In vitro assessment of surface congruency and integration of chondrocytes at adjacent edges of micro-fabricated clefts on cartilage

Osteochondral grafts are common treatment options for joint focal defects due to their excellent functionality. However, the difficulty is matching the topography of host and graft(s) surfaces flush to one another. Incongruence could lead to disintegration particularly when the gap reaches subchondoral region. The aim of this study is therefore to investigate cell response to gap geometry when forming cartilage-cartilage bridge at the interface. The question is what would be the characteristics of such a gap if the cells could bridge across to fuse the edges? To answer this, osteochondral plugs devoid of host cells were prepared through enzymatic decellularization and artificial clefts of different sizes were created on the cartilage surface using laser ablation. High density pellets of heterologous chondrocytes were seeded on the defects and cultured with chondrogenic differentiation media for 35 days. The results showed that the behavior of chondrocytes was a function of gap topography. Depending on the distance of the edges two types of responses were generated. Resident cells surrounding distant edges demonstrated superficial attachment to one side whereas clefts of 150 to 250 µm width experienced cell migration and anchorage across the interface. The infiltration of chondrocytes into the gaps provided extra space for their proliferation and laying matrix; as the result faster filling of the initial void space was observed. On the other hand, distant and fit edges created an incomplete healing response due to the limited ability of differentiated chondrocytes to migrate and incorporate within the interface. It seems that the initial condition of the defects and the curvature profile of the adjacent edges were the prime determinants of the quality of repair; however, further studies to reveal the underlying mechanisms of cells adapting to and modifying the new environment would be of particular interest.

Fine tuning of elasticity via crosslinking collagen-based materials to mediate mechanotransduction and stability using corona treatment

The common goal of tissue engineering is to develop substitutes that can closely mimic the structure of extracellular matrix (ECM). However, similarly important is the intensive material properties which have often been overlooked, in particular, for soft tissues that are not to bear load assumingly. The mechanostructural properties determine not only the structural stability of biomaterials but also their physiological functionality by directing cellular activity and regulating cell fate decision. The aim here is to emphasize that cells could sense intensive material properties like elasticity and reside, proliferate, migrate and differentiate accordinglyno matter if the construct is from a natural source like cartilage, skin etc. or of synthetic one. Meanwhile, the very objective of this work is to provide a tunable scheme for manipulating the elasticity of collagen-based constructs to be used to demonstrate how to engineer cell behavior and regulate mechanotransduction. Articular cartilage was chosen as it represents one of the most complex hierarchical arrangements of collagen meshwork in both connective tissues and ECM-like biomaterials. Corona discharge treatment was used to produce constructs with varying density of crosslinked collagen and stiffness accordingly. The results demonstrated that elastic modulus increased up to 33% for samples treated up to one minute as crosslink density was found to increase with exposure time. According to the thermal analysis, longer exposure to corona increased crosslink density as the denaturation enthalpy increased. However the spectroscopy results suggested that despite the stabilization of the collagen structure the integrity of the triple helical structure remained intact. The in vitro superficial culture of heterologous chondrocytes also determined that the corona treatment can modulate migration with increased focal adhesion of cells due to enhanced stiffness, without cytotoxicity effects, and providing the basis for reinforcing three-dimensional collagen-based biomaterials in order to direct cell function and mediate mechanotransduction.

A stepped-wedge cluster randomised controlled trial for evaluating rates of falls among inpatients in aged care rehabilitation units receiving tailored multimedia education in addition to usual care : a trial protocol

