Doorway to research : Issues in the development of an interactive website for international graduate students

This paper describes results of a study evaluating the content, functionality and design features of an innovative online website called the Doorway to Research (http://rsc.acid.net.au/Main.aspx) , which was developed to support international graduate students studying at universities in Australia. First, the key features of the website are described. Second, the result of a pilot study involving 12 students and faculty members who tested key aspects of the design, content and functionality of the website and provided written and oral feedback base on task-based questions and focus group discussions are explored. Finally, recommendations for future development are presented. Results of the study indicate general student satisfaction with the website and its design, content and functionality, with specific areas identified for further development.

Antiretroviral therapy (ART) adherence among people living with HIV/AIDS (PLHIV) in the north of Vietnam : a multi-method approach

The antiretroviral therapy (ART) program for People Living with HIV/AIDS (PLHIV) in Vietnam has been scaled up rapidly in recent years (from 50 clients in 2003 to almost 38,000 in 2009). ART success is highly dependent on the ability of the patients to fully adhere to the prescribed treatment regimen. Despite the remarkable extension of ART programs in Vietnam, HIV/AIDS program managers still have little reliable data on levels of ART adherence and factors that might promote or reduce adherence. Several previous studies in Vietnam estimated extremely high levels of ART adherence among their samples, although there are reasons to question the veracity of the conclusion that adherence is nearly perfect. Further, no study has quantitatively assessed the factors influencing ART adherence. In order to reduce these gaps, this study was designed to include several phases and used a multi-method approach to examine levels of ART non-adherence and its relationship to a range of demographic, clinical, social and psychological factors. The study began with an exploratory qualitative phase employing four focus group discussions and 30 in-depth interviews with PLHIV, peer educators, carers and health care providers (HCPs). Survey interviews were completed with 615 PLHIV in five rural and urban out-patient clinics in northern Vietnam using an Audio Computer Assisted Self-Interview (ACASI) and clinical records extraction. The survey instrument was carefully developed through a systematic procedure to ensure its reliability and validity. Cultural appropriateness was considered in the design and implementation of both the qualitative study and the cross sectional survey. The qualitative study uncovered several contrary perceptions between health care providers and HIV/AIDS patients regarding the true levels of ART adherence. Health care providers often stated that most of their patients closely adhered to their regimens, while PLHIV and their peers reported that “it is not easy” to do so. The quantitative survey findings supported the PLHIV and their peers’ point of view in the qualitative study, because non-adherence to ART was relatively common among the study sample. Using the ACASI technique, the estimated prevalence of onemonth non-adherence measured by the Visual Analogue Scale (VAS) was 24.9% and the prevalence of four-day not-on-time-adherence using the modified Adult AIDS Clinical Trials Group (AACTG) instrument was 29%. Observed agreement between the two measures was 84% and kappa coefficient was 0.60 (SE=0.04 and p<0.0001). The good agreement between the two measures in the current study is consistent with those found in previous research and provides evidence of cross-validation of the estimated adherence levels. The qualitative study was also valuable in suggesting important variables for the survey conceptual framework and instrument development. The survey confirmed significant correlations between two measures of ART adherence (i.e. dose adherence and time adherence) and many factors identified in the qualitative study, but failed to find evidence of significant correlations of some other factors and ART adherence. Non-adherence to ART was significantly associated with untreated depression, heavy alcohol use, illicit drug use, experiences with medication side-effects, chance health locus of control, low quality of information from HCPs, low satisfaction with received support and poor social connectedness. No multivariate association was observed between ART adherence and age, gender, education, duration of ART, the use of adherence aids, disclosure of ART, patients’ ability to initiate communication with HCPs or distance between clinic and patients’ residence. This is the largest study yet reported in Asia to examine non-adherence to ART and its possible determinants. The evidence strongly supports recent calls from other developing nations for HIV/AIDS services to provide screening, counseling and treatment for patients with depressive symptoms, heavy use of alcohol and substance use. Counseling should also address fatalistic beliefs about chance or luck determining health outcomes. The data suggest that adherence could be enhanced by regularly providing information on ART and assisting patients to maintain social connectedness with their family and the community. This study highlights the benefits of using a multi-method approach in examining complex barriers and facilitators of medication adherence. It also demonstrated the utility of the ACASI interview method to enhance open disclosure by people living with HIV/AIDS and thus, increase the veracity of self-reported data.

