Rationale and design of the national benchmarking and evidence-based national clinical guidelines for chronic heart failure management programs study

OBJECTIVES: The National Benchmarks and Evidence-Based National Clinical Guidelines for Heart Failure Management Programs Study is a national, multicenter study designed to determine the nature, range, and effect of interventions applied by chronic heart failure management programs (CHF-MPs) throughout Australia on patient outcomes. Its primary objective is to use these data to develop national benchmarks and evidence-based clinical guidelines and optimize their cost-effective application by reducing quality and outcome variability. DATA SOURCES/STUDY SETTING: Primary data will be collected from CHF-MP coordinators and CHF patients enrolled in these programs on a national basis. Secondary outcome data will be collected from a national morbidity record and from patients' medical records. STUDY DESIGN: Stage I of the study involves a prospective clinical audit of all CHF-MPs throughout Australia (n = 45) to determine the extent of variability in programs currently. Stage II is a prospective cross-sectional survey design enrolling 1,500 patients (average of 40 patients per program) to firstly determine the typical profile of patients being managed via a CHF-MP in Australia and, secondly, the subsequent morbidity and mortality during the 6-month follow-up. Outcome data will be subject to multivariate analysis to determine the key components of care in this regard. All study data will be then examined in the final stage of the study (III) to develop national benchmarks for the application and auditing of CHF-MPs in Australia. CONCLUSION: Variability in patient outcomes is a product of heterogeneity among CHF-MPs. The development of national benchmarks will minimize such heterogeneity and will provide a greater level of evidence for their cost-effective application.

Development of a food composition database for the estimation of dietary intakes of glucosinolates, the biologically active constituents of cruciferous vegetables

Evidence indicates that cruciferous vegetables are protective against a range of cancers with glucosinolates and their breakdown products considered the biologically active constituents. To date, epidemiological studies have not investigated the intakes of these constituents due to a lack of food composition databases. The aim of the present study was to develop a database for the glucosinolate content of cruciferous vegetables that can be used to quantify dietary exposure for use in epidemiological studies of diet–disease relationships. Published food composition data sources for the glucosinolate content of cruciferous vegetables were identified and assessed for data quality using established criteria. Adequate data for the total glucosinolate content were available from eighteen published studies providing 140 estimates for forty-two items. The highest glucosinolate values were for cress (389 mg/100 g) while the lowest values were for Pe-tsai chinese cabbage (20 mg/100 g). There is considerable variation in the values reported for the same vegetable by different studies, with a median difference between the minimum and maximum values of 5·8-fold. Limited analysis of cooked cruciferous vegetables has been conducted; however, the available data show that average losses during cooking are approximately 36 %. This is the first attempt to collate the available literature on the glucosinolate content of cruciferous vegetables. These data will allow quantification of intakes of the glucosinolates, which can be used in epidemiological studies to investigate the role of cruciferous vegetables in cancer aetiology and prevention.

Selenium content of Australian foods: a review of literature values

The aim of this study was to review the published literature values for the selenium content of Australian foods. A secondary aim was to compare the results for Australian foods with food composition data from international sources to investigate the extent of geographical variation. Published food composition data sources for the selenium content in Australian foods were identified and assessed for data quality using established criteria. The selenium content is available for 148 individual food items. The highest values found are for fish (12.0–63.2 μg/100 g), meats (4.75–37.9 μg/100 g) and eggs (9.00–41.4 μg/100 g), followed by cereals (1.00–20.3 μg/100 g). Moderate levels are seen in dairy products (2.00–7.89 μg/100 g) while most fruits and vegetables have low levels (trace—3.27 μg/100 g). High selenium foods show the greatest level of geographical variation, with foods from the United States generally having higher selenium levels than Australian foods and foods from the United Kingdom and New Zealand having lower levels. This is the first attempt to review the available literature for selenium composition of Australian foods. These data serve as an interim measure for the assessment of selenium intake for use in epidemiological studies of diet–disease relationships.

Nurse practitioner competency standards: findings from collaborative Australian and New Zealand research

Background: The title, Nurse Practitioner, is protected in most jurisdictions in Australia and New Zealand and the number of nurse practitioners is increasing in health services in both countries. Despite this expansion of the role, there is scant national or international research to inform development of nurse practitioner competency standards.

Objectives: The aim of this study was to research nurse practitioner practice to inform development of generic standards that could be applied for the education, authorisation and practice of nurse practitioners in both countries.

Design: The research used a multi-methods approach to capture a range of data sources including research of policies and curricula, and interviews with clinicians. Data were collected from relevant sources in Australia and New Zealand.

Settings: The research was conducted in New Zealand and the five states and territories in Australia where, at the time of the research, the title of nurse practitioner was legally protected.

