Improving the coordination of care for low back pain patients by creating better links between acute and community services

This paper reports on the development of a care-pathway to improve service linkages between the acute setting and community health services in the treatment of low back pain. The pathway was informed by two processes: (1) a literature review based on best-practice guidelines in the assessment, treatment and continuity of care for low back pain patients; and (2) consultation with staff and key stakeholders. Stakeholders from both the acute and community sectors comprised the Working Group, who identified central areas of concern to be addressed in the care-pathway, with the goal of preventing chronicity of low back pain and reducing emergency department presentations. The main outcomes achieved include: the development of a new care-coordinator role, which would support a greater focus on integration between acute and community sectors for low back pain patients; identifying the need to screen at-risk patients; implementation of the SCTT (Service Coordination Tool Templates) tool as a system of referral across the acute and community settings; and agreement on the need to develop an evidence-based self-management program to be offered to low back pain patients. The benefits and challenges of implementing this care pathway are discussed.

Low back pain and activity

Low back pain (LBP) may decrease physical activity. This thesis investigated the relationship between LBP and activity, interventions to alter LBP and the mechanisms for pain reduction. The results showed no association between LBP and activity, and although the intervention reduced LBP, the mechanism for its effect was not identified.

HRM research in China : looking back and looking forward

Purpose – The purpose of this paper is to provide an overview of the field of human resource management (HRM) in China, with insights drawn from recent times to several millennia earlier, with a view to informing the further work that needs to be done to better understand managing people in China.
Design/methodology/approach – The authors examined Chinese ancient texts related to people management and drew on reviews of HRM research in China since the establishment of the People’s Republic of China in 1949 till current times, to draw lessons for HRM in China today and for the future.
Findings – The 2,500 year gap that separates the literatures studied as part of this review cannot hide the striking similarities between the conceptual views about the importance of people and their management in the two periods. Yet, there remains a lack of empirical studies of the Chinese style of HRM practices. The majority of recent research in the field of HRM in China is focussed on comparison between HRM practices in various types of enterprises operating in China and those in the west, with the apparent aim of better understanding the latter rather than the former.
Originality/value – As China is rapidly becoming a key global player, and its enterprises represent an increasing share of the global market, it is crucial to understand how Chinese firms have managed their people at home and globally to achieve performance outcomes. Are there lessons other firms, especially those in emerging markets could learn? What are the implications for building global
management and organisational knowledge? This paper provides some directions for future research about HRM in China, which may help gain a better understanding of the Chinese style of management and further develop management and organisation theories in the China context.

Individuals with chronic low back pain have greater difficulty in engaging in positive lifestyle behaviours than those without back pain : an assessment of health literacy

Background: Despite the large volume of research dedicated to understanding chronic low back pain (CLBP), patient outcomes remain modest while healthcare costs continue to rise, creating a major public health burden. Health literacy - the ability to seek, understand and utilise health information - has been identified as an important factor in the course of other chronic conditions and may be important in the aetiology of CLBP. Many of the currently available health literacy measurement tools are limited since they measure narrow aspects of health literacy. The Health Literacy Measurement Scale (HeLMS) was developed recently to measure broader elements of health literacy. The aim of this study was to measure broad elements of health literacy among individuals with CLBP and without LBP using the HeLMS.
Methods: Thirty-six community-dwelling adults with CLBP and 44 with no history of LBP responded to the HeLMS. Individuals were recruited as part of a larger community-based spinal health study in Western Australia. Scores for the eight domains of the HeLMS as well as individual item responses were compared between the groups.
Results: HeLMS scores were similar between individuals with and without CLBP for seven of the eight health literacy domains (p > 0.05). However, compared to individuals with no history of LBP, those with CLBP had a significantly lower score in the domain ‘Patient attitudes towards their health’ (mean difference [95% CI]: 0.46 [0.11- 0.82]) and significantly lower scores for each of the individual items within this domain (p < 0.05). Moderate effect sizes ranged from d = 0.47-0.65.
Conclusions: Although no differences were identified in HeLMS scores between the groups for seven of the health literacy domains, adults with CLBP reported greater difficulty in engaging in general positive health behaviours. This aspect of health literacy suggests that self-management support initiatives may benefit individuals with CLBP.

