Professional learning through narratives of practice

Narratives of practice are a primary means by which educators understand their work, shaping the identities and practices of those who engage with them. Written narratives are examined as a resource for professional learning in three contexts: a writing group for adult educators, a national professional development initiative and a teacher appraisal program.

Multidisciplinary team developed and implemented protocols to assist mechanical ventilation weaning : a systematic review of literature

Aim: The aim of this review was to determine if ventilation-weaning protocols developed and implemented by multidisciplinary teams (MDTs) reduced the duration of mechanical ventilation in adult intensive care patients compared to usual care.

Method: A systematic review was conducted to review published research studies from January 1999 to June 2009 to identify and analyse the best available evidence on MDT-based weaning protocols in adult intensive care patients. All relevant studies based on electronic searches of MEDLINE, EMBASE, CINAHL, the Cochrane Controlled Trials Registry and the Cochrane Database of Systematic Reviews were included. Where possible data were pooled and a meta-analysis performed. A narrative synthesis of data was conducted to provide a critical appraisal of nonrandomised controlled trials included in the review.

Results: Three pre- and postinterventional studies were identified for inclusion in this review. Results show equivocal support for weaning protocols developed and implemented by MDTs for reducing duration of mechanical ventilation.

Conclusion: Communication and organizational processes must be addressed for multidisciplinary protocols to be effective. Due to methodological limitations of included studies, large randomised controlled trials are required to provide high-level evidence of the effects of MDT-based protocols on duration of mechanical ventilation.

Dies of culture and religion : India and Australia, from settlement to post/modern times

In historical sketches of India-Australia or Australia-India relations, the important dimensions of the cultural and religious connections from the shared colonial period and Gandhi's nationalist voice echoing in all corners of the Empire, through to the diasporic migration, settlement and temple culture, is largely overlooked. This essay intends the redress that absence in current research and contribute toward a critical appraisal of that rather 'esoteric' part of history, arguably still in its infancy. The story begins close to the early white settlement period to the aftermath of the events of 9/11 (2001 in New York) and Bali (2002). The focus will be on Hindus with some reference to Sikhs, Muslims, Sri Lankan Tamils, and migrants from the subcontinent, as the conduits for the particular Indian-Australian diasporic connection and 'spiritual diplomacy' being explored.

Evolution in a cold climate

A brief appraisal of marine fossils from high latitudes and episodically cold climate especially in east Australia and New Zealand during Late Palaeozoic and Early Mesozoic times shows patterns of evolution and survival that differ from those adduced for the palaeotropics and Northern Hemisphere. Examples taken from amongst phyla Scyphozoa, Bryozoa, Brachiopoda and Classes Bivalvia and Class Cephalopoda suggest these attributes:
1. Evolution and demise of species and genera proceeded at a rate close to that known for palaeotropical and Northern Hemisphere macro-invertebrates, but involved fewer families and orders.
2. Possibly, intraspecific variation was greater amongst southern palaeohemisphere Permian species than in those of the Permian palaeotropics.
3. There was no proven diminution of life at the end of the Guadalupian (Middle Permian) at southern high latitudes, where however the fossil record is meagre for this interval. Younger Wuchiapingian and Changhsingian faunas were moderately diverse.
4. There is no evidence for a high latitude Southern Hemisphere anoxic event in the Early Triassic despite claims of a world-wide anoxic interval. Nor has any substantial volcanic eruption or bolide impact left any marked traces in the sedimentary record.
5. As a consequence, some major groups such as Bryozoa and Conulariida (Staurozoa) survived the end- Permian extinction shock in the Southern Hemisphere.
6. Other major groups appear to have survived better in the south than in the north, notably, mollusc Bivalvia and Cephalopoda. It therefore appears likely that Triassic seas were restocked substantially from the Southern Hemisphere and that the Permian extinction shock was asymmetric with respect to latitudes in its distribution and affect.

