External breast prosthesis use: experiences and views of women with breast cancer, breast care nurses, and prosthesis fitters

After mastectomy, the provision of an appropriate breast prosthesis can help to improve body image and quality of life and reduce associated emotional distress. Although up to 90% of women use an external breast prosthesis after mastectomy, little is known about their experiences and satisfaction with breast prosthesis use. Focus groups were conducted with women who had been fitted with an external breast prosthesis, breast care nurses, and prosthesis fitters to explore women's experiences of prosthesis use. Qualitative thematic content analysis of focus group transcripts indicated that whereas women's initial reaction to the prosthesis generally was negative, this improved over time. Provision of adequate information and support, characteristics of the fitter and the fitting experience, and relationships with breast care nurses and prosthesis fitters were important to women's acceptance and satisfaction with their prosthesis. The study results highlighted the key role that breast care nurses play and the underestimation of the prosthesis fitter's role. Common themes concerning the impact of prosthesis use included body image, appearance, and feminine identity. These findings have important implications for professionals involved in the delivery of breast prostheses services.

Valuing creativity in technology education

When he was only twelve, Peter Jackson (director of The Lord of the Rings trilogy) cut fur strips from his mother's stole, and using wire he made a 20 cm model of King Kong. After a long incubation period for his ideas, he devised a modem version of the film King Kong. Research shows that the generation of new ideas (generative mental state) cannot exist at the same time as the non-generative/analytical mental state. This research has implications for technology educators who value creativity. We explored how an incubation period of non-focused thinking affected children's creative ideas for their technological products. Five teachers and 117 children from primary schools in a Victorian regional city and a semirural village participated in the study. The teachers factored in an incubation period that allowed time for the children's attention to wander in a relaxed and uncompetitive environment. We analyzed transcripts of teacher interviews and the children's written evaluations and drawings. We found a correlation between the incubation of ideas and the degree of creativity exhibited by the children. This key finding suggests that teachers of technology should take the incubation period into account in order to enhance creativity in the children's technology designs.

In dialogue with A.D. Hope: dialogue one: childhood and adolescence

[Alec Derwent Hope, born in Cooma 1907, won a scholarship to University College, Oxford, after majoring in English and Philosophy at Sydney University, and returned to a life of teaching and writing from the ‘thirties. His pre-eminence in literary culture was underpinned by his appointment as Professor of English at University College, Canberra, the forerunner of the Australian National University. His work in poetry, translations, and criticism provoked intense response, never indifference. His first published volumes were the satirical sequence, Dunciad Minimus : An Heroic Poem (1950), and selection of poems, The Wandering Islands (1955); amongst the final volumes were the autobiographical Chance Encounters (1992) and Selected Poems (1992).
Dialogue One was designed to explore what connections can be made between the life of the child and the values engendered in this formative phase and the adult’s creative work and view of the world; an exploration shaped by what might be seen as a relentless irony inherent in his poetry and his other scholarly productions and by Hope’s view that childhood is a place of the sacred and of secrets that are best protected from the limiting force of definition--somehow best kept suspended between the unconscious and the conscious mind to draw from when enacting a poetic vision of life. To that extent, Dialogue One is an attempt to navigate territory that might be seen as Hope’s mindscape and landscape as it emerged in childhood and adolescence.
The following exchange comprises selected excerpts from the transcripts of Ann McCulloch’s videoed interviews in Melbourne 1988, The Dance of Language: The Life and Work of A.D. Hope, as well as from her many conversations with Hope between 1981 and 1996 in Canberra.]