Introduction Falls are the most frequent adverse event reported in hospitals. Approximately 30% of in-hospital falls lead to an injury and up to 2% result in a fracture. A large randomised trial found that a trained health professional providing individualised falls prevention education to older inpatients reduced falls in a cognitively intact subgroup. This study aims to investigate whether this efficacious intervention can reduce falls and be clinically useful and cost-effective when delivered in the real-life clinical environment. Methods A stepped-wedge cluster randomised trial will be used across eight subacute units (clusters) which will be randomised to one of four dates to start the intervention. Usual care on these units includes patient's screening, assessment and implementation of individualised falls prevention strategies, ongoing staff training and environmental strategies. Patients with better levels of cognition (Mini-Mental State Examination >23/30) will receive the individualised education from a trained health professional in addition to usual care while patient's feedback received during education sessions will be provided to unit staff. Unit staff will receive training to assist in intervention delivery and to enhance uptake of strategies by patients. Falls data will be collected by two methods: case note audit by research assistants and the hospital falls reporting system. Cluster-level data including patient's admissions, length of stay and diagnosis will be collected from hospital systems. Data will be analysed allowing for correlation of outcomes (clustering) within units. An economic analysis will be undertaken which includes an incremental cost-effectiveness analysis. Ethics and dissemination The study was approved by The University of Notre Dame Australia Human Research Ethics Committee and local hospital ethics committees. Results The results will be disseminated through local site networks, and future funding and delivery of falls prevention programmes within WA Health will be informed. Results will also be disseminated through peer-reviewed publications and medical conferences.

A reciprocal collaborative method using relevance feedback and feature importance

In a people-to-people matching systems, filtering is widely applied to find the most suitable matches. The results returned are either too many or only a few when the search is generic or specific respectively. The use of a sophisticated recommendation approach becomes necessary. Traditionally, the object of recommendation is the item which is inanimate. In online dating systems, reciprocal recommendation is required to suggest a partner only when the user and the recommended candidate both are satisfied. In this paper, an innovative reciprocal collaborative method is developed based on the idea of similarity and common neighbors, utilizing the information of relevance feedback and feature importance. Extensive experiments are carried out using data gathered from a real online dating service. Compared to benchmarking methods, our results show the proposed method can achieve noticeable better performance.

Randomized controlled trial of MICBT for co-existing alcohol misuse and depression : outcomes to 36-months

Integrated psychological treatment addressing co-existing alcohol misuse and depression has not been compared with single-focused treatment. This trial evaluates changes over 36 months following randomization of 284 outpatients to one of four motivational interviewing and cognitive-behavior therapy (MICBT) based interventions: (1) brief integrated intervention (BI); or BI plus 9 further sessions with (2) an integrated-, (3) alcohol-, or (4) depression-focus. Outcome measures included changes in alcohol consumption, depression (BDI-II: Beck Depression Inventory) and functioning (GAF: Global Assessment of Functioning), with average improvements from baseline of 21.8 drinks per week, 12.6 BDI-II units and 8.2 GAF units. Longer interventions tended to be more effective in reducing depression and improving functioning in the long-term, and in improving alcohol consumption in the short-term. Integrated treatment was at least as good as single-focused MICBT. Alcohol-focused treatment was as effective as depression-focused treatment at reducing depression and more effective in reducing alcohol misuse. The best approach seems to be an initial focus on both conditions followed by additional integrated- or alcohol-focused sessions.

Future-proofing the pharmacy profession in a hypercompetitive market

This paper highlights the hypercompetitive nature of the current pharmacy landscape in Australia and to suggest either a superior level of differentiation strategy or a focused differentiation strategy targeting a niche market as two viable, alternative business models to cost leadership for small, independent community pharmacies. A description of the Australian health care system is provided as well as background information on the current community pharmacy environment in Australia. The authors propose a differentiation or focused differentiation strategy based on cognitive professional services (CPS) which must be executed well and of a superior quality to competitors' services. Market research to determine the services valued by target customers and that they are willing to pay for is vital. To achieve the superior level of quality that will engender high patient satisfaction levels and loyalty, pharmacy owners and managers need to develop, maintain and clearly communicate service quality specifications to the staff delivering these services. Otherwise, there will be a proliferation of pharmacies offering the same professional services with no evident service differential. However, to sustain competitive advantage over the long-term, these smaller, independent community pharmacies will need to exploit a broad core competency base in order to be able to continuously introduce new sources of competitive advantage. With the right expertise, the authors argue that smaller, independent community pharmacies can successfully deliver CPS and sustain profitability in a hypercompetitive market.

