Can the Cardiac ARIA Index Improve Cardiac Care for Australia's Indigenous Population?

Background: Timely access to appropriate cardiac care is critical for optimising outcomes. Our aim was to derive an objective, comparable, geographic measure reflecting access to cardiac services for Australia's 20,387 population locations. Methods: An expert panel defined a single patient care pathway. Using geographic information systems (GIS) the numeric/alpha index was modelled in two phases. The acute phase index (numeric) ranged from 1 (access to tertiary centre with PCI ≤1 h) to 8 (no ambulance service, >3 h to medical facility, air transport required). The aftercare index was modelled into 5 alphabetic categories; A (Access to general practitioner, pharmacy, cardiac rehabilitation, pathology ≤1 h) to E (no services available within 1 h). Results: Approximately 70% or 13.9 million people lived within a CardiacARIAindex category 1A location. Disparity continues in access to category 1A cardiac services for 5.8 million (30%) of all Australians, 60% of Aboriginal and Torres Strait Islander people and 32% of people over 65 years of age. In a cardiac emergency only 40% of the Indigenous population reside within one hour of category 1 hospital. Approximately 30% (81,491 Indigenous persons) are more than one to three hours from basic cardiac services. Conclusion: Geographically, the majority of Australian's have timely access for survival of a cardiac event. The CardiacARIAindex objectively demonstrates that the healthcare system may not be providing for the needs of 60% of Indigenous people residing outside the 1A geographic radius. Innovative clinical practice maybe required to address these disparities.

Where not to have a Heart Attack in Australia!: The Cardiac ARIA Index

Background/aims: Access to appropriate health care following an acute cardiac event is important for positive outcomes. The aim of the Cardiac ARIA index was to derive an objective, comparable, geographic measure reflecting access to cardiac services across Australia. Methods: Geographic Information Systems (GIS) were used to model a numeric-alpha index based on acute management from onset of symptoms to return to the community. Acute time frames have been calculated to include time for ambulance to arrive, assess and load patient, and travel to facility by road 40–80 kph. Results: The acute phase of the index was modelled into five categories: 1 [24/7 percutaneous cardiac intervention (PCI) ≤1 h]; 2 [24/7 PCI 1–3 h, and PCI less than an additional hour to nearest accident and emergency room (A&E)]: 3 [Nearest A&E ≤3 h (no 24/7 PCI within an extra hour)]: 4 [Nearest A&E 3–12 h (no 24/7 PCI within an extra hour)]: 5 [Nearest A&E 12–24 h (no 24/7 PCI within an extra hour)]. Discharge care was modelled into three categories based on time to a cardiac rehabilitation program, retail pharmacy, pathology services, hospital, GP or remote clinic: (A) all services ≤30 min; (B) >30 min and ≤60 min; (C) >60 min. Examples of the index indicate that the majority of population locations within capital cities were category 1A; Alice Springs and Byron Bay were 3A; and the Northern Territory town of Maningrida had minimal access to cardiac services with an index ranking of 5C. Conclusion: The Cardiac ARIA index provides an invaluable tool to inform appropriate strategies for the use of scarce cardiac resources.

What's happening down under : young adolescent education in Australia

The middle years are an important period of learning, in which knowledge of fundamental disciplines are developed, yet this is also a time when students are at the greatest risk of disengagement from learning. Student motivation and engagement in these years is critical, and can be influenced by tailoring approaches to teaching with learning activities and learning environments that specifically consider the needs of middle years’ students.

Trust, reputation and the small firm : building online brand reputation for SMEs

Social media provides numerous opportunities for small businesses to promote their products and services, build brand communities and reach diverse market niches. An important factor in seizing these opportunities is developing trust and creating reputation among consumers. This qualitative study examines how a group of Australian small business managers utilize social media websites to connect to, communicate with and maintain their customer base. For the purpose of this paper we are using case studies of four companies physically based in Victoria, Australia. These businesses have a high presence in online consumer groups, being both active members of communities and representatives of their businesses. The duality of their role as participant and company representative imposes difficulties in creating reputation among community members. We have used in-depth interviews as a primary research method, additionally monitoring their activities on social media sites such as forums, social networking services, blogs and micro-blogs. We have identified practices helpful for developing trust, building reputation and create a brand image in online communities.

