Knowledge-in-practice in the caring professions : multidisciplinary perspectives

Contents:  Ideas of knowledge in practice / Struan Jacobs -- Information, knowledge, and wisdom in medical practice / P. B. Greenberg -- The practice of the psychiatrist / Alex Holmes -- Social work knowledge-in-practice / Heather D'Cruz -- Disability : a personal approach / Lisa Chaffey -- Knowledge in the making : an analytical psychology perspective / Joy Norton -- Knowledge to action in the practice of nursing / Alison Hutchinson, Tracey Bucknall -- The risky business of birth / Frances Sheean and Jennifer M. Cameron -- Skills for person-centred care : health professionals supporting chronic condition prevention and self-management / Sharon Lawn and Malcolm Battersby -- Knowledge and reasoning in practice : an example from physiotherapy and occupational therapy / Megan Smith ... [et al.] -- Using knowledge in the practice of dealing with addiction : an ideal worth aiming for / Peter Miller.

Supporting self-management of chronic health conditions : Common approaches

Objective : The aims of this paper are to provide a description of the principles of chronic condition self-management, common approaches to support currently used in Australian health services, and benefits and challenges associated with using these approaches.
Methods : We examined literature in this field in Australia and drew also from our own practice experience of implementing these approaches and providing education and training to primary health care professionals and organizations in the field.
Results : Using common examples of programs, advantages and disadvantages of peer-led groups (Stanford Courses), care planning (The Flinders Program), a brief primary care approach (the 5As), motivational interviewing and health coaching are explored.
Conclusions : There are a number of common approaches used to enhance self-management. No one approach is superior to other approaches; in fact, they are often complimentary.
Practice implications : The nature and context for patients’ contact with services, and patients’ specific needs and preferences are what must be considered when deciding on the most appropriate support mode to effectively engage patients and promote self-management. Choice of approach will also be determined by organizational factors and service structures. Whatever self-management support approaches used, of importance is how health services work together to provide support.

The Melbourne 2006 Commonwealth Games : what does it mean for the local property market?

In 2006 Melbourne will host the 18th Commonwealth Games with Brisbane being the last Australian city to host this event over two decades ago in 1982. Melbourne has not held a major global sporting event since the 1956 Olympic Games, although the 2006 Commonwealth Games follows on from the successful 2000 Sydney Olympics. These sporting events have continued to grow from strength to strength, and have been assisted by Australia's close affiliation with sport and the widespread global media coverage. In a similar manner to other sporting events that Melbourne hosts, including the Australian Tennis Open, Formula One Grand Prix, Motorcycle Grand Prix, Melbourne Cup and Australian Football League, the city and its inhabitants are consumed by these events. The 2006 Commonwealth Games is certain to follow this trend.
The task of hosting the Commonwealth Games is enormous, although actively pursued in a fierce bidding process by competing cities. The benefits are undisputed and include an influx of visitors to the host city, an opportunity to enhance or rebuild infrastructure such as transport, plus the worldwide focus on the host city before and during the event. A high level of planning is undertaken for years well in advance of the event, and this may have an effect on the surrounding property market. Through the media both buyers and sellers are constantly reminded of the upcoming Games, the venues and the increased demand that will occur. Accordingly, this research investigates the task of hosting a major global sporting event such as the Commonwealth Games, and importantly how affects infrastructure in a host city. Attention is placed on the 2006 Commonwealth Games and the Melbourne property market. Whilst every host city differs in characteristics such as size, location and timing of the event, the findings of this study will assist a future host city to plan for the highly irregular circumstances that accompany a high profile one-off major sporting event.

