Implementation of evidence into practice : Development of a tool to improve emergency nursing care of acute stroke

Background
Stroke is an increasing global health issue that places considerable burden on society and health care services. An important part of acute stroke management and decreasing stroke-related mortality is preventing complications within the first 24–48 hours. The current climate of prolonged time spent in the Emergency Department (ED) means that many aspects of stroke management are now the responsibility of emergency nurses.

Aims
The aims of this paper are to: i) examine the evidence related to nursing care of acute stroke, ii) identify evidence-based elements of stroke care with most applicability to emergency nursing and iii) use evidence-based stroke care recommendations to develop a guideline for the emergency nursing management of acute stroke.

Results
Emergency nursing care of acute stroke should focus on optimal triage decisions, physiological surveillance, fluid management, risk management, and early referral to specialists.

Conclusions
The role of emergency nurses in stroke care will increase and it is important that emergency nurses deliver evidence-based stroke care in order to optimise patient outcomes. Guidelines and decision support tools for use in emergency nursing must be practical and have high levels of clinical utility for maximum uptake in a busy clinical environment.

The effects of repetitive loading on bone mass and geometry in young male tennis players : a quantative study using magnetic resonance imaging

Pre- and early puberty seem to be the most opportune times for exercise to  improve bone strength in girls, but few studies have addressed this issue in boys. This study investigated the site-, surface-, and maturity-specific exercise-induced changes in bone mass and geometry in young boys. The osteogenic effects of loading were analyzed by comparing the playing and nonplaying humeri of 43 male pre-, peri-, and postpubertal competitive tennis players 10-19 yr of age. Total bone area, medullary area, and cortical area were determined at the mid (40-50%) and distal humerus (60-70%) of both arms using MRI. Humeral bone mass (BMC) was derived from a whole body DXA scan. In prepubertal boys, BMC was 17% greater in the playing compared with nonplaying arm (p < 0.001), which was accompanied by a 12-21% greater cortical area, because of greater periosteal expansion than medullary expansion at the midhumerus and periosteal expansion associated with medullary contraction at the distal humerus. Compared with prepuberty, the side-to-side differences in BMC (27%) and cortical area (20-33%) were greater in peripuberty (p < 0.01). No differences were found between peri- and postpuberty despite longer playing history in the postpubertal players.The osteogenic response to loading was greater in peri- compared with prepubertal boys, which is in contrast with our previous findings in girls and may be caused by differences in training history. This suggests that the window of opportunity to improve bone mass and size through exercise may be longer in boys than in girls.

The impact of business outsourcing on corporate real estate in India

Driven by Western companies' requirements for efficiency and effectiveness, a trend towards outsourcing of business activities to India and other low-cost countries commenced in the early 1990s and has continued to grow at a surprisingly fast pace. In a relatively short timeframe India has become a global hub for back-office services, although the effect on the urban cities is yet to be fully comprehended. As American and European companies continue to relocate their information technology services and other back office works to the subcontinent, there has been a considerable flow-on effect on Indian corporate real estate. This paper addresses two key questions. Firstly, the factors important for Western companies' outsourcing of organisational activities to India, and secondly, the effect of business outsourcing on corporate real estate locational requirements in India. A survey of corporate real estate representatives in India and the UK was conducted with the results providing an insight into the present state and possible future direction of outsourcing for India. This research presents a unique insight into the impacts of Western business outsourcing on corporate real estate in India, and presents findings that are useful to both organisations seeking to relocate business activities to India and for property market analysts looking to understand drivers behind this sustained demand for Indian corporate real estate.

It's my time to shine : young Australians reflect on past, present and imagined future alcohol consumption

Drawing on interviews about the drinking trajectories of sixty young Victorian drinkers (aged 20-24), this paper outlines patterns of change over time and explores two drinking biographies in depth. For most research participants, drinking alcohol was an enjoyable and integral part of their social lives, but its role changed as they made other transitions in their lives. Most participants considered their early twenties to be a time for heavy alcohol consumption, and most imagined that they would drink less when they were middle-aged.

