Pandemic (H1N1) Influenza 2009 and Australian emergency departments : implications for policy, practice and pandemic preparedness

Objective: To describe the reported impact of Pandemic (H1N1) 2009 on EDs, so as to inform future pandemic policy, planning and response management.

Methods: This study comprised an issue and theme analysis of publicly accessible literature, data from jurisdictional health departments, and data obtained from two electronic surveys of ED directors and ED staff. The issues identified formed the basis of policy analysis and evaluation.

Results: Pandemic (H1N1) 2009 had a significant impact on EDs with presentation for patients with ‘influenza-like illness’ up to three times that of the same time in previous years. Staff reported a range of issues, including poor awareness of pandemic plans, patient and family aggression, chaotic information flow to themselves and the public, heightened stress related to increased workloads and lower levels of staffing due to illness, family care duties and redeployment of staff to flu clinics. Staff identified considerable discomfort associated with prolonged times wearing personal protective equipment. Staff believed that the care of non-flu patients was compromised during the pandemic as a result of overwork, distraction from core business and the difficulties associated with accommodating infectious patients in an environment that was not conducive.

Conclusions: This paper describes the breadth of the impact of pandemics on ED operations. It identifies a need to address a range of industrial, management and procedural issues. In particular, there is a need for a single authoritative source of information, the re-engineering of EDs to accommodate infectious patients and organizational changes to enable rapid deployment of alternative sources of care.

Wikis as individual student learning tools : the limitations of technology

This paper presents research into the attitudes and behaviours of students using wikis for individual writing tasks. The wiki-based assignment differs from the use of wikis normally researched because it was an individual task, not involving collaborative writing. This activity provides an excellent opportunity to learn more about how wikis are actually used by students in higher education. The research finds there is no compelling evidence that the wiki on its own improves performance over and above the general aptitude of students. It also finds that students generally did not utilise the wikis for high-intensity editing and revision. However, students did report that the wiki was valuable as a way of aiding them to review and develop their ideas. We conclude that using wikis for individual writing tasks can, where appropriate active instructions are given to support development of cognitive abilities, lead to improved outcomes for students.

Designing social media into university learning : technology of collaboration or collaboration for technology?

Using the example of an undergraduate unit of study that is taught both on-campus and externally, but uses Internet-based learning in both cases, we explore how social media might be used effectively in higher education. We place into question the assumption that such technologies necessarily engage students in constructivist learning; we argue that the affordances of social media must be complemented by social affordances, designed into the learning experience, which thereby generate the necessary connection between students’ motivations to study and their motivations to exploit social media. We demonstrate, via the example given, how assessment structures and strategies are the most effective focus when attempting to create the pedagogical affordances that might lead to collaborative learning.

The pragmatic portfolio : an assessment approach for distributed learning

Portfolios, especially where they involve some use of or link to online technologies, are currently a popular focus for learning innovation in universities, drawing on a tradition of using portfolios in some areas of higher education and attempting to extend and broaden this practice. In some cases this focus has led to ambitious plans for whole-of-institution approaches, often involving significant technological development. However, the term portfolio can also cover a wider variety of possible learning and assessment activities and there are ways of using portfolios which, while quite traditional in their own form and approach, enable teachers to approach other aspects of their curriculum and pedagogy in far more innovative ways. This paper explores the conceptual basis on which the Department of Internet Studies at Curtin University of Technology is utilising a pragmatic approach to portfolio assessment within individual units of study, so as to enable a more thorough implementation of distributed learning. In this form of learning, where students regularly contribute to their own and others' learning through short tasks and conversations, the evidence of achievement is widely distributed and not easily accessible for either formative or summative assessment. As explained in the paper, students are required to collate, select, and then contextualise a sample of these numerous productive moments of their ongoing study. The paper concludes that while other goals for portfolio assessment (such as encouraging reflection) can also be used with this approach, its primary value is in unleashing the potential of social media creativity in a manner that motivates students via the requirement of assessment, enables feedback to be provided to guide learning, and which promotes shared responsibility between teachers and students in determining the kind and extent of their learning activities.

The social side of social media : technology or collaboration?

This paper discusses how course design may draw upon social media in order to teach students appropriate skills for a network society in the context of team-work based learning. The emphasis is not upon web 2.0 and social media as inherently suited to providing educational solutions, but upon the ways in which they can be adapted by course designers within the framework of explicit learning objectives. More specifically, we provide a case study of how the use of social media in a blended or wholly-online learning environment provides affordances for team-based collaborative learning, especially when incorporated within a course design that encourages independent, self-directed and authentic learning. This paper argues we need to assess the social aspects of social media, rather than upon the technological, that is, avoid the fetishisation of 'apps,' through the creation of assessment that alternately foregrounds a critical appraisal of web 2.0 technologies and places onus upon the students to develop, with guidance, teamwork skills and processes. We provide an example of how it is possible to integrate web 2.0 technologies into their learning processes and assessment, in order to teach about the realities of collaborating with others in small teams in a work environment increasingly mediated by the Internet. In order to achieve these learning outcomes, course design needs to balance scaffolding with the need to place the imperative for learning specific content and skills upon the students, the latter through the provision of assessment outcomes and resources that the students need to work towards together.

