Community-associated methicillin-resistant Staphylococcus aureus transmission in households of infected cases : a pooled analysis of primary data from three studies across international settings

Diverse strain types of methicillin-resistant Staphylococcus aureus (MRSA) cause infections in community settings worldwide. To examine heterogeneity of spread within households and to identify common risk factors for household transmission across settings, primary data from studies conducted in New York (USA), Breda (The Netherlands), and Melbourne (Australia) were pooled. Following MRSA infection of the index patient, household members completed questionnaires and provided nasal swabs. Swabs positive for S. aureus were genotyped by spa sequencing. Poisson regression with robust error variance was used to estimate prevalence odds ratios for transmission of the clinical isolate to non-index household members. Great diversity of strain types existed across studies. Despite differences between studies, the index patient being colonized with the clinical isolate at the home visit (P < 0·01) and the percent of household members aged <18 years (P < 0·01) were independently associated with transmission. Targeted decolonization strategies could be used across geographical settings to limit household MRSA transmission.

(Particularly) Burdensome prison time should reduce imprisonment length — and not merely in theory

Imprisonment is the harshest sanction in our system of law. It is a sanction that isincreasingly imposed by the courts. The severity of imprisonment as a sanction stemsprincipally from the considerable restrictions it imposes on an individual’s liberty.However, the deprivation experienced by a prisoner can vary considerably, depending onthe strictness of the prison regime in which the prisoner is confined and his or her state ofhealth. Prisoners subjected to non-mainstream conditions almost invariably suffer morethan those in normal conditions. There is no settled approach regarding the extent towhich prison conditions should impact on the length of a prison term. The jurisprudencein this area is inconsistent. It is particularly unsettled when the additional burden stemsfrom subjective matters relating to an accused, such as ill health. In this article we makerecommendations regarding the manner in which prison conditions should impact on thelength of a prison term. The main recommendation is that prisoners who spend time inparticularly burdensome conditions should have their sentence reduced by a factor of0.5 days for each day spent in such conditions. In this article we also recommend thatAustralia should adopt a model similar to those which exist in some Scandinaviancountries, whereby the only deprivation stemming from imprisonment is the loss ofliberty. This would mean that few prisoners would ever be subjected to particularlyburdensome conditions. This would make many of the recommendations in this paperobsolete. However, there is no evidence that Australian prison conditions are about tofundamentally alter. Hence, the recommendations will remain pragmatically relevant inthe foreseeable future.

An RCT to evaluate the utility of a clinical protocol for staff in the management of behavioral and psychological symptoms of dementia in residential aged-care settings

Objectives: Behavioral and psychological symptoms of dementia (BPSD) cause significant stress and distress to both aged-care residents and staff. This study evaluated a training program to assist staff to manage BPSD in residential care. Method: A randomised controlled trial (RCT) was employed. The study was included in the Australian and New Zealand Clinical Trial Register residential care facilities. Staff (n = 204) and residents (n = 187) were from 16 residential care facilities. Facilities were recruited and randomly assigned to four staff training conditions: (1) training in the use of a BPSD-structured clinical protocol, plus external clinical support, (2) a workshop on BPSD, plus external clinical support, (3) training in the use of the structured clinical protocol alone, and (4) care as usual. Staff and resident outcome measures were obtained pre-intervention, three months and six months post-intervention. The primary outcome was changes in BPSD, measured using the Cohen-Mansfield Agitation Inventory (CMAI) as well as frequency and duration of challenging behaviors. Secondary outcomes were changes in staff adjustment. Results: There were improvements in challenging behaviors for both intervention conditions that included training in the BPSD instrument, but these were not maintained in the condition without clinical support. The training/support condition resulted in sustained improvements in both staff and resident variables, whereas the other conditions only led to improvement in some of the measured variables. Conclusion: These results demonstrate the effectiveness of the BPSD protocol in reducing BPSD and improving staff self-efficacy and stress.

Cultural influence on peer relationships in early childhood settings

This paper presents a cultural perspective of young children’s peer relationships. Through reporting on a study of a group of Chinese immigrant children’s learning experiences with peers of the same cultural backgrounds in English dominant early childhood contexts, it reveals that the sharing of a similar cultural heritage may play an important role in the development of relationships for young children in diverse cultural learning communities. This paper is written from the perspectives of socioculture and culture theory. Central to my argument is the contextual dimension of culture. This dimension provides an explanatory structure for understanding immigrant children’s formation of home-culture oriented peer togetherness and peer culture within the paradigm of English dominant spheres. My position is to recognize that the children’s responses to peers are both subject to the influences of their home cultures, and the relationship between different cultures. The notion of cultural relationship is important in this paper, leading to the suggestion that early childhood settings should create an enabling and empowering sociocultural milieu that provides immigrant children with opportunities for intercultural ways of learning and development.

