Interobserver reproducibility of histopathologic prognostic variables in primary cutaneous melanomas

Background: The prognosis for patients with localized primary cutaneous melanoma is known to depend principally on tumor thickness, and to a lesser extent on ulcerative state and Clark level. We have recently found in an analysis of 3661 patients that tumor mitotic rate (TMR) is also an important prognostic parameter, ranking second only to tumor thickness. However, few studies have assessed the accuracy and reproducibility with which these features of a melanoma are recorded by histopathologists.
Aim: To assess interobserver reproducibility of major pathologic prognostic parameters in cutaneous melanoma.
Methods: Single hematoxylin and eosin-stained slides of 69 dermally invasive primary cutaneous melanomas were circulated among six pathologists with differing experience in the assessment of melanocytic tumors. The observers independently determined the tumor thickness, Clark level of invasion, ulcerative state, and TMR for each lesion. Intraclass correlation coefficients and kappa scores for multiple ratings per subject were calculated.
Results: The intraclass correlation coefficients were 0.96 for tumor thickness and 0.76 for TMR. The kappa scores were 0.83 for ulcerative state and 0.60 for Clark level. These results indicated excellent agreement among the pathologists for measurements of tumor thickness, ulcerative state, and TMR and fair to good agreement for Clark level.
Conclusions: Appropriately trained and experienced histopathologists can assess prognostically important features of melanomas accurately and reproducibly. Given our recent finding of the significance of TMR in determining prognosis, it is important that this feature be assessed by a standardized method and documented for all primary cutaneous melanomas.

'Learning to cooperate': a study of how primary teachers and children construct classroom cultures

This paper reports on the findings of a study, the 'Constructing Classroom Cultures' project, funded by a small Australian Research Council grant at the University of Melbourne. Located in three primary school classrooms in Melbourne, Victoria, this study investigated how teachers and grade 3-4 students develop shared values and understandings concerning formal and informal codes of behaviour. Drawing on classroom observations, individual interviews with teachers and focus group interviews with children, this paper discusses the ways that teachers and children together build classroom cultures. Practices that work to produce supportive classroom environments as well as problem areas are identified. Examining classroom cultures at the micro-political level offers scope for considering how power relations can contribute positively to educational processes. Additionally, the ways in which informal interactions between teacher and students and among students call into play collaboration, compliance and resistance are opened up for examination. These case studies aim to contribute to understanding how productive classroom cultures are constructed in day-to-day interactions, a significant area of concern for teachers and teacher education students.

Ambulance call triage outcomes for patients reporting pain : a retrospective cross-sectional analysis of pain score versus traige level

Objective: To identify any association between the response priority code generated during calls to the ambulance communication centre and patient reports of pain severity.

Methods: A retrospective analysis of patient care records was undertaken for all patients transported by paramedics over a 7-day period. The primary research interest was the association between the response code allocated at the time of telephone triage and the initial pain severity score recorded using a numeric rating scale (NRS). Univariate and multivariate logistic regression methods were used to analyse the association between the response priority variable and explanatory variables.

Results: There were 1246 cases in which both an initial pain score using the NRS and a response code were recorded. Of these cases, 716/1246 (57.5%) were associated with a code 1 ("time-critical") response. After adjusting for gender, age, cause of pain and duration of pain, a multivariate logistic regression analysis found no significant change in the odds of a patient in pain receiving a time-critical response compared with patients who had no pain, regardless of their initial pain score (NRS 1–3, odds ratio (OR) 1.11, 95% CI 0.7 to 1.8; NRS 4–7, OR 1.12, 95% CI 0.7 to 1.8; NRS 8–10, OR 0.84, 95% CI 0.5 to 1.4).

Conclusion: The severity of pain experienced by the patient appeared to have no influence on the priority (urgency) of the dispatch response. Triage systems used to prioritise ambulance calls and decide the urgency of response or type of referral options should consider pain severity to facilitate timely and humane care.

Predictors of body mass index change in Australian primary school children

Objective. To assess associations between multiple potential predictors and change in child body mass index (BMI). Methods.In the 1997 Health of Young Victorians Study, children in Grades preparatory to three (aged 510 years) had their height and weight measured. Parents provided information on potential predictors of childhood overweight across six domains (children’s diet, children’s activity level, family composition, sociodemographic factors, prenatal factors and parental adiposity). Measures were repeated three years later in 2000/1. BMI was transformed to standardised (z) scores using the US 2000 Growth Chart data and children were classified as non-overweight or overweight according to international cutpoints.Regression analyses, including baseline BMI z-score as a covariate, assessed the contribution of each potential predictor to change in BMI z-score, development of overweight and spontaneous resolution of overweight in 1 373 children.Results. BMI z-score change was positively associated with frequency of take-away food, food quantity, total weekly screen time, non-Australian paternal country of birth, maternal smoking during pregnancy, and maternal and paternal BMI.Inverse associations were noted for the presence of siblings and rural residence (all pB0.05). Predictors of categorical change (development and resolution of overweight) were less clearly identified, apart from an association between maternal BMI and overweight development (p0.02). Multivariable models suggested individual determinants have a cumulative effect on BMI change. Conclusions. Strong short-term tracking of BMI makes it difficult to identify predictors of change. Nonetheless, putative determinants across all domains assessed were independently associated with adiposity change. Multi-faceted solutions are likely to be required to successfully deal with the complexities of childhood overweight.

