Intensive care nurses' perceptions of brain death

Research during the last 2 decades has revealed significant confusion or lack of acceptance and inconsistent application of the brain death concept within the medical and nursing professions. The aim of this naturalistic and descriptive study was to investigate the extent to which a sample of 40 Australian intensive care nurses regarded brain death as a meaningful conception of death. In contrast with the majority of the literature pertaining to health care professionals' perceptions of brain death which has focused upon clinical knowledge, the study elicited the expression of personal beliefs. The study utilised a structured interview method with nurses from seven metropolitan intensive care units (ICUs). Transcript analysis revealed five categories of perception constituting a spectrum ranging from complete acceptance to complete rejection, with almost half (48%, n=19) the sample regarding the brain dead patient as less than completely meaningfully dead.<br /><br />Rather than supporting the literature's suggestion that non-acceptance of the medico-legally recognised brain death notion is, necessarily, evidence of professional ignorance, the findings suggest the participants holding these perceptions were generally well-informed about brain stem function and brain death diagnosis. The study affirms the importance of supportive workplace environments which facilitate the expression of dissonant perceptions and proposes that educators and managers must acknowledge these dissonances.<br />

A bioeconomic evaluation of a commercial scale recirculating finfish growout system - an Australian perspective

This study, based on 3 years of commercial data, presents the results of an economic analysis of a 20-tonne per annum (TPA) commercial recirculating aquaculture system (RAS) facility located in Warrnambool, Victoria, Australia. Based on the assumptions of the analysis, results highlight the non-viability of the facility, with a 10-year projected negative cumulative cash flow of &minus; $648,038, and negative net present value (NPV) of &minus; $707,546. Economies of scale were assessed by the development of economic models for hypothetical 50-TPA and 100-TPA facilities, based on the actual figures obtained from the 20-TPA case study. These analyses highlighted marginal viability for the 50-TPA facility (with a ten-year projected cumulative cash flow of $1,030,300; negative NPV of &minus; $167,651 and internal rate of return (IRR) of 11.75%), and an economically viable 100-TPA facility (with a ten-year projected cumulative cash flow of $3,176,750; NPV of $522,200 and IRR of 21.03%). Sensitivity analysis highlighted that the greatest gains to be realised in improving profitability were those associated with increasing the productive capacity of the facility, increasing the sale price of the product, and decreasing the capital costs of RAS facilities. Contradictions between the results from the present study to similar studies clearly highlight a need for further economic analyses of commercial RAS facilities, using commercial data sets and standard economic analysis procedures.<br />

Food insecurity, malnutrition and mortality in Maewo and Ambae islands, Vanuatu

Context: This paper reports on findings from the ex-post evaluation of the Maewo Capacity Building project in Maewo Island, Vanuatu, which was funded by World Vision Australia.<br />Objectives: To examine the extent to which the infrastructure and systems left behind by the project contributed to the improvement of household food security and health and nutritional outcomes in Maewo Island, using Ambae Island as a comparator.<br />Setting: Two-stage cluster survey conducted from 6 to 20 July 2004, which included anthropometric measures and 4.5-year retrospective mortality data collection.<br />Participants: A total of 406 households in Maewo comprising 1623 people and 411 households in Ambae comprising 1799 people.<br />Main outcome measures: Household food insecurity, crude mortality rate (CMR), under-five mortality rate (U5MR) and malnutrition prevalence among children.<br />Results: The prevalence of food insecurity without hunger was estimated at 15.3%<br />(95% confidence interval (CI): 12.1, 19.2%) in Maewo versus 38.2% (95% CI: 33.6, 43.0%) in Ambae, while food insecurity with hunger in children did not vary by location. After controlling for the child&rsquo;s age and gender, children in Maewo had higher weight-for-age and height-for-age Z-scores than children of the same age in Ambae. The CMR was lower in Maewo (CMR &frac14; 0.47/10 000 per day, 95% CI: 0.39, 0.55) than in Ambae (CMR &frac14; 0.59/10 000 per day, 95% CI: 0.51, 0.67) but no difference existed in U5MR. The major causes of death were similar in both locations, with frequently reported causes being malaria, acute respiratory infection and<br />diarrhoeal disease.<br />Conclusions: Project initiatives in Maewo Island have reduced the risks of mortality and malnutrition. Using a cross-sectional &lsquo;external control group&rsquo; design, this paper demonstrates that it is possible to draw conclusions about project effectiveness where baseline data are incomplete or absent. Shifting from donor-driven evaluations to impact evaluations has greater learning value for the organisation, and greater value when reporting back to the beneficiaries about project impact and transformational<br />development in their community. Public health nutritionists working in the field are well versed in the collection and interpretation of anthropometric data for evaluation of nutritional interventions such as emergency feeding programmes. These same skills can be used to conduct impact evaluations, even some time after project completion, and elucidate lessons to be learned and shared. These skills can also be applied more widely to projects which impact on the longer-term nutritional status of<br />communities and their food security.<br />