Assessing cycling-friendly environments for children: are micro-environmental factors equally important across different street settings?

BACKGROUND: As physical activity levels decrease as children age, sustainable and accessible forms of physical activity are needed from a young age. Transportation cycling is one such physical activity and has been associated with many benefits. The aims of the study were to identify whether manipulating micro-environmental factors (e.g. speed limis, evenness of cycle path) within a photographed street influences the perceived supportiveness for transportation cycling; and whether changing these micro-environmental factors has the same effect across different street settings. METHODS: We recruited 305 fifth and sixth grade children and their parents from twelve randomly selected primary schools in Flanders, Belgium. They completed a web-based questionnaire including 12 choice-based conjoint tasks, in which they had to choose between two possible routes depicted on manipulated photographs, which the child would cycle along. The routes differed in four attributes: general street setting (enclosed, half open, open), evenness of cycle path (very uneven, moderately uneven, even), speed limit (70 km/h, 50 km/h, 30 km/h) and degree of separation between a cycle path and motorised traffic (no separation, curb, hedge). Hierarchical Bayes analyses revealed the relative importance of each micro-environmental attribute across the three street settings. RESULTS: For each attribute, children and their parents chose routes that had the best alternative (i.e. open street setting, even cycle path, 30 km/h, a hedge separating the cycle path from motorised traffic). The evenness of the cycle path and lower speed limit had the largest effect for the children, while the degree of separation and lower speed limit had the largest effect for their parents. Interactions between micro-scale and macro-scale factors revealed differences in the magnitude but not direction of their effects on route choice. The results held across the different kinds of street settings tested. CONCLUSIONS: Improving micro-scale attributes may increase the supportiveness of a street for children's transportation cycling. We call for on-site research to test effects of changes in micro-environmental attributes on transportation cycling among children.

Understanding feedback report uptake: process evaluation findings from a 13-month feedback intervention in long-term care settings

BACKGROUND: Long-term care settings provide care to a large proportion of predominantly older, highly disabled adults across the United States and Canada. Managing and improving quality of care is challenging, in part because staffing is highly dependent on relatively non-professional health care aides and resources are limited. Feedback interventions in these settings are relatively rare, and there has been little published information about the process of feedback intervention. Our objectives were to describe the key components of uptake of the feedback reports, as well as other indicators of participant response to the intervention. METHODS: We conducted this project in nine long-term care units in four facilities in Edmonton, Canada. We used mixed methods, including observations during a 13-month feedback report intervention with nine post-feedback survey cycles, to conduct a process evaluation of a feedback report intervention in these units. We included all facility-based direct care providers (staff) in the feedback report distribution and survey administration. We conducted descriptive analyses of the data from observations and surveys, presenting this in tabular and graphic form. We constructed a short scale to measure uptake of the feedback reports. Our analysis evaluated feedback report uptake by provider type over the 13 months of the intervention. RESULTS: We received a total of 1,080 survey responses over the period of the intervention, which varied by type of provider, facility, and survey month. Total number of reports distributed ranged from 103 in cycle 12 to 229 in cycle 3, although the method of delivery varied widely across the period, from 12% to 65% delivered directly to individuals and 15% to 84% left for later distribution. The key elements of feedback uptake, including receiving, reading, understanding, discussing, and reporting a perception that the reports were useful, varied by survey cycle and provider type, as well as by facility. Uptake, as we measured it, was consistently high overall, but varied widely by provider type and time period. CONCLUSIONS: We report detailed process data describing the aspects of uptake of a feedback report during an intensive, longitudinal feedback intervention in long-term care facilities. Uptake is a complex process for which we used multiple measures. We demonstrate the feasibility of conducting a complex longitudinal feedback intervention in relatively resource-poor long-term care facilities to a wider range of provider types than have been included in prior feedback interventions.