Primary school teacher perceived self-efficacy to teach fundamental motor skills

Fundamental Movement Skills (FMS) are a part of the school curricula, yet many Australian primary-age children are not mastering FMS. One reason may be a lack of perceived self-efficacy of primary teachers to teach FMS. This study investigated the level of perceived self-efficacy of primary school teachers to teach FMS in Victoria, Australia. A cross-sectional survey, based on the Victorian Institute of Teaching Standards of Professional Practice, was used to sample sixty-five pre-service and forty-six in-service teachers. Most primary school teachers were self-efficacious in teaching FMS (67.59 per cent); almost one-third (32.41 per cent) were not. Male teachers had higher perceived self-efficacy than female teachers, and a positive relationship was found between perceived self-efficacy to teach FMS and interest in, and participation in, physical activity (r = 0.52 and r = 0.31 respectively). Implications for practice include providing FMS teaching resources and professional training. Further research should explore the effect of perceived self-efficacy on teaching performance.

Can we skill and activate children through primary school physical education lessons? "Move it Groove it" - a collaborative health promotion intervention

Background: Physical education (PE) lessons are an ideal setting to improve child fundamental movement skills (FMSs) and increase physical activity (PA) for optimal health. Despite this, few studies have assessed the potential to do both simultaneously. The “Move It Groove It” primary school intervention in New South Wales, Australia, had this opportunity.

Methods: A whole school approach to implementation included establishment of school project teams, a teacher “buddy” system, project Web site, teacher training workshops, and small grants for equipment. The quasi-experimental evaluation involved 1,045 year 3 and 4 children (aged 7 to 10 years) in nine intervention and nine control rural primary schools (53% boys/47% girls). It utilised pre- and postobservational surveys of (1) mastery or near mastery levels for each of eight FMSs, (2) proportion of PE lesson time spent in moderate to vigorous PA (MVPA) and vigorous PA (VPA), and (3) teacher- and lesson-related contextual covariates. Data were analysed by hierarchical logistic multiple regression.

Results: For FMSs, overall mastery or near mastery level at baseline was 47% ranging from 22.7% for the overarm throw among girls to 75.4% for the static balance among boys. The intervention delivered substantial improvements in every FMS for both genders ranging from 7.2% to 25.7% (13 of 16 comparisons were significant). For PA level, mean MVPA at baseline was 34.7%. Baseline MVPA for boys was 38.7% and for girls was 33.2%. The intervention was associated with a nonsignificant 4.5% increase in MVPA and a significant 3.0% increase in VPA. This translates to a gain of <1 minute of MVPA per average 21-minute lesson.

Conclusions: This is the first study to show that by modifying existing PE lessons, significant improvements in FMS mastery can be gained without adversely affecting children’s MVPA and VPA. To increase PA levels, we recommend increasing the number of PE lessons per week.

What's needed to increase research capacity in rural primary health care

The aim of this study is to identify ways to build research capacity within primary health. A consultation was undertaken in late 2004 using a combination of a one-page survey and a guided meeting format, in a primary health setting in rural NSW. Most (81.3%) of the 134 individuals consulted were part of an Area Health Service, with 12.7% from non-government settings. Most (80.6%) were clinicians, with a third (31.5%) nurses, 8.3% in medicine, and the remainder from a range of allied health professions. Eleven organisations were represented. The main  outcome measures were identification of support needs, processes to enhance research engagement, and barriers and enablers to clinicians’ research  involvement. The results showed that popular delivery modes for research training and support were courses and “one-to- one” advice. Writing topics were generally more popular than others. Common barriers were time and technology issues. A key enabler was a discipline-specific focus. This is one of few rural Australian  consultations on research needs in primary health conducted with a diverse  range of clinicians at the clinician level. It will direct future research capacity  building efforts towards maximising face-to-face discipline specific options and  minimising technology use.

Fundamental movement skills - How do primary school children perform? The 'Move it Groove it' program in rural Australia

Child Fundamental Movement Skills (FMS) underpin active lifestyles yet little is known of their distribution and mastery.

‘Move it Groove it’ project rated proficiency of primary school children (n=1045, 18 schools) in skills of balance, throw, catch, sprint, hop, kick, side gallop and jump. Rating categories were ‘mastery’, ‘near mastery’ or ‘poor’ (ie mastered all, all but one, or less of the five to six components of an FMS).

Less than half of all child tests were rated at mastery (21.3%) or near mastery (25.7%) level. In grade three, 75.4% of children achieved mastery or near mastery (MNM) in static balance but less than half did so for any other FMS. In grade four, 59.0% achieved MNM in the side gallop and 56.0% in the catch but less than half did so for any other FMS.

Although the highest percent mastery for both genders was for the balance, the skills best performed thereafter by boys (throw and kick) rated poorest for girls. Conversely the hop and side gallop which rated, after balance, as the skills best mastered by girls, were among the more poorly performed skills for boys.

The low prevalence of FMS mastery found in this survey suggests that there may be great potential to improve fundamental movement skills of primary aged children in many parts of rural Australia. Even if the aim were for children to achieve near mastery levels, the improvement could be substantial in every skill category. Where appropriate, gender differences in mastery might easily be addressed by tailored physical education programs and modification of social and physical environments.

Implementation of student active learning in primary mathematics in Indonesia

Twenty years after the first pilot projects began to develop Student Active Learning (SAL) in Indonesia, and four years since it was adopted for use in the last provinces, this research investigates the implementation of Student Active Learning in Indonesian primary mathematics classrooms. A study of the relevant literature indicates that teaching based on constructivist principles is unlikely to be implemented well in mathematics classrooms unless there are high quality teachers, readily available manipulative materials, and a supportive learning environment. As Indonