Influences of spatial practices on pressure ulcer management in the context of spinal cord injury

Nursing practice is significantly influenced by the type and use of space in which nursing is practised. While investigating current patterns of service delivery for the management of pressure ulcers from the perspective of people with spinal cord injuries and their families, the space in which care was delivered was identified as a central determinant of care. Qualitative methods were used to investigate consumer perspectives among patients residing in both metropolitan and rural communities who had been hospitalized for the management of pressure ulcers. Issues related to the spatial practices of the hospital are discussed, demonstrating a link between well-being and the creation of an appropriate caring milieu. It is concluded that service could be improved markedly if health-care professionals placed more consideration on the impact of space on their service delivery.

The contexts of mathematics tasks and the context of the classroom: are we including all students?

Mathematics teachers are encouraged to use realistic contexts in order to make mathematics more meaningful and accessible for all students. However, the focus group research reported in this article shows that decisions on the suitability of contexts are complex and multidimensional. Similarly, the way the task contexts are presented, and the way the tasks are incorporated into classroom routines have potential to alienate some groups of students. We suggest that teachers and researchers should be sensitive to difficulties that students might experience as a result of both the task and classroom contexts, and take specific steps to avoid or overcome the difficulties.

Options for change in the Australian cervical cancer screening program in context of HPV detection and vaccination

Introduction:
Cervical cancer screening has been implemented for over a decade in Australia and has significantly reduced the mortality and morbidity of the disease. The emergence of new technologies for cervical cancer, such as the Human Papillomavirus (HPV) vaccine and DNA testing has encouraged debate regarding the effective use of resources in cervical cancer prevention. The present study evaluates the cost-effectiveness, from a health sector perspective, of various screening strategies in the era of these new technologies.

Methods:
A stochastic epidemiological model using a discrete event and continuous algorithm was developed to describe the natural history of cervical cancer. By allowing one member of the cohort into the model at a time, this micro-simulation model encompasses the characteristics of heterogeneity and can track individual life histories. To evaluate the cost-effectiveness of the HPV vaccine a Markov model was built to simulate the effect on the incidence of HPV and subsequent cervical cancer. A number of proposed screening strategies were evaluated with the stochastic model for the application of HPV DNA testing, with changes in the screening interval and target population. Health outcomes were measured by Disability-Adjusted Life-Years (DALYs), adjusted for application within an evaluation setting (i.e. the mortality component of the DALY was adjusted by a disability weight when early mortality due to cervical cancer is avoided). Costs in complying with the Australian updated guidelines were assessed by pathway analysis to estimate the resources associated with cervical cancer and its pre-cancerous lesion treatment. Sensitivity analyses were performed to investigate the key parameters that influenced the cost-effectiveness results.

Results:
Current practice has already brought huge health gain by preventing more than 4,000 deaths and saving more than 86,000 life-years in a cohort of a million women. Any of the alternative screening strategies alter the total amount of health gain by a small margin compared to current practice. The results of incremental analyses of the alternative screening strategies compared to current practice suggest the adoption of the HPV DNA test as a primary screening tool every 3 years commencing at age 18, or the combined pap smear/HPV test every 3 years commencing at age 25, are more costly than current practice but with reasonable ICERs (AUD$1,810 per DALY and AUD$18,600 per DALY respectively). Delaying commencement of Pap test screening to age 25 is less costly than current practice, but involves considerable health loss. The sensitivity analysis shows, however, that the screening test accuracy has a significant impact on these conclusions. Threshold analysis indicates that a sensitivity ranging from 0.80 to 0.86 for the combined test in women younger than 30 is required to produce an acceptable incremental cost-effectiveness ratio.

Conclusions:
The adoption of HPV and combined test with an extended screening interval is more costly but affordable, resulting in reasonable ICERs. They appear good value for money for the Australian health care system, but need more information on test accuracy to make an informed decision. Potential screening policy change under current Australian HPV Vaccination Program is current work in progress. A Markov model is built to simulate the effect on the incidence of HPV and subsequent cervical cancer. Adoption of HPV DNA test as a primary screening tool in the context of HPV vaccination is under evaluation.

