Clinical placement and rurality of career commencement : a pilot study

This article reports on a project that aimed to discover whether rural placement can influence new graduates to take up rural positions, and what factors play a role in the decision-making. This pilot study reports the findings from a pre-survey of students (n = 110) who completed a questionnaire at the end of their rural placement in the Greater Green Triangle region, Australia. Findings are compared with matched questionnaire responses for students who subsequently completed a post-survey after graduation and who commenced work (n = 28). Rural placement appears to be associated with commencing rural practice after graduation. More graduates with an urban home address commenced rural practice than graduates with a rural home address who started their careers in the city. Longer placements may sway those with a city background to start work in a rural area.

A qualitative evaluation of a regional early psychosis service 3 years after its commencement

Objective. To outline the major findings of a qualitative evaluation of an Early Psychosis Service 3 years after its establishment.

Design. Data to evaluate the service were collected from team meetings, focus groups, individual interviews and questionnaires administered to clinicians, school staff, patients, carers and families.

Setting. Barwon Health; Mental Health, Drug and Alcohol Services provide public mental health care to the Geelong, Victoria, region (population 270 000), which is a mixed urban and rural setting. The Early Psychosis Service model implemented involved the placement of two early psychosis workers into each offive adult geographically based Area Mental Health Teams rather than the establishment of a single Early Psychosis Team.

Results. The service was found not to adhere to its original design in several key respects. Caseloads and periods of case management were found to be lower and shorter respectively than was originally planned for, caseworkers often experienced isolation and resentment from their adult service coworkers, the service was perceived to be difficult to access and premises not to be youth friendly and communication and engagement with external agencies and service providers was perceived to be poor.

Conclusions. The choice of service model, inadequate consultation with stakeholders and inadequate promotion of the service contributed to its failure to reach early expectations. Because of these and other issues, including difficulties distinguishing between early psychosis and non-psychosis, a decision was made to restructure youth services and

Effect of timing of dialysis commencement on clincial outcomes of patients with planned initiation of peritoneal dialysis in the ideal trial

Background: Since the mid-1990s, early dialysis initiation has dramatically increased in many countries. The Initiating Dialysis Early and Late (IDEAL) study demonstrated that, compared with late initiation, planned early initiation of dialysis was associated with comparable clinical outcomes and increased health care costs. Because residual renal function is a key determinant of outcome and is better preserved with peritoneal dialysis (PD), the present pre-specified subgroup analysis of the IDEAL trial examined the effects of early-compared with late-start dialysis on clinical outcomes in patients whose planned therapy at the time of randomization was PD.

Methods: Adults with an estimated glomerular filtration rate (eGFR) of 10 - 15 mL/min/1.73 m2 who planned to be treated with PD were randomly allocated to commence dialysis at an eGFR of 10 - 14 mL/min/1.73 m2 (early start) or 5 - 7 mL/min/1.73 m2 (late start). The primary outcome was all-cause mortality.

Results: Of the 828 IDEAL trial participants, 466 (56%) planned to commence PD and were randomized to early start (n = 233) or late start (n = 233). The median times from randomization to dialysis initiation were, respectively, 2.03 months [interquartile range (IQR):1.67 - 2.30 months] and 7.83 months (IQR: 5.83 - 8.83 months). Death occurred in 102 early-start patients and 96 late-start patients [hazard ratio: 1.04; 95% confidence interval (CI): 0.79 - 1.37]. No differences in composite cardiovascular events, composite infectious deaths, or dialysis-associated complications were observed between the groups. Peritonitis rates were 0.73 episodes (95% CI: 0.65 - 0.82 episodes) per patient-year in the early-start group and 0.69 episodes (95% CI: 0.61 - 0.78 episodes) per patient-year in the late-start group (incidence rate ratio: 1.19; 95% CI: 0.86 - 1.65; p = 0.29). The proportion of patients planning to commence PD who actually initiated dialysis with PD was higher in the early-start group (80% vs 70%, p = 0.01).

Conclusion: Early initiation of dialysis in patients with stage 5 chronic kidney disease who planned to be treated with PD was associated with clinical outcomes comparable to those seen with late dialysis initiation. Compared with early-start patients, late-start patients who had chosen PD as their planned dialysis modality were less likely to commence on PD.

