. Outcome measures will be collected using patient self-administered questionnaire, interviewer administered questionnaire and clinician assessment at commencement of radiotherapy, weekly during radiotherapy, and four weeks after the completion of radiotherapy. Discussion: Despite advances of radiologic advances and supportive care, RISR are still not well managed. There is a lack of efficacious interventions in managing RISR. While anecdotal evidence suggests that Moogoo Udder Cream® may be effective in managing RISR, research is needed to substantiate this claim. This paper presents the design of a double blind randomised controlled trial that will evaluate the effects of Moogoo Udder Cream® versus aqueous cream for managing in RISR in patients with cancer. Trial registration: ACTRN 12612000568819

Evaluation of the iPhone with an acrylic sleeve versus the Scoliometer for rib hump measurement in scoliosis

Background. Vertebral rotation found in structural scoliosis contributes to trunkal asymmetry which is commonly measured with a simple Scoliometer device on a patient's thorax in the forward flexed position. The new generation of mobile 'smartphones' have an integrated accelerometer, making accurate angle measurement possible, which provides a potentially useful clinical tool for assessing rib hump deformity. This study aimed to compare rib hump angle measurements performed using a Smartphone and traditional Scoliometer on a set of plaster torsos representing the range of torsional deformities seen in clinical practice. Methods. Nine observers measured the rib hump found on eight plaster torsos moulded from scoliosis patients with both a Scoliometer and an Apple iPhone on separate occasions. Each observer repeated the measurements at least a week after the original measurements, and were blinded to previous results. Intra-observer reliability and inter-observer reliability were analysed using the method of Bland and Altman and 95% confidence intervals were calculated. The Intra-Class Correlation Coefficients (ICC) were calculated for repeated measurements of each of the eight plaster torso moulds by the nine observers. Results. Mean absolute difference between pairs of iPhone/Scoliometer measurements was 2.1 degrees, with a small (1 degrees) bias toward higher rib hump angles with the iPhone. 95% confidence intervals for intra-observer variability were +/- 1.8 degrees (Scoliometer) and +/- 3.2 degrees (iPhone). 95% confidence intervals for inter-observer variability were +/- 4.9 degrees (iPhone) and +/- 3.8 degrees (Scoliometer). The measurement errors and confidence intervals found were similar to or better than the range of previously published thoracic rib hump measurement studies. Conclusions. The iPhone is a clinically equivalent rib hump measurement tool to the Scoliometer in spinal deformity patients. The novel use of plaster torsos as rib hump models avoids the variables of patient fatigue and discomfort, inconsistent positioning and deformity progression using human subjects in a single or multiple measurement sessions.

Built to last versus meant to end : time bounds specification in strategic alliances

This article explores an important temporal aspect of the design of strategic alliances by focusing on the issue of time bounds specification. Time bounds specification refers to a choice on behalf of prospective alliance partners at the time of alliance formation to either pre-specify the duration of an alliance to a specific time window, or to keep the alliance open-ended (Reuer & Ariňo, 2007). For instance, Das (2006) mentions the example of the alliance between Telemundo Network and Mexican Argos Comunicacion (MAC). Announced in October 2000, this alliance entailed a joint production of 1200 hours of comedy, news, drama, reality and novella programs (Das, 2006). Conditioned on the projected date of completing the 1200 hours of programs, Telemundo Network and MAC pre-specified the time bounds of the alliance ex ante. Such time-bound alliances are said to be particularly prevalent in project-based industries, like movie production, construction, telecommunications and pharmaceuticals (Schwab & Miner, 2008). In many other instances, however, firms may choose to keep their alliances open-ended, not specifying a specific time bound at the time of alliance formation. The choice between designing open-ended alliances that are “built to last”, versus time bound alliances that are “meant to end” is important. Seminal works like Axelrod (1984), Heide & Miner (1992), and Parkhe (1993) demonstrated that the choice to place temporal bounds on a collaborative venture has important implications. More specifically, collaborations that have explicit, short term time bounds (i.e. what is termed a shorter “shadow of the future”) are more likely to experience opportunism (Axelrod, 1984), are more likely to focus on the immediate present (Bakker, Boros, Kenis & Oerlemans, 2012), and are less likely to develop trust (Parkhe, 1993) than alliances for which time bounds are kept indeterminate. These factors, in turn, have been shown to have important implications for the performance of alliances (e.g. Kale, Singh & Perlmutter, 2000). Thus, there seems to be a strong incentive for organizations to form open-ended strategic alliances. And yet, Reuer & Ariňo (2007), one of few empirical studies that details the prevalence of time-bound and open-ended strategic alliances, found that about half (47%) of the alliances in their sample were time bound, the other half were open-ended. What conditions, then, determine this choice?