Participants: The research was conducted with a purposeful sample of nurse practitioners from diverse clinical settings in both countries. Interviews and material data were collected from a range of sources and data were analysed within and across these data modalities.

Results: Findings included identification of three generic standards for nurse practitioner practice: namely, Dynamic Practice, Professional Efficacy and Clinical Leadership. Each of these standards has a number of practice competencies, each of these competencies with its own performance indicators.

Conclusions: Generic standards for nurse practitioner practice will support a standardised approach and mutual recognition of nurse practitioner authorisation across the two countries. Additionally, these research outcomes can more generally inform education providers, authorising bodies and clinicians on the standards of practice for the nurse practitioner whilst also contributing to the current international debate on nurse practitioner standards and scope of practice.

Grounded theory as foundations for methods in applied ontology

Research into domain specific ontologies is difficult to treat empirically. This is because it is difficult to ground domain ontology while simultaneously being true to its guiding philosophy or theory. Further, ontology generation is often introspective and reflective or relies on experts for ontology generation. Even those relying on expert generation lack rigour and tend to be more ad-hoc. We ask how Grounded Theory can be used to generate domain specific ontologies where appropriate high level theory and suitable textual data sources are available. We are undertaking generation of a domain ontology for the discipline of information systems by applying the Grounded Theory method. Specifically we are using Roman Ingarden’s theory of scientific works to seed a coding family and adapting the method to ask relevant questions when analysing rich textual data. We have found that a guiding ontological theory, such as Ingarden’s, can be used to seed a coding family giving rise to a viable method for generating ontologies for research. This is significant because Grounded Theory may be one of the key methods for generating ontologies where substantial uniform quality text is available to the ontologist. We also present our partial analysis of information systems research.

Student's pedagogical knowledge: a source of pedagogical content knowledge

This paper presents the results of interviews with Year 5 and 6 students about their views of effective teaching practices in mathematics. The students interviewed were part of a largescale study into improving middle years mathematics and science. Their views confirm findings from the literature and other data sources from the project, and provide valuable insights into student perceptions of effective teaching practice in middle years mathematics.

Does gymnastics training inhibit growth of females?

OBJECTIVE: The increasingly dominant performance of smaller-sized female gymnasts and increased magnitude of training beginning at an early age have prompted public and medical concerns, especially from an auxological perspective. The objective of this review is to determine if gymnastics training inhibits growth of females. DATA SOURCES: An extensive research of MedLine (PubMed interface) along with cross-referencing was conducted using the Text and MeSH words "gymnastics" in combination with "growth," "maturation," "body height," "body weight," and "growth plate." Our analysis is limited to English articles only.
STUDY SELECTION: All published studies that included data related to the research questions were included. MAIN RESULTS: Although data from three historical cohort studies indicate that female gymnasts are short even before they begin training, clinical reports and cohort studies do suggest that some female gymnasts experience attenuated growth during training followed by catch-up growth during periods of reduced training or retirement. There is conflicting evidence whether the "catch-up" is complete. There were no studies reporting prevalence or incidence of inadequate growth. Three cohort studies provide evidence of reduced growth but training was not partitioned from other confounding factors in the gymnastics environment. Although there is a paucity of studies examining the link of dietary practices with diminished growth in female gymnasts, a review of related dietary literature indicates the potential for insufficient energy and nutrient intake among female gymnasts.
CONCLUSIONS: Elite level or heavily involved female gymnasts may experience attenuated growth during their years of training and competition followed by catch-up growth during reduced training schedules or the months following retirement. However, a cause-effect relation between gymnastics training and inadequate growth of females has not been demonstrated.

Competency and capability: imperative for nurse practitioner education

Objective:
The objective of this study was to conduct research to inform the development of standards for nurse practitioner education in Australia and New Zealand and to contribute to the international debate on nurse practitioner practice.
Setting:
The research was conducted in all states of Australia where the nurse practitioner is authorised and in New Zealand.
Subjects:
The research was informed by multiple data sources including nurse practitioner program curricula documents from all relevant universities in Australia and New Zealand, interviews with academic convenors of these programs and interviews with nurse practitioners.
Primary argument:
Findings from this research include support for master's level of education as preparation for the nurse practitioner. These programs need to have a strong clinical learning component and in-depth education for the sciences of specialty practice. Additionally an important aspect of education for the nurse practitioner is the centrality of student directed and flexible learning models. This approach is well supported by the literature on capability.
Conclusions:
There is agreement in the literature about the lack of consistent standards in nurse practitioner practice, education and nomenclature. The findings from this research contribute to the international debate in this area and bring research informed standards to nurse practitioner education in Australia and New Zealand.

