The lived experience of gay men caring for others whith HIV/AIDS : resilient coping skills

There is a dearth of research conducted on the relationship aspect of gay men caring for gay men. This Australian research conducted in 2002 investigated the emotional effects of HIV/AIDS on the gay male carers of gay men with the disease. This study was phenomenological inquiry and employed van Manen's approach to content analysis. Twelve participants for the study were recruited. The results produced emergent themes relating to coping with HIV/AIDS, living day-to-day with HIV/AIDS, coping with the last phase of AIDS towards death, saying goodbye and remembrance. This research highlights the resilient coping style of carers of persons living with HIV/AIDS. The research also gives rise to recommendations for practice and educational contexts in terms of the support and care considerations for persons living with HIV/AIDS and their carers.

Trajectory characterizations for a discrete-time bearing-only navigation strategy

In this paper we explore the geometry of a particular navigation scheme which guides a pursuer from a fixed initial position to a given fixed final position using a one-step look ahead strategy and using only bearing measurements. We explicitly characterize the optimal trajectories for the problem in terms of the Cramer-Rao bound such that the derived trajectories permit a minimization in the error of an unbiased estimate of the target position.

Optimal trajectory characterization for a pursuer navigation scheme

In this paper we examine the geometry of a number of bearing-only navigation schemes for guiding a pursuer from a fixed initial position to a final target position. We explicitly characterize the optimal trajectories for the given problems in terms of analyzing those trajectories which attempt to minimize the error in an estimate of the target position using successive bearing measurements made along the trajectory.

Identifying the "right patient" : nurse and patient perspectives on how to verify patient identity during medication administration

In this paper, we report on a research project funded by the Australian College of Mental Health Nurses’ and Bristol Myers Squibb Research Grant in 2007. We examined ways in which Mental Health Nurses could correctly identify patients during medication administration that promote medication safety and that are acceptable to both consumers and nurses. Central to the safe practice of medication administration are the “five rights” – giving the right drug, in the right dose, to the right patient, via the right route, at the right time. In non-psychiatric settings, such as medical and surgical inpatient units, the use of identification aids, such as wristbands, are common. In most Victorian psychiatric inpatient units, however, standardised identification aids are not used. Anecdotally, consumers dislike some methods of patient identification, such as wearing wrist bands, and some nurses perceive consumers’ rights are infringed through wearing personal identifiers. In focus groups, mental health consumers and Mental Health Nurses were invited to discuss their experiences of patient identification during routine psychiatric inpatient medication administration. They were also asked their opinions of, and preferences for, different ways of verifying “right patient” during routine medication administration. In our paper, we will present the findings of a qualitative research project in which we explored the experiences, opinions, and preferences of mental health consumers and Mental Health Nurses towards methods of correctly identifying patients during medication administration.

Identifying the "right patient" : nurse and patient perspectives on how to verify patient identity during medication administration

In this paper, we report on a research project funded by the Australian College Mental Health Nurses’ and Bristol Myers Squibb Research Grant in 2007. We examined ways in which mental health nurses could correctly identify patients during medication administration that promote medication safety and that are acceptable to both consumers and nurses.

Central to the safe practice of medication administration are the “five rights”- giving the right drug, in the right dose, to the right patient, via the right route, at the right time. In non-psychiatric settings, such as medical and surgical inpatient units, the use of identification aids, such as wristbands, are common. In most Victorian psychiatric inpatient units, however, standardised identification aids are not used. Anecdotally, consumers dislike some methods of patient identification, such as wearing wrist bands, and some nurses perceive consumers' rights are infringed through wearing personal identifiers.

In focus groups, mental health consumers and mental health nurses were invited to discuss their experiences of patient identification during routine psychiatric inpatient medication administration. They were also asked their opinions of, and preferences for, different ways of verifying “right patient” during routine medication administration. In our paper, we will present the findings of a qualitative research project in which we explored the experiences, opinions, and preferences of mental health consumers and mental health nurses towards methods of correctly identifying patients during medication administration.