An exploratory cluster randomised controlled trial of knowledge translation strategies to support evidence-informed decision-making in local governments (The KT4LG study)

Background: Childhood overweight and obesity is the most prevalent and, arguably, politically complex child health problem internationally. Governments, communities and industry have important roles to play, and are increasingly expected to deliver an evidence-informed system-wide prevention program. However, efforts are impeded by a lack of organisational access to and use of research evidence. This study aims to identify feasible, acceptable and ideally, effective knowledge translation (KT) strategies to increase evidence-informed decision making in local governments, within the context of childhood obesity prevention as a national policy priority.
Methods/Design: This paper describes the methods for KT4LG, a cluster randomised controlled trial which is exploratory in nature, given the limited evidence base and methodological advances. KT4LG aims to examine a program of KT strategies to increase the use of research evidence in informing public health decisions in local governments. KT4LG will also assess the feasibility and acceptability of the intervention. The intervention program comprises a facilitated program of evidence awareness, access to tailored research evidence, critical appraisal skills development, networking and evidence summaries and will be compared to provision of evidence summaries alone in the control program. 28 local governments were randomised to intervention or control, using computer generated numbers, stratified by budget tertile (high, medium or low). Questionnaires will be used to measure impact, costs, and outcomes, and key informant interviews will be used to examine processes, feasibility, and experiences. Policy tracer studies will be included to examine impact of intervention on policies within relevant government policy documents.
Discussion: Knowledge translation intervention studies with a focus on public health and prevention are very few in number. Thus, this study will provide essential data on the experience of program implementation and evaluation of a system-integrated intervention program employed within the local government public health context. Standardised programs of system, organisational and individual KT strategies have not been described or rigorously evaluated. As such, the findings will make a significant contribution to understanding whether a facilitated program of KT strategies hold promise for facilitating evidence-informed public health decision making within complex multisectoral government organisations.

Assessing free-living physical activity using accelerometry : practical issues for researchers and practitioners

Physical activity is an integral component of a healthy lifestyle, with relationships documented between physical activity, chronic diseases, and disease risk factors. There is increasing concern that many people are not sufficiently active to benefit their health. Consequently, there is a need to determine the prevalence of physical activity engagement, identify active and inactive segments of the population, and evaluate the effectiveness of interventions. The aim of the present study was to identify and explain a number of methodological and decision-making processes associated with accelerometry, which is the most commonly used objective measure of physical activity in child and adult research.

Specifically, this review addresses:
(a) pre-data collection decisions,
(b) data collection procedures,
(c) processing of accelerometer data, and
(d) outcome variables in relation to the research questions posed.

An appraisal of the literature is provided to help researchers and practitioners begin field-based research, with recommendations offered for best practice. In addition, issues that require further investigation are identified and discussed to inform researchers and practitioners of the surrounding debates.

Overall, the review is intended as a starting point for field-based physical activity research using accelerometers and as an introduction to key issues that should be considered and are likely to be encountered at this time.

Not one of us is without bias : identifying and challenging racism and homophobia

This article reviews a teaching process that aimed to prepare final year social work students for critical practice with diverse and marginalized populations. Alongside lecture input, in small group discussions and in the two sequenced written assignments students were encouraged to personalize questions of bias and stigma by recalling both their experiences of being “other-ed” as well as their participation in practices that “other-ed”, such as racist and homophobic imaging and acting. Feedback to the unit’s first iteration in 2004 was generally positive yet a significant minority of students were clearly dissatisfied. Whilst retaining the same formal content in 2005, greater attention was devoted to generating a supportive group process and a positive environment for “negative” self-disclosure. This milieu acted to contain and normalize the students’ struggle with internalized stereotypes, a stage associated with their greater preparedness to identify and challenge their own personal, cultural and ideological locations. Within the context of the unit remaining explicit about its value stance, by adopting an approach to the teaching / learning process that neither collided nor colluded, as teachers we believe the 2005 revision better achieved the units aims. First, the unit received broader positive appraisal from students and, second, it appeared that the unit more firmly promoted the prospects for students carrying forward a capacity for critical self review post graduation.