Comparison of the EN 15251 and Ashrae Standard 55 adaptive thermal comfort models in the context of a Mediterranean climate

Strong heat waves in the past decade and resulting legal cases which gave full responsibility for indoor thermal comfort to building professionals lead to an increased uncertainty how to maintain thermal comfort in offices without the use of a cooling system. Adaptive thermal comfort standards such as EN 15251 and Ashrae Standard 55 provide methodologies to evaluate comfort in naturally ventilated spaces. Based on a parametric study for a typical cellular office in the context of Athens, Greece, and using the building simulation software EnergyPlus, this study investigates the potentials for the applicability of natural ventilation in a Mediterranean climate. The Ashrae Standard 55 and EN 15251 adaptive thermal comfort models are compared in this context, and conclusions are drawn how the use of natural ventilation based on adaptive models can be further encourgaged.

Understanding the context of distance students : differences in on- and off-campus engagement with an online learning environment

 While a growing number of higher education institutions are providing online modes of study for both on- and off-campus students, there are very real differences in demography, technology experiences, reasons for study, etc. between on- and off-campus students, and research into engagement with online learning environments (OLEs) indicate differences in the way that on- and off-campus students interact with OLEs. In Australia, Deakin University is a major provider of distance and online education, and provides a case study of a higher education institution with a mature and large-scale OLE implementation providing support to both on- and off-campus students. Deakin Studies Online (DSO) is Deakin University’s OLE. Based on a representative sample of 1322 responses to the 2011 DSO evaluation survey, this paper presents a large-scale, up-to-date and fine-grained investigation of impact of mode of study on the student experience of using an OLE. It was found that the primary place of access to DSO for both groups was home, mobile access to DSO seems likely to be of growing importance to both groups, and there was no statistically significant difference in the mean satisfaction ratings between on- and off-campus students for virtually all DSO functions. Off-campus students gave significantly higher mean ratings of importance (though not satisfaction) to a range of DSO functions that could be viewed as ‘value adders’ by off-campus students, enhancing their overall learning experience. For more than half of the DSO functions surveyed, on-campus students reported statistically significant higher mean frequency of access than off-campus students. The finding that elements of the institutional OLE are not universally perceived and used the same way by all students groups challenges the value of standard, one-size-fits-all institutional policies and templates relating to the use of OLEs.

Health promotion practice in the context of climate change

Climate change and environmental degradation caused by human activities are having an irrefutable impact on human health. This thesis by publication demonstrates that health promotion practitioners are well placed to use their professional competencies, strategies and principles to facilitate action on climate change and environmental sustainability.

Realist evaluation of a remote hospital programme in the context of Australian health care reforms

Background: Since 2008, Australia has embarked on major healthcare reforms extending across all states and territories. Only limited evidence linking national healthcare reforms to improvement in public hospital performance exists. This evidence gap is even more pronounced in the case of remote hospital performance. This article describes a protocol retrospectively assessing a remote hospital programme to implement emergency department performance indicators, in the context of national reforms, over a period of 7 years (2008–2014). Challenges to implementing these reforms are explored.Method: Assessing the complex scenario of reform implementation requires an in-depth analysis, offered by a Realist Evaluation framework. Within this framework, a case study design is adopted to enable descriptive analysis. Interviews with key hospital stakeholders were followed by a literature review to identify a programme theory. The programme theory was articulated in the form of a preliminary context-mechanism-outcome configuration (CMOC). This theory will underlie further data collection, analysis, and interpretation. Both Realist Evaluation and case study allow flexibility in a choice of methods; both quantitative and qualitative methods will be incorporated. The thematic analysis will be employed to identify causal relationships and linkages in collected data.Discussion: Assembled data will be used to develop final CMOC patterns. The final CMOC will help in understanding the theory and mechanisms in use in the hospital.

An abominable crime: filicide in the context of parental separation and divorce

The victims of filicide in the context of parental separation and divorce have recently been identified as the largest group among all filicide victims in Australia. Nevertheless, research into this group of victims has been sparse, fragmentary and contradictory, with the consequence that confusion has prevailed. This article critically reflects on the existing research on filicide and argues that it has been insufficiently comprehensive and reliable and, therefore, is not suitable for use as a knowledge base for professional individuals, programmatic and policy interventions, and prevention. The article suggests ways of developing more reliable research for knowledge building and details the data developed so far that underpins their recommendations for a national programme of research.