A shared reading intervention with parents to enhance young children’s early literacy skills

Parental reading to children from an early age has been shown to enhance children’s emergent literacy skills. A pragmatic randomized controlled trial (RCT) was used to investigate the effects of two forms of shared reading interventions on children’s language and literacy skills. Parents of 80 preparatory year children from outer suburban schools of an Australian metropolitan city were trained to use shared reading strategies in an eight-week home intervention. Families were assigned to one of three groups: Dialogic Reading (DR), Dialogic Reading with the addition of Print Referencing (DR + PR), or an attention-matched control group. The sample comprised 42 boys and 38 girls ranging in age from 4.9 years to 6.3 years (M = 5.5, SD = 0.3). Data were collected at pre, post, and at three months follow-up. Measures assessed children’s oral language (receptive and expressive vocabulary), phonological awareness (rhyme, word completion), alphabet knowledge, and concepts about print. Analyses of change from pre to post showed significant effects for the DR and DR + PR groups compared to the control group on three of the six measures: expressive language, rhyme, and concepts about print. At 3-month follow-up assessment, the two intervention groups maintained significantly better performance on the measure of concepts of print only. At both time points, there were no group differences between the DR and DR+PR conditions. These findings illustrate the potential of a brief home focused intervention on promoting children’s emergent literacy.

Multifunctional agriculture in policy and practice? A comparative analysis of Norway and Australia

Ideals of productivist agriculture in the Western world have faded as the unintended consequences of intensive agriculture and pastoralism have contributed to rural decline and environmental problems. In Norway and Australia, there has been an increasing acceptance of the equal importance of social and environmental sustainability as well as economic sustainability. Alongside this shift is a belief that primary production needs to move away from an intensive, productivist-based agriculture to one that may be defined as post-productivist. In this paper, we argue that the dualism of productivism and post-productivism as concepts on agricultural policy regimes are too simplistic and discuss whether multifunctional agriculture is a better concept for a comparison of rural primary production at two extreme points of the scale, the market-oriented, liberalistic Australian agriculture and the market-protected small-scale Norwegian agriculture. We argue that multifunctionality in Australia rates relatively weakly as an ideology or policy and even less as a discourse or practice and hence is situated toward a ‘weak’ end of a continuum of a level of multifunctional agriculture. In Norwegian agriculture, multifunctional agriculture has thrived within a protectionist setting with the support of the public, the state and agricultural actors. In this sense it is very clearly a policy, practice and discourse that aims to preserve and conserve rural spaces, the cultural landscape, the farming way of life and food safety. Norway is as such situated toward a ‘strong’ end of a continuum of a level of multifunctional agriculture.

OSCE online : making assessment of clinical competencies transparent, accountable & authentic

Creating an authentic assessment which at once assesses competencies, scene management, communication and overall patient care is challenging in the competitive tertiary education market. Increasing student numbers and the cost of evaluating scenario based competencies serve to ensure the need for consistent objectivity and need for timely feedback to students on their performance. Objective structured clinical examination (OSCE) is currently the most flexible approach to competency based formative and summative assessment and widely used within paramedic degree programs. Students are understandably compelled to perform well and can be frustrated by not receiving timely and appropriate feedback. Increasingly a number of products aimed at providing a more efficient and paperless approach have begun to enter the market. These products, it is suggested are aimed at medicine programs and not at allied health professions and limited to one operating system and therefore ignore issues surrounding equity and accessibility. OSCE Online aims to address this gap in the market and is tailored to these disciplines. The application will provide a service that can be both tailored and standardised from a pre-written bank, depending upon requirement to fit around the needs of clinical competency assessment. Delivering authentic assessments to address student milestones in their training to become paramedics is the cornerstone of OSCE Online. By not being restricted to a specific device it will address issues of functionality, adaptability, accessibility, authenticity and importantly: transparency and accountability by producing contemporaneous data allowing issues to be easily identified and rectified.