Role of exercise in the development of bone strength during growth

Exercise during growth may increase peak bone mass; if the benefits are maintained it may reduce the risk of fracture later in life (1). It is hypothesised that exercise will preferentially enhance bone formation on the surface of cortical bone that is undergoing bone modeling at the time (2). Therefore, exercise may increase bone mass accrual on the outer periosteal surface during the pre- and peri-pubertal years, and on the inner endocortical surface during puberty (3). An increase in bone formation on the periosteal surface is, however, more effective for increasing bone strength than medullary contraction (4). While exercise may have a role in osteoporosis prevention, there is little evidential basis to support this notion. It is generally accepted that weight-bearing exercise is important, but it is not known how much, how often, what magnitude or how long children need to exercise before a clinically important increase in bone density is obtained. In this thesis, the effect of exercise on the growing skeleton is investigated in two projects. The first quantifies the magnitude and number of loads associated with and in a moderate and low impact exercise program and non-structured play. The second project examines how exercise affects bone size and shape during different stages of growth. Study One: The Assessment of the Magnitude of Exercise Loading and the Skeletal Response in Girls Questions: 1) Does moderate impact exercise lead to a greater increase in BMC than low impact exercise? 2) Does loading history influence the osteogenic response to moderate impact exercise? 3) What is the magnitude and number of loads that are associated with a moderate and low impact exercise program? Methods: Sixty-eight pre-and early-pubertal girls (aged 8.9±0.2 years) were randomised to either a moderate or low impact exercise regime for 8.5-months. In each exercise group the girls received either calcium fortified (-2000 mg/week) or non-fortified foods for the duration of the study. The magnitude and number of loads associated with the exercise programs and non-structured play were assessed using a Pedar in-sole mobile system and video footage, respectively. Findings: After adjusting for baseline BMC, change in length and calcium intake, the girls in the moderate exercise intervention showed greater increases in BMC at the tibia (2.7%) and total body (1.3%) (p ≤0.05). Girl's who participated in moderate impact sports outside of school, showed greater gains in BMC in response to the moderate impact exercise program compared to the low impact exercise program (2.5 to 4.5%, p ≤0.06 to 0.01). The moderate exercise program included -400 impacts per class, that were applied in a dynamic manner and the magnitude of impact was up to 4 times body weight. Conclusion: Moderate-impact exercise may be sufficient to enhance BMC accrual during the pre-pubertal years. However, loading history is likely to influence the osteogenic response to additional moderate impact exercise. These findings contribute towards the development of school-based exercise programs aimed at improving bone health of children. Study Two: Exercise Effect on Cortical Bone Morphology During Different Stages of Maturation in Tennis Players Questions: 1) How does exercise affect bone mass (BMC) bone geometry and bone strength during different stages of growth? 2) Is there an optimal stage during growth when exercise has the greatest affect on bone strength? Methods: MRI was used to measure average total bone, cortical and medullary areas at the mid- and distal-regions of the playing and non-playing humerii in 47 pre-, peri- and post-pubertal competitive female tennis players aged 8 to 17 years. To assess bone rigidity, each image was imported into Scion Image 4.0.2 and the maximum, minimum and polar second moments of area were calculated using a custom macro. DXA was used to measure BMC of the whole humerus. Longitudinal data was collected on 37 of the original cohort. Findings: Analysis of the entire cohort showed that exercise was associated with increased BMC and cortical area (8 to 14%), and bone rigidity (11 to 23%) (all p ≤0.05). The increase in cortical bone area was associated with periosteal expansion in the pre-pubertal years and endocortical contraction in the post-pubertal years (p ≤0.05). The exercise-related gains in bone mass that were accrued at the periosteum during the pre-pubertal years, did not increase with advanced maturation and/or additional training. Conclusion: Exercise increased cortical BMC by enhancing bone formation on the periosteal surface during the pre-pubertal years and on the endocortical surface in the post-pubertal years. However, bone strength only increased in response to bone acquisition on the periosteal surface. Therefore the pre-pubertal years appear to be the most opportune time for exercise to enhance BMC accrual and bone strength

Field fitness testing and training patterns for women in three masters sports

This study involved 33 women, aged 44-71 years involved in either masters swimming, field hockey or lawn bowls. Subjects undertook a 12-week competitive training program and participated in one fitness test session, to trial field-based tests of aerobic fitness, muscle power, body fat and flexibility. The field-based fitness testing proved practical. Athlete fitness was affected by age, competitiveness, training intensity and volume.

The contribution of upper limb and total body movement to adolescents’ energy expenditure whilst playing Nintendo Wii

Little research documents the contribution of upper limb and total body movement to energy expenditure (EE) during active video gaming. To address this, EE, heart rate (HR), and, upper limb and total body movement were assessed in 11- to 17-year-old adolescents whilst playing three active (Nintendo Wii) and one sedentary (XBOX 360) video games. Non-dominant upper limb activity, EE and HR were significantly greater during Wii Sports boxing [mean 267.2 (SD 115.8) J kg−1 min−1; 136.7 (24.5) beats min−1] than tennis or bowling (P ≤ 0.044). For all active games hip activity best predicted EE (R 2 ≥ 0.53), with two-measure models of HR and single-site activity data, and multi-site activity data, similarly explaining the variance in EE (R 2 ≥ 0.64). The physiological cost of upper-body orientated active video games increased when movement of both upper limbs was encouraged. Improvements in EE explanatory power provide support for multi-site activity monitoring during unique, non-ambulatory activities.

Energy expenditure in adolescents playing new generation computer games

Objective: To compare the energy expenditure of adolescents when playing sedentary and new generation active computer games.

Design: Cross sectional comparison of four computer games. Setting Research laboratories.

Participants: Six boys and five girls aged 13–15 years.

Procedure: Participants were fitted with a monitoring device validated to predict energy expenditure. They played four computer games for 15 minutes each. One of the games was sedentary (XBOX 360) and the other three were active (Wii Sports).

Main outcome measure: Predicted energy expenditure, compared using repeated measures analysis of variance.

Results: Mean (standard deviation) predicted energy expenditure when playing Wii Sports bowling (190.6 (22.2) kl/kg/min), tennis (202.5 (31.5) kl/kg/min), and boxing (198.1 (33.9) kl/kg/min) was significantly greater than when playing sedentary games (125.5 (13.7) kl/kg/min) (P<0.001). Predicted energy expenditure was at least 65.1 (95% confidence interval 47.3 to 82.9) kl/kg/min greater when playing active rather than sedentary games.

Conclusions: Playing new generation active computer games uses significantly more energy than playing sedentary computer games but not as much energy as playing the sport itself. The energy used when playing active Wii Sports games was not of high enough intensity to contribute towards the recommended daily amount of exercise in children.

Comparison of energy expenditure in adolescents when playing new generation and sedentary computer games: cross sectional study

Objective : To compare the energy expenditure of adolescents when playing sedentary and new generation active computer games.

Design : Cross sectional comparison of four computer games.

Setting : Research laboratories.

Participants : Six boys and five girls aged 13-15 years.

Procedure : Participants were fitted with a monitoring device validated to predict energy expenditure. They played four computer games for 15 minutes each. One of the games was sedentary (XBOX 360) and the other three were active (Wii Sports).

Main outcome measure : Predicted energy expenditure, compared using repeated measures analysis of variance.

Results : Mean (standard deviation) predicted energy expenditure when playing Wii Sports bowling (190.6 (22.2) kJ/kg/min), tennis (202.5 (31.5) kJ/kg/min), and boxing (198.1 (33.9) kJ/kg/min) was significantly greater than when playing sedentary games (125.5 (13.7) kJ/kg/min) (P<0.001). Predicted energy expenditure was at least 65.1 (95% confidence interval 47.3 to 82.9) kJ/kg/min greater when playing active rather than sedentary games.

Conclusions : Playing new generation active computer games uses significantly more energy than playing sedentary computer games but not as much energy as playing the sport itself. The energy used when playing active Wii Sports games was not of high enough intensity to contribute towards the recommended daily amount of exercise in children.

Alternative water strategies in public domains : innovative strategies in progress along North Terrace, Adelaide

Water sensitive design on our urban threshold is increasingly becoming topical. In Adelaide it is being driven by stormwater management strategies and economic efficiencies in a city that is beginning to embrace its Mediterranean environment, low water sustainability, and whether our showpiece public domains in Adelaide can afford large expanses of manicured lawns.