"When I saw walking I just kind of took it as wheeling": interpretations of mobility-related items in generic, preference-based health state instruments in the context of spinal cord injury

Background : In health economic analyses, health states are typically valued using instruments with few items per dimension. Due to the generic (and often reductionist) nature of such instruments, certain groups of respondents may experience challenges in describing their health state. This study is concerned with generic, preference-based health state instruments that provide information for decisions about the allocation of resources in health care. Unlike physical measurement instruments, preference-based health state instruments provide health state values that are dependent on how respondents interpret the items. This study investigates how individuals with spinal cord injury (SCI) interpret mobility-related items contained within six preference-based health state instruments.

Methods : Secondary analysis of focus group transcripts originally collected in Vancouver, Canada, explored individuals’ perceptions and interpretations of mobility-related items contained within the 15D, Assessment of Quality of Life 8-dimension (AQoL-8D), EQ-5D-5L, Health Utilities Index (HUI), Quality of Well-Being Scale Self-Administered (QWB-SA), and the 36-item Short Form health survey version 2 (SF-36v2). Ritchie and Spencer’s ‘Framework Approach’ was used to perform thematic analysis that focused on participants’ comments concerning the mobility-related items only.

Results : Fifteen individuals participated in three focus groups (five per focus group). Four themes emerged: wording of mobility (e.g., ‘getting around’ vs ‘walking’), reference to aids and appliances, lack of suitable response options, and reframing of items (e.g., replacing ‘walking’ with ‘wheeling’). These themes reflected item features that respondents perceived as relevant in enabling them to describe their mobility, and response strategies that respondents could use when faced with inaccessible items.

Conclusion : Investigating perceptions to mobility-related items within the context of SCI highlights substantial variation in item interpretation across six preference-based health state instruments. Studying respondents’ interpretations of items can help to understand discrepancies in the health state descriptions and values obtained from different instruments. This line of research warrants closer attention in the health economics and quality of life literature.

Small businesses as social formations : diverse rationalities in the context of e-business adoption

Small-business adoption of electronic business has been analyzed largely in conventional business terms such as benefits and costs, returns on investment, and competitive advantage. While these factors are important, small businesses are also embedded in social contexts which shape the rationalities with which they approach e-business. These rationalities are different from those that characterize larger businesses. They involve personal relationships, social esteem, lifestyle issues, and family considerations. Drawing on the theoretical work of Granovetter and Weber, this chapter examines interview data from a number of Australian studies of e-commerce by small businesses. These interviews illustrate the influence of the social context on the adoption (or deferral) of e-commerce. By recognizing that small businesses are social as well as economic formations, governments can tailor their programs to assist this important group of businesses in their approach to e-business.

How e-Entrepreneurs operate in the context of open source software

The Internet has become an integral part of our everyday lives and it is often difficult to imagine how we ever functioned without it. This chapter presents experiences of two entrepreneurial companies, one of which has survived the 'dot-com bubble burst.' The chapter identifies current and future online business environments especially in light of open source software (OSS)   being accepted globally. Unlike proprietary software (such as Windows), OSS comes with its internal implementation details (source code) visible both to its developers and users, along with the freedom to change and redistribute this source. The significant implications of this unique style of software distribution for e-entrepreneurs are examined. Having a flexible  strategic plan; possessing management skills; providing excellent service; and having patience are some of the recommendations provided by  interviewed e-entrepreneurs. When made part of the decision making  process, these recommendations would enhance current and future e_entrepreneurs in sustaining their business.

Brand value in the context of Australian Football League clubs

This conceptual paper focuses on brand value for non-traditional products, and particularly, brand value in relation to Australian Football League Clubs, and its measurement. The concept of brand value has been addressed by a plethora of definitions and models in the literature, many of which focus on the measurement of brand value within traditional product industries. These models are often contingent on the intrinsic utility of the product itself, yet within non-traditional product areas, the product and the brand may be two distinct entities which should be differentiated in order to facilitate an accurate measurement of consumer-based brand value. To date, there has been limited research in this area and the general aim of this paper is to reveal the gaps in the current literature by providing an extension of traditional brand valuation theory to a non-traditional field. This paper illustrates its points with reference to a relevant model associated with “traditional” brand theories, and shows how it can be applied to the area of Australian Football League Clubs. This paper argues for the configuration of a more holistic model of brand value, including the antecedents and consequences of the value ascribed to brands by consumers, in order to encourage future research in brand equity based on the total utility derived from Australian Football League Clubs’ brands.