Year 12 students' mental models of the nature of light

This article reports on the third year of a three-year longitudinal investigation into six secondary students' understanding of optics at a secondary school level. In the third year of this investigation the students, who by now were in Year 12, underwent a teaching sequence that centred on the teaching and learning of physical optics and quantum ideas. The students' mental models of the nature of light were explored prior to, and following this teaching sequence. The researcher took on the dual roles of teacher and researcher. This paper will outline the findings of the third year of this study and the implications they have for the teaching and learning of optics at secondary school level.<br />

Where in the world is room N101? Engaging with first year education students' experiences of transition

National reports on students&rsquo; experiences in their first year of tertiary study suggest that many students, particularly those coming directly from&nbsp; secondary schools, find the transition into university life particularly difficult. These reports suggest that while many students find the experience to be a challenging hurdle others feel disengaged and unconnected to academic life. Reports also note that many students enter university with the expectation that their university experience should 'fit into their lives' rather than vice-versa.<br /><br />Additionally, research indicates that successful transitional experiences for undergraduate students are critical in promoting effective learning habits, positive attitudes and openness to new knowledge. Establishing positive practices in the early days of the undergraduate course can enable students to utilise these experiences and knowledge as a part of their life-long professional habits. However, in order for this to occur, connections must be made, and relationships built, between students and their new peer groups and with the wider academic community. Connections must also be made between students' prior experiences and their new knowledge.<br /><br />In light of the findings of recent research and reports, Deakin University has instituted a First Year Initiative to assist students in their transitions. Alongside and complementary to this, the Faculty of Education has developed a new three year Education Studies Major program which began this year.<br /><br />In this paper, we discuss the ways in which the first two units of this new educational program aim to address some of the issues that students face when making the transition into university life. We see the implementation of the first two units as a 'pilot study' and while at this stage, evaluation of these units is only beginning, here we will consider some of the pedagogical strategies, resources, organisational structures and 'grounded' experiences that are being trialled as means to help students make the connections and take the first successful steps in their journey to becoming professional educators. Ways in which these new approaches aim to build important relationships between students, with staff and, as well, help them connect their prior experiences with new knowledge, will be considered in light of the literature on first year student transitions.<br /><br />

Review of first-year engineering and technology units based on student unit evaluations

There is recognition that the first-year of university study is a critical phase in the preparation, motivation and retention of science, mathematics,&nbsp; engineering and technology (SMET) students. First-year provides the foundation/generic skills upon which students will base their undergraduate studies and professional practice; first-year is where many poorly prepared/at risk students will drop out and contribute to the poor student retention rate observed in the SMET disciplines; and first-year is when students may lose the motivation to pursue their chosen career direction if they find the studies at the commencement of their undergraduate program appear to bear no relationship to their intended career. In 2003, the Learning Resources Advisory Group of the Deakin University School of Engineering and Technology was requested to undertake a review of first-year units in the School&rsquo;s programs. The information contained in anonymous unit evaluation questionnaires from the years 2000-2002 was used as the basis for analysing student perceptions of first-year units. In unit evaluations, students reported a wide range of issues that impacted negatively on their perception of the content and conduct of first-year units. It was noted that units service taught by other Schools form a significant element of the first-year of all of the Engineering and Technology undergraduate programs &ndash; typically 25 to 50 percent of the content. The significant influence of these units on the perceptions of the first-year of the School&rsquo;s commencing students means that the School should exercise some control over the content and delivery of these units.<br />

Mortality rates, prevalence of malnutrition, and prevalence of lost pregnancies among the drought-ravaged population of Tete province Mozambique

Background: Tete Province, Mozambique has experienced chronic food insecurity and a dramatic fall in livestock numbers due to the cyclic problems characterized by the floods in 2000 and severe droughts in 2002 and 2003. The Province has been a beneficiary of emergency relief programs, which have assisted &gt;22% of the population. However, these programs were not based on sound epidemiological data, and they have not established baseline data against which to assess the impact of the programs. Objective: The objective of this study was to document mortality rates, causes of death, the prevalence of malnutrition, and the prevalence of lost pregnancies after 2.5 years of humanitarian response to the crisis. Methods: A two-stage, 30-cluster household survey was conducted in the Cahora Bassa and Changara districts from 22 October to 08 November 2004. A total of 838 households were surveyed, with a population size of 4,688 people. Results: Anthropometric data were collected among children 6-59 months of age. In addition, crude mortality rates (CMRs), under five mortality rates (U5MRs), causes of deaths, and prevalence of lost pregnancies were determined among the sample population. The prevalence of malnutrition was 8.0% (95% confidence interval (CI)=6.2-9.8%) for acute malnutrition, 26.9% (95% CI=24.0-29.9%) for being underweight, and 37.0% (95% CI=33.8-40.2%) for chronic malnutrition. Boys were more likely to be underweight than were girls (odds ratio (OR)=1.34; 95% CI=1.00, 1.82; p&lt;0.05) after controlling for age, household size, and food aid beneficiary status. Similarly, children 30-59 months of age were significantly less likely to suffer from acute malnutrition (OR=0.45; 95% CI=0.26, 0.79; p&lt;0.01) and less likely to be underweight (OR=0.37; 95% CI=0.27, 0.51; p&lt;0.01) than children 6-29 months of age, after adjusting for the other, aforementioned factors. The proportion of lost pregnancies was estimated at 7.7% (95% CI=4.5-11.0%). A total of 215 deaths were reported during the year preceding the survey. Thirty-nine (18.1%) children &lt;5 years of age died. The CMR was 1.23/10 000/day (95% CI=1.08-1.38), and an U5MR was 1.03/10 000/day (95% CI=0.71-1.35). Diarrheal diseases, malaria, tuberculosis, and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) accounted for more than two-thirds of all deaths. Conclusions: The observed CMR in Tete Province, Mozambique is three times higher than the baseline rate for sub-Saharan Africa and 1.4 times higher than the CMR cut-off point used to define excess mortality in emergencies. The current humanitarian response in Tete Province would benefit from an improved alignment of food aid programming in conjunction with diarrheal disease control, HIV/AIDS, and malaria prevention and treatment programs. The impact of the food programs would be improved if mutually acceptable food aid programme objectives, verifiable indicators relevant to each objective, and beneficiary targets and selection criteria are developed. Periodic re-assessments and evaluations of the impact of the program and evidenced-based decision-making urgently are needed to avert a chronic dependency on food aid.<br />

Family, school, peer and individual influences on early adolescent alcohol use: first-year impact of the Resilient Families programme

<b>Introduction and Aims</b>:&nbsp; This study aimed to examine: (a) the influence of family factors relative to school, peer and individual influences on the development of adolescent alcohol use during the first year of secondary school; and (b) the feasibility of preventing adolescent alcohol use by modifying family factors. <b>Design and Methods</b>:&nbsp; Twenty-four schools in Melbourne, Australia were randomly assigned to either the 'Resilient Families' intervention or a control condition. A baseline cohort of 2315 grade 7 students (mean age 12.3 years) were followed-up one year later (n = 2128 for longitudinal analyses). A sub-set of parents (n = 1166) also returned baseline surveys. <b>Results</b>: The prevalence of lifetime alcohol use in year 7 was 33% and rose to 47% by year 8. Student-reported predictors of year 8 alcohol use included baseline alcohol [Odds Ratio (OR) 3.64] and tobacco use (2.68), and school friend's alcohol (1.41) and tobacco use (1.64). After adjusting for other influences, student-reported family factors were not maintained as significant predictors of year 8 alcohol use. Parent-report predictors of student-reported alcohol use included allowing alcohol use in the home (2.55), parental alcohol use (1.88) and child hyperactivity (1.85). Protective factors included attendance at brief parent education (0.60) and parent involvement in school education (0.65). <b>Discussion and Conclusions</b>: The intervention appeared to benefit education-related outcomes, but no overall effect in reducing student alcohol use was found in year 8. Intervention effects on alcohol misuse may become significant in later secondary school once the entire program has been implemented. Considerable alcohol use was detected in early secondary school,&nbsp;&nbsp; suggesting that interventions to reduce alcohol use may be usefully implemented prior to this period.<br />

