The phenomenon of resilience in crisis care mental health clinicians

The purpose of this study, undertaken in 2003, was to explore the phenomenon of resilience as experienced by Australian crisis care mental health clinicians working in a highly demanding, complex, specialized and stressful environment. For the purpose of this research, the term 'resilience' was defined as the ability of an individual to bounce back from adversity and persevere through difficult times. The six participants for this study were drawn from Melbourne metropolitan mental health organizations – the disciplines of nursing, allied health and medicine. A number of themes were explicated from the participants' interview transcripts – Participants identified the experience of resilience through five exhaustive descriptions, which included: 'The team is a protective veneer to the stress of the work'; Sense of self; Faith and hope; Having insight; and Looking after yourself. These exhaustive descriptions were integrated into a fundamental structure of resilience for clinicians in this role. The study's findings have the potential to inform organizations in mental health to promote resilience in clinicians, with the potential to reduce the risk of burnout and hence staff attrition, and promote staff retention and occupational mental health.

The impact of communications and understanding on the success of business/IT alignment

This article reports on an investigation of IS stakeholders communication and mutual understanding, and their impact on the success of business / IT alignment. In particular, by following a hermeneutic study of transcripts of two focus groups and several interviews conducted with senior business and IT executives, the paper explores the issues of modern business context and practices, project scope and structure, trust, language and nomenclature, and the barriers to the effective stakeholder communication and  understanding. The study results are finally compared against the standard model of business and IT alignment. The main unexpected finding being executives' pre-occupation with issues of "marginal" value to the alignment model, such as day-to-day management of communicative and understanding effectiveness, as opposed to the fundamental issues of strategy and infrastructure fit.

Empirical generalisation as an inadequate cognitive scaffold to theoretical generalisation of a more complex concept

The impact of prior learning on new learning is highlighted by the case of Dean, a Year 8 student who developed his own method to find the sum of the interior angles of a polygon without knowing why his method worked. Enriched transcripts and visual displays of the cognitive, social (Dreyfus, Hershkowitz, & Schwarz, 2001) and affective elements (Williams, 2002) of Dean's interrupted abstraction process informed the identification of factors that inhibited Dean's constructing process. It was found Dean possessed an empirical, not theoretical, generalization (Davydov, 1990) about sums of interior angles of triangles that was an inadequate cognitive artifact for constructing the new more complex theoretical generalization. The study suggests use of tasks designed with the opportunity develop assumed knowledge in conjunction with new concepts.

Stories seldom told: paediatric nurses` experiences of caring for hospitalized children with special needs and their families.

Stories seldom told: paediatric nurses' experiences of caring for hospitalized children with special needs and their families

Aims of the study. This study explored paediatric nurses' experiences of caring for children with special needs and their families in an acute care setting. The aim of the study was to increase understanding of nurses' experiences of caring for these children and their families. The study was designed to reveal the caring practices embedded within these relationships through exploring nurses' stories.

Study design/methods. Gadamerian hermeneutic phenomenology and feminist research principles were the approaches used to guide the study. Interviews were held with experienced paediatric nurses and interpretation of interview transcripts using a Gadamerian hermeneutic phenomenological approach resulted in the identification of four themes.

Findings. The four themes revealed were: Special Relationships; Multiple Dimensions of Who is Expert; Development of Trust Between Nurses and Families; and Feelings of Frustration and Guilt.

Conclusions. The study emphasized the context-specific nature of relationships between nurses and children and their families. The nurses spoke about the difficulties they encountered in their practice and some of the ways that they dealt with these problems. They discussed the things that they valued and those that made them feel guilty and frustrated. In doing so, they revealed their warmth, strength, humanity and caring.

Factors that influence women's disclosures of substance use during pregnancy : a qualitative study of ten midwives and ten pregnant women

The present study was designed to examine the factors that motivate or act as barriers to disclosure of substance use by pregnant women. Participants included 10 midwives and 10 pregnant women who attended two ante-natal clinics at an Australian maternity hospital. One clinic specialized in women who were substance users and one clinic was specifically for young women (under 19 years of age). Midwives and pregnant women were interviewed in-depth about disclosure of substance use. Interview transcripts were analyzed, and the results revealed six main themes: practice style, assessment of substance use, practice environment and privacy, child protection issues, health of the baby, and continuity of care. The findings are discussed in relation to recommendations for best practice in midwifery care when working with pregnant women who use substances.