Impact of tobacco tax reforms on tobacco prices and tobacco use in Australia

OBJECTIVE: To document the impact of changes to tobacco taxes on the range and price of tobacco sold during the period when the National Tobacco Campaign (NTC) was run.

DATA SOURCES: Information about brand availability, pack size, and price was extracted from Australian Retail Tobacconist. A retail observational survey was undertaken to monitor actual retail prices. Data on cigarette prices, brands, packet configurations, and outlets from which they were purchased were obtained from the benchmark and three follow up population telephone surveys conducted to evaluate the NTC.

METHOD: Data from the three sources were compared to see the extent to which the impact of tax changes had been offset by greater retail discounting and a more concerted effort by consumers to purchase cheaper products.

RESULTS: Smokers were unable to cushion themselves from the sharp price increases that occurred during the third phase of the NTC. Both average recommended retail prices of manufactured cigarettes and average actual cigarette prices paid by smokers increased by 25% in real prices.

CONCLUSION: The fall in smoking prevalence over the first two phases of the NTC was substantially greater than would be expected due to tax changes alone. The fall in smoking consumption over the first two phases was slightly less than would be expected and in the third considerably higher than would be expected.

Where pain = no gain : perspectives on sport, exercise and health, c. 1850-1920

A common perspective today is that sportspeople must train and compete to a level of exertion beyond the ‘pain threshold’ if they are to succeed; a view that has given rise to the popular expression ‘No Pain, No Gain’. Indeed, a common aphorism is that the health and quality of life of individuals and of the wider population is positively correlated with the frequency and vigour of physical exercise. In the period when modern sports were taking on their present characteristics (approximately 1850-1920), the prevailing opinions about the health and well-being effects of exercise were far more cautious, however. While the benefits of moderate exercise for physical and mental well-being went without question, too great an exertion was considered to be as risky as too little, causing ‘strain’ with the potential to inflict lasting and potentially fatal damage, including mental and physical complaints as diverse as neuralgia and ‘athletes’ heart’. The supposedly more strenuous sports, such as football, athletics and rowing, and the training required for them came under particular scrutiny in medical and popular discourses. This paper, an exercise in historical sociology, examines these discourses to demonstrate how advice about the risks on health of participating in sports and of too little or too much exercise more generally, was informed by prevailing physiological models and the interpretation of these within the medical profession and the wider population. The data sources include medical journals and texts, and sports training manuals from the period under investigation.

Child labour and supply chain : profitability or (mis)management

Purpose – The purpose of this paper is to provide a realistic assessment, with an historical perspective, of the current practises and progress made by organisations towards elimination of child labour in global supply chains.

Design/methodology/approach – Literature review in the area of use of child labour within the global supply chain was combined with additional information obtained from the company searches of the GRI database, company ranking tables, and other sources.

Findings – Child labour is one of a number of areas of concern in global supply chains. Continued exploitation of child labour indicates an imbalanced state and consequently forces can be unleashed through standardization, collaboration and communication amongst all stakeholders to ensure protection of the vulnerable. This paper is part of the broader analysis informing incremental changes to supply chain management to preserve the rights and welfare of children in the present and future generations. Research/limitations/implications – The analysis is based on secondary data sources and further research is thus needed to verify the individual weightings of the criteria used in the primary ranking of the companies.

Practical implications – The findings provide encouragement for policy and decision makers to implement incremental changes to global supply chains in order to protect the rights and welfare of children, according to the standards of Social Accountability (SA) 8000, the International Labour Organisation (ILO), and other world trade stakeholders.

Originality/value – This paper questions the view that child labour incidences have diminished proportional to economic development. A swinging fulcrum with hidden traps for developed and developing nations in light of cross border transactions through supply chains has been proposed.

The effectiveness of nutrition interventions on dietary outcomes by relative social disadvantage : a systematic review

Objective: To determine whether nutrition interventions widen dietary inequalities across socioeconomic status groups.

Design: Systematic review of interventions that aim to promote healthy eating.

Data sources: CINAHL and MEDLINE were searched between 1990 and 2007.

Review methods: Studies were included if they were randomised controlled trials or concurrent controlled trials of interventions to promote healthy eating delivered at a group level to low socioeconomic status groups or studies where it was possible to disaggregate data by socioeconomic status.