Differential effects of dietary fatty acids on genes associated with liver fat metabolism

Background – It has been recognized that specific fatty acids have the ability to directly influence the abundance of gene transcripts in organs such as the liver. However little comparison has been made between the effects of common dietary of fatty acids and there influence on gene expression.
Objectives – To determine the effect of diets rich saturated, monounsaturated and polyunsaturated on gene transcripts associated with liver fat metabolism. Specifically how these three classes of fatty acids influence mRNA levels of key transcriptional regulators (PGC1a, PPARa, PPARd, SREBP1C & ChREBP), fat oxidative (ACO, LCPT1, HMG-CoA lyase & UCP-2) and fat synthetic (ACC, MCD, GPAT & malic enzyme) genes were investigated.
Design - Rats (n=32) were evenly divided into four groups; a saturated fat diet, a monounsaturated fat diet, a polyunsaturated fat diet (each diet contained 23% fat) and standard rat chow (7% fat) diet and fed for 12 weeks. Real-time PCR analysis was performed on liver tissue.
Outcomes – PGC1a and SREBP1C increased 1.9 fold or greater in all groups. Conversely, PPARa, PPARd and ChREBP demonstrated variable changes with diet composition. Monounsaturated and polyunsaturated fat increased HMG-CoA lyase 2.8 fold, a response that was absent in the saturated fat fed animals. UCP-2 was decrease 3.0 fold by all dietary treatments. Malic enzyme was increased 2.8 and 2.4 fold with saturated and polyunsaturated diets respectively, yet was unaltered by the monounsaturated fat diet.
Conclusion – Modifications in common dietary fat composition initiated divergent gene responses in liver. These alterations were complex, with no uniform alteration in transcription factors with closely related functions (PPARfamily) and genes encoding proteins within the same metabolic pathway (fat oxidation or fat synthesis). Further studies are necessary to identify the predominant mechanisms regulating these differences in gene expression.

Squalene supplementation alters genes associated with liver cholesterol metabolism

Background – Squalene is a component of shark liver oil and has been speculated to have cholesterol reducing properties. High levels of total and LDL cholesterol have been shown to contribute to the development of chronic heart disease. The liver is central to the regulation of cholesterol metabolism and dietary intervention has long been recognized as a primary means to reduce the risks of chronic heart disease and related ailments.
Objectives – To determine the effect of dietary squalene supplementation on gene transcripts associated with liver cholesterol metabolism. Specifically the effect of squalene supplementation on mRNA levels for proteins that
regulate cholesterol biosynthesis (HMDH & ERG1), cholesterol elimination (SRB1), bile synthesis (CP7A1 & CP27A) and cholesterol excretion by the liver into bile (ABCG5 & ABCG8) was investigated.
Design – Rats (n=32) were divided into four groups and supplemented for 12 weeks. Groups one and two were fed a cholesterol rich diet for six weeks followed by six weeks of a cholesterol rich diet plus 1.75mg/day of squalene or 3.5 mg/day. Group three was fed a cholesterol rich diet for 12 weeks and group four was fed standard rat chow for 12 weeks. Blood lipid levels were monitored during the study and liver gene expression was determined at the
conclusion of the feeding trial via RT-PCR.
Outcomes – 3.5 mg/day of squalene lowered total and LDL cholesterol in rats consuming a cholesterol rich diet. This dose of squalene also resulted in constant levels of HMDH and ERG1 whereas the cholesterol rich diet halved mRNA levels of these enzymes. Furthermore 3.5 mg/day of squalene caused a greater than 3.0 fold increase in mRNA levels of the proteins SRB1, CP7A1, CP27A and ABCG5.
Conclusion – Dietary squalene supplementation at a dose of 3.5 mg/day lowers total and LDL cholesterol in rats consuming a cholesterol rich diet. These reductions in cholesterol levels may be due to increased cholesterol
elimination, bile synthesis and cholesterol excretion by the liver into bile mediated by changes in gene expression of key enzymes involved in these metabolic pathways

Doing it in the courts : opening research to public scrutiny

This paper analyses the positioning of researchers and their research by the courts in legal complaints brought against educational authorities. Over the past decade at least eleven formal complaints related to deaf children's access to native sign language in education have been lodged with the Human Rights and Equal Opportunity Commission.