Measurable progress? Teaching artsworkers to assess and articulate the impact of their work

The National Cultural Policy Discussion Paper—drafted to assist the Australian Government in developing the first national Cultural Policy since Creative Nation nearly two decades ago—envisages a future in which arts, cultural and creative activities directly support the development of an inclusive, innovative and productive Australia. "The policy," it says, "will be based on an understanding that a creative nation produces a more inclusive society and a more expressive and confident citizenry by encouraging our ability to express, describe and share our diverse experiences—with each other and with the world" (Australian Government 3). Even a cursory reading of this Discussion Paper makes it clear that the question of impact—in aesthetic, cultural and economic terms—is central to the Government's agenda in developing a new Cultural Policy. Hand-in-hand with the notion of impact comes the process of measurement of progress. The Discussion Paper notes that progress "must be measurable, and the Government will invest in ways to assess the impact that the National Cultural Policy has on society and the economy" (11). If progress must be measurable, this raises questions about what arts, cultural and creative workers do, whether it is worth it, and whether they could be doing it better. In effect, the Discussion Paper pushes artsworkers ever closer to a climate in which they have to be skilled not just at making work, but at making the impact of this work clear to stakeholders. The Government in its plans for Australia's cultural future, is clearly most supportive of artsworkers who can do this, and the scholars, educators and employers who can best train the artsworkers of the future to do this.

Facet-controlled Self-assembly of ZnO Nanocrystals by Non-Hydrolytic Aminolysis and their Photodegradation Activities

We report a method for controlling the exposed facets and hence the dimensionality and shape of ZnO nanocrystals using a non-hydrolytic aminolysis synthesis route. The effects of changes to reaction conditions on ZnO formation were investigated and possible self-assembly mechanisms proposed. The crystal facet growth and hence morphologies of the ZnO nanocrystals were controlled by varying reaction temperature and the reactant ratio. Four distinct ZnO nanocrystal types were produced (nanocones, nanobullets, nanorods and nanoplates). The relative photocatalytic activities of the exposed facets of these ZnO nanostructures were also examined, which showed the activities obviously depended on the reactivity of exposed crystal facets in the order: {1011}>>{0001}, {1010}.

New strategies of managing waste in office building retrofit projects

Retrofit projects are different from newly-built projects in many respects. A retrofit project involves an existing building, which imposes constraints on the owners, designers, operators and constructors throughout the project process. Retrofit projects are risky, complex, less predictable and difficult to be well planned, which need greater coordination. For office building retrofit project, further restrictions will apply as these buildings often locate in CBD areas and most have to remain operational during the progression of project work. Issues such as site space, material storage and handling, noise and dust, need to be considered and well addressed. In this context, waste management is even more challenging with small spaces for waste handling, uncertainties in waste control, and impact of waste management activities on project delivery and building occupants. Current literatures on waste management in office building retrofit projects focus on increasing waste recovery rate based on project planning, monitoring and stakeholders’ collaboration. However, previous research has not produced knowledge of understanding the particular retrofit processes and their impact on waste generation and management. This paper discusses the interim results of a continuing research on new strategies for waste management in office building retrofit projects. Firstly based on the literature review, it summarizes the unique characteristics of office building retrofit projects and their influence on waste management. An assumption on waste management strategies is formed. Semi-structured interviews were conducted towards industry practitioners and findings are then presented in the paper. The assumption of the research was validated in the interviews from the opinions and experiences of the respondents. Finally the research develops a process model for waste management in office building retrofit projects. It introduces two different waste management strategies. For the dismantling phase, waste is generated fast along with the work progress, so integrated planning for project delivery and waste generation is needed in order to organize prompt handling and treatment. For the fit-out phase, the work is similar as new construction. Factors which are particularly linked to generating waste on site need to be controlled and monitored. Continuing research in this space will help improve the practice of waste management in office building retrofit projects. The new strategies will help promote the practicality of project waste planning and management and stakeholders’ capability of coordinating waste management and project delivery.