Who, and what, is odd here? De-naturalizing students' experiences of 'the other'

This paper reviews a teaching process that aimed to prepare final year social work students for critical practice with diverse and marginalized populations. Alongside lecture input, in small group discussions and in the two sequenced written assignments students were encouraged to personalize questions of bias and stigma by recalling both their experiences of being ‘other-ed’ as well as their participation in practices that ‘other-ed’, such as racist and homophobic imaging and acting. Feedback to the unit's first iteration in 2004 was generally positive yet a significant minority of students were clearly dissatisfied. Whilst retaining the same formal content in 2005, greater attention was devoted to generating a supportive group process and a positive environment for ‘negative’ self-disclosure. This milieu acted to contain and normalize the students' struggle with internalized stereotypes, a stage associated with their greater preparedness to identify and challenge their own personal, cultural and ideological locations. Within the context of the unit remaining explicit about its value stance, by adopting an approach to the teaching/learning process that neither collided nor colluded we believe the 2005 revision better achieved the units aims. First, the unit received broader positive appraisal from students and, second, it appeared that the unit more firmly promoted the prospects for students carrying forward a capacity for critical self review post graduation.

IMCE : integrated media creation environment

We discuss the design and implementation of an integrated media creation environment, and demonstrate its efficacy in the generation of two simple home movies. The significance for the average user seeking to create home movies lies in the flexible and automatic application of film principles to the task, removal of tedious low-level editing by means of wellformed media transformations in terms of high-level film constructs (e.g. tempo), and content repurposing powered by those same transformations added to the rich semantic information maintained at each phase of the process.

Mental health-related risk factors for violence : using the evidence to guide mental health triage decision making

Mental health clinicians working in emergency crisis assessment teams or mental health triage roles are required to make rapid and accurate risk assessments. The assessment of violence risk at triage is particularly pertinent to the early identification and prevention of patient violence, and to enhancing the safety of clinical staff and the general public. To date, the evidence base for mental health triage violence risk assessment has been minimal. This study aimed to address this evidence gap by identifying best available evidence for mental health-related risk factors for patientinitiated violence.We conducted a systematic review based on the National Health and Medical Research Council of Australia’s methodology for systematic reviews. A total of 6847 studies were retrieved, of which 326 studies met the study inclusion criteria. Of these studies, 277 met inclusion criteria but failed the quality appraisal process, thus a total of 49 studies were included in the final review. The risk factors that achieved the highest evidence grading were predominantly related to dynamic clinical factors immediately observable in the patient’s general appearance, behaviour and speech. These factors included hostility/anger, agitation, thought disturbance, positive symptoms of schizophrenia, suspiciousness and irritability.

Major quantitative techniques for risk analysis in the construction industry : a comparative analysis

Risk analysis is one of the critical functions of the risk management process. It relies on a detailed understanding of risks and their possible implications. Construction projects, because of their large and complex nature, are plagued by a variety of risks which must be considered and responded to in order to ensure project success. This study conducts an extensive comparative analysis of major quantitative risk analysis techniques in the construction industry. The techniques discussed and comparatively analyzed in this report include: Programme Evaluation and Review Technique (PERT), Judgmental Risk Analysis Process (JRAP), Estimating Using Risk Analysis (ERA), Monte Carlo Simulation technique, Computer Aided Simulation for Project Appraisal and Review (CASPAR), Failure Modes and Effects Analysis technique (FMEA) and Advanced Programmatic Risk Analysis and Management model (APRAM). The findings highlight the fact that each risk analysis technique addresses risks in any or all of the following areas – schedule risks, budget risks or technical risks. Through comparative analysis, it has been revealed that a majority of risk analysis techniques focus on schedule or budget risks. Very little has been documented in terms of technical risk analysis techniques. In an era where clients are demanding and expecting higher quality projects and finishes, project managers must endeavor to invest time and resources to ensure that the few existing technical risk analysis techniques are developed and further refined, and that new technical risk analysis techniques are developed to suit the current construction industries requirements.