This ongoing legal action has brought a pedagogical debate over educational policy into the courts. The most recent case to reach the Federal Court of Australia was taken by the families of two deaf children against a state educational authority, allegedly for failing to provide the children with an adequate education. The complainants called for teachers fluent in Auslan (Australian Sign Language) or interpreters to be employed alongside mainstream teachers.

As a researcher in this field, I have acted as an expert witness in eight of these cases, tendered my thesis as evidence, and been cross-examined in the Federal Court. Court transcripts from the two most recent cases provide the data for an analysis of the way in which legal counsel position researchers (as 'advocates', having vested interests, representing lobby groups) and interpret their research to support the legal arguments being made.

Exploring general practitioners' experience of informing women about prenetal screening tests for foetal abnomalities : a qualitative focus group study

Background: Recent developments have made screening tests for foetal abnormalities available earlier in pregnancy and women have a range of testing options accessible to them. It is now recommended that all women, regardless of their age, are provided with information on prenatal screening tests. General Practitioners (GPs) are often the first health professionals a woman consults in pregnancy. As such, GPs are well positioned to inform women of the increasing range of prenatal screening tests available. The aim of this study was to explore GPs experience of informing women of prenatal genetic screening tests for foetal abnormality.
Methods: A qualitative study consisting of four focus groups was conducted in metropolitan and rural Victoria, Australia. A discussion guide was used and the audio-taped transcripts were independently coded
by two researchers using thematic analysis. Multiple coders and analysts and informant feedback were employed to reduce the potential for researcher bias and increase the validity of the findings.
Results: Six themes were identified and classified as 'intrinsic' if they occurred within the context of the consultation or 'extrinsic' if they consisted of elements that impacted on the GP beyond the scope of the
consultation. The three intrinsic themes were the way GPs explained the limitations of screening, the extent to which GPs provided information selectively and the time pressures at play. The three extrinsic
factors were GPs' attitudes and values towards screening, the conflict they experienced in offering screening information and the sense of powerlessness within the screening test process and the health
care system generally. Extrinsic themes reveal GPs' attitudes and values to screening and to disability, as well as raising questions about the fundamental premise of testing.
Conclusion: The increasing availability and utilisation of screening tests, in particular first trimester tests,has expanded GPs' role in facilitating women's informed decision-making. Recognition of the importance
of providing this complex information warrants longer consultations to respond to the time pressures that GPs experience. Understanding the intrinsic and extrinsic factors that impact on GPs may serve to shape
educational resources to be more appropriate, relevant and supportive.

Corporate social responsibility, new activism and public relations

Purpose – This paper aims to analyse why some contemporary corporate organisations are reluctant to articulate the effect of their market positioning behaviour on the unwilling communities that oppose their activities. It describes the communicative interactions between several large corporate organisations and the grassroots activist groups opposing their activities, in Victoria, Australia.

Design/methodology/approach – Extensive secondary data were collected, including extensive newspaper and radio transcripts from the campaign periods, web site downloads, letters and other campaign documents. The research design applied to the data, a qualitative, interpretative analysis, drawing on key theoretical frameworks.

Findings – The research findings suggest that powerful protest strategies, combined with the right political and social conditions, and a shift in the locus of politics and expertise, bring to light public concerns about the ethics of corporate practices, such as public relations, used egocentrically by organisations, to harmonise their activities in late modern Western society. It finds that no serious overhaul of business ethics can occur until the unity of public relations is critically scrutinised and reformed. It helps define an alternative holistic communicative approach which could be applied more widely to business practice that helps avoid the limitations and relativism of public relations.

Originality/value – The research flags new ways of thinking expressed in the notion of public communication that could lead to creative and unusual coherences vital to deal with the apparent ecological challenges for society in late modernity.