Southern drift : the learning styles of first and third-year students of the built environment

This paper investigates learning processes across a built environment design curriculum through the recognition of the four learning styles defined in the experiential learning theory of Kolb, i.e., 'accommodating', 'diverging', 'assimilating' and 'converging.' The paper focuses on the results of a cross-curriculum learning style survey. The results of the survey appear to explain why many prior studies of the personality characteristics, learning and cognitive styles of practitioners and of design students at different stages of their education appear conflicting. The hypothesis tested to resolve these inconsistencies asked whether design-learning styles are fixed or change as students' progress through their studies. The survey provides evidence of a statistically significant relationship between learning styles and year of study. The evidence suggests a southern drift (the term refers to the spatial interrelationship of styles in the two-dimensional Kolb Learning Style Index [LSI] cycle) towards the abstract conceptualisation mode of the learning process as students near the completion of their studies. This fluidity in learning style remains a hypothesis until further research is able to study one cohort for the entirety of a degree program. The paper argues that the possibility of learning style fluidity needs determining if learning style theory is to provide a workable model for informing the teaching of architecture.<br />

Australian law students' perceptions of their values: interim results in the first year--2001--of a three--year empirical assessment

This study attempts to answer an essential social policy question: what values are characteristic of the mass of Australian lawyers' in their last year of law school and their early careers, and how do these values develop or degrade over time? This question is important because of the concern felt in the community as to the activities of lawyers. In recent years the Australian legal profession has sustained more scrutiny by governments, regulators and consumer movements than in any previous period of our history. The perception that practitioners' competencies and ethics are deficient and materially linked both to reduced standards of performance and to higher levels of public complaints, has received attention from academics, law societies, parliamentary committees and the Australian Competition and Consumer Commission. <br /><br /><br />

Year 12 students' mental models of the nature of light

This paper reports on the third year of a three-year longitudinal investigation into six Year 10 secondary students&rsquo; understanding of optics at a secondary school level. During the first two years of the study the students&rsquo; understanding of geometrical optics was explored with the adoption of constructivist teaching and learning strategies. The students' understanding of geometrical optics following the Year 11 teaching stage then formed the basis of exploration of their mental models of the nature of light. This exploration occurred before, during and following a Year 12 teaching stage where the students studied physical optics and quantum ideas. Before the Year 12 teaching stage the students had constructed mental models of light that related to their understanding of a ray. Over the Year 12 teaching stage the students&rsquo; mental models changed to conceptualizations of a photon. There was evidence in the students&rsquo; mental models of a hybridization of the particle and wave scientific models. That is, they conceptualized the photon as having both wave and particle characteristics. The variation in the students&rsquo; hybrid models also suggested a variation in the way they conceived of the nature of scientific models.<br />

The effect pf diary foods on CHD: a systematic review of prospective cohort studies

There is interest in the degree to which fats in dairy foods contribute to CHD. We undertook a systematic review to investigate the effect of dairy&nbsp; consumption on CHD using prospective cohort studies. A systematic search of electronic databases identified studies relating dairy food intake in adulthood to episodes or death from CHD, IHD and myocardial infarction. Included studies were assessed for quality based on study methodology, validity of dietary assessment, success of follow-up, standardised&nbsp; assessment of CHD, IHD or myocardial infarction end points and&nbsp; appropriateness of statistical adjustment. Data from twelve cohorts involving &gt;280 000 subjects were included. Most studies had follow-up of &gt;80 %, adjusted statistically for three or more confounders and used standard criteria to determine end points. About half the studies used a validated FFQ, administered the FFQ more than once or had follow-up of &gt;20 years. Fewer than half the studies involved subjects representative of the general population. Four of the twelve cohorts found no association between dairy intake and CHD. Eight studies reported varying relationships between different dairy foods and CHD or differential associations based on race, sex or over time. Although dairy foods contribute to the SFA composition of the diet, this systematic review could find no consistent evidence that dairy food consumption is associated with a higher risk of CHD. This could be due to the limited sensitivity of the dietary assessment methods to detect an effect of a single food in a mixed diet on complex clinical outcomes.<br />