A biphasic scaffold design combined with cell sheet technology for simultaneous regeneration of alveolar bone/periodontal ligament complex

This study describes the design of a biphasic scaffold composed of a Fused Deposition Modeling scaffold (bone compartment) and an electrospun membrane (periodontal compartment) for periodontal regeneration. In order to achieve simultaneous alveolar bone and periodontal ligament regeneration a cell-based strategy was carried out by combining osteoblast culture in the bone compartment and placement of multiple periodontal ligament (PDL) cell sheets on the electrospun membrane. In vitro data showed that the osteoblasts formed mineralized matrix in the bone compartment after 21 days in culture and that the PDL cell sheet harvesting did not induce significant cell death. The cell-seeded biphasic scaffolds were placed onto a dentin block and implanted for 8 weeks in an athymic rat subcutaneous model. The scaffolds were analyzed by μCT, immunohistochemistry and histology. In the bone compartment, a more intense ALP staining was obtained following seeding with osteoblasts, confirming the μCT results which showed higher mineralization density for these scaffolds. A thin mineralized cementum-like tissue was deposited on the dentin surface for the scaffolds incorporating the multiple PDL cell sheets, as observed by H&E and Azan staining. These scaffolds also demonstrated better attachment onto the dentin surface compared to no attachment when no cell sheets were used. In addition, immunohistochemistry revealed the presence of CEMP1 protein at the interface with the dentine. These results demonstrated that the combination of multiple PDL cell sheets and a biphasic scaffold allows the simultaneous delivery of the cells necessary for in vivo regeneration of alveolar bone, periodontal ligament and cementum. © 2012 Elsevier Ltd.

The pedagogical, linguistic and content features of popular English language learning websites in China : a framework for analysis and design

As increasing numbers of Chinese language learners choose to learn English online (CNNIC, 2012), there is a need to investigate popular websites and their language learning designs. This paper reports on the first stage of a study that analysed the pedagogical, linguistic and content features of 25 Chinese English Language Learning (ELL) websites ranked according to their value and importance to users. The website ranking was undertaken using a system known as PageRank. The aim of the study was to identify the features characterising popular sites as opposed to those of less popular sites for the purpose of producing a framework for ELL website design in the Chinese context. The study found that a pedagogical focus with developmental instructional materials accommodating diverse proficiency levels was a major contributor to website popularity. Chinese language use for translations and teaching directives and intermediate level English for learning materials were also significant features. Content topics included Anglophone/Western and non-Anglophone/Eastern contexts. Overall, popular websites were distinguished by their mediation of access to and scaffolded support for ELL.

Supporting the learning of rapid application development in a database environment

Intelligent Tutoring Systems (ITSs) are computer systems designed to provide individualised help to students, learning in a problem solving context. The difference between an ITS and a Computer Assisted Instruction (CAI) system is that an ITS has a Student Model which allows it to provide a better educational environment. The Student Model contains information on what the student knows, and does not know, about the domain being learnt, as well as other personal characteristics such as preferred learning style. This research has resulted in the design and development of a new ITS: Personal Access Tutor (PAT). PAT is an ITS that helps students to learn Rapid Application Development in a database environment. More specifically, PAT focuses on helping students to learn how to create forms and reports in Microsoft Access. To provide an augmented learning environment, PAT’s architecture is different to most other ITSs. Instead of having a simulation, PAT uses a widelyused database development environment (Microsoft Access). This enables the students to ask for help, while developing real applications using real database software. As part of this research, I designed and created the knowledge base required for PAT. This contains four models: the domain, student, tutoring and exercises models. The Instructional Expert I created for PAT provides individualised help to the students to help them correctly finish each exercise, and also proposes the next exercise that a student should work on. PAT was evaluated by students enrolled in the Databases subject at QUT, and by staff members involved in teaching the subject. The results of the evaluation were positive and are discussed in the thesis.

Intercultural usability of language learning websites

Website usability can be defined as the ease of use of websites. General usability, pedagogical usability, technical usability and intercultural usability can be considered and examined for the understanding of the usability of language learning websites, which requires a discipline-specific approach. In the field of computer-assisted language learning, usability issues have been addressed mainly in terms of evaluation criteria and have been commonly discussed in relation to user expectations and user experiences. In spite of a growing interest in intercultural language learning, however, little research on intercultural usability of language learning websites has been published yet. There is a need to answer the question of how language learning websites integrate the target language and culture for the development of intercultural sensitivity and competence. This article explores intercultural aspects of language learning websites and presents usability guidelines for designing intercultural language learning websites.

Professional development and technology in second language learning : do best practices work?