Characterization of the zebrafish matrix metalloproteinase 9 gene and its developmental expression pattern

Members of the matrix metalloproteinase (MMP) family are important for the remodeling of the extracellular matrix in a number of biological processes including a variety of immune responses. Two members of the family, MMP2 and MMP9, are highly expressed in specific myeloid cell populations in which they play a role in the innate immune response. To further expand the repertoire of molecular reagents available to study zebrafish myeloid cell development, the matrix metalloproteinase 9 (mmp9) gene from this organism has been identified and characterized. The encoded protein is 680 amino acids with high homology to known MMP9 proteins, particularly those of other teleost fish. Maternal transcripts of mmp9 are deposited in the oocyte and dispersed throughout the early embryo. These are replaced by specific zygotic transcripts in the notochord from 12 h post fertilization (hpf) and also transiently in the anterior mesoderm from 14 to 16 h post fertilization. From 24 h post fertilization, mmp9 expression was detected in a population of circulating white blood cells that are distinct from macrophages, and which migrate to the site of trauma, and so likely represent zebrafish heterophils. In the adult, mmp9 expression was most prominent in the splenic cords, a site occupied by mature myeloid cells in other species. These results suggest that mmp9 will serve as a useful marker of mature myeloid cells in the zebrafish.

Financial, family, and social factors impacting on cardiac rehabilitation attendance

Background
Attendance in phase 2 cardiac rehabilitation program after acute myocardial infarction is poor.

Objective
To identify and explore the demographic factors that influence peoples’ decisions to attend cardiac rehabilitation programs.

Methods
A descriptive-interpretive design was used. Semi-structured interviews were conducted with 10 people post infarction in Victoria, Australia after their first scheduled appointment to attend outpatient cardiac rehabilitation. The interview transcripts were thematically analysed.

Results
The perceived relevance of cardiac rehabilitation related to the context of people’s lives, namely their financial, family and social situation, and how important program outcomes were seen to be relevant to this context.

Conclusion
The findings of this study suggest that there are a proportion of people unlikely to attend outpatient cardiac rehabilitation programs following an AMI despite encouragement to attend. It may be unrealistic to aim for 100% referral and uptake into cardiac rehabilitation programs and therefore an inappropriate endpoint by which to evaluate such programs.

Impaired expression of notch signaling genes in aged human skeletal muscle

Notch signaling is essential for myogenesis and the regenerative potential of skeletal muscle: however, its regulation in human muscle is yet to be fully characterized. Increased expression of Notch3, Jagged1. Hes1, and Hes6 gene transcripts were observed during differentiation of cultured human skeletal muscle cells. Furthermore, significantly lower expressions of Notch1, Jagged1, Numb, and Delta-like 1 were evident in muscle biopsies from older men (60-75 years old) compared to muscle from younger men (18-25 years old). Importantly, with supervised resistance exercise training, expression of Notch1 and Hes6 genes were increased and Delta-like 1 and Numb expression were decreased. The differences in Notch expression between the age groups were no longer evident following training. These results provide further evidence to support the role of Notch in the impaired regulation of muscle mass with age and suggest that some of the benefits provided by resistance training may be mediated through the Notch signaling pathway.

Leptin stimulation of COXIV is impaired in obese skeletal muscle myotubes

Objective
To investigate the effects of leptin on the mRNA abundance of key genes involved in fatty acid oxidation and mitochondrial biogenesis in cultured skeletal muscle myotubes derived from lean and obese individuals.

Research methods and procedures
Rectus abdominus muscle biopsies were obtained from surgical patients to establish primary skeletal muscle cell cultures. Two distinct primary cell culture groups were established (Lean and Obese) n = 7 in each group. Differentiated cultures were then exposed to leptin (2.5 μg/ml) for 6 h. mRNA expression was subsequently measured by real-time PCR analysis.