Cardiovascular surveys : manual of operations

Cardiovascular disease (CVD) is the leading cause of death and hospitalization in both men and women in nearly all countries of Europe. The most frequent forms of CVD are those of an atherosclerotic origin, mainly ischaemic heart disease, stroke and heart failure. The magnitude of the problem contrasts with the usual paucity and poor quality of data available on incidence and prevalence of CVD, except for few rigorous but limited studies.<br /><br />The objectives of the health interview and health examination surveys (HIS/HES) are to evaluate the frequency and the distribution of the disease, to evaluate trends and treatment effectiveness, to estimate risk factors distribution and prevalence of high risk conditions and to monitor prevention programmes.<br /><br />According to the EUROCISS project (EUROpean Cardiovascular Surveillance Set) recommendations, surveys are aimed at describing the prevalence of the following CVD conditions: myocardial infarction, heart failure, angina pectoris, peripheral arterial disease, stroke, and ischaemic heart disease.<br /><br />HIS and HES were developed to supplement information collected from routine databases and population-based registers to implement consistent public health policies. HIS can be repeated periodically in a new sample of the population, or can follow up over time the population recruited at baseline. Procedures and methods to collect information from participants include self-administered questionnaires, direct interviewer-administered questions and telephone interviews. A minimum set of questions to be administered every year, along with a longer, more detailed module to be administered periodically are recommended to evaluate CVD prevalence. The addition of HES provides more detailed and objective information that can be used to improve estimates regarding prevalence of both risk factors and disease status.<br /><br />The selection of more specialized CVD-specific tests will depend on the objective the survey is designed to achieve, the assumed response rate and the cost and time considerations. For HES on CVD the minimum required is to perform the following measurements: height, weight, blood pressure, waist circumference, total and high density lipoprotein-cholesterol and glucose assay in a nonfasting blood sample. The next appropriate step would be to perform an electrocardiogram. High costs usually make HES difficult to carry out.<br /><br />Standardization of measurements, training of personnel and quality control are essential to assure reliable data. A high response rate is extremely important, as nonrespondents tend to have different health characteristics from the rest of the sample and their omission therefore results in bias.<br /><br />This manual of operations is intended for health professionals and policy makers and provides a standardized and simple model for the implementation of a CVD survey.<br />

Family food environments as determinants of children's eating : implications for obesity prevention