Unmet needs and distress in people with inoperable lung cancer at the commencement of treatment

Purpose : People with lung cancer report a higher burden of unmet needs, specifically psychological and daily living unmet needs. They experience more psychological distress and more physical hardship than other tumour sites. This study examined the levels of unmet need and psychological distress in inoperable lung cancer patients at the start of treatment.

Methods : A cross-section survey methodology was employed using baseline data from a randomised controlled trial designed to evaluate a supportive care intervention. Eligible lung cancer patients were approached to participate at the start of treatment. Consenting patients completed questionnaires prior to or just after the commencement of treatment. Reliable and valid measures included Needs Assessment for Advanced Lung Cancer Patients, Hospital Anxiety and Depression Scale and Brief Distress Thermometer.

Results : Of the 108 patients participating, the top unmet need was ‘Dealing with concerns about your family’s fears and worries’ (62%); with the next four also coming from the psychological/emotional domain, but, on average, most needs related to medical communication. Thirty two percent of patients reported clinical or subclinical anxiety and 19% reported HADS scores suggestive of clinical or subclinical depression. Moreover, 39.8% of the sample reported distress above the cut-off on the distress thermometer and this was associated with higher needs for each need subscale (p < 0.05).

Conclusions : People with lung cancer have high levels of unmet needs especially regarding psychological/emotional or medical communication. People with lung cancer who are classified as distressed have more unmet needs.

An introduction to CLERP 9

An Introduction to CLERP 9, as its title suggests, is aimed at providing legal practitioners and students with an overview of Australia’s corporate governance reforms, but more than that, it also analyses the events that led to the reforms and provides practical examples of how the amendments will change corporate practices.

The book begins by defining what is generally meant by good corporate governance. It then outlines the relevant recent events that led to introduction and commencement of the Corporate Law Economic Reform Program (Audit Reform and Corporate Disclosure) Act 2004 (CLERP 9) on 1 July this year. The corporate failures of Enron and HIH – and subsequent Royal Commission – in 2001, and the failure of private auditing firms to warn of their client’s problems are well summarised.

As well as the Sarbanes Oxley Act of 2002, the US equivalent to CLERP 9, the establishment of the ASX Corporate Governance Council and the release of its Principles of Good Corporate Governance and Best Practice Recommendations are examined in detail.

The book covers all the chief changes, including the new rules for audit independence, financial disclosure, whistleblowing, remuneration for directors and executives and continuous disclosure.

Throughout, the book provides a comprehensive and easy to understand commentary on how the CLERP 9 Act alters the Corporations Act 2001 and the ASIC Act 2001, as well as highlighting important changes that affect present practice. For example, the author notes that under the auditor independence rules, when an audit firm contravenes an independence requirement, liability is placed on all members and directors of the audit firm, not just the lead auditor responsible for a particular audit. This, he says, is aimed at introducing a “culture of compliance”.

As well as providing a quick reference guide to how the CLERP 9 Act amends the Corporations and ASIC Acts at the beginning of the book, the table at the end of the book comparing the corporate governance reforms in the US, UK and Australia will be very useful for practitioners trying to make sense of how multinational clients might be liable across different jurisdictions.

Breeding biology, adult survival and territoriality of the white-browed treecreeper (climacteris affinis) in north-west Victoria, Australia

This is the first study to present empirical data describing the social organisation and breeding biology of the White-browed Treecreeper (Climacteris affinis). The species is typical of many small Australian passerines in that it has high annual survival (~80%), small clutches (mean = 1.95 ± 0.05), long breeding seasons (eggs laid August to November) and long incubation (17–18 days) and nestling periods (25–26 days), corrected for body weight. Reproductive effort is modified in response to variation in climatic conditions by adjusting the commencement of breeding and number of clutches laid per season, which is facilitated by an extended breeding season. White-browed Treecreepers occupied relatively large (mean = 8.4 ± 0.8 ha), all-purpose territories throughout the year. However, unlike many group territorial birds, territory size was not related to the number of occupants. The role of food limitation and climatic variability in relation to territory dispersion and life-history traits is explored. Facultative cooperative breeding was confirmed. Cooperative groups were formed through male philopatry, with usually only one, but up to three, male helpers present in a moderate fraction (35%) of breeding units. Thus, all species of Climacteris are now confirmed as facultative cooperatively breeding species, which provides further evidence for the aggregation of cooperative breeders at the generic level in mixed (i.e. cooperative and pair breeders) phylogenetic clades. In C. affinis, males may attain breeding positions through inheritance of their natal territory or by filling vacancies in nearby territories. Females obtained breeding positions by ‘floating’ as non-breeding residents in established territories, waiting for a vacancy to arise.