Comparative susceptibility of mosquito populations in North Queensland, Australia to oral infection with dengue virus

Dengue is the most prevalent arthropod-borne virus, with at least 40% of the world’s population at risk of infection each year. In Australia, dengue is not endemic, but viremic travelers trigger outbreaks involving hundreds of cases. We compared the susceptibility of Aedes aegypti mosquitoes from two geographically isolated populations with two strains of dengue virus serotype 2. We found, interestingly, that mosquitoes from a city with no history of dengue were more susceptible to virus than mosquitoes from an outbreak-prone region, particularly with respect to one dengue strain. These findings suggest recent evolution of population-based differences in vector competence or different historical origins. Future genomic comparisons of these populations could reveal the genetic basis of vector competence and the relative role of selection and stochastic processes in shaping their differences. Lastly, we show the novel finding of a correlation between midgut dengue titer and titer in tissues colonized after dissemination.

National curriculum reform and equipping pre-service teachers to teach about Australia in the Asian Century

Currently a range of national policy settings are reshaping schooling and teacher education in Australia. This paper presents some of the findings from a small qualitative pilot study conducted with a group of final year pre-service teachers studying a secondary social science curriculum method unit in an Australian university. One of the study’s research objectives aimed at identifying how students reflected on their capacity to navigate curriculum change and, more specifically, on teaching about Australia and Asia in the forthcoming implementation of the first national history curriculum. The unit was designed and taught by the researcher on the assumption that beginning social science teachers need to be empowered to deal with the curriculum change they’ll encounter throughout their careers. The pilot study’s methodology was informed by a constructivist approach to grounded theory and its scope was limited to one semester with volunteer students. Of the pre-service teacher reflections on their preparedness to teach, this paper reports on the content, pedagogy and learning they experienced in one segment of the unit with specific reference to the new history curriculum’s ‘Australia in a world history’ approach and the development of Asia literacy. The findings indicate that whilst pre-service teachers valued the opportunity to engage with learning experiences which enhanced their intercultural understanding and extended their pedagogical and content knowledge on campus, the nature of the final practicum in schools was also influential in shaping their preparedness to enter the profession.

Prevalence of undiagnosed urinary tract infections on admission to a rehabilitation unit

Background Through clinical observation nursing staff of an inpatient rehabilitation unit identified a link between incontinence and undiagnosed urinary tract infections (UTIs). Further, clinical observation and structured continence management led to the realisation that urinary incontinence often improved, or resolved completely, after treatment with antibiotics. In 2009 a small study found that 30% of admitted rehabilitation patients had an undiagnosed UTI, with the majority admitted post-orthopaedic fracture. We suspected that the frequent use of indwelling urinary catheters (IDCs) in the orthopaedic environment may have been a contributing factor. Therefore, a second, more thorough, study was commenced in 2010 and completed in 2011. Aim The aim of this study was to identify what proportion of patients were admitted to one rehabilitation unit with an undiagnosed UTI over a 12-month period. We wanted to identify and highlight the presence of known risk factors associated with UTI and determine whether urinary incontinence was associated with the presence of UTI. Methods Data were collected from every patient that was admitted over a 12-month period (n=140). The majority of patients were over the age of 65 and had an orthopaedic fracture (36.4%) or stroke (27.1%). Mid-stream urine (MSU) samples, routinely collected and sent for culture and sensitivity as part of standard admission procedure, were used by the treating medical officer to detect the presence of UTI. A data collection sheet was developed, reviewed and trialled, before official data collection commenced. Data were collected as part of usual practice and collated by a research assistant. Inferential statistics were used to analyse the data. Results This study found that 25 (17.9%) of the 140 patients admitted to rehabilitation had an undiagnosed UTI, with a statistically significant association between prior presence of an IDC and the diagnosis of UTI. Urinary incontinence improved after the completion of treatment with antibiotics. Results further demonstrated a significant association between the confirmation of a UTI on culture and sensitivity and the absence of symptoms usually associated with UTI, such as burning or stinging on urination. Overall, this study suggests careful monitoring of urinary symptoms in patients admitted to rehabilitation, especially in patients with a prior IDC, is warranted.