Evaluation of a community-based mental health drug and alcohol nurse in the care of people living with HIV/AIDS

There is a growing need for advanced practice mental health and drug and alcohol nursing roles in the care of people living with HIV/AIDS; however, limited publications address these domains. This study evaluated a community-based mental health drug and alcohol nurse role caring for people living with HIV/AIDS (Mental Health D&A Nurse) in a large not-for-profit district nursing organization providing care to people living with HIV/AIDS in an Australian city. Outcomes from a client assessment and 6–8-week follow-up by the Mental Health D&A Nurse are presented as captured by the Depression Anxiety Stress Scales (DASS 21), Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), Health of the Nation Outcome Scales (HONOS) and WHOQoL BREF. Mean scores and caseness were analysed, and significant differences were found on the 'impairment' and 'social problems' subscales of the HONOS. Results of semi-structured interviews with clients describe effective and supportive mental health care and health-promoting education following visits by the Mental Health D&A Nurse. These positive findings support continuing implementation of the role within this community setting and indicate that even greater benefits will ensue as the role develops further. Findings are of interest to clinicians and policy makers seeking to implement similar roles in community-based HIV/AIDS care.

Commercial sex work, survival sex, sexual violence and HIV/AIDS prevention in Arumeru District, Arusha region Of Tanzania

Objective: To examine the knowledge and practices about HIV/AIDS among female Tanzanian commercial sex workers (CSWs) and assess the contextual dynamics that prevent safer sexual behaviours.

Method: The study used mixed methods and was implemented in two phases. Phase one assessed the knowledge and practices about HIV/AIDS among CSWs. Data were obtained with 54 CSWs, who were selected by using a snowball sampling approach. Semi-structured, face-to-face interviews with the CSWs were undertaken to allow the research participants to describe and discuss their lived realities as they perceive and experience them. In phase two, three discrete focus group discussions, each comprising 6-10 women, were carried out with 26 of the 54 CSWs who were interviewed in phase one.

Results: There was exploitation and inequity in the women's lives due to the multiple and overlapping oppressions of poverty and patriarchy. Sexual violence was framed, legitimised and reinforced by structural and cultural inequities. Such exploitation impacted not only on CSWs' lives as sex workers, but on their previous and/or simultaneous lives as mothers, wives, girlfriends and daughters. The women practised ‘survival sex’ as CSWs and/or sexual partners of men, and experienced sexual violence from their clients/partners. This violence was either culturally legitimised within a patriarchal framework or manifested itself as ‘displaced aggressive sex’ by men experiencing marginalisation in socio-economic spheres.

Lived experience of gay men caring for others with HIV/AIDS : living, loving and dying in the era of HIV/AIDS

This thesis explored gay male carers’ experience of caring for their partner, brother or friend who had HIV/AIDS. Through using phenomenological methodology (van Manen, 1990), the day-to-day caring experiences were uncovered. The data gathered were then analysed through a nursing ‘lens’, with the concept of stigma as an anchoring point. The dual stigmas of homophobia and AIDS phobia impacted on the daily lives of these men as they cared for their loved one. The research identified six themes. These were: 1) the relationship; 2) coping with HIV and AIDS; 3) the corporal impact of HIV/AIDS; 4) experiences of carers including the absence of others; 5) living daily with the virus: Demands of people living with HIV/AIDS (PLWHA); and 6) saying goodbye, but wanting to keep the memory alive. The caring these men undertook, for which they were frequently unprepared, was intensive and complex, but because of their commitment and love they battled on. Because of a sense of shame associated with AIDS phobia on the part of the PLWHA, the carer often had to undertake this care in isolation, without support from family, friends or home health care agencies. The carers struggled with not only the demands of day-to-day care, but also with non-acceptance from family, both of the nature of the relationship with their partner and of their homosexuality. Family members were forced, often with great difficulty, to acknowledge the close commitment the men had to each other. Recognition that one had a terminal disease, HIV/AIDS was also required. The fear of potential transmission was high among carers, friends and family members. Notably, there was an absence of blame on the part of the carer towards his partner for contracting HIV/AIDS. The physical decline and marking of the body further stigmatised the PLWHA, which added to carers’ burdens. They endeavoured to minimise the physical decline in their partner, so he could continue to pass as healthy, and attempted to make the day-to-day living as normal as possible. The methods of combating weight loss and opportunistic infections meant frequent medical appointments, complex intensive medical procedures and help with personal care, which was undertaken at home largely without support from health care staff. Carers frequently struggled also with their partner’s denial of being ill. One strategy all carers used was to escape with their partners from their everyday life in Melbourne and attempt metaphorically to leave the HIV/AIDS behind; this was a time when they could rekindle their life together as it was before HIV/AIDS came into their lives. Some carers chose to holiday without their partner, to give themselves a break from the day-to-day caring, while others planned and took holidays with their partner. The decline of the health in the PLWHA meant that family members had to recognise and accept both the nature of the relationship and the presence of the disease. This recognition and acceptance often came only when the partner was very ill, even at the point of dying. Carers and their partners discussed the potential use of euthanasia, as a means of ending the final phase of life with some dignity. One carer and his partner used euthanasia, despite its illegal status. The main concern for all carers was providing comfort and a reduction in the pain associated with HIV/AIDS for the partner. The widespread grief associated with HIV/AIDS was evident amongst these carers. All had known other gay men who had died, some carers own partner had died, or was about to die. There was an overwhelming sense of grief, which at times was repressed as a means of coping day-to-day. All carers felt it was important and necessary to remember those lost to HIV/AIDS through the various public memorials, as they did not want their partner to be just another faceless person lost to this disease. This phenomenological study of carers’ experience highlights the need for health care workers to be aware of the differing strategies that gay men use to cope with HIV/AIDS. While it may seem that the carers are coping with care of their partner, the outer façade is not always an accurate portrayal of the true situation. Health care workers should enquire as to the assistance these carers need from health care services in order to continue to care for their loved one. Such assistance can be the simple recognition of the partner and acceptance of them as part of the PLWHA’s network; this inclusion and acceptance is half the battle.