Cost-effectiveness of mammographic screening in Australia

The purpose of this research was to estimate the cost-effectiveness of mammographic screening to supplement the results of the National Evaluation of Breast Cancer Screening which identified the mortality benefit as the most sensitive parameter. This appraisal used a different computer model, MISCAN, which models the effects of introducing a national screening program into a previously unscreened population, rather than basing estimates on the assumption of a fully established program. For the 40 to 49 age group a mortality reduction of 8 per cent was assumed, rather than the 30 per cent estimate utilised in the National Evaluation. The revised estimate is based on the two Swedish trials (Malmo and WE). New estimates for treatment costs were also incorporated into the MISCAN model. The cost-effectiveness of the policy recommended in the National Evaluation Report, $11 000 per life year saved with two-yearly screening of women over 40, is estimated by the MISCAN model to be $20 300. These differences arise partly from the difference in mortality effects for the 40 to 49 age group, but also from differences inherent in the steady-state and dynamic population approaches to modelling premature deaths averted. The MISCAN results confirm that screening for women over 50 is more cost-effective than screening women under 50. Screening all women aged 50 to 69 every two to three years is reasonable value for money. For women aged 40 to 49 the mortality benefit and cost-effectiveness is less clear, and it would be prudent to allow screening in this group until further evidence is available.

A randomised trial of robotic and open prostatectomy in men with localised prostate cancer

Background
Prostate cancer is the most common male cancer in the Western world however there is ongoing debate about the optimal treatment strategy for localised disease. While surgery remains the most commonly received treatment for localised disease in Australia more recently a robotic approach has emerged as an alternative to open and laparoscopic surgery. However, high level data is not yet available to support this as a superior approach or to guide treatment decision making between the alternatives. This paper presents the design of a randomised trial of Robotic and Open Prostatectomy for men newly diagnosed with localised prostate cancer that seeks to answer this question.

Methods
200 men per treatment arm (400 men in total) are being recruited after diagnosis and before treatment through a major public hospital outpatient clinic and randomised to 1) Robotic Prostatectomy or 2) Open Prostatectomy. All robotic prostatectomies are being performed by one surgeon and all open prostatectomies are being performed by one other surgeon. Outcomes are being measured pre-operatively and at 6 weeks and 3, 6, 12 and 24 months post-surgery. Oncological outcomes are being related to positive surgical margins, biochemical recurrence +/ the need for further treatment. Non-oncological outcome measures include: pain, physical and mental functioning, fatigue, summary (preference-based utility scores) and domain-specific QoL (urinary incontinence, bowel function and erectile function), cancer specific distress, psychological distress, decision-related distress and time to return to usual activities. Cost modelling of each approach, as well as full economic appraisal, is also being undertaken.

Discussion
The study will provide recommendations about the relative benefits of Robotic and Open Prostatectomy to support informed patient decision making about treatment for localised prostate cancer; and to assist in treatment services planning for this patient group. Trial Registration ACTRN12611000661976

It is what you do, and the way that you do it : working smarter, not harder for best practice.

By integrating some of the required tasks, assessment, planning, appraisal and self review, teachers can use one set of documentation for a number of tasks. What this can do is highlight common threads and inform teachers about ways to improve practice and create improved outcomes for children, families - and teachers.

Charting Australia Felix : re-interpreting cultural landscape creation through a land health lens

The landscape of the Western District of Victoria has been extensively transformed in the imagery and aspirations of United Kingdom estates but markedly modified to address the climatic and agricultural prospects of the District landscape. By assembling land, the original squatters had a clean sheet to map, comprehend, and configure an economically viable pastoral estate. ‘Charting Australia Felix’ seeks to ascertain the spatial and geographical logic and rationale that informed this pastoral estate formation. These settlers mastered an economically viable estate that respected climate, soil quality and ensured water security which were the essential ingredients of a quality land holding; their successful grazing and specialisation were dependent upon these attributes. Thus, they successfully comprehended the essences of the landscape in line with contemporary land care and rural land management strategies. Charting Australia Felix involves the use of the historic landscape characterisation method to map, assess and model some 5 exemplar pastoral stations in the Western District to quantify their temporal landscape characteristics, their responses to landscape evolution, and change to test and quantify what the archetypes are that may have informed these patterns. Using Murndal and Glenormiston pastoral stations as the lens of investigation, a preliminary appraisal is offered in this paper.