Discriminating stromatolite formation modes using rare earth element geochemistry: Trapping and binding versus in situ precipitation of stromatolites from the Neoproterozoic Bitter Springs Formation, Northern Territory, Australia

Stromatolites consist primarily of trapped and bound ambient sediment and/or authigenic mineral precipitates, but discrimination of the two constituents is difficult where stromatolites have a fine texture. We used laser ablation-inductively coupled plasma-mass spectrometry to measure trace element (rare earth element – REE, Y and Th) concentrations in both stromatolites (domical and branched) and closely associated particulate carbonate sediment in interspaces (spaces between columns or branches) from bioherms within the Neoproterozoic Bitter Springs Formation, central Australia. Our high resolution sampling allows discrimination of shale-normalised REE patterns between carbonate in stromatolites and immediately adjacent, fine-grained ambient particulate carbonate sediment from interspaces. Whereas all samples show similar negative La and Ce anomalies, positive Gd anomalies and chondritic Y/Ho ratios, the stromatolites and non-stromatolite sediment are distinguishable on the basis of consistently elevated light REEs (LREEs) in the stromatolitic laminae and relatively depleted LREEs in the particulate sediment samples. Additionally, concentrations of the lithophile element Th are higher in ambient sediment samples than in stromatolites, consistent with accumulation of some fine siliciclastic detrital material in the ambient sediment but a near absence in the stromatolites. These findings are consistent with the stromatolites consisting dominantly of in situ carbonate precipitates rather than trapped and bound ambient sediment. Hence, high resolution trace element (REE + Y, Th) geochemistry can discriminate fine-grained carbonates in these stromatolites from coeval non-stromatolitic carbonate sediment and demonstrates that the sampled stromatolites formed primarily from in situ precipitation, presumably within microbial mats/biofilms, rather than by trapping and binding of ambient sediment. Identification of the source of fine carbonate in stromatolites is significant, because if it is not too heavily contaminated by trapped ambient sediment, it may contain geochemical biosignatures and/or direct evidence of the local water chemistry in which the precipitates formed.

Just give me the facts? literalism versus symbolism in B2B advertising

For decades the prevailing idea in B2B marketing has been that buyers are motivated by product/service specifications. Sellers are put on approved supplier lists, invited to respond to RFPs, and are selected on the basis of superior products, at the right price, delivered on time. The history of B2B advertising is filled with the advice “provide product specifications” and your advertising will be noticed, lead to sales inquiries, and eventually result in higher sales. Advertising filled with abstractions might work in the B2C market, but the B2B marketplace is about being literal. What we know about advertising — and particularly the message component of advertising — is based on a combination of experience, unproven ideas and a bit of social science. Over the years, advertising guidelines produced by the predecessors of BMA (National Industrial Advertising Association, Association of Industrial Advertising, and the Business/Professional Advertising Association) stressed emphasizing product features and tangible benefits. The major publishers of B2B magazines, e.g., McGraw-Hill, Penton Publishing, et al. had similar recommendations. Also, B2B marketing books recommend advertising that focuses on specific product features (Kotler and Pfoertsch, 2006; Lamons, 2005). In more recent times, abstraction in advertising messages has penetrated the B2B marketplace. Even though such advertising legends as David Ogilvy (1963, 1985) frequently recommended advertising based on hard-core information, we’ve seen the growing use of emotional appeals, including humor, fear, parental affection, etc. Beyond the use of emotion, marketers attempt to build a stronger connection between their brands and buyers through the use of abstraction and symbolism. Below are two examples of B2B advertisements — Figure 1A is high in literalism and Figure 1B is high in symbolism. Which approach — a “left-brain” (literal) or “right brain” (symbolic) is more effective in B2B advertising? Are the advertising message creation guidelines from the history of B2B advertising accurate? Are the foundations of B2B message creation (experience and unproven ideas) sound?

Producing readings : freedom versus normativity?

The subject known as English has been framed in terms of a number of models which can be broadly defined through the literature as cultural heritage (associated with Matthew Arnold and F.R. Leavis), personal growth (associated with John Dixon and James Britton) and cultural studies (associated with Raymond Williams and Roland Barthes). Traditionally these models have been assumed to reflect different theories of English, each one being hailed as a radical break with the previous model. Taking the reading lesson as an example, the paper attempts to trouble the idea that the models of English are radically different, first by identifying an unhelpful dialectic that historically informs discussions of literature teaching and English and second, by exploring a circularity that characterises arguments used to justify the radical nature of cultural studies English.