This paper reviews four projects in progress along the North Terrace in Adelaide. The first involves a major redesign of First Creek as it traverses Adelaide Botanic Garden to address stormwater management issues. The redesign includes strategies to control flash flooding, to cleanse stream water from pollutants, and to carefully incorporate a wetland system as an integral botanical and horticultural feature of a botanic garden. Further down North Terrace, the University of Adelaide is evaluating a scenario that will totally redesign Goodman Crescent, its picture-postcard promenade lawn. The scenario is to host an integrated water retention and water purification and cleansing system that will service independently of mains water an irrigation system and a waterfall. The proposal draws upon a similar strategy recently adopted by the South Australian Museum to capture and cleanse surface and roof water but place the installation and process on display as part of its overall biodiversity museum display that will unfold over the next five years under director Tim Flannery. The fourth example, in process at present, is to devise an integrated water system that may enable the Government House grounds to remove itself from dependence upon costly mains water to totally sustain its extensive gardens and lawns.

Importantly each project has similar threads: creative water maximization and purification use, and a desire to place these ‘installations’ on display as public statements of their commitment to water sustainability in Adelaide. But radically, here are four prominent cultural institutions readily willing to redefine the notion and traditional visual imagery of a ‘wetland’ on what is the main cultural boulevard of a capital city.

The end of economic growth? A contracting threshold hypothesis

This paper argues that GDP growth in both developed and developing countries has associated costs that can outweigh the benefits and thus reduce sustainable well-being. This conclusion is based upon the findings of empirical applications of the Genuine Progress Indicator (GPI) to a range of countries in the Asia-Pacific region. The studies conducted on seven Asia-Pacific countries indicate that, in the case of five of the seven nations, more recent GDP growth has reduced the sustainable well-being experienced by the average citizen residing within them. Moreover, the threshold point at which the costs of GDP growth outweigh the benefits appears to be contracting (i.e., occurring at a much lower per capita level of GDP). This paper therefore introduces a new contracting threshold hypothesis: as the economies of the Asia-Pacific region and the world collectively expand in a globalised economic environment, there is a contraction over time in the threshold level of per capita GDP. As a consequence, the threshold point confronting growth late-comers (i.e., developing countries) occurs at a much lower level of sustainable welfare than what wealthy nations currently enjoy. The consequences of this for developing countries are clearly significant and require a new approach to economic development.

Interfacial energy states of moisture-exposed cracks in mica

Results of crack growth observations on mica in water-containing environments are described. The study focuses on equilibrium crack states for reversed loading cycles, i.e., for initial propagation through virgin solid and subsequent retraction-repropagation through healed or misoriented-healed interfaces. Departures from these equilibrium states are manifest as steady-state forward or backward crack velocities at specific applied loads. The equilibria are thereby interpreted as quiescent, threshold configurations G = W_E, with G the Griffith mechanical-energy-release rate and W_E the Dupré work of adhesion, on crack velocity (v-G) diagrams. Generally, W_E is found to decrease with concentration of water, in accordance with a Gibbs formalism. Hysteresis is observed in the forward-backward-forward crack propagation cycle, signifying a reduction in the adhesion energy on exposure of the open interface to environmental species prior to healing. This hysteresis is especially marked for those interfaces that are misoriented before healing, indicating that the structure of the underlying solid substrate as well as of the intervening fluid is an important consideration in the interface energetics. The equilibrium states for different environments can be represented on a simple energy-level diagram, as differences between thermodynamic end-point states: initial, closed-interface states refer to crystallographic bonding configurations ahead of the crack-tip adhesion zone; final, open interface states refer to configurations behind the crack-tip zone. The significance of this diagram in relation to the fundamental atomic structure of interfaces in fracture and other adhesion geometries, including implications concerning kinetics, is discussed.

Pressurized internal lenticular cracks at healed mica interfaces

The equilibrium states of internal penny cracks at interfaces in thin-sheet bodies are investigated. Consideration is given to cracks held open by a center-loading force from an entrapped particle in combination with a uniform pressure from a fixed mass of entrapped gas. A fracture mechanics analysis indicates that under these conditions the cracks are stable, but are amenable to growth from an enhancement in net pressure (increase in internal pressure or decrease in external pressure) or effective particle size. Essential details of the theory are confirmed by experiments on lenticular cracks at healed interfaces in muscovite mica. The results are pertinent to flaw responses in brittle ceramic systems where structural integrity is an issue.