Clinical performance of an innovative back surface multifocal contact lens in correcting presbyopia

Purpose: This prospective study was designed to subjectively and objectively evaluate the performance of an aspheric multifocal back surface rigid gas permeable (RGP) contact lens. The multifocal element of this lens design consisted of an aspheric optical zone that varied according to the patient's ametropia, corneal topography, and required reading addition.

Methods: We fit 28 presbyopic subjects with an aspheric multifocal back surface RGP contact lens (age range: 45 to 68 years). Reading additions ranged from +0.75 D to +2.50 D. Subjects were assessed initially and at 2, 6, and 12 weeks for ocular changes, visual performance, and subjective responses.

Results: We required 116 RGP lenses to achieve an acceptable fit and visual acuity in 28 subjects (55 eyes). At the final visit, the distance logMAR acuity with the multifocal contact lens (+0.12 +/-0.10) was not statistically different (t=-0.623, P= 0.5388) from spectacle acuity at the initial visit (+0.10 +/-0.12). The near logMAR acuity with the multifocal contact lens at the final visit (0.36 +/- 0.12) was not statistically different from that for near acuity with spectacles at the initial visit (0.33 +/- 0.13). No slit lamp signs worsened during the study. A reduction in myopia of 0.67 D was noted by the final visit. Spectacle blur was noted if the acuity at the initial refraction was compared to the acuity with the same refraction at the final visit (t= -3.287, P= 0.0028) but not when the refractive changes were incorporated (t= 1.058, P= 0.3127). All subjects rated the performance of the lenses very highly: comfort, 86%; distance acuity, 83%; near acuity, 73%; and stability of vision, 74%. Twenty-four subjects (86%) chose the multifocal contact lens as their preference.

Conclusion: We demonstrated that a multifocal design is able to provide acceptable distance and near correction for presbyopic patients. The aspheric geometry required can be optimized for a given patient by considering his/her degree of ametropia, as well as the corneal topography.

Re-composing the elephant' : bringing the big picture back into IS research

Information Systems is a practice-based discipline. It experiences periodic debates about the rigour and relevance of its research. The tensions between pretensions to be a ‘real’ science (rigour) and the need to contribute to practice (relevance) are intensified at a time of low student enrolment, lack of a clear identity, and uncertainties about the viability of our discipline. This essay argues that decomposing phenomena into narrow topics of research to achieve rigour is damaging to our discipline if we fail to then ‘recompose’ or integrate these back into understanding, lessons and guidelines for application to real-world practices. This argument is illustrated through recent work on the motors that drive changes in technology appropriation. It highlights the importance of plurality of theories and methods in understanding complex real-world phenomena in order to achieve both rigour and relevance.

Feeding back and enhancing authentic learning in quality course assessment design : locating information systems education in rigorous educational research

Locating information systems education foursquare within rigorous and substantial educational research is crucial if the discipline is to receive the scholarly attention that it warrants. One way to do that is to highlight how current information systems course design in Australian undergraduate and postgraduate programs exhibits the strongest possible elements of contemporary learning theories. This paper analyses selected features of the design of an information systems postgraduate course in an Australian university, including the use of peer review of journal entries and writing professional reports to enhance authentic learning and maximise quality assessment design. The analysis is framed by the principles of instructional design theory (Snyder 2009). The authors argue that, by demonstrating theoretically grounded and effective educational practice, the course highlights the value of being located in wider educational research, and of bringing the two fields more closely together.

The notion of self in the journey back from addiction

In this study we explored how those recovering from addiction negotiated self, and the role supported accommodation played in the journey back from addiction. Transcripts from 11 in-depth interviews were analyzed by 2 coders who identified the most salient themes relevant to the self in recovery within the personal contexts of participants. The participants noted that reclaiming the self that had been lost to addiction was of primary importance to them. The recovery journey exposed a self that had reached the lowest point in life; one that was hardly recognizable; one that was undesirable. Engaging with supported accommodation provided participants with a sanctuary within which to reclaim the self, and was seen as central to their recovery.

Back calculation of parent austenite orientation using a clustering approach

A new approach is presented for calculating the parent orientation from sets of variants of orientations produced by phase transformation. The parent austenite orientation is determined using the orientations of bainite variants that transformed from a single parent austenite grain. In this approach, the five known orientation relationships are used to back transform each observed bainite variant to all their potential face-centered-cubic (f.c.c.) parent orientations. A set of potential f.c.c. orientations has one representative from each bainite variant, and each set is assembled on the basis of minimum mutual misorientation. The set of back-transformed orientations with the minimum summation of mutual misorientation angle (SMMA) is selected as the most probable parent (austenite) orientation. The availability of multiple sets permits a confidence index to be calculated from the best and next best fits to a parent orientation. The results show good agreement between the measured parent austenite orientation and the calculated parent orientation having minimum SMMA.

Cross-cultural adaption of the Health Educaiton Impact Questionnaire: experimental study showed expert committee, not back-translation, added value

Objectives
To assess the contribution of back-translation and expert committee to the content and psychometric properties of a translated multidimensional questionnaire.

Study Design and Setting
Recommendations for questionnaire translation include back-translation and expert committee, but their contribution to measurement properties is unknown. Four English to French translations of the Health Education Impact Questionnaire were generated with and without committee or back-translation. Face validity, acceptability, and structural properties were compared after random assignment to people with rheumatoid arthritis (N = 1,168), chronic renal failure (N = 2,368), and diabetes (N = 538). For face validity, 15 bilingual people compared translations quality with the original. Psychometric properties were examined using confirmatory factor analysis (metric and scalar invariance) and item response theory.

Results
Qualitatively, there were five types of translation errors: style, intensity, frequency/time frame, breadth, and meaning. Bilingual assessors ranked best the translations with committee (P = 0.0026). All translations had good structural properties (root mean square error of approximation <0.05; comparative fit index [CFI], ≥0.899; and Tucker–Lewis index, ≥0.889). Full measurement invariance was observed between translations (ΔCFI ≤ 0.01) with metric invariance between translations and original (lowest ΔCFI = 0.022 between fully constrained models and models with free intercepts). Item characteristic curve analyses revealed no significant differences.

Conclusion
This is the first experimental evidence that back-translation has moderate impact, whereas expert committee helps to ensure accurate content.

Intimacy at work: Playback theatre and corporate cultural change in Mercedes Benz, Brazil

On the back of a faltering economic year in 2007 and a major merger of motor car and truck dealerships, international motor car giant Mercedes Benz adopted a radical approach to re-aligning the company vision for their Brazilian business. Adopting a people-centred approach to change, they integrated participatory theatre and personal stories into a nationwide cultural development programme producing twelve performances in twelve cities. The central content of the performances came from employees who told personal stories that were then performed onstage. Each event acted as a unique expression of workplace values that would be led by employee attitudes and behaviour. Through the dialogic process, the company established a new code of conduct for customer care for the next phase of company activity. This article critiques various aspects of the programme and considers the value and limitations in the person-centred approach facilitated through theatre.

An accelerated particle swarm optimization based levenberg marquardt back propagation algorithm

The Levenberg Marquardt (LM) algorithm is one of the most effective algorithms in speeding up the convergence rate of the Artificial Neural Networks (ANN) with Multilayer Perceptron (MLP) architectures. However, the LM algorithm suffers the problem of local minimum entrapment. Therefore, we introduce several improvements to the Levenberg Marquardt algorithm by training the ANNs with meta-heuristic nature inspired algorithm. This paper proposes a hybrid technique Accelerated Particle Swarm Optimization using Levenberg Marquardt (APSO_LM) to achieve faster convergence rate and to avoid local minima problem. These techniques are chosen since they provide faster training for solving pattern recognition problems using the numerical optimization technique.The performances of the proposed algorithm is evaluated using some bench mark of classification’s datasets. The results are compared with Artificial Bee Colony (ABC) Algorithm using Back Propagation Neural Network (BPNN) algorithm and other hybrid variants. Based on the experimental result, the proposed algorithms APSO_LM successfully demonstrated better performance as compared to other existing algorithms in terms of convergence speed and Mean Squared Error (MSE) by introducing the error and accuracy in network convergence.

Using video to promote pre-service teachers’ thinking about their transition to teaching

This paper reports on research investigating the use of video representations of first-year teachers’ experiences in undergraduate teacher education workshops that focus on the transition to teaching. The use of the video is a responsive act that draws on the notion of looking back, where graduates in their first year of teaching ‘speak to’ current students. Scenes from video footage of the theatre-based research performance The First Time shaped workshop activities and discussions in the unit. Themes ranged from pedagogical to practical, covering topics such as teacher identity discourses; epiphanic and revelatory moments of transition to becoming a teacher; and preparing for job applications and interviews. Data from the researcher’s journal, Student Evaluation of Teaching and Units (SETU) comments, and semi-structured interviews with undergraduate students upon completion of the workshops are framed within a phenomenographic paradigm. The aim in phenomenography is to describe variations of conception that people have of a particular phenomenon (Sin, 2010), in this case the video as a tool to promote critical thinking about the transition to teaching. The researcher explored her own, and participants’ experiences, and identified a range of conceptual meanings of the phenomenon. These were classified into categories according to their similarities and differences concerning the effectiveness of this specific video in assisting undergraduates in their transition to teaching. Early results reveal some similarities and many variations among participants as to the effectiveness of the video as a tool. Their conceptions of the phenomenon are individual and relational, and as such are quite varied. Emergent varied themes include: ‘I know what it is that I need to learn’; ‘Is this theory or practice?’; and ‘I don’t do drama’. Emergent similarities include: ‘Preparing for the unexpected’.

Give back peace that will never end: Hibakusha poets as public intellectuals

US censorship of public discussion of the bombings during the Allied Occupation of Japan ensured that the Japanese public knew little about the human consequences of the atomic bombing of Hiroshima and Nagasaki. When hibakusha poets seek a public audience for their poetry, their experiences make them potentially powerful public intellectuals. As Noam Chomsky has observed, the most effective public intellectuals are dissidents who act from the margins. Tōge Sankichi and Kurihara Sadako became activists and their poetry offers a powerful and rousing response to the atomic bombing and lobbies for nuclear disarmament. The simplicity and accessibility of these poems is essential to the public dissemination of their message and Kurihara’s and Tōge’s identification as public intellectuals. This article examines the ways in which hibakusha poets can be recognised as public intellectuals when they seek public audiences for their work. Discussion hinges on a number of considerations centred on public intellectualism, trauma and the uses of language.

Low back pain in microgravity and bed rest studies

BACKGROUND: The prevalence of low back pain (LBP) for astronauts in space (68%) is higher than the 1-mo prevalence for the general population on Earth (39%). It is unclear whether differences occur between healthy subjects and astronauts with a history of LBP. Knowledge of this issue is important to assess whether a history of LBP could have an operational impact. METHODS: We evaluated LBP prospectively during short duration spaceflight (15 d; N=20) and compared this with similar data collected during two bed rest studies (N=40). Astronauts completed a questionnaire 5-10 d preflight, during each flight day, and 5-10 d postflight. RESULTS: All astronauts with a history of LBP also developed LBP in flight. These astronauts reported a significantly longer duration of LBP and a different pain location. LBP was most often experienced in the central area of the lower back during spaceflight with an incidence of 70% and a mean pain level of 3 (on a scale of 0-10). Pain resolved within 10 d of flight. No neurological signs were present. The most frequently reported countermeasure was assuming a "knees to chest (fetal tuck) position" combined with stretching. Greater LBP intensity was reported in spaceflight than bed rest with a trend indicating a greater number of days of pain during spaceflight. DISCUSSION: The current study represents a prospective study of LBP in spaceflight. The results indicate that LBP is self-limiting in spaceflight and should not pose an operational risk. Prior LBP on Earth appears to be a risk factor for LBP in spaceflight.