Role of exercise in the development of bone strength during growth

Exercise during growth may increase peak bone mass; if the benefits are maintained it may reduce the risk of fracture later in life (1). It is hypothesised that exercise will preferentially enhance bone formation on the surface of cortical bone that is undergoing bone modeling at the time (2). Therefore, exercise may increase bone mass accrual on the outer periosteal surface during the pre- and peri-pubertal years, and on the inner endocortical surface during puberty (3). An increase in bone formation on the periosteal surface is, however, more effective for increasing bone strength than medullary contraction (4). While exercise may have a role in osteoporosis prevention, there is little evidential basis to support this notion. It is generally accepted that weight-bearing exercise is important, but it is not known how much, how often, what magnitude or how long children need to exercise before a clinically important increase in bone density is obtained. In this thesis, the effect of exercise on the growing skeleton is investigated in two projects. The first quantifies the magnitude and number of loads associated with and in a moderate and low impact exercise program and non-structured play. The second project examines how exercise affects bone size and shape during different stages of growth. Study One: The Assessment of the Magnitude of Exercise Loading and the Skeletal Response in Girls Questions: 1) Does moderate impact exercise lead to a greater increase in BMC than low impact exercise? 2) Does loading history influence the osteogenic response to moderate impact exercise? 3) What is the magnitude and number of loads that are associated with a moderate and low impact exercise program? Methods: Sixty-eight pre-and early-pubertal girls (aged 8.9±0.2 years) were randomised to either a moderate or low impact exercise regime for 8.5-months. In each exercise group the girls received either calcium fortified (-2000 mg/week) or non-fortified foods for the duration of the study. The magnitude and number of loads associated with the exercise programs and non-structured play were assessed using a Pedar in-sole mobile system and video footage, respectively. Findings: After adjusting for baseline BMC, change in length and calcium intake, the girls in the moderate exercise intervention showed greater increases in BMC at the tibia (2.7%) and total body (1.3%) (p ≤0.05). Girl's who participated in moderate impact sports outside of school, showed greater gains in BMC in response to the moderate impact exercise program compared to the low impact exercise program (2.5 to 4.5%, p ≤0.06 to 0.01). The moderate exercise program included -400 impacts per class, that were applied in a dynamic manner and the magnitude of impact was up to 4 times body weight. Conclusion: Moderate-impact exercise may be sufficient to enhance BMC accrual during the pre-pubertal years. However, loading history is likely to influence the osteogenic response to additional moderate impact exercise. These findings contribute towards the development of school-based exercise programs aimed at improving bone health of children. Study Two: Exercise Effect on Cortical Bone Morphology During Different Stages of Maturation in Tennis Players Questions: 1) How does exercise affect bone mass (BMC) bone geometry and bone strength during different stages of growth? 2) Is there an optimal stage during growth when exercise has the greatest affect on bone strength? Methods: MRI was used to measure average total bone, cortical and medullary areas at the mid- and distal-regions of the playing and non-playing humerii in 47 pre-, peri- and post-pubertal competitive female tennis players aged 8 to 17 years. To assess bone rigidity, each image was imported into Scion Image 4.0.2 and the maximum, minimum and polar second moments of area were calculated using a custom macro. DXA was used to measure BMC of the whole humerus. Longitudinal data was collected on 37 of the original cohort. Findings: Analysis of the entire cohort showed that exercise was associated with increased BMC and cortical area (8 to 14%), and bone rigidity (11 to 23%) (all p ≤0.05). The increase in cortical bone area was associated with periosteal expansion in the pre-pubertal years and endocortical contraction in the post-pubertal years (p ≤0.05). The exercise-related gains in bone mass that were accrued at the periosteum during the pre-pubertal years, did not increase with advanced maturation and/or additional training. Conclusion: Exercise increased cortical BMC by enhancing bone formation on the periosteal surface during the pre-pubertal years and on the endocortical surface in the post-pubertal years. However, bone strength only increased in response to bone acquisition on the periosteal surface. Therefore the pre-pubertal years appear to be the most opportune time for exercise to enhance BMC accrual and bone strength