Results
Basal mRNA expression of βHAD, COXIII, COXIV, PGC-1α and SOCS3 in the cultured human skeletal muscle myotubes were similar, however, PDK4 mRNA was elevated (P < 0.05) in the myotubes derived from obese individuals. The addition of leptin resulted in a 2.5-fold increase in COXIV mRNA expression in the myotubes derived from Lean individuals only (P < 0.05). There was also a tendency for leptin to increase COXIII, βHAD and PDK4 mRNA expression in this same group. Leptin had no impact on the gene expression of all measured transcripts in myotubes derived from obese individuals.

Conclusion
Short-term exposure of human skeletal muscle myotubes to leptin stimulated the expression of the mitochondrial enzyme COXIV in myotubes derived from lean individuals, an effect that was abrogated in myotubes derived from obese individuals. These data demonstrate a novel capacity for leptin to increase mitochondrial biogenesis and thus, a possible increased capacity for lipid oxidation and the persistence of a defect in leptin signalling in human myotubes cultured from obese individuals.

Genomic analyses and cloning of novel chicken natriuretic peptide genes reveal new insights into natriuretic peptide evolution

The natriuretic peptide (NP) family consists of multiple subtypes in teleosts, including atrial, B-type, ventricular, and C-type NPs (ANP, BNP, VNP, CNP-1–4, respectively), but only ANP, BNP, CNP-3, and CNP-4 have been identified in tetrapods. As part of understanding the molecular evolution of NPs in the tetrapod lineage, we identified NP genes in the chicken genome. Previously, only BNP and CNP-3 have been identified in birds, but we characterized two new chicken NP genes by cDNA cloning, synteny and phylogenetic analyses. One gene is an orthologue of CNP-1, which has only ever been reported in teleostei and bichir. The second gene could not be assigned to a particular NP subtype because of high sequence divergence and was named renal NP (RNP) due to its predominant expression in the kidney. CNP-1 mRNA was only detected in brain, while CNP-3 mRNA was expressed in kidney, heart, and brain. In the developing embryo, BNP and RNP transcripts were most abundant 24 h post-fertilization, while CNP mRNA increased in a stage-dependant manner. Synthetic chicken RNP stimulated an increase in cGMP production above basal level in chicken kidney membrane preparations and caused a potent dose-dependant vasodilation of pre-constricted dorsal aortic rings. From conserved chromosomal synteny, we propose that the CNP-4 and ANP genes have been lost in chicken, and that RNP may have evolved from a VNP-like gene. Furthermore, we have demonstrated for the first time that CNP-1 is retained in the tetrapod lineage.

Barriers to pharmacist participation in continuing education in Australia

Background: The pharmacy profession recognises of the need for continuing education (CE), however, the rate of participation in organised CE remains low. Little is known about the reasons for low participation rates in CE, particularly in the Australian context. Aim: This research aimed to identify the barriers to participation of Australian pharmacists in CE. Method: Focus groups were held with Australian community pharmacists, grouped into experienced pharmacists, recently qualified pharmacists, pharmacists with specialist-training needs, and pharmacists practising in rural or remote areas. Focus group transcripts were thematically analysed. Results: Barriers identified by pharmacists included time constraints, accessibility - in terms of travel and cost, relevance, motivation, quality and method of CE delivery. Participants provided ideas to improve uptake of CE. Conclusion: The major barriers identified were time, accessibility and relevance of content. To improve uptake of CE a wider variety of flexibly delivered programs supplemented with in-depth workshops could be utilised.