The prevalence of childhood obesity is escalating rapidly and it considered to be a major public health problem. Diet is a recognised precursor of fatness, and current evidence supports the premise that in Westernised countries, the dietary intakes of children are likely to be important in obesity genesis. However, we have a relatively poor understanding of the environments in which a child’s eating is learnt and maintained. Much of the existing work in this area is based on small-scale or experimental studies, or has been derived from homogeneous populations within the USA. Despite these limitations, there is evidence that aspects of the child’s family environment are likely to be important in determining obesity risk in children. This thesis examines the impact of the family food environment on a child’s eating through two related studies. The first study, titled the Children and Family Eating (CAFÉ) study comprised three phases. Phase one involved qualitative interviews with 17 parents of 5-6 year-old children to explore parental perceptions regarding those factors in a child’s environment believed to influence the development of their child’s eating habits. These interviews were used to inform the development of quantitative measures of the family food environment. The second phase involved the development of a Food Frequency Questionnaire (FFQ) to assess dietary intake in 5-6 year-olds. The FFQ was informed by analysis of 1995 Australian National Nutrition Survey data. In the final phase the relationships between dietary intakes of 5-6 year-old children, and potential predictors of dietary intake were examined in a cross-sectional study of 560 families. Predictors included measures of: parental perceptions of the adequacy of their child’s diet; food availability and accessibility; child-feeding; the opportunities for parental modelling of food intake; a child’s television exposure; maternal Body Mass Index; and maternal education. Analysis of the CAFÉ data provides unique information regarding the relationships between a child’s family food environment and their food consumption. Models developed for a range of dietary outcomes considered to be predictive of increased risk for obesity, including total energy and fat intakes, vegetable variety, vegetable consumption, and high-energy (non-dairy) fluid consumption, explained between 11 and 20 percent of the variance in dietary intake. Two aspects of the family food environment, parental perception of a child’s dietary adequacy, and the total minutes of television viewed per day, were frequently found to be predictive of dietary outcomes likely to promote fatness in these children. The second study, titled the Parent Education and Support (PEAS) Feeding Intervention Study, was a prospective pre/post non-randomised intervention trial that assessed the impact of a feeding intervention to 240 first-time mothers of one-year-old children. This intervention focused on one aspect of the family food environment, child-feeding, which has been proposed as influential in the development of obesogenic eating behaviours. In this study, Maternal and Child Health Nurses (MCHNs), using a ‘Division of Responsibility’ model of feeding, taught parents to provide nutritious food at regular intervals and to let children decide if to eat and how much to eat. Thus parents were encourages to food their child without exerting pressure, or employing coercion or rewards (controlling behaviours). The aim was to influence parental attitudes and beliefs regarding child-feeding. Through the use of these feeding techniques, this intervention also aimed to increase the variety of fruits and vegetables a child consumed by teaching parents to persist with offering these foods, over the year of the intervention, in non-emotive environments. Fruits and vegetables were chosen in this intervention because they are likely to be protective in the development of obesity. Analysis of the PEAS data suggests that this low-level feeding intervention, delivered through existing Maternal and Child Health services, was modestly effective in changing parental attitudes and beliefs regarding the feeding of young children. Further, the validity of fruits offered to intervention group children increased. This thesis expands the existing knowledge base by providing a comprehensive analysis of the relative impact of aspects of the family environment on dietary intakes of 5-6 year-olds. Further, the analysis of a feeding intervention in first-time parents provides important insights regarding the potential to influence child-feeding and the impact this may have on the promotion of eating behaviours protective against obesity.

The role of the medical emergency team in end-of-life care : a multicenter, prospective, observational study

<b>Objective:</b> To investigate the role of medical emergency teams in end-of-life care planning.<br /><br /><b>Design:</b> One month prospective audit of medical emergency team calls.<br /><br /><b>Setting:</b> Seven university-affiliated hospitals in Australia, Canada, and Sweden.<br /><br /><b>Patients:</b> Five hundred eighteen patients who received a medical emergency team call over 1 month.<br /><br /><b>Interventions:</b> None.<br /><br /><b>Measurements and Main Results:</b> There were 652 medical emergency team calls in 518 patients, with multiple calls in 99 (19.1%) patients. There were 161 (31.1%) patients with limitations of medical therapy during the study period. The limitation of medical therapy was instituted in 105 (20.3%) and 56 (10.8%) patients before and after the medical emergency team call, respectively. In 78 patients who died with a limitation of medical therapy in place, the last medical emergency team review was on the day of death in 29.5% of patients, and within 2 days in another 28.2%. Compared with patients who did not have a limitation of medical therapy, those with a limitation of medical therapy were older (80 vs. 66 yrs; p &lt; .001), less likely to be male (44.1% vs. 55.7%; p .014), more likely to be medical admissions (70.8% vs. 51.3%; p &lt; .001), and less likely to be admitted from home (74.5% vs. 92.2%, p &lt; .001). In addition, those with a limitation of medical therapy were less likely to be discharged home (22.4% vs. 63.6%; p &lt; .001) and more likely to die in hospital (48.4% vs. 12.3%; p &lt; .001). There was a trend for increased likelihood of calls associated with limitations of medical therapy to occur out of hours (51.0% vs. 43.8%, p .089).<br /><br /><b>Conclusions:</b> Issues around end-of-life care and limitations of medical therapy arose in approximately one-third of calls, suggesting a mismatch between patient needs for end-of-life care and resources at participating hospitals. These calls frequently occur in elderly medical patients and out of hours. Many such patients do not return home, and half die in hospital. There is a need for improved advanced care planning in our hospitals, and to confirm our findings in other organizations.<br />