Beyond mimesis : place, interpretation and response

My study examines the subjective nature of artistic interpretation through the notion of mimesis as process or transformation of material. Influential factors that mediate in the artistic process, such as memory, reflection and an awareness of cultural analogy and metaphor, are examined and related to a specific project in the studio, where the mediation process is further influenced by the materials used to produce the images. My studies of the concept of mimesis have revealed an intermediary realm that exists in the space between empirical reality and its interpretation. Throughout history the process of mimesis has been integral to all forms of the arts. In Plato's time the production of an image that simulated things as they appeared to the eye was considered a desired ideal. Aristotle later introduced developments which extended this concept to include a refiguring or reforming of material derived from the original source, making new connections between existing factors and in this transformation bringing new meanings to a symbolically constituted world. This discussion of the representation of reality, the influence of a dialogue between notions of imitation and the recreation of material continues throughout the exegesis. My study emphasises the interpretive stage of the mimetic process where a consideration of these themes is most relevant and some of the factors that can influence its outcome. It is my opinion that the production of images in response to the particularities of place can be defined in three stages. Firstly, the experience of the place; secondly, the beginning and maturation of the idea or concept; where mimesis takes place, and thirdly, the production of the art work in response. This process is illustrated in Part 2 of the exegesis, where the development of the studio work is documented and linked with the themes discussed in Part 1. The geographic site or place I selected to study is adjacent to Mt. Noorat, a volcanic site in the Western district of Victoria; the surrounding plains are littered with scoria that has been thrown out of the volcano thousands of years ago. Early British, Scottish and Irish settlers to this region used the stone to construct fences reminiscent of their homeland, through this activity they cleared the land and confined and protected their stock. My interests are in factors that include - the material of the stone, notions of enclosure and safety, of boundaries and circumscribed space, and of the cultural reflection that has taken place in this reconstruction of Eurocentric vision. These walls also represent the means by which land was enclosed and property defined, moving from a situation of public access to notions of ownership and the annexation of land for individual gain. Around each point of eruption, the craggy volcanic scoria has been used to create a constructed landscape which both symbolises and mirrors the Anglo - Celtic origins of the people. I have used the legend of Narcissus to illustrate the self-reflective and introspective processes that the settlers invoked in their attempts to come to terms with a strange land. I consider that the story of Narcissus, who fell in love with his own reflection, finds a parellel in the creation of the walls. The re-creation of artifacts from their own cultural environment provided the settlers with a familiar 'face' in an alien world; a reassurance of the familiar in an unfamiliar terrain. Part of this study is an investigation of this notion of landscape as cultural reflection. Geographers have long known that landscape is a cultural construct, an historically evolving ideal manifested in painting, prints and drawings as well as poetry, gardens and parks. One can view these constructions as illustrations or images of meaning which constitute representations of cultural ideals. The neo-classical influence reflected in the paintings of artists who accompanied the early expeditions to Australia demonstrates these themes. The medium of the mirror provides the opportunity to suggest aspects of a cultural reflection and an awareness of identity that has relevance to contemporary Australian culture, therefore, I have allowed it to play a major role throughout this study. Its role in mimesis, firstly, as a reflection in an imitative sense is established, then in its refigurative role, in which the similarities between the original and the reformed rely more on correlative factors than representation. I have used examples from the history of art to illustrate this potential. The formation and development of a narrative involving reflection threads throughout the thesis, both in the visual presentation and in the exegesis. The production of a body of paintings, drawings and sculpture reflect my interpretation and response to the particular site. The correspondences between these works and my theoretical concerns is articulated in the exegesis. The metaphor implied by the use of the walls as agents of enclosure also refers to the capacity of the individual to be confined by notional boundaries and restrictive practices where totalising systems of thought dominate theoretical debate and restrict its freedom. I have used images where gaps in the walls represent the potential implicit to the concept of liminal space, where the spectator moves from one physical space to another and from one stage of development to another. The threshold of this opening in the walls becomes the site where transformation can take place, a metaphor for the mimetic process where the initial experience is translated and transformed into the final product. The paintings, drawings and other works in this series fulfil the role of marks on the surface of the mirror, separating the initial experience from the processes of memory, reflection and speculation. The works draw attention to the materiality that they represent and yet provide the opportunity for new insights and experiences, allowing the subjective nature of artistic activity to combine symbolic elements relating to the site, resulting in the production of meaning.

Is phase-specific, community-oriented treatment of early psychosis- an economically viable method of improving outcome?

Objective: The Early Psychosis Prevention and Intervention Centre (EPPIC) provides a comprehensive 'real-world' model of early intervention to young people experiencing an emerging psychotic disorder. A prospective study has already provided evidence of improved clinical outcome at 12 months after entry. The present study examined whether the service was also cost-effective.