Results: Six studies met the inclusion criteria. Four were set in educational setting (three elementary schools, one vocational training). The first found greater increases in fruit and vegetable consumption in children from high-income families after 1 year (mean difference 2.4 portions per day, p<0.0001) than in children in low-income families (mean difference 1.3 portions per day, p<0.0003). The second did not report effect sizes but reported the nutrition intervention to be less effective in disadvantaged areas (p<0.01). The third found that 24-h fruit juice and vegetable consumption increased more in children born outside the Netherlands ("non-native") after a nutrition intervention (beta coefficient = 1.30, p<0.01) than in "native" children (beta coefficient = 0.24, p<0.05). The vocational training study found that the group with better educated participants achieved 34% of dietary goals compared with the group who had more non-US born and non-English speakers, which achieved 60% of dietary goals. Two studies were conducted in primary care settings. The first found that, as a result of the intervention, the difference in consumption of added fat between the intervention and the control group was –8.9 g/day for blacks and –12.0 g/day for whites (p<0.05). In the second study, there was greater attrition among the ethnic minority participants than among the white participants (p<0.04).

Conclusions: Nutrition interventions have differential effects by socioeconomic status, although in this review we found only limited evidence that nutrition interventions widen dietary inequalities. Due to small numbers of included studies, the possibility that nutrition interventions widen inequalities cannot be excluded. This needs to be considered when formulating public health policy.

MammoSapiens: eResearch of the lactation program.

Delivering bioinformatics power to life science researchers inevitably runs into problems of limited computing resources in the context of exponentially increasing data sources, access time, costs, lack of skills and, rapidly evolving technology and software tools with poorly defined standards. In this context the development of e-facilities to best enable collaborative research often needs to be customized to specific project applications in close cooperation with the experimentalist users and, to be concerned with the storage and management of results to allow more consistency and traceability of e-results on a broad access data mining platform.

Here we showcase an internet based eResearch platform using the PHP/MySQL paradigm for the collaborative, integrative and comparative analysis of lactation related gene sequences and gene expression experiments to support lactation research. We also illustrate how these resources are used, how they enable research by allowing meta-analysis of data and results and, how the bottom-up development of customized eResearch components can lead to the production of more generic functional software tools and eResearch environments for deployment to a larger number of biological research users working on other bio-systems.

The effect of tai chi on psychosocial well-being : a systematic review of randomized controlled trials

Objective : This systematic review aimed to critically appraise published clinical trials designed to assess the effect of Tai Chi on psychosocial well-being.

Data Sources : Databases searched included MEDLINE, CINAHL, EMBASE, HEALT, PsycINFO, CISCOM, the Cochrane Central Register of Controlled Trials of the Cochrane Library, and dissertations and conference proceedings from inception to August 2008.

Review Methods : Methodological quality was assessed using a modified Jadad scale. A total of 15 studies met the inclusion criteria (i.e. English publications of randomized controlled trials with Tai Chi as an intervention and psychological well-being as an outcome measure), of which eight were high quality trials. The psychosocial outcomes measured included anxiety (eight studies), depression (eight studies), mood (four studies), stress (two studies), general mental health three studies), anger, positive and negative effect, self-esteem, life satisfaction, social interaction and self-rated health (one study each).

Results : Tai Chi intervention was found to have a significant effect in 13 studies, especially in the management of depression and anxiety. Although the results seemed to suggest Tai Chi is effective, they should be interpreted cautiously as the quality of the trials varied substantially. Furthermore, significant findings were shown in only six high quality studies. Moreover, significant between group differences after Tai Chi intervention was demonstrated in only one high quality study (the other three significant results were observed in non-high quality studies). Two high quality studies in fact found no significant Tai Chi effects.

Conclusion : It is still premature to make any conclusive remarks on the effect of Tai Chi on psychosocial well-being.

An exploration of the pedagogies employed to integrate knowledge in work-integrated learning

This article describes a three-sector, national research project that investigated the integration aspect of work-integrated learning (WIL). The context for this study is three sectors of New Zealand higher education: business and management, sport, and science and engineering, and a cohort of higher educational institutions that offer WIL/cooperative education in variety of ways. The aims of this study were to investigate the pedagogical approaches in WIL programs that are currently used by WIL practitioners in terms of learning, and the integration of academic-workplace learning. The research constituted a series of collective case studies, and there were two main data sources � interviews with three stakeholder groups (namely employers, students, and co-op practitioners), and analyses of relevant documentation (e.g., course/paper outlines, assignments on reflective practice, portfolio of learning, etc.). The research findings suggest that there is no consistent mechanism by which placement coordinators, off-campus supervisors, or mentors seek to employ or develop pedagogies to foster learning and the integration of knowledge. Learning, it seems, occurs by means of legitimate peripheral participation with off-campus learning occurring as a result of students working alongside professionals in their area via an apprenticeship model of learning. There is no evidence of explicit attempts to integrate on- and off-campus learning, although all parties felt this would and should occur. However, integration is implicitly or indirectly fostered by a variety of means such as the use of reflective journals.