Proteasome activities decrease during dexamethasone-induced apoptosis of thymocytes

The induction of apoptosis in thymocytes by the glucocorticoid dexamethasone was used as a model system to investigate whether there are changes in 20 S and 26 S proteasome activities during apoptosis. We observed that thymocytes contain high concentrations of proteasomes and that following treatment with dexamethasone, cell extracts showed a decrease in proteasome chymotrypsin-like activity which correlated with the degree of apoptosis observed. The decrease in chymotrypsin-like activity of 20 S and 26S proteasomes was still apparent after these complexes had been partially puri®ed from apoptotic thymocyte extracts and was therefore not due to competition resulting from a general increase in protein turnover. The trypsin-like and peptidylglutamylpeptide hydrolase activities of proteasome complexes were also observed to decrease during apoptosis, but these decreases were reversed by the inhibition of apoptosis by the caspase inhibitor benzyloxycarbonyl-Val-Ala-Asp(OMe)-¯uoromethylketone. However, the chymotrypsin-like activity of proteasomes decreased further in the presence of the apoptosis inhibitor. Val-Ala-Asp-¯uoromethylketone was found to inhibit the chymotrypsin- and trypsin-like activity of 26 S proteasomes in .itro. The decrease in proteasome activities in apoptosis did not appear to be due to a decrease in the concentration of total cellular proteasomes. Thus, the early decreases in 20 S and 26 S proteasome activities during apoptosis appear to be due to a down-regulation of their proteolytic activities and not to a decrease in their protein concentration. These data suggest that proteasomes may be responsible, in thymocytes, for the turnover of a protein that functions as a positive regulator of apoptosis.

Catalytic properties of 26 S and 20 S proteasomes and radiolabeling of MB1, LMP7, and C7 subunits associated with trypsin-like and chymotrypsin-like activities*

20 and 26 S proteasomes were isolated from rat liver. The procedure developed for the 26 S proteasome resulted in greatly improved yields compared with previously published methods. A comparison of the kinetic properties of 20 and 26 S proteasomes showed significant differences in the kinetic characteristics with certain substrates and differences in the effects of a protein substrate on peptidase activity. Observed differences in the kinetics of peptidylglutamyl peptide hydrolase activity suggest that the 26 S complex cannot undergo the conformational changes of 20 S proteasomes at high concentrations of the substrate benzyloxycarbonyl (Z) -Leu-Leu-Glu-b-naphthylamide. Various inhibitors that differentially affect the trypsin-like and chymotrypsin-like activities have been identified. Ala-Ala-Phe-chloromethyl (CH2Cl) inhibits chymotrypsin-like activity assayed with succinyl (Suc) -Leu-Leu-Val-Tyr-AMC, but surprisingly not hydrolysis of Ala-Ala-Phe-7-amido-4-methylcoumarin (AMC). Tyr-Gly-Arg-CH2Cl inhibits Suc-Leu-Leu-Val-Tyr-AMC hydrolysis as well as trypsinlike activity measured with t-butoxycarbonyl (Boc) -Leu-Ser-Thr-Arg-AMC, while Z-Phe-Gly-Tyr-diazomethyl (CHN2) was found to inhibit only the two chymotrypsin- like activities. Radiolabeled forms of peptidyl chloromethane and peptidyl diazomethane inhibitors, [3H]acetyl-Ala-Ala-Phe-CH2Cl, [3H]acetyland radioiodinated Tyr-Gly-Arg-CH2Cl, and Z-Phe-Gly- Tyr-(125I-CHN2), have been used to identify catalytic components associated with each of the three peptidase activities. In each case, incorporation of the label could be blocked by prior treatment of the proteasomes with known active site-directed inhibitors, calpain inhibitor 1 or 3,4-dichloroisocoumarin. Subunits of labeled proteasomes were separated either by reverse phase-HPLC and SDS-polyacrylamide gel electrophoresis or by twodimensional polyacrylamide gel electrophoresis followed by autoradiography/fluorography and immunoblotting with subunit-specific antibodies. In each case, label was found to be incorporated into subunits C7, MB1, and LMP7 but in different relative amounts depending on the inhibitor used, consistent with the observed effects on the different peptidase activities. The results strongly suggest a relationship between trypsin-like activity and chymotrypsin-like activity. They also help to relate the different subunits of the complex to the assayed multicatalytic endopeptidase activities

