Reducing office workers' sitting time: rationale and study design for the Stand Up Victoria cluster randomized trial

Background
Excessive time spent in sedentary behaviours (sitting or lying with low energy expenditure) is associated with an increased risk for type 2 diabetes, cardiovascular disease and some cancers. Desk-based office workers typically accumulate high amounts of daily sitting time, often in prolonged unbroken bouts. The Stand Up Victoria study aims to determine whether a 3-month multi-component intervention in the office setting reduces workplace sitting, particularly prolonged, unbroken sitting time, and results in improvements in cardiometabolic biomarkers and work-related outcomes, compared to usual practice.

Methods/design
A two-arm cluster-randomized controlled trial (RCT), with worksites as the unit of randomization, will be conducted in 16 worksites located in Victoria, Australia. Work units from one organisation (Department of Human Services, Australian Government) will be allocated to either the multi-component intervention (organisational, environmental [heightadjustable workstations], and individual behavioural strategies) or to a usual practice control group. The recruitment target is 160 participants (office-based workers aged 18–65 years and working at least 0.6 full time equivalent) per arm. At each assessment (0- [baseline], 3- [post intervention], and 12-months [follow-up]), objective measurement via the activPAL3 activity monitor will be used to assess workplace: sitting time (primary outcome); prolonged sitting time (sitting time accrued in bouts of ≥30 minutes); standing time; sit-to-stand transitions; and, moving time. Additional outcomes assessed will include: non-workplace activity; cardio-metabolic biomarkers and health indicators (including fasting glucose, lipids and insulin; anthropometric measures; blood pressure; and, musculoskeletal symptoms); and, work-related outcomes (presenteeism, absenteeism, productivity, work performance). Incremental cost-effectiveness and identification of both workplace and individual-level mediators and moderators of change will also be evaluated.

Research in practice : an exercise in generative urban massing

The following paper explores practice based research as a means of identifying issues within current urban design methods. It considers the application of parametric systems as a means of addressing these issues. These systems are developed and tested across both Australian and international urban design projects within Grimshaw Architects. A methodology is proposed for the development and application of these parametric tools across multiple scales of design resolution. It reports on the application of a set of parametric urban scale massing tools in real world design projects. This exploration is carried out in distinct phases of design defined by the scale of resolution. The phasing allows for discrete problems to be addressed more effectively at different stages of the design process while still encouraging a seamless, bi directional workflow through a digital master model.

Advancing community engagement practice for strategic urban planning : learning from allied and remote disciplines

Urban planning has the potential to draw on allied and remote disciplines to improve community consultation processes for strategic planning projects. Urban design and landscape architecture have quantitative and qualitative methods which can be utilised to visualise different options of urban intensification which may fit within communities’ expectations of change. Furthermore political science has long used scientifically established psychometric techniques to collect data from broad sections of the population, analysing demographic profiles of communities and understanding their perceptions and attitudes. By appropriating quantitative and qualitative methods from other disciplines, urban planning policies can be developed which may reflect communities’ aspirations of amenity and neighbourhood character. The aim of this paper is to assist local government urban planners with their community engagement practice in order to form policies which are acceptable to the affected communities. The paper draws on Victoria as a case study of community engagement practice, examines research methods from allied and remote disciplines and proposes a community engagement framework which introduces rigour within the community engagement process.

Shifts in thinking and practice: reflecting on an applied learning programme

The implementation of the first iteration of a curriculum for an applied learning programme for police trainers received a hostile response from participants. It was perceived as irrelevant and supplanting, rather than augmenting, trainers’ fixed and untested training practices. This paper presents the reflections on my journey as a nonpolice person straddling an outsider-insider position while challenging that which is taken-for-granted and introducing an educative intent, as opposed to a doctrinal, technical intent, to police training. On a daily basis I simultaneously work within and against the prevailing D/discourses and dominant subcultures, while establishing and nurturing relationships with police trainers: being teacher, coach and ‘critical friend’. The response to the second and now third iterations of the learning programme has been increasingly positive, revealing shifts in trainers’ thinking and practice.

Towards global benchmarking of food environments and policies to reduce obesity and diet-related non-communicable diseases : design and methods for nation-wide surveys

Introduction: 

The contribution of Building Information Modelling (BIM) to Green Building Design and Assessment in Abu Dhabi "ESTIDAMA"

Estidama is a mandatory Green Building code in Abu Dhabi by which the compliance of building design is being assessed. This paper examines the current design and assessment approaches for Green Buildings to identify the reasons that lead to delay defects and it investigates a new approach for improvement. The available literature provides a realistic understanding to the problems and shows the road to some potential solutions. The identified problems were mainly attributed to the manual assessment with too much human interference. The piled documents with limited resources left the assessment system too slow to handle the whole projects within the greater Abu Dhabi engendering high risk of the commitment to review mistakes. Therefore, this paper investigates the potentiality of automating several stages via the use of Building Information Modeling (BIM) into the assessment process. Different experienced participants from all aspects within the construction industry were interviewed to contribute to the research. Also, a close question questionnaire was distributed to examine the current practice in Abu Dhabi to compare it with the initial findings. The findings point out significant requirements to adopt BIM in the assessment process, such as the availability of proper contracts form to shape the relationship between BIM parties and the readiness of the current system. Hence, the authors suggest a new model that integrates BIM capabilities within the system to accelerate the process and reduce human involvement.