Will it work? an initial examination of the processes and outcomes of converting course materials to CD-ROMs

The Faculty of Business and Law at Deakin University (Victoria, Australia) decided to dispense of all printed post-graduate learning materials and replace them with CD-ROMs from the commencement of the 2006 academic year. In addition, CD-ROMs were developed for a limited
number of undergraduate units as part of a future delivery plan for this cohort of students. The following paper describes this project, the reasons underpinning it, and the processes the Faculty adopted to implement the project. The project is ongoing and part of a broader agenda for change
that will see an even greater application of electronic technology to teaching and learning within the Faculty. Although only initial findings and observations are possible at this stage, the project provides a basis for longitudinal reporting and, potentially, a guide for other institutions who may
be considering such a move. The paper reports on these observations and on those in the educational development arena and suggests that the Faculty will need to learn from these initial experiences and evaluate the project in greater depth to guarantee a smooth transition for all stakeholders.

Modification of tissue fatty acid composition in Murray cod (Maccullochella peelii peelii, Mitchell) resulting from a shift from vegetable oil diets to a fish oil diet.

The dynamics of fatty acid composition modifications were examined in tissues of Murray cod fed diets containing fish oil (FO), canola oil (CO) and linseed oil (LO) for a 25-week period and subsequently transferred to a FO (finishing/wash-out) diet for a further 16 weeks. At the commencement of the wash-out period, following 25 weeks of vegetable oil substitution diets, the fatty acid compositions of Murray cod fillets were reflective of the respective diets. After transfer to the FO diet, differences decreased in quantity and in numerousness, resulting in a revert to the FO fatty acid composition. Changes in percentages of the fatty acids and total accumulation in the fillet could be described by exponential equations and demonstrated that major modifications occurred in the first days of the finishing period. A dilution model was tested to predict fatty acid composition. In spite of a general reliability of the model (Y=0.9234X+0.4260, R²=0.957, P<0.001, where X is the predicted percentage of fatty acid; Y the observed percentage of fatty acid), in some instances the regression comparing observed and predicted values was markedly different from the line of equity, indicating that the rate of change was higher than predicted (i.e. Y=0.4205X+1.191, R²=0.974, P<0.001, where X is the predicted percentage of α-linolenic acid; Y the observed percentage of α-linolenic acid). Ultimately, using the coefficient of distance (D), it was shown that the fatty acid composition of fish previously fed the vegetable oil diets returned to the average variability of the fillet fatty acid composition of Murray cod after 70 or 97 days (LO and CO respectively).

Effect of fire on Benthic Algal Assemblage structure and recolonisation in intermittent streams

Dry biofilm on rocks and other substrata forms an important drought refuge for benthic algae in intermittent streams following the cessation of flow. This dry biofilm is potentially susceptible to disturbance from bushfires, including direct burning and/or scorching and damage from radiant heat, particularly when streams are dry. Therefore, damage to dry biofilms by fire has the potential to influence algal recolonization and assemblage structure in intermittent streams following commencement of flow. The influence of fire on benthic algal assemblages and recolonization was examined in intermittent streams of the Grampians National Park, Victoria, Australia, using a field survey and manipulative field experiment. The field survey compared assemblages in two intermittent streams within a recently burnt area (within 5 months of the fire) with two intermittent streams within an unburnt area. The two burnt streams were still flowing during the fire so most biofilms were not likely to be directly exposed to flames. Considerable site-to-site and stream-to-stream variation was detected during the field survey, which may have obscured potential differences attributable to indirect effects of the fire. The manipulative field experiment occurred in two intermittent streams and consisted of five treatments chosen to replicate various characteristics of bushfires that may influence dry biofilms: dry biofilm exposed directly to fire; dry biofilm exposed to radiant heat; dry biofilm exposed to ash; and two procedural controls. After exposure to the different treatments, rocks were replaced in the streams and algae were sampled 7 days after flow commenced. Differences occurred across treatments, but treatment differences were inconsistent across the two streams. For example, direct exposure to fire reduced the abundance of recolonizing algae and altered assemblage structure in both streams, while radiant heat had an effect on assemblage structure in one stream only. The manipulative field experiment is likely to have represented the intensity of a small bushfire only. Nonetheless, significant differences across treatments were detected, so these experimental results suggest that fire can damage dry biofilms, and hence, influence algal recolonization and assemblage structure in intermittent streams.