Diver navigation system acoustic signal encoding/decoding optimisation

This thesis describes the optimisation of the encoding and decoding processes used to transmit and receive frequency coded data tones acoustically during the operation of an underwater diver navigation system. The aim was to reduce the time required to both generate these data tones for transmission as well as to decode these tones during reception. Encoding of the data tones is performed using a phase lock loop under the control of a microcontroller. A technique was developed which combined both hardware and software modifications to effectively halve the phase lock loop settling time, and therefore the time required to generate these tones. Decoding of these data tones is achieved using the Fast Fourier Transform. Alternative forms of the Discrete Fourier Transform were explored to find the most efficient in terms of execution time. Numerous software optimisations were then applied which led to a reduction in program execution time of 54 % with no penalty in program complexity or length. Testing of the system under identical real-life operating conditions showed no evidence of any system performance degradation as a result of these optimisations.

Applying outcomes of lifelong learning to organisational achievement

The focus of this doctoral research study is making the most what a person knows and can do, as an outcome from their lifelong learning, so as to better contribute to organisational achievement. This has been motivated by a perceived gap in the extensive literature linking knowledge with organisational achievement. Whereas there is a rich body of literature addressing the meta-philosophies giving rise to the emergence of learning organisations there is, as yet, scant attention paid to the detail of planning and implementing action which would reveal individual/organisational opportunities of mutual advantage and motivate, and sustain, participation at the day-to-day level of the individual. It is in this space that this dissertation seeks to contribute by offering a mechanism for bringing the, hindsight informed, response “but that’s obvious” into the abiding explicit realm at the level of the individual. In moving beyond the obvious which is prone to be overlooked, the emphasis on “better” in the introductory sentence, is very deliberately made and has a link to awakening latent individual, and hence organisational, capabilities that would otherwise languish. The evolved LCM Model – a purposeful integration valuing the outcomes from lifelong learning (the L) with nurturing a culture supporting this outcome (the C) and with responsiveness to potentially diverse motivations (the M) – is a reflective device for bringing otherwise tacit, and latent, logic into the explicit realm of action. In the course of the development of the model, a number of supplementary models included in this dissertation have evolved from the research. They form a suite of devices which inform action and lead to making the most of what an individual knows and can do within the formal requirements of a job and within the informal influences of a frequently invisible community of practice. The initial inquiry drew upon the views and experiences of water industry engineering personnel and training facilitators associated with the contract cleaning and waste management industries. However, the major research occurred as an Emergency Management Australia (EMA) project with the Country Fire Authority (CFA) as the host organisation. This EMA/CFA research project explored the influence of making the most of what a CFA volunteer knows and can do upon retention of that volunteer. In its aggregate, across the CFA volunteer body, retention is a critical community safety objective. A qualitative research, ethnographic in character, approach was adopted. Data was collected through interviews, workshops and outcomes from attempts at action research projects. Following an initial thirteen month scoping study including respondents other than from the CFA, the research study moved into an exploration of the efficacy of an indicative model with four contextual foci – i.e. the manner of welcoming new members to the CFA, embracing training, strengthening brigade sustainability and leadership. Interestingly, the research environment which forced a truncated implementation of action research projects was, in itself, an informing experience indicative of inhibitors to making the most of what people know and can do. Competition for interest, time and commitment were factors governing the manner in which CFA respondents could be called upon to explore the efficacy of the model, and were a harbinger of the influences shaping the more general environment of drawing upon what CFA volunteers know and can do. Subsequent to the development of the indicative model, a further 16 month period was utilised in the ethnographic exploration of the relevance of the model within the CFA as the host organisation. As a consequence, the model is a more fully developed tool (framework) to aid reflection, planning and action. Importantly, the later phase of the research study has, through application of the model to specific goals within the CFA, yielded operational insight into its effective use, and in which activity systems have an important place. The model – now confidently styled as the LCM Model – has three elements that when enmeshed strengthen the likelihood of organisational achievement ; and the degree of this meshing, as relevant to the target outcome, determines the strength of outcome. i.e. - • Valuing outcomes from learning: When a person recognises and values (appropriately to achievement by the organisation) what they know and can do, and associated others recognise and value what this person knows and can do, then there is increased likelihood of these outcomes from learning being applied to organisational achievement. • Valuing a culture that is conducive to learning: When a person, and associated others, are further developing and drawing upon what they know and can do within the context of a culture that is conducive to learning, then there is increased likelihood that outcomes from learning will be applied to organisational achievement. • Valuing motivation of the individual: When a person’s motivation to apply what they know and can do is valued by them, and associated others, as appropriate to organisational achievement then there is increased likelihood that appropriately drawing upon outcomes from learning will occur. Activity theory was employed as a device to scope and explore understanding of the issues as they emerged in the course of the research study. Viewing the data through the prism of activity theory led not only to the development of the LCM Model but also to an enhanced understanding of the role of leadership as a foundation for acting upon the model. Both formal and informal leadership were found to be germane in asserting influence on empowering engagement with learning and drawing upon its outcomes. It is apparent that a “leaderful organisation”, as postulated by Raelin (2003), is an environment which supports drawing upon the LCM model; and it may be the case that the act of drawing upon the model will move a narrowly leadership focused organisation toward leaderful attributes. As foreshadowed at the beginning of this synopsis, nurturing individual and organisational capability is the guiding mantra for this dissertation - “Capability embraces competence but is also forward-looking, concerned with the realisation of potential” (Stephenson 1998, p. 3). Although the inquiry focussed upon a need for CFA volunteer retention, it began with a broader investigation as part of the scoping foundation and the expanded usefulness of the LCM Model invites further investigation. The dissertation concludes with the encapsulating sentiment that “You have really got to want to”. With this predisposition in mind, this dissertation contributes to knowledge through the development and discussion of the LCM model as a reflective device informing transformative learning (Mezirow and Associates 1990). A leaderful environment (Raelin 2003) aids transformative learning – accruing to the individual and the organisation - through engendering and maintaining making the most of knowledge and skill – motivating and sustaining “the will”. The outcomes from this research study are a strong assertion that wanting to make the most of what is known and can be done is a hallmark of capability. Accordingly, this dissertation is a contribution to the “how” of strengthening the capability, and the commitment to applying that capability, of an individual and an organisation.

Syphilis and AIDS : historical and social comparisons

Drawing on the literatures of history, sociology, epidemiology, and microbiology, this thesis compares syphillis with human immunodeficiency virus, with special reference to the social and historical factors likely to be relevant to the control or eradication of acquired imune dificiency syndrom (AIDS). The sudden appearance of a new disease causing suffering and death in a community, engenders apprehension and fear which is often manifested as hysteria against, and vilification of, those who have the disease. This fear is greatly increased should the disease be sexually-transmitted. Syphilis in a venereal form, occured in Europe toward the end of the 15th Century. Initially it was an acute, fulminating disease which rapidly spread through Europe and Asia. Attempts to control the disease have gone through periods of either partial successes or massive failures and have ended in frustration for the authorities. When the syndrome of acquired immune deficiency (AIDS) was first reported, it was seen in Western countries in homosexual men. However, as non-homosexual community members and children became infected, it became apparent to authorities that a pandemic was accurring. Within a few years, the disease was identified worldwide. Isolation of the virus (HIV-1), and development of test for detection of carriers, plus restoration of clean blood and blood-product supplies, have reassured the community to some extent. The history of syphilis shows that neither the epidemiological medical, nor the economic political approaches to disease control work, although there are positive aspects resulting from both. It is social responses that will offer the most hope in the long term for the control of AIDS and other sexually-transmitted diseases.