A research framework for assessing the effects of heat stress on construction workers

Hong Kong in summer (June - October) is hot and humid. Construction workers have to undertake physically demanding activities and often in confined spaces. They are vulnerable to heat stress in summer hence health and safety measures associated to heat stress measured by scientific and clinical parameters are urgently needed. This paper provides an initial report of a research project funded by the Research Grants Council (RGC) of the HKSAR. The aim of this study is to develop a set of indices measured by clinical and scientific methods to detect impending attacks of heat stress. These indices would be of tremendous value in better safeguarding workers’ health and safety by reducing the occurrences of heat stress on site. This paper firstly reports on the statistics of construction incidents arising from heat stress. Qualitative and quantitative research methods applied in conducting the research are discussed. It is believed that the construction industry and the government would benefit a lot as a result of this study.

The relationship between chronic disease self-efficacy and nutritional status, functional ability and quality of life in older adults at risk of hospital readmission

Background and significance: Older adults with chronic diseases are at increasing risk of hospital admission and readmission. Approximately 75% of adults have at least one chronic condition, and the odds of developing a chronic condition increases with age. Chronic diseases consume about 70% of the total Australian health expenditure, and about 59% of hospital events for chronic conditions are potentially preventable. These figures have brought to light the importance of the management of chronic disease among the growing older population. Many studies have endeavoured to develop effective chronic disease management programs by applying social cognitive theory. However, limited studies have focused on chronic disease self-management in older adults at high risk of hospital readmission. Moreover, although the majority of studies have covered wide and valuable outcome measures, there is scant evidence on examining the fundamental health outcomes such as nutritional status, functional status and health-related quality of life. Aim: The aim of this research was to test social cognitive theory in relation to self-efficacy in managing chronic disease and three health outcomes, namely nutritional status, functional status, and health-related quality of life, in older adults at high risk of hospital readmission. Methods: A cross-sectional study design was employed for this research. Three studies were undertaken. Study One examined the nutritional status and validation of a nutritional screening tool; Study Two explored the relationships between participants. characteristics, self-efficacy beliefs, and health outcomes based on the study.s hypothesized model; Study Three tested a theoretical model based on social cognitive theory, which examines potential mechanisms of the mediation effects of social support and self-efficacy beliefs. One hundred and fifty-seven patients aged 65 years and older with a medical admission and at least one risk factor for readmission were recruited. Data were collected from medical records on demographics, medical history, and from self-report questionnaires. The nutrition data were collected by two registered nurses. For Study One, a contingency table and the kappa statistic was used to determine the validity of the Malnutrition Screening Tool. In Study Two, standard multiple regression, hierarchical multiple regression and logistic regression were undertaken to determine the significant influential predictors for the three health outcome measures. For Study Three, a structural equation modelling approach was taken to test the hypothesized self-efficacy model. Results: The findings of Study One suggested that a high prevalence of malnutrition continues to be a concern in older adults as the prevalence of malnutrition was 20.6% according to the Subjective Global Assessment. Additionally, the findings confirmed that the Malnutrition Screening Tool is a valid nutritional screening tool for hospitalized older adults at risk of readmission when compared to the Subjective Global Assessment with high sensitivity (94%), and specificity (89%) and substantial agreement between these two methods (k = .74, p < .001; 95% CI .62-.86). Analysis data for Study Two found that depressive symptoms and perceived social support were the two strongest influential factors for self-efficacy in managing chronic disease in a hierarchical multiple regression. Results of multivariable regression models suggested advancing age, depressive symptoms and less tangible support were three important predictors for malnutrition. In terms of functional status, a standard regression model found that social support was the strongest predictor for the Instrumental Activities of Daily Living, followed by self-efficacy in managing chronic disease. The results of standard multiple regression revealed that the number of hospital readmission risk factors adversely affected the physical component score, while depressive symptoms and self-efficacy beliefs were two significant predictors for the mental component score. In Study Three, the results of the structural equation modelling found that self-efficacy partially mediated the effect of health characteristics and depression on health-related quality of life. The health characteristics had strong direct effects on functional status and body mass index. The results also indicated that social support partially mediated the relationship between health characteristics and functional status. With regard to the joint effects of social support and self-efficacy, social support fully mediated the effect of health characteristics on self-efficacy, and self-efficacy partially mediated the effect of social support on functional status and health-related quality of life. The results also demonstrated that the models fitted the data well with relative high variance explained by the models, implying the hypothesized constructs under discussion were highly relevant, and hence the application for social cognitive theory in this context was supported. Conclusion: This thesis highlights the applicability of social cognitive theory on chronic disease self-management in older adults at risk of hospital readmission. Further studies are recommended to validate and continue to extend the development of social cognitive theory on chronic disease self-management in older adults to improve their nutritional and functional status, and health-related quality of life.