This study was undertaken to examine the influence that a set of Professional Development (PD) initiatives had on faculty use of Moodle, a well known Course Management System. The context of the study was a private language university just outside Tokyo, Japan. Specifically, it aimed to identify the way in which the PD initiatives adhered to professional development best practice criteria; how faculty members perceived the PD initiatives; what impact the PD initiatives had on faculty use of Moodle; and other variables that may have influenced faculty in their use of Moodle. The study utilised a mixed methods approach. Participants in the study were 42 teachers who worked at the university in the academic year 2008/9. The online survey consisted of 115 items, factored into 10 constructs. Data was collected through an online survey, semi-structured face-to-face interviews, post-workshop surveys, and a collection of textual artefacts. The quantitative data were analysed in SPSS, using descriptive statistics, Spearman's Rank Order correlation tests and a Kruskal-Wallis means test. The qualitative data was used to develop and expand findings and ideas. The results indicated that the PD initiatives adhered closely to criteria posited in technology-related professional development best practice criteria. Further, results from the online survey, post workshop surveys, and follow up face-to-face interviews indicated that while the PD initiatives that were implemented were positively perceived by faculty, they did not have the anticipated impact on Moodle use among faculty. Further results indicated that other variables, such as perceptions of Moodle, and institutional issues, had a considerable influence on Moodle use. The findings of the study further strengthened the idea that the five variables Everett Rogers lists in his Diffusion of Innovations model, including perceived attributes of an innovation; type of innovation decision; communication channels; nature of the social system; extent of change agents' promotion efforts, most influence the adoption of an innovation. However, the results also indicated that some of the variables in Rogers' DOI seem to have more of an influence than others, particularly the perceived attributes of an innovation variable. In addition, the findings of the study could serve to inform universities that have Course Management Systems (CMS), such as Moodle, about how to utilise them most efficiently and effectively. The findings could also help to inform universities about how to help faculty members acquire the skills necessary to incorporate CMSs into curricula and teaching practice. A limitation of this study was the use of a non-randomised sample, which could appear to have limited the generalisations of the findings to this particular Japanese context.

Factors influencing the impact of primary and secondary prevention strategies for cervical cancer among Queensland women

Since the introduction of the National Human Papillomavirus Vaccine Program (NHPVP) in 2007, few studies have assessed women's knowledge, beliefs and attitudes towards cervical screening and human papillomavirus (HPV) vaccination in Australia. It is imperative to ascertain this, as substantial changes are anticipated to the National Cervical Screening Program (NCSP) through a process called 'the Renewal', to ensure any changes that are introduced will be acceptable and well understood by women. The objectives of this study were to describe Queensland women's current knowledge of cervical cancer/screening and HPV, their beliefs and attitudes towards Pap smears and the HPV vaccine and seek their advice on effective methods for communicating changes to the NCSP in their communities. This research was a descriptive-exploratory study that incorporated a combination of qualitative and quantitative methods within the context of the Health Belief Model (HBM). A computer-assisted telephone interview (CATI) survey of 1002 Queensland women was conducted in Phase 1 of the study. During Phase 2 of the study, 23 focus groups were conducted throughout Queensland to gather in-depth information about women's knowledge, awareness and acceptance about cervical cancer prevention strategies. This study found high levels of awareness of HPV (over 60%) and the HPV vaccine (over 86%) amongst Queensland women. However, it also identified considerable uncertainty amongst participants about perceived susceptibility to cervical cancer, especially, the link between cervical cancer, HPV and sexual activity. Women also had limited understanding of the benefit of the Pap smear as a preventative strategy, with many women thinking the main purpose of the Pap smear was for the early detection of cancer. Despite high awareness of HPV, women participating in this study also had significant knowledge deficits about their susceptibility to HPV and the severity of HPV infection. Queensland women had high levels of awareness of the HPV vaccine, which was most commonly via the media. High acceptance of the HPV vaccine was found amongst participants although awareness of the full benefits of vaccination was not evident with little acknowledgement that the quadrivalent vaccine used in the NHPVP would also prevent genital warts. Extensive barriers to having Pap smears, including physical and psychological discomfort, were identified and the most common barriers to vaccination were concerns about side effects and a lack of information upon which to make a decision about consent. Women described enablers for screening participation, such as reminder systems and practitioner characteristics, and expressed positive views towards self collected testing as an enabler, particularly for women who did not attend screening. As this study was conducted with Queensland women it may therefore not be representative of women from other parts of Australia and as participants were more likely to report they were regular screeners than Queensland women overall, these results may not be representative of women least likely to participate in cervical screening. The use of self-reported cervical screening history may also have led to over-reporting of screening status and previous abnormalities by participants. This study reveals significant gaps in Queensland women's knowledge that require effective communication strategies to address. Recommendations from this study highlight the need for increased community education to raise awareness about primary and secondary cervical cancer prevention strategies, training of cervical screening providers in sensitive examination techniques, a reduction in costs associated with screening, the exploration of alternative service models and communication plans that incorporate methods women trust and recommend for disseminating information about changes to the NCSP. This study is the first large study to explore women's perceptions of the Pap smear and barriers to screening, their knowledge about HPV and their attitudes towards the HPV vaccine in Queensland, since the introduction of the NHPVP. It highlights considerable uncertainty about many aspects of cervical cancer and primary and secondary prevention strategies available in Australia and identified many barriers to cervical screening and concerns about HPV vaccination. These knowledge gaps and barriers need to be taken into account and addressed within the context of anticipated changes to the NCSP to ensure benefits are maximised for women in future primary and secondary cervical cancer prevention strategies in the Australian context.