Method: A cost-effectiveness analysis compared EPPIC with its immediate precursor service, from the perspective of the government funding agency. Only direct costs were included.

Results: EPPIC proved to be more cost-effective. The weighted average cost per patient for the first 12 months was cheaper (by äD 7110 per patient), while treatment outcomes were superior. The savings were due to the marked reduction in in-patient costs outweighing substantial increases in the costs of community care.

Conclusion: These results, while encouraging in terms of the further development of integrated, phase-specific intervention programmes for early psychosis, are not conclusive, and further research is required.

A Rasch analysis of the teachers music confidence scale

This article presents a new measure of teachers’ confidence to conduct musical activities with young children; Teachers Music Confidence Scale (TMCS). The TMCS was developed using a sample of 284 in-service and pre-service early childhood teachers in Hong Kong Special Administrative Region (HKSAR). The TMCS consisted of 10 musical activities. Teachers rated their confidence levels to conduct each activity on a scale from 1 (Not confident at all) to 5 (Very confident). An exploratory factor analysis retained a 10-item single factor that was replicated using confirmatory factor analysis procedures. All items of the TMCS fitted the Rasch model adequately. In-service teachers showed higher confidence levels to conduct several musical activities with young children than pre-service teachers. Implications of these findings for measuring teachers’ confidence to conduct musical activities with young children were discussed.

Targeted exercise against osteoporosis : a systematic review and meta-analysis for optimising bone strength throughout life

Background
Exercise is widely recommended to reduce osteoporosis, falls and related fragility fractures, but its effect on whole bone strength has remained inconclusive. The primary purpose of this systematic review and meta-analysis was to evaluate the effects of long-term supervised exercise (≥6 months) on estimates of lower-extremity bone strength from childhood to older age.

Methods
We searched four databases (PubMed, Sport Discus, Physical Education Index, and Embase) up to October 2009 and included 10 randomised controlled trials (RCTs) that assessed the effects of exercise training on whole bone strength. We analysed the results by age groups (childhood, adolescence, and young and older adulthood) and compared the changes to habitually active or sedentary controls. To calculate standardized mean differences (SMD; effect size), we used the follow-up values of bone strength measures adjusted for baseline bone values. An inverse variance-weighted random-effects model was used to pool the results across studies.

Results
Our quality analysis revealed that exercise regimens were heterogeneous; some trials were short in duration and small in sample size, and the weekly training doses varied considerably between trials. We found a small and significant exercise effect among pre- and early pubertal boys [SMD, effect size, 0.17 (95% CI, 0.02-0.32)], but not among pubertal girls [-0.01 (-0.18 to 0.17)], adolescent boys [0.10 (-0.75 to 0.95)], adolescent girls [0.21 (-0.53 to 0.97)], premenopausal women [0.00 (-0.43 to 0.44)] or postmenopausal women [0.00 (-0.15 to 0.15)]. Evidence based on per-protocol analyses of individual trials in children and adolescents indicated that programmes incorporating regular weight-bearing exercise can result in 1% to8% improvements in bone strength at the loaded skeletal sites. In premenopausal women with high exercise compliance, improvements ranging from 0.5% to 2.5% have been reported.

Conclusions
The findings from our meta-analysis of RCTs indicate that exercise can significantly enhance bone strength at loaded sites in children but not in adults. Since few RCTs were conducted to investigate exercise effects on bone strength, there is still a need for further well-designed, long-term RCTs with adequate sample sizes to quantify the effects of exercise on whole bone strength and its structural determinants throughout life.

Carbohydrate intake strategies to enhance endurance exercise performance

While elite Olympic distance triathletes consume adequate carbohydrate pre-competition, many fail to meet suggested guidelines during actual competition. Furthermore, metabolic adaptations that occur in response to training appear similar under varying conditions of carbohydrate availability. However, daily training with high carbohydrate availability increases the use of carbohydrate consumed during exercise.

Institutional pedagogical waypoints : reflections on doctoral journeys between Taiwan and Australia

Spatial, social and academic journeys undertaken between Taiwan and Australia for doctoral education are the focus of reflection here. The discussion centres on the authors’ experiences of, on the one hand, the development of a Faculty of Education’s doctoral pedagogies in the early 2000s to reflect its international PhD candidature profile – especially from Taiwan – and, on the other, of Taiwanese doctoral candidates’ journeys through their PhDs in the Faculty. The authors write from their particular perspectives: Evans as an Australian academic and a manager of doctoral studies, and Liou as a Taiwanese academic pursuing her doctorate in an Australian university. The article considers the Australian and Taiwanese doctoral contexts between which the students transited. The institutional pedagogical strategies, from pre-enrolment to completion, are examined as waypoints on the doctoral journey for both staff and candidates.