Validation of a food behavior questionnaire for male blue collar workers

During nutrition intervention programs, some form of dietary assessment is usually necessary. This dietary assessment can be for: initial screening; development of appropriate programs and activities; or, evaluation. Established methods of dietary assessment are not always practical, nor cost effective in such interventions, therefore an abbreviated dietary assessment tool is needed. The Queensland Nutrition Project developed such a tool for male Blue Collar Workers, the Food Behaviour Questionnaire, consisting of 27 food behaviour related questions. This tool has been validated in a sample of 23 men, through full dietary assessment obtained via food frequency questionnaires and 24 hour dietary recalls. Those questions which correlated poorly with the full dietary assessment were deleted from the tool. In all, 13 questions was all that was required to distinguish between high and low dietary intakes of particular nutrients. Three questions when combined had correlations with refined sugar between 0.617 and 0.730 (p<0.005); four questions when combined had correlations with dietary fibre as percentage of energy of 0.45 (p<0.05); five questions when combined had a correlation with total fat of 0.499 (p<0.05); and, 4 questions when combined had a correlation with saturated fat of between 0.451 and 0.589 (p<0.05). A significant correlation could not be found for food behaviour questions with respect to dietary sodium. Correlations for fat as a function of energy could not be found.

Using BIM for smarter and safer scaffolding and formwork construction: a preliminary methodology

The goal of this research project is to develop specific BIM objects for temporary construction activities which are fully integrated with object design, construction efficiency and safety parameters. Specifically, the project will deliver modularised electronic scaffolding and formwork objects that will allow designers to easily incorporate them into BIM models to facilitate smarter and safer infrastructure and building construction. This research first identified there is currently a distinct lack of BIM objects for temporary construction works resulting in productivity loss during design and construction, and opportunities for improved consideration of safety standards and practices with the design of scaffolding and formwork. This is particularly relevant in Australia, given the “harmonisation” of OHS legislation across all states and territories from 1 January 2012, meaning that enhancements to Queensland practices will have direct application across Australia. Thus, in conjunction with government and industry partners in Queensland, Australia, the research team developed a strategic three-phase research methodology: (1) the preliminary review phase on industrial scaffolding and formwork practices and BIM implementation; (2) the BIM object development phase with specific safety and productivity functions; and (3) the Queensland-wide workshop phase for product dissemination and training. This paper discusses background review findings, details of the developed methodology, and expected research outcomes and their contributions to the Australian construction industry.

Preservice teachers teaching technology with robotics

This study investigates the value of a robotics-based school engagement experience for preservice teachers enrolled in a fourth year technology education curriculum unit and analyses their perceived abilities and confidence to design and implement engaging technology activities following this experience. Technology is a key learning area in Australian schools but research shows that most teachers find this subject challenging to teach. This could be attributed to teachers’ attitudes and their lack of knowledge, hence investigating preservice teachers’ involvement with technology may provide further insights. In this study, 30 preservice teachers used robotics to implement technology activities with 22 primary school students from a school in a low socio-economic area. Surveys were administered to ascertain the preservice teachers' perceptions of their school engagement experiences. The data gathered from the participants showed that they had gained confidence and knowledge from the experience and felt the engagement activity would assist them to develop and implement technology activities in their future classrooms.