A model of online teaching and learning

Deakin University has a long history of supporting distance education with technology. Such presentations have matured from a mix of remote-login/FTP/email in the 1980s through web mediated access in the 1990s to institution-wide learning management systems which are emerging currently. By the commencement of semester I, 2003, online teaching at the University will be supported by a single, institution-wide, learning management system, which is expected to support approximately 28,000 students, who will each be accessing up to 4 of some 1500 undergraduate and 700 postgraduate courses. In this paper we describe a model for online teaching of both on-campus and off-campus students in the Bachelor of Computing, using various technologies to support different aspects of online teaching and learning. This programme has been running in a web-mediated environment for over six years. Each year the administration of the programme has been modified in a reactive manner, based on student feedback and the identification of failure points during the previous semester, resulting in the model maturing over that time. We discuss how the changes have impacted the model, the academics involved in the teaching of the unit and the students' experience of learning in the online environment. We also discuss the advantages and disadvantages of online teaching and learning, as well as some potential pitfalls and how to avoid them, or, at least, minimise their impact.

Changing work and OHS: the challenge of labour hire employment

The expansion of labour hire employment from traditional clerical placements to a range of blue collar occupations raises concerns about the level of occupational safety risks labour hire workers encounter. Overseas evidence points to a higher incidence and severity of injury for such workers. Is this pattern of injury replicated in Australia? This paper explores this issue through an analysis of workers’ compensation claims in Victoria, and preliminary investigation into case histories of 220 injured Victorian labour hire employees. Overseas research findings in relation to injury are confirmed through aggregate data analysis. The paper then provides a preliminary examination of agency-related employment factors such as the extent and nature of training and supervision provided by the host, and the timing of injuries in relation to commencement with the host. The evidence suggests both agency and host employers need to be more proactive in overcoming the vulnerability experienced by these workers.

Review of first-year engineering and technology units based on student unit evaluations

There is recognition that the first-year of university study is a critical phase in the preparation, motivation and retention of science, mathematics,  engineering and technology (SMET) students. First-year provides the foundation/generic skills upon which students will base their undergraduate studies and professional practice; first-year is where many poorly prepared/at risk students will drop out and contribute to the poor student retention rate observed in the SMET disciplines; and first-year is when students may lose the motivation to pursue their chosen career direction if they find the studies at the commencement of their undergraduate program appear to bear no relationship to their intended career. In 2003, the Learning Resources Advisory Group of the Deakin University School of Engineering and Technology was requested to undertake a review of first-year units in the School’s programs. The information contained in anonymous unit evaluation questionnaires from the years 2000-2002 was used as the basis for analysing student perceptions of first-year units. In unit evaluations, students reported a wide range of issues that impacted negatively on their perception of the content and conduct of first-year units. It was noted that units service taught by other Schools form a significant element of the first-year of all of the Engineering and Technology undergraduate programs – typically 25 to 50 percent of the content. The significant influence of these units on the perceptions of the first-year of the School’s commencing students means that the School should exercise some control over the content and delivery of these units.

Evaluation of a stress management course in adult education centres in rural Australia

Objective: To investigate whether attending a six-week stress management course in a rural adult education centre is effective in reducing participants' levels of stress, anxiety and depression.

Design: Repeated measures design using self-report measures of stress, anxiety and depression at commencement and completion of a six-week stress management course, and six months post-completion follow up.

Setting and participants: One hundred and thirty-two adults (age range 18–73 years) living in a rural community who self-enrolled in the stress management course at adult education centres.

Intervention: The course consisted of six weekly group sessions. Each two-hour session conducted by mental health professionals, included teaching cognitive behavioural strategies targeted at reducing individual symptoms of stress.

Main outcome measures: Comparative analysis of pre- and post-test and six-month follow up on measures of stress (Stress Symptom Checklist), anxiety and depression (Hospital Anxiety and Depression Scale).

Results: Results indicated a significant reduction in stress symptoms (F(7,90) = 34.92, P < 0.001), anxiety and depression (F(3,95) = 87.92, P < 0.001) from course commencement to course completion. These improvements were sustained six months after course completion for stress symptoms (F(11,65) = 22.40, P < 0.001), anxiety and depression (F(5,73) = 41.78, P < 0.001).

Conclusion: Findings demonstrate the stress management course is an effective community intervention in a rural community. Challenges for future implementation of the program are discussed.