Advances in the systemic therapy of malignant pleural mesothelioma

Malignant pleural mesothelioma is an aggressive thoracic malignancy associated with exposure to asbestos, and its incidence is anticipated to increase during the first half of this century. Chemotherapy is the mainstay of treatment, yet sufficiently robust evidence to substantiate the current standard of care has emerged only in the past 5 years. This Review summarizes the evidence supporting the clinical activity of chemotherapy, discusses the use of end points for its assessment and examines the influence of clinical and biochemical prognostic factors on the natural history of malignant pleural mesothelioma. Early-phase clinical trials of second-line and novel agents are emerging from an increased understanding of mesothelioma cell biology. Coupled with high-quality translational research, such developments have real potential to improve the outlook of patients at a time of increasing incidence.

A metastatic neuroendocrine anaplastic small cell tumor in a patient with multiple endocrine neoplasia type 1 syndrome : assessment of disease status and response to doxorubicin, cyclophosphamide, etoposide chemotherapy through scintigraphic imaging with 111In-pentetreotide

Extrapulmonary small cell and small cell neuroendocrine tumors of unknown primary site are, in general, aggressive neoplasms with a short median survival. Like small cell lung cancer (SCLC), they often are responsive to chemotherapy and radiotherapy. Small cell lung cancer and well differentiated neuroendocrine carcinomas of the gastrointestinal tract and pancreas tend to express somatostatin receptors. These tumors may be localized in patients by scintigraphic imaging using radiolabeled somatostatin analogues. A patient with an anaplastic neuroendocrine small cell tumor arising on a background of multiple endocrine neoplasia type 1 syndrome is reported. The patient had a known large pancreatic gastrinoma and previously treated parathyroid adenopathy. At presentation, there was small cell cancer throughout the liver and skeleton. Imaging with a radiolabeled somatostatin analogue, 111In- pentetreotide (Mallinckrodt Medical B. V., Petten, Holland), revealed all sites of disease detected by routine biochemical and radiologic methods. After six cycles of chemotherapy with doxorubicin, cyclophosphamide, and etoposide, there was almost complete clearance of the metastatic disease. 111In-pentetreotide scintigraphy revealed uptake consistent with small areas of residual disease in the liver, the abdomen (in mesenteric lymph nodes), and posterior thorax (in a rib). The primary gastrinoma present before the onset of the anaplastic small cell cancer showed no evidence of response to the treatment. The patient remained well for 1 year and then relapsed with brain, lung, liver, and skeletal metastases. Despite an initial response to salvage radiotherapy and chemotherapy with carboplatin and dacarbazine, the patient died 6 months later.

What encourages sun protection among outdoor workers from four industries?

Objectives: We aimed to identify current practice of sun protection and factors associated with effective use in four outdoor worker industries in Queensland, Australia. Methods: Workplaces in four industries with a high proportion of outdoor workers (building/construction, rural/farming, local government, and public sector industries) were identified using an online telephone directory, screened for eligibility, and invited to participant via mail (n=15, recruitment rate 37%). A convenience sample of workers were recruited within each workplace (n=162). Workplaces’ sun protective policies and procedures were identified using interviews and policy analysis with workplace representatives, and discussion groups and computer-assisted telephone interviews with workers. Personal characteristics and sun protection knowledge, attitudes and behaviors were collated and analysed. Results: Just over half the workplaces had an existing policy which referred to sun protection (58%), and most provided at least some personal protective equipment (PPE), but few scheduled work outside peak sun hours (43%) or provided skin checks (21%). Several worker and workplace characteristics were associated with greater sun protection behaviour among workers, including having received education on the use of PPE (p<0.001), being concerned about being in the sun (p=0.002); and working in a smaller workplace (p=0.035). Conclusions: Uptake of sun protection by outdoor workers is affected by a complex interplay of both workplace and personal factors, and there is a need for effective strategies targeting both the workplace environment and workers’ knowledge, attitudes and behaviors to decrease harmful sun exposure further.

Cisplatin and gemcitabine in the management of metastatic penile cancer

Penile cancer is rare and receives little public attention. There are few treatment options for advanced disease. The most active regimen to date is a combination of bleomycin, methotrexate, and cisplatin. However the treatment-related mortality is 11% and hence this combination has not been adapted as a standard of care. We report two cases of advanced penile cancer where a sustained palliative response was observed with combination chemotherapy using cisplatin and gemcitabine. Our experience demonstrates that this is a well tolerated regimen active in this setting. © 2009 Elsevier Inc. All rights reserved.