Predicting the resistance of fired clay bricks to salt attack

The salt attack of Fired Clay Bricks (FCBs) causes surface damage that is aesthetically displeasing and eventually leads to structural damage. Methods for determining the resistances of FCBs to salt weathering have mainly tried to simulate the process by using accelerating aging tests. Most research in this area has concentrated on the types of salt that can cause damage and the damage that occurs during accelerated aging tests. This approach has lead to the use of accelerated aging tests as standard methods for determining resistance. Recently, it has been acknowledged that are not the most reliable way to determine salt attack resistance for all FCBs in all environments. Few researchers have examined FCBs with the aim of determining which material and mechanical properties make a FCB resistant to salt attack. The aim of this study was to identify the properties that were significant to the resistance of FCBs to salt attack. In doing so, this study aids in the development of a better test method to assess the resistance of FCBs to salt attack. The current Australian Standard accelerated aging test was used to measure the resistance of eight FCBs to salt attack using sodium sulfate and sodium chloride. The results of these tests were compared to the water absorption properties and the total porosity of FCBs. An empirical relationship was developed between the twenty-four-hour water absorption value and the number of cycles to failure from sodium sulfate tests. The volume of sodium chloride solution was found to be proportional to the total porosity of FCBs in this study. A phenomenological discussion of results led to a new mechanism being presented to explain the derivation of stress during salt crystallisation of anhydrous and hydratable salts. The mechanical properties of FCBs were measured using compression tests. FCBs were analysed as cellular materials to find that the elastic modules of FCBs was equivalent for extruded FCBs that had been fired a similar temperatures and time. Two samples were found to have significantly different elastic moduli of the solid microstructure. One of these samples was a pressed brick that was stiffer due to the extra bond that is obtained during sintering a closely packed structure. The other sample was an extruded brick that had more firing temperature and time compared with the other samples in this study. A non-destructive method was used to measure the indentation hardness and indentation stress-strain properties of FCBs. The indentation hardness of FCBs was found to be proportional to the uniaxial compression strength. In addition, the indentation hardness had a better linear correlation to the total porosity of FCBs except for those samples that had different elastic moduli of the solid microstructure. Fractography of exfoliated particles during salt cycle tests and compression tests showed there was a similar pattern of fracture during each failure. The results indicate there were inherent properties of a FCB that determines the size and shape of fractured particles during salt attack. The microstructural variables that determined the fracture properties of FCBs were shown to be important variables to include in future models that attempt to estimate the resistance of FCBs to salt attack.

Separating the contributions of hearing, lexical knowledge and speech production to speech perception scores in children with hearing impairments.

Open-set word and sentence speech-perception test scores are commonly used as a measure of hearing abilities in children and adults using cochlear implants and/or hearing aids. These tests are usually presented auditorily with a verbal response. In the case of children, scores are typically lower and more variable than for adults with hearing impairments using similar devices. It is difficult to interpret children's speech-perception scores without considering the effects of lexical knowledge and speech-production abilities on their responses. This study postulated a simple mathematical model to describe the effects of hearing, lexical knowledge, and speech production on the perception test scores for monosyllabic words by children with impaired hearing. Thirty-three primary-school children with impaired hearing, fitted with hearing aids and/or cochlear implants, were evaluated using speech-perception, reading-aloud, speech-production, and language measures. These various measures were incorporated in the mathematical model, which revealed that performance in an open-set word-perception test in the auditory-alone mode is strongly dependent on residual hearing levels, lexical knowledge, and speech-production abilities. Further applications of the model provided an estimate of the effect of each component on the overall speech-perception score for each child.

On the geometry of localization, tracking and navigation

The thesis characterizes the geometry of certain localization, tracking and navigation problems. For instance, the potential localization performance of certain multi-sensor systems is measurably linked to the relative sensor-target geometry. Additionally, several optimal and robust algorithms for localization and tracking are designed which exploit the underlying geometry of the problem considered.

Effectiveness of an HIV / AIDS prevention approach across three countries

The study examined the effectiveness of one community based HIV / AIDS prevention approach, Community Counselling, in PNG, India and Zambia. Results indicated the three countries differed along cultural dimensions. Differences on behaviour, attitude, knowledge and risk perceptions associated with HIV / AIDS were noted within each country that reflected exposure to the approach. The professional portfolio examines the curent situations in which cultural guidelines have been developed to assist clinicians in considering indigenous cultural differences in increasingly multicultural societies. Four case studies are presented in which aspects of these issues are identified and discussed.