Maintaining dignity and managing stigma in the interview encounter : the challenge of paid-for participation

The interview is both popular and problematic in social research. In this article, we describe and make problematic interviews from a study conducted with impoverished elders in Melbourne, Australia. Participants were paid $20 for each of two interviews. The result of the paid-for participation was double-edged in that it provided funds for impoverished participants, but the payment modified the exchange of free and open discussion. We describe key exchanges within the research interviews to exemplify how participants managed their experience and presentation of stigma and dignity. We demonstrate, with examples from the transcripts, strategies used by participants to gain agency over the process, while at the same time maintain enough of a semblance of conversational genre to make paid-for participation legitimate. We see this as an interesting methodological event that should inform analysis, interpretations, and the validity of interviews, rather than a problem with the interviewee.

Being resilient as described by people who experience mental illness

Aim: The purpose of this research was to explore resilience as described by consumers of mental health services in Australia who have experienced mental illness.

Background: Most qualitative research pertaining to resilience has focused on child and adolescent groups. In relation to the Australian context there appears to be a paucity of qualitative studies on resilience and the experience of mental illness.

Method: The study utilized a phenomenological approach elucidated by Colaizzi as the philosophical underpinnings of the study. In keeping with Colaizzi’s (1978) approach to inquiry, information was gathered through in-depth, semi-structured individual interviews. Information analysis utilised Colaizzi’s (1978) original seven-step approach with the inclusion of two additional steps, making this study’s analysis a nine step process.

Findings: Emergent themes explicated from participant transcripts follow: Universality, Acceptance, Naming and knowing, Faith, Hope, Being the fool and, Striking a balance, Having meaning and meaningful relationships, and ‘Just doing it’. The emergent conceptualisation which encapsulated the themes was; Viewing life from the ridge with eyes wide open. - choosing to walk through the darkness all the while knowing the risks and dangers ahead and making a decision for life amid ever-present hardships.

Conclusion: The findings of this study suggest being resilient can be learnt and therefore, should be a fundamental consideration in guiding therapeutic interventions within the context of clinical practice.

Sentencing of male and female child sex offenders : Australian study

Research suggests that, in line with the chivalry hypothesis of female offending, a range of mitigatory factors such as mental health problems, substance abuse, and personal experiences of abuse are brought into play when women who offend against children are brought to trial. This is reflected in sentencing comments made by judges and in the sanctions imposed on the offenders, and as a result female offenders are treated differently to male offenders. The current study investigated this in an Australian context. Seven cases of female-perpetrated child sexual abuse were identified over a 6-year period through the Austlii database. Seven cases of male-perpetrated child sex abuse matched as far as possible to these were identified. Court transcripts were then located, and sentencing comments and sanctions imposed were analysed. All offenders were sentenced to imprisonment, but in general the women were more likely than the men to receive less jail time and lower non-parole periods because their personal backgrounds or situation at the time of the offending (i.e., difficulties with intimate relationship, male dependence issues, depression, loneliness and anger) were perceived as worthy of sympathy, and they were considered as likely to be rehabilitated. Further investigations are needed to support these findings.

The roles of social bonds in the Australian tourism network

There is limited published research on the social bonds between employees in two organizations. This paper aims to examine 1) relationships in the Australian tourism industry, 2) the nature and role of social bonds and commercial friendships, 3) the nature and roles of the investments in economic and social resources, and 4) the nature of personal relationships in the tourism network. The perspective and attitudes of the tourism network participants become clear and their vested interests are highlighted. Network pictures are developed for the 5 key sectors of this industry. The adaptations of these sectors are also discussed. The nature and role of social bonds and commercial friendships is examined. The Leximancer program is used to qualitatively analyze interview transcripts. Findings show the centrality of relationships in this industry and the importance of social bonds to the travel agency sector. This study provides additional insight into the nature of social bonds in the development of successful business to business relationships. A discussion of antecedents and outcomes of social bonds will be further developed.