Psychosocial and communication variables involved in mediating the individual experience of older adults following a severe weather event

The recent floods in south-east Queensland have focused policy, academic and community attention on the challenges associated with severe weather events (SWE), specifically pre-disaster preparation, disaster-response and post-disaster community resilience. Financially, the cost of SWE was $9 billion in the 2011 Australian Federal Budget (Swan 2011); psychologically and emotionally, the impact on individual mental health and community wellbeing is also significant but more difficult to quantify. However, recent estimates suggest that as many as one in five will subsequently experience major emotional distress (Bonanno et al. 2010). With climate change predicted to increase the frequency and intensity of a wide range of SWE in Australia (Garnaut 2011; The Climate Institute 2011), there is an urgent and critical need to ensure that the unique psychological and social needs of more vulnerable community members - such as older residents - are better understood and integrated into disaster preparedness and response policy, planning and protocols. Navigating the complex dynamics of SWE can be particularly challenging for older adults and their disaster experience is frequently magnified by a wide array of cumulative and interactive stressors, which intertwine to make them uniquely vulnerable to significant short and long-term adverse effects. This current article provides a brief introduction to the current literature in this area and highlights a gap in the research relating to communication tools during and after severe weather events.

An efficient and effective localization method for networked disjoint top-view cameras

Disjoint top-view networked cameras are among the most commonly utilized networks in many applications. One of the open questions for these cameras' study is the computation of extrinsic parameters (positions and orientations), named extrinsic calibration or localization of cameras. Current approaches either rely on strict assumptions of the object motion for accurate results or fail to provide results of high accuracy without the requirement of the object motion. To address these shortcomings, we present a location-constrained maximum a posteriori (LMAP) approach by applying known locations in the surveillance area, some of which would be passed by the object opportunistically. The LMAP approach formulates the problem as a joint inference of the extrinsic parameters and object trajectory based on the cameras' observations and the known locations. In addition, a new task-oriented evaluation metric, named MABR (the Maximum value of All image points' Back-projected localization errors' L2 norms Relative to the area of field of view), is presented to assess the quality of the calibration results in an indoor object tracking context. Finally, results herein demonstrate the superior performance of the proposed method over the state-of-the-art algorithm based on the presented MABR and classical evaluation metric in simulations and real experiments.

An ICT Implementation Strategy for Primary Schools in Fiji

Information and Communication Technology (ICT) has been embraced with hope and optimism in both developing and developed countries. While in the developed countries most citizens have access to one or many of the devices which utilize this technology (e.g. desktop, laptop, tablet, mobile phone), in developing countries this “luxury” can only be afforded by a privileged few. The use of these technologies in primary schools in developing countries is low. This is due to the fact that there are other bigger issues that some of these countries have to grapple with such as meeting the basic health and education needs of its citizens. Quality primary education and global development partnerships are two of the eight Millennium Development Goals of the United Nations (UNDP, 2012). Many Governments, NGO’s, service organizations, and individuals in developing countries are always looking at ways in which the disparity (not just in terms of ICT) can be narrowed. There has to be a greater collaboration between stakeholders in developing and developed countries (Mutonyi & Norton, 2007). How do stakeholders from developed countries engage with partners in developing countries to deliver meaningful and relevant outcomes for primary school students using ICT? As a first step getting the key stakeholders on side is critical. In the Fijian context, schools are managed and run by committees who are members of the community. Therefore, getting the committee on side together with the head-teachers and teachers is critical. Conversations about teaching and learning with technology can then follow with greater ease. The sustainability of any innovative approaches is also an essential element of this equation. Through this lens, this chapter investigates how ICT can be implemented in primary schools in Fiji. It proposes a three-layered approach which focuses on: (1) the community, school leadership, and teachers; (2) content, pedagogy, and technology, and (3) sustainability.