Drug use in Australian nightlife settings: estimation of prevalence and validity of self-report

AIMS: This study aimed to 1) estimate the prevalence of illicit drug use in night-time entertainment districts across five major cities in Australia; and 2) validate self-reported drug use using biochemical marker oral swabs. DESIGN: Street intercept surveys and oral drug swabs conducted over a seven-month period during 2011-2012. SETTING: The night-time entertainment districts of three metropolitan cities (Sydney, Melbourne and Perth) and two regional cities (Wollongong and Geelong) in Australia, between the hours of 10 pm and 5 am. PARTICIPANTS: 7,340 individuals agreed to participate in the survey (a 93% response rate). More than half (62%) of the sample was male, with a median age of 22 years (range 18-73). MEASUREMENTS: Patrons were approached in thoroughfares, and while entering and leaving licensed venues. Data collected included demographics and current session alcohol and other substance use. Drug swabs (n = 401) were performed with a sub-sample of participants. FINDINGS: Approximately 9% (95% CI, 7% to 12%) of participants self-reported consumption of illicit or non-prescribed pharmaceutical drugs prior to interview; of those, 81% identified psychostimulants as the drug used. One in five drug swabs returned a positive result, with psychostimulants the most commonly detected drugs (15%; 95% CI, 12%-19%). Kappa statistics indicate agreement between self-report of any illicit drug and a positive drug swab is in the slight range (κ = 0.12 (95% CI, .05 to .20) p = .000). CONCLUSIONS: Self-report findings suggest drug use in the nightlife in Australia is common, though still very much a minority past-time. Drug swabs indicate a higher prevalence of use (20%) than self-report (9%), which suggests that self-reported drug use may not be reliable in this context. This article is protected by copyright. All rights reserved.

The diversity and complexity of settings and arrangements forming the ‘experienced environments’ for doctoral candidates : some implications for doctoral education

A significant feature of contemporary doctoral education is the continuing trend for research and research education to migrate beyond discipline-based institutional teaching and research structures. The result is a more diverse array of settings and arrangements for doctoral education linked to an increasingly global research enterprise. Recognising the complexity of what is a distributed environment challenges some commonly held assumptions about doctoral education and its practice. Drawing on data gathered in an Australian study of PhD programme development in Australia carried out in 2006–2009, the article describes the fluid and complex arrangements forming the ‘experienced environments’ for doctoral candidates, an environment that can afford them varying opportunities and challenges for completing their candidacy. Some implications for doctoral education are discussed.

Medication communication during handover interactions in specialty practice settings

AIMS AND OBJECTIVES: To investigate what and how medication information is communicated during handover interactions in specialty hospital settings. BACKGROUND: Effective communication about patients' medications between health professionals and nurses at handover is vital for the delivery of safe continuity of care. DESIGN: An exploratory qualitative design and observational study. METHODS: Participant observation was undertaken at a metropolitan Australian public hospital in four specialty settings: cardiothoracic care, intensive care, emergency care and oncology care. A medication communication model was applied to the data and thematic analysis was performed. RESULTS: Over 130 hours of observational data were collected. In total, 185 (predominately nursing) handovers were observed across the four specialty settings involving 37 nurse participants. Health professionals communicated partial details of patients' medication regimens, by focusing on auditing the medication administration record, and through the handover approach employed. Gaps in medication information at handover were evident as shown by lack of communication about detailed and specific medication content. Incoming nurses rarely posed questions about medications at handover. CONCLUSIONS: Handover interactions contained restricted and incomplete medication information. Improving the transparency, completeness and accuracy of medication communication is vital for optimising patient safety and quality of care in specialty practice settings. RELEVANCE TO CLINICAL PRACTICE: For nurses to make informed and rapid decisions regarding appropriate patient care, information about all types of prescribed medications is essential, which is communicated in an explicit and clear way. Jargon and assumptions related to medication details should be minimised to reduce the risk of misunderstandings. Disclosure of structured medication information supports nurses to perform accurate patient assessments, make knowledgeable decisions about the appropriateness of medications and their doses, and anticipate possible adverse events associated with medications. In addition, benefits of patient and family member contributions in communicating about medications at handover should also be considered.