Extreme surfing : personal and psychological aspects of big wave riders

This qualitative study investigated personal and psychological aspects of big wave riders. A cross-sectional design with non probability purposive sampling was used to gain personal interviews with 32 elite surfers who regularly ride big, life threatening waves. Each athlete was asked three open questions: 1. What do you think are the most important qualities and attributes a surfer needs for riding big waves? 2. What type of mindset is best for riding big waves?, and 3.What motivates you to ride big waves? Content analysis of the taped interview transcripts revealed seven key qualities and attributes including having a thrill seeking, confident and goal oriented personality, a high level of mental strength and control, and an intimate relationship with the ocean. The best mindset included an individually defined arousal level, a committed attitude, and a simple, yet highly aware, focus. Motivations were primarily intrinsic, though drives indicative of a behavioral addiction to the act of riding big waves also emerged. Evidence of common developmental stages for riding big waves also arose from the interviews. Optimal mental approach and preparation techniques are discussed that will enable big wave riders, and other extreme athletes, to more safely and successfully manage extreme situations.

The emotional context of self-management in chronic illness: A qualitative study of the role of health professional support in the self-management of type 2 diabetes

Background: Support for patient self-management is an accepted role for health professionals. Little evidence exists on the appropriate basis for the role of health professionals in achieving optimum self-management outcomes. This study explores the perceptions of people with type 2 diabetes about their self-management strategies and how relationships with health professionals may support this.

Methods: Four focus groups were conducted with people with type 2 diabetes:  two with English speaking and one each with Turkish and Arabic-speaking. Transcripts from the groups were analysed drawing on grounded hermeneutics and interpretive description.

Results: We describe three conceptually linked categories of text from the focus groups based on emotional context of self management, dominant approaches to self management and support from health professionals for self management. All groups described important emotional contexts to living with and self-managing diabetes and these linked closely with how they approached their diabetes management and what they looked for from health professionals. Culture seemed an important influence in shaping these linkages.

Conclusion: Our findings suggest people construct their own individual self-management and self-care program, springing from an important emotional base. This is shaped in part by culture and in turn determines the aims each  person has in pursuing self-management strategies and the role they make available to health professionals to support them. While health professionals'  support for self-care strategies will be more congruent with patients' expectations if they explore each person's social, emotional and cultural circumstances, pursuit of improved health outcomes may involve a careful balance between supporting as well as helping shift the emotional constructs surrounding a patient life with diabetes.

Multiple urea transporter proteins in the kidney of holocephalan elephant fish (Callorhinchus milii)

Reabsorption of filtered urea by the kidney is essential for retaining high levels of urea in marine cartilaginous fish. Our previous studies on the shark facilitative urea transporter (UT) suggest that additional UT(s) comprising the urea reabsorption system could exist in the cartilaginous fish kidney. Here, we isolated three cDNAs encoding UTs from the kidney of elephant fish, Callorhinchus milii, and termed them efUT-1, efUT-2 and efUT-3. efUT-1 is orthologous to known elasmobranch UTs, while efUT-2 and efUT-3 are novel UTs in cartilaginous fish. Two variants were found for efUT-1 and efUT-2, in which the NH₂-terminal intracellular domain was distinct between the variants. Differences in potential phosphorylation sites were found in the variant-specific NH2-terminal domains. When expressed in Xenopus oocytes, all five UT transcripts including the efUT-1 and efUT-2 variants induced more than a 10-fold increase in [¹⁴C] urea uptake. Phloretin inhibited dose-dependently the increase of urea uptake, suggesting that the identified UTs are facilitative UTs. Molecular phylogenetic analysis revealed that efUT-1 and efUT-2 had diverged in the cartilaginous fish lineage, while efUT-3 is distinct from efUT-1 and efUT-2. The present finding of multiple UTs in elephant fish provides a key to understanding the molecular mechanisms of urea reabsorption system in the cartilaginous fish kidney.