Young gifted children

This is a practical guide for pre-service and practising early childhood professionals and junior primary teachers, to support them in understanding and meeting the needs of young gifted children and their families.
The book includes a range of practical strategies and suggestions for working with young gifted children in early childhood settings and the first years of school, supported by examples and case studies.
It also discusses the transition to school, including addressing issues such as processes around early entry to school, full or partial grade acceleration, school policies and practices and evidence of effective early years school programs.

TV viewing behaviour among preschoolers : implications for public health recommendations

Excessive television (TV) viewing in early childhood has been associated with adverse cognitive and behavioural outcomes.[1-3] A recent review of the literature revealed that TV viewing in the formative pre-school years has also been linked with other health concerns including sleep difficulties, increased aggression, anxiety and obesity.[4] Given that early childhood is the time in which the foundations for future behaviours and habits are established and evidence shows that TV behaviours track from early childhood to adolescence,[5] it is not surprising that there has been much interest in determining an ‘appropriate’ amount of screen time for pre-schoolers. The aim of this paper is to review current recommendations around Australian pre-school children's TV use and the implications of these guidelines when we consider current data pertaining to young children's TV viewing behaviour.

Learning to engage with human rights in heritage

Cultural heritage should not be seen merely as a technical matter or from a narrow visitor management point of view but rather as cultural practice—a form of cultural politics dominated by ruling regimes and social groups in which decisions are made about the future of and access to scarce resources. Several scholars have sought to push this approach further by arguing that heritage studies should take on the protection of human rights as a core consideration in the processes of identifying, inscribing, conserving and interpreting cultural heritage. This paper builds on these previous works to explore what the shift to a rights-based management approach in the World Heritage system might mean for various stakeholders in the heritage protection enterprise as they learn to meet this challenge and to find ways to support people’s right to access, enjoy and maintain cultural heritage. Reaffirming the need to maintain a strong relationship between theory and praxis, the paper draws into the discussion heritage practitioners, decision makers in governments and government agencies, scholars and educators. Of these, the principal emphasis in this paper is on educators who are seen to have a fundamentally important role in developing a critical understanding of the cultural heritage concept, how heritage is created, used and misused and how conservation approaches and programs sit within the broader context of community attitudes and aspirations and governmental responsibilities. A distinction is made between teachers in universities and trainers offering short courses more focused on specific employer needs. The paper focuses on World Heritage but refers to both tangible and intangible aspects. It shows how current moves to establish a rights-based approach to the management of World Heritage sites connects with moves elsewhere in global governance, most notably in the United Nations Permanent Forum on Indigenous Issues and the United Nations Human Rights Commission.

Effect of tensile pre-strain on bending and unloading of automotive steels

In recent years, advanced high strength steels (AHSS) have been used in a wide range of automotive applications; they may have property variations through the thickness and the properties may also be dependent of prior processing including pre-straining. In order to model forming processes precisely using, for example, finite element analysis, it is important that material input data should adequately reflect these effects. It is known that shape defects in roll forming are related to small strains in material that has undergone prior deformation in a different strain path. Much research has already been performed on the change in the Young’s Modulus once a steel sheet has been plastically deformed,however many of these tests have only been conducted using tensile testing, and therefore may not take into account differences in compressive and tensile unloading. This research investigates the effect of tensile pre-straining on bending behaviour for various types of material;in bending, one half of the sheet will load and unload in compression and hence experience deformation under a reversed stress. Four different materials were pre-strained in tension with 1%, 3%, 7%, 11% and 25% elongation. Using a free bending test, moment curvature diagrams were obtained for bending and unloading. The results showed that the characteristics of the moment curvature diagram depended on the degree of pre-straining; more highly strained samples showed an earlier elastic-plastic transformation and a decreased Young's Modulus during unloading. This was compared to previous literature results using only tensile tests. Our results could influence the modeling of springback in low tension sheet operations, such as roll forming.