Investigating the effectiveness of teacher education for early career teachers in diverse settings: the longitudinal research we have to have

There have been more than 100 reports focusing on the effectiveness of teacher education in Australia over the last 35 years with many positioning teacher education as flawed and in need of reform. These frequent criticisms have drawn attention to the difficulty teacher educators can experience when trying to interrupt or contest this representation: a situation not unique to Australia. In the United States, for example, Pam Grossman has suggested that those in teacher education “seem ill prepared to respond to critics who question the value of professional education for teachers with evidence of our effectiveness” (Grossman in J Teach Educ 59(1):10–23, 2008). A key question facing teacher educators, therefore, concerns the kinds of research that will most effectively allow us to lead debates about teacher preparation. This paper outlines an approach to the conceptualization and conduct of research into the effectiveness of teacher education that seeks to move debates in new directions. Drawing upon the theoretical resources of Soja (Thirdspace: journeys to Los Angeles and other real-and-imagined places, 1996) and Lefebre (The production of space, 1991) we outline the ways in which a spatial approach to conceptualizing teacher education influenced the design and conduct of a large scale, longitudinal project that investigated the question of the effectiveness of teacher education in Australia. In exploring the design features of this ARC linkage grant the paper demonstrates how research changes when teacher education is conceptualised from a spatial point of view and illustrates the ways in which consideration of the conceived, perceived and lived spaces of teacher education can move research about effectiveness into new directions.

The influence of incarceration length and protection status on perceptions of prison social climate

Using a 2 (incarceration length) × 2 (custody type) between-groups design, the present study assessed whether inmates’ perceptions of the prison social climate were influenced by their security classification and length of time they had been incarcerated. Analyses of data collected from 76 male prisoners who completed a 15-item measure of prison social climate revealed an interaction effect between length of incarceration and protective prisoner status. Those housed in protectivecustody who had been incarcerated for longer than 6 months rated the social climate significantly more positively than both protective custody prisoners incarcerated for less than 6 months and those not in protective custody. This interaction was strongest on those social climate dimensions relating to therapeutic hold and social cohesion. A univariate effect was also observed whereby protective custody prisoners, irrespective of incarceration length, reported that they experienced the environment as less safe than their mainstream (non-protective custody) counterparts.

Teachers’ aides working in secondary school settings: preparedness and professional learning

In Victoria, Australia teachers’ aides (TAs) are employed to provide support to students with disabilities in accessing their education. The role of the TAs varies within and across school settings. Drawing from the findings of a quantitative study, the purpose of this paper is to develop an understanding of teachers’ aides’ perceptions of their preparedness to perform 18 student-related tasks within the state secondary school setting in Victoria, Australia. In all, 163 participants completed the on-line questionnaire. The results of the study showed that that in general TAs perceive there are tasks relevant to their roles in supporting students with disabilities; and there are tasks that are not applicable to that role. The TAs in this study considered that they had training that enabled them to effectively perform the listed student related tasks to support students with disabilities in the secondary school environment.

Brief report: associations between self-reported paternal relationships, anger, alcohol, and intimate partner violence in a prison sample

This study investigates the association between family relationships, anger, alcohol use, and self-reported intimate partner violence (IPV). Participants were 55 male prisoners who completed a survey about their family relationships, anger, alcohol use, and aggression. Exposure to parental IPV predicted rates of self-reported perpetration of IPV, suggesting the importance of understanding more about the developmental pathways to IPV if effective prevention, intervention, and assessment strategies are to be developed for use with this high-risk population.

Exploring undergraduate nursing students' perceptions of working in aged care settings: a review of the literature

OBJECTIVES: To explore undergraduate nursing students' perceptions of working in the aged care setting through a review of the literature. DESIGN: A review of available literature relating to undergraduate nursing students' attitudes, perceptions and experiences in the aged care setting, or in the care of older adults. DATA SOURCES: CINAHL Plus with Full Text was the primary database used. Other databases include PsycINFO and Health Source: Nursing/Academic Edition. REVIEW METHODS: Studies focused on undergraduate nursing students and their experiences in the aged care setting and on the perceptions and attitudes of nursing students toward older adults, were included. Studies that did not present an original study or those that did not meet the aim of the study were excluded from the review. RESULTS: Following removal of duplicates and exclusion of articles not meeting the aim of this paper, 24 articles remained. Three main themes emerged from the review of the literature: perceptions of aged care placement, attitudes to working in aged care, and experiences in aged care. CONCLUSION: The experiences of nursing students employed as undergraduate AINs in the aged care setting can provide an immersive clinical learning experience in preparation for their new graduate (NG) year. Furthermore, it is an opportunity to challenge ageist attitudes and instil core nursing values in novice nurses such as promoting compassionate care.