Intense exercise up-regulates Na+, K+ -ATPase isoform mRNA, but not protein expression in human skeletal muscle

Characterization of expression of, and consequently also the acute exercise effects on, Na+,K+-ATPase isoforms in human skeletal muscle remains incomplete and was therefore investigated. Fifteen healthy subjects (eight males, seven females) performed fatiguing, knee extensor exercise at 40% of their maximal work output per contraction. A vastus lateralis muscle biopsy was taken at rest, fatigue and 3 and 24 h postexercise, and analysed for Na+,K+-ATPase 1, 2, 3, ß1, ß2 and ß3 mRNA and crude homogenate protein expression, using Real-Time RT-PCR and immunoblotting, respectively. Each individual expressed gene transcripts and protein bands for each Na+,K+-ATPase isoform. Each isoform was also expressed in a primary human skeletal muscle cell culture. Intense exercise (352 ± 69 s; mean ±S.E.M.) immediately increased 3 and ß2 mRNA by 2.4- and 1.7-fold, respectively (P < 0.05), whilst 1 and 2 mRNA were increased by 2.5- and 3.5-fold at 24 h and 3 h postexercise, respectively (P < 0.05). No significant change occurred for ß1 and ß3 mRNA, reflecting variable time-dependent responses. When the average postexercise value was contrasted to rest, mRNA increased for 1, 2, 3, ß1, ß2 and ß3 isoforms, by 1.4-, 2.2-, 1.4-, 1.1-, 1.0- and 1.0-fold, respectively (P < 0.05). However, exercise did not alter the protein abundance of the 1–3 and ß1–ß3 isoforms. Thus, human skeletal muscle expresses each of the Na+,K+-ATPase 1, 2, 3, ß1, ß2 and ß3 isoforms, evidenced at both transcription and protein levels. Whilst brief exercise increased Na+,K+-ATPase isoform mRNA expression, there was no effect on isoform protein expression, suggesting that the exercise challenge was insufficient for muscle Na+,K+-ATPase up-regulation.

Reciprocal mentoring across generations: sustaining professional development for english teachers

This article draws on a collaborative research project entitled Teachers Investigate Unequal Literacy Outcomes: Cross-generational Perspectives, funded by the Australian Research Council 2002-2004 and awarded to Barbara Comber, University of South Australia and Barbara Kamler, Deakin University. The university researchers invited early career teachers in their first five years of teaching, and late career teachers with at least twenty-five years experience, to collaboratively explore the problem of unequal outcomes in literacy. Over a period of three years, the teacher researchers conducted audits of their classroom literacy programs and the effects on different children; case studies of students they were most concerned about; and redesigns of their literacy curriculum and pedagogy.  Bev Maney and Ivan Boyer collaborated as research partners in the context of their work together as English teachers at Portland Secondary College, Victoria. This paper is based on transcripts of their many conversations with one other and the research team and is represented as an interrupted conversation with the university researchers. Here they critique current models of professional development and the effects of standardised testing and argue for the importance of serious teacher conversations and ongoing school-based research.

A qualitative examination of the experience of 'depression' in hospitalized medically ill patients

Background: Research into depression in the medically ill has progressed without sufficient attention being given to the validity, in this group, of the taxonomic categories. We aimed to describe, using qualitative interviews, the experience of 'being depressed', separating experiences that are unique to depression from experiences that are common to being ill and in hospital.
Method: Forty-nine patients hospitalized for medical illness underwent a 30-min interview in which they were asked to 'Describe how you have been unwell and, in particular, how that has made you feel.' From the transcripts, a 'folk' taxonomy was constructed using a phenomenological framework involving four steps: frame elicitation to identify the important themes, componential analysis to systematically cluster the attributes into domains, a comparison of the experiences of patients screening depressed and  not-depressed, and a theoretical analysis comparing the resulting taxonomy with currently used theoretical constructs.
Results: Experiences common to all patients were being in hospital, being ill or in pain, adjusting to not being able to do things, and having time to think. In addition, all participants described being depressed, down or sad. Patients who were identified by screening as being depressed described unique experiences of depression, which included 'having to think about things' (a forceful intrusive thinking), 'not being able to sleep', 'having to rely on others', 'being a burden' to others (with associated shame and guilt), feelings of 'not getting better' and 'feeling like giving up'. Theoretical analysis suggested that this experience of depression fitted well with the concept of demoralization described by Jerome Frank.
Conclusions: Demoralization, which involves feelings of being unable to cope, helplessness, hopelessness and diminished personal esteem, characterizes much of the depression seen in hospitalized medically ill patients