Prevention of aromatase inhibitor-induced bone loss with alendronate in postmenopausal women: the BATMAN trial

Abstract:
Postmenopausal women on aromatase inhibitors (AI) are at risk of aromatase inhibitor-associated bone loss (AIBL) and fractures.

In 2005 Osteoporosis Australia proposed an algorithm for bisphosphonate intervention. Three hundred and three postmenopausal women with early breast cancer (EBC) were enrolled (osteoporotic, n=25; osteopaenic, n=146; normal bone mineral density (BMD), n=126). Weekly alendronate (70 mg) treatment efficacy as triggered by the algorithm in preventing bone loss was evaluated. All patients received anastrozole (1 mg daily), calcium and vitamin D.

Results:
All osteoporotic patients received alendronate at baseline. Eleven out of the 146 (7.5%) osteopaenic patients commenced alendronate within 18 months of participation and eleven commenced after. One hundred and twenty four out of the 146 (84.9%) osteopaenic patients and all 126 with normal baseline BMD did not trigger the algorithm.

At three years, lumbar spine mean BMD increased (15.6%, p<0.01) in the osteoporotic group. BMD in the osteopaenic group with early intervention significantly increased at three years (6.3%, p=0.02). No significant change was seen in the late intervention group. No change was observed in those with osteopaenia without alendronate.

There was a significant drop in lumbar spine (−5.4%) and hip (−4.5%) mean BMD, in the normal BMD group, none of whom received alendronate.

Fracture data will be presented.

Conclusion:
In postmenopausal women with endocrine-responsive EBC, BMD improved over time when a bisphosphonate is administered with anastrozole in osteoporotic patients using an osteoporosis schedule. Subjects with normal baseline BMD experienced the greatest BMD loss, although none became osteoporotic.

Prospective memory in a virtual environment: beneficial effects of cue saliency

Prospective Memory (PM) research focuses on how the cognitive system successfully encodes and retains an intention, before retrieving it at a particular future time or in response to a particular future event. Previous work using 2D text stimuli has shown that increasing the saliency of the retrieval cue can improve performance. In this work, we investigated the effect of increased cue saliency in a more ecologically valid 3D virtual environment. The findings indicate that increased perceptual saliency of the cue does benefit PM in a dynamic and visually rich environment but that the impact of cue saliency does not interact with attentional load.

Researching maternal, neonatal and child health service use in rural and pastoralist Ethiopia: A key informant research approach

Like many nations in sub-Saharan Africa, Ethiopia has both a high neonatal mortality rate and maternal mortality ratio and is unlikely to meet Millennium Development Goals 4 and 5 by 2015. This working paper examines how Key Informant Research (KIR) in rural and pastoralist Ethiopia will identify facilitators and barriers to the use of maternal, neonatal and child health services. The methodology is informed by Participative Ethnographic Evaluation Research (PEER) and Key Informant Monitoring (KIM). Key Informant Research (KIR) training will provide research skills to Health Extension Workers (HEWs) and Non-government organisation (NGO) staff to enable them to develop research questions, collect data and participate in preliminary data analysis. This will enable the identification of strategies that improve the identification of risk, enhance early referral, increase access, affordability and acceptability of skilled birthing services in rural and pastoralist Ethiopia.

The prevalence and risk factors of epiretinal membranes: the Melbourne collaborative cohort study

Purpose
To determine the prevalence of epiretinal membranes (ERMs) in Melbourne, Australia and its risk factors in this population.

Methods
The Melbourne Collaborative Cohort Study is a prospective study investigating the role of diet and life style in the causation of common chronic diseases. Eighty-six percent of participants were of Northern European origin born in Australia or United Kingdom and 14% were migrants from Greece or Italy (Southern European origin). Nonmydriatic digital retinal photography was implemented at Melbourne Collaborative Cohort Study follow-up. The ERMs were recorded as cellophane macular reflex without retinal folds or preretinal macular fibrosis (PMF) with retinal folds.

Results
A total of 22,406 participants had retinal photography, 95% (n = 21,241) were eligible for ERM grading. The ERM prevalence were 8.9% (1,882); cellophane macular reflex, 4.9% (1,047); and preretinal macular fibrosis, 3.9% (835). After adjustment for age, sex, level of education, smoking status, level of cholesterol, body mass index, waist-to-hip ratio, waist measurement, blood pressure, diabetes, and stroke, increasing age and Southern European ethnicity was significantly associated with ERMs. Overall, in Southern Europeans, ERMs odd ratio was 1.97 (95% confidence intervals, 1.67–2.31), P < 0.001; preretinal macular fibrosis was 1.82 (95% confidence intervals, 1.43–2.31), P < 0.001; and cellophane macular reflex was 1.93 (1.57–2.38), P < 0.001.

Conclusion
In an older Australian population, the prevalence of ERMs was 8.9% and was almost two times higher in participants of Southern European origin than Northern European origin.