Development of a management algorithm for post-operative pain (MAPP) after total knee and total hip replacement: study rationale and design

Evidence from clinical practice and the extant literature suggests that post-operative pain assessment and treatment is often suboptimal. Poor pain management is likely to persist until pain management practices become consistent with guidelines developed from the best available scientific evidence. This work will address the priority in healthcare of improving the quality of pain management by standardising evidence-based care processes through the incorporation of an algorithm derived from best evidence into clinical practice. In this paper, the methodology for the creation and implementation of such an algorithm that will focus, in the first instance, on patients who have undergone total hip or knee replacement is described.

Enhancing and assessing group and team learning in architecture and related design contexts

EXECUTIVE SUMMARYTeamwork skills are essential in the design industry where practitioners negotiate often-conflicting design options in multi-disciplinary teams. Indeed, many of the bodies that accredit design courses explicitly list teamwork skills as essential attributes of design graduates e.g., the Australian Institute of Architects (AIA), Royal Institute of British Architects (RIBA), the National Council of Architectural Registration Boards (NCARB) of the United States and the Institution of Engineers, Australia (IEAust). In addition to the need to meet the demands of the accrediting bodies, there are many reasons for the ubiquitous use of teamwork assignments in design schools. For instance, teamwork learning is seen as being representative of work in practice where design is nearly always a collaborative activity. Learning and teaching in teamwork contexts in design education are not without particular challenges. In particular, two broad issues have been identified: first, many students leave academia without having been taught the knowledge and skills of how to design in teams; second, teaching, assessment and assignment design need to be better informed by a clear understanding of what leads to effective teamwork and the learning of teamwork skills. In recognition of the lack of a structured approach to integrating teamwork learning into the curricula of design programs, this project set out to answer three primary research questions: • How do we teach teamwork skills in the context of design? • How do we assess teamwork skills?• How do design students best learn teamwork skills?In addition, four more specific questions were investigated:1. Is there a common range of learning objectives for group-and-team-work in architecture and related design disciplines that will enable the teaching of consistent and measurable outcomes?2. Do group and team formation methods, learning styles and team-role preferences impact students’ academic and course satisfaction outcomes?3. What combinations of group-and-team formation methods, teaching and assessment models significantly improve learning outcomes?4. For design students across different disciplines with different learning styles and cultural origins, are there significant differences in performance, student satisfaction (as measured through questionnaires and unit evaluations), group-and-team working abilities and student participation?To elucidate these questions, a design-based research methodology was followed comprising an iterative series of enquiries: (a) A literature review was completed to investigate: what constitutes effective teamwork, what contributes to effectiveness in teams, what leads to positive design outcomes for teams, and what leads to effective learning in teams. The review encompassed a range of contexts: from work-teams in corporate settings, to professional design teams, to education outside of and within the design disciplines. The review informed a theoretical framework for understanding what factors impact the effectiveness of student design teams. (b) The validity of this multi-factorial Framework of Effectiveness in Student Design Teams was tested via surveys of educators’ teaching practices and attitudes, and of students’ learning experiences. 638 students and 68 teachers completed surveys: two pilot surveys for participants at the four partner institutions, which then informed two national surveys completed by participants from the majority of design schools across Australia. (c) The data collected provided evidence for 22 teamwork factors impacting team effectiveness in student design teams. Pedagogic responses and strategies to these 22 teamwork factors were devised, tested and refined via case studies, focus groups and workshops. (d) In addition, 35 educators from a wide range of design schools and disciplines across Australia attended two National Teaching Symposiums. The first symposium investigated the wider conceptualisation of teamwork within the design disciplines, and the second focused on curriculum level approaches to structuring the teaching of teamwork skills identified in the Framework.The Framework of Effectiveness in Student Design Teams identifies 22 factors impacting effective teamwork, along with teaching responses and strategies that design educators might use to better support student learning. The teamwork factors and teaching strategies are categorised according to three groups of input (Task Characteristics, Individual Level Factors and Team Level Factors), two groups of processes (Teaching Practice & Support Structures and Team Processes), and three categories of output (Task Performance, Teamwork Skills, and Attitudinal Outcomes). Eight of the 22 teamwork factors directly relate to the skills that need to be developed in students, one factor relates to design outputs, and the other thirteen factors inform pedagogies that can be designed for better learning outcomes. In Table 10 of Section 4, we outline which of the 22 teamwork factors pertain to each of five stakeholder groups (curriculum leaders, teachers, students, employers and the professional bodies); thus establishing who will make best use the information and recommendations we make. In the body of this report we summarise the 22 teamwork factors and teaching strategies informed by the Framework of Effectiveness in Student Design Teams, and give succinct recommendations arising from them. This material is covered in depth by the project outputs. For instance, the teaching and assessment strategies will be expanded upon in a projected book on Teaching Teamwork in Design. The strategies are also elucidated by examples of good practice presented in our case studies, and by Manuals on Teamwork for Teachers and Students. Moreover, the project website (design.com index.html=""> visited by representatives of stakeholder groups in Australia and Canada), is seeding a burgeoning community of practice that promises dissemination, critical evaluation and the subsequent refinement of our materials, tools, strategies and recommendations. The following three primary outputs have been produced by the project in answer to the primary research questions:1. A theoretical Framework of Effectiveness in Student Design Teams;2. Manuals on Teamwork for Teachers and Students (available from the website);3. Case studies of good/innovative practices in teaching and assessing teamwork in design;In addition, five secondary outputs/outcomes have been produced that provide more nuanced responses:4. Detailed recommendations for the professional accrediting bodies and curriculum leaders;5. Online survey data (from over 700 participants), plus Team Effectiveness Scale to determine the factors influencing effective learning and successful outputs for student design teams;6. A community of practice in policy, programs, practice and dialogue;7. A detailed book proposal (with sample chapter), submitted to prospective publishers, on Teaching Teamwork in Design; 8. An annotated bibliography (accessed via the project website) on learning, teaching and assessing teamwork.The project has already had an international impact. As well as papers presented in Canada and New Zealand, the surveys were participated in by six Canadian schools of architecture, whose teaching leaders also provided early feedback on the project aims and objectives during visits made to them by the project leader. In addition, design schools in Vancouver, Canada, and San Diego in the USA have already utilised the Teacher’s Manual, and in February 2014 the project findings were discussed at Tel Aviv University in a forum focusing on the challenges for sustainability in architectural education.design.com>

Remixing to design learning: social media and peer-to-peer interaction

Social and participatory media offer opportunities to interact and share user-generated content. After some investigation and research, the authors are in their initial stages of using such media to provide a pathway for thinking about learning design in higher education. Using the concept of remixing, the authors aim to creatively blend and manipulate ideas to build a sustainable approach to course/program enhancement. Remixing is touted as one of the most important practices within the field of open educational resources, but it is not mainstream practice in educational thinking or design. This article highlights the authors’ approach and uses their pre-service teacher education program and their previous high school study as an example of remixing. The high school study involved the integration of social and participatory media into the face-to-face classroom; Author 1 was the practitioner researcher in the high school study. This article articulates the use of online social environments at the high school level to highlight concepts of sharing and remixing as a creative and social approach to designing learning in higher education. It also attempts to consider this within a course-wide approach.

Clinical practice guidelines for nurse-administered procedural sedation and analgesia in the cardiac catheterization laboratory: a modified Delphi study

Aim : To develop clinical practice guidelines for nurse-administered procedural sedation and analgesia in the cardiac catheterization laboratory.

Background : Numerous studies have reported that nurse-administered procedural sedation and analgesia is safe. However, the broad scope of existing guidelines for the administration and monitoring of patients who receive sedation during medical procedures without an anaesthetist present means there is a lack of specific guidance regarding optimal nursing practices for the unique circumstances where nurse-administered procedural sedation and analgesia is used in the cardiac catheterization laboratory.

Methods : A sequential mixed methods design was used. Initial recommendations were produced from three studies conducted by the authors: an integrative review; a qualitative study; and a cross-sectional survey. The recommendations were revised according to responses from a modified Delphi study. The first Delphi round was completed by nine senior cardiac catheterization laboratory nurses. All but one of the draft recommendations met the predetermined cut-off point for inclusion with 59 responses to the second round. Consensus was reached on all recommendations.

Implications for nursing : The guidelines that were derived from the Delphi study offer 24 recommendations within six domains of nursing practice: Pre-procedural assessment; Pre-procedural patient and family education; Pre-procedural patient comfort; Intra-procedural patient comfort; Intra-procedural patient assessment and monitoring; and Postprocedural patient assessment and monitoring.

Conclusion : These guidelines provide an important foundation towards the delivery of safe, consistent and evidence-based nursing care for the many patients who receive sedation in the cardiac catheterization laboratory setting.

Therapist-assisted Internet-delivered cognitive behavior therapy for depression and anxiety: translating evidence into clinical practice.

This dissemination study examined the effectiveness of therapist-assisted Internet-delivered Cognitive Behavior Therapy (ICBT) when offered in clinical practice. A centralized unit screened and coordinated ICBT delivered by newly trained therapists working in six geographically dispersed clinical settings. Using an open trial design, 221 patients were offered 12 modules of ICBT for symptoms of generalized anxiety (n=112), depression (n=83), or panic (n=26). At baseline, midpoint and post-treatment, patients completed self-report measures. On average, patients completed 8 of 12 modules. Latent growth curve modeling identified significant reductions in depression, anxiety, stress and impairment (d=.65-.78), and improvements in quality of life (d=.48-.66). Improvements in primary symptoms were large (d=.91-1.25). Overall, therapist-assisted ICBT was effective when coordinated across settings in clinical practice, but further attention should be given to strategies to improve completion of treatment modules.

Engineers' professional learning: a practice-theory perspective

With the increasing challenges facing professional engineers working in more complex, global and interdisciplinary contexts, different approaches to understanding how engineers practice and learn are necessary. This paper draws on recent research in the social sciences from the field of workplace learning, to suggest that a practice-theory perspective on engineers' professional learning is fruitful. It shifts the focus from the attributes of the individual learner (knowledge, skills and attitudes) to the attributes of the practice (interactions, materiality, opportunities and challenges). Learning is thus more than the technical acquisition and transfer of knowledge, but a complex bundle of activities, that is, social, material, embodied and emerging. The paper is illustrated with examples from a research study of the learning of experienced engineers in the construction industry to demonstrate common practices – site walks and design review meetings – in which learning takes place.

On exploratory factor analysis: a review of recent evidence, an assessment of current practice, and recommendations for future use

Exploratory factor analysis (hereafter, factor analysis) is a complex statistical method that is integral to many fields of research. Using factor analysis requires researchers to make several decisions, each of which affects the solutions generated. In this paper, we focus on five major decisions that are made in conducting factor analysis: (i) establishing how large the sample needs to be, (ii) choosing between factor analysis and principal components analysis, (iii) determining the number of factors to retain, (iv) selecting a method of data extraction, and (v) deciding upon the methods of factor rotation. The purpose of this paper is threefold: (i) to review the literature with respect to these five decisions, (ii) to assess current practices in nursing research, and (iii) to offer recommendations for future use. The literature reviews illustrate that factor analysis remains a dynamic field of study, with recent research having practical implications for those who use this statistical method. The assessment was conducted on 54 factor analysis (and principal components analysis) solutions presented in the results sections of 28 papers published in the 2012 volumes of the 10 highest ranked nursing journals, based on their 5-year impact factors. The main findings from the assessment were that researchers commonly used (a) participants-to-items ratios for determining sample sizes (used for 43% of solutions), (b) principal components analysis (61%) rather than factor analysis (39%), (c) the eigenvalues greater than one rule and screen tests to decide upon the numbers of factors/components to retain (61% and 46%, respectively), (d) principal components analysis and unweighted least squares as methods of data extraction (61% and 19%, respectively), and (e) the Varimax method of rotation (44%). In general, well-established, but out-dated, heuristics and practices informed decision making with respect to the performance of factor analysis in nursing studies. Based on the findings from factor analysis research, it seems likely that the use of such methods may have had a material, adverse effect on the solutions generated. We offer recommendations for future practice with respect to each of the five decisions discussed in this paper.

Assessing and managing breast cancer risk: Clinicians' current practice and future needs

Decision support tools for the assessment and management of breast cancer risk may improve uptake of prevention strategies. End-user input in the design of such tools is critical to increase clinical use. Before developing such a computerized tool, we examined clinicians' practice and future needs. Twelve breast surgeons, 12 primary care physicians and 5 practice nurses participated in 4 focus groups. These were recorded, coded, and analyzed to identify key themes. Participants identified difficulties assessing risk, including a lack of available tools to standardize practice. Most expressed confidence identifying women at potentially high risk, but not moderate risk. Participants felt a tool could especially reassure young women at average risk. Desirable features included: evidence-based, accessible (e.g. web-based), and displaying absolute (not relative) risks in multiple formats. The potential to create anxiety was a concern. Development of future tools should address these issues to optimize translation of knowledge into clinical practice.

Transition to specialty practice programs in Australian emergency nursing

 Transition to Specialty Practice Programs (TSPPs) provide structured support and education to novice nurses. This study examined the prevalence, design, characteristics and functions of emergency nursing TSPPs in Australia, and found that TSPPs served an important function in recruitment, preparation and retention of emergency nurses. A framework for future emergency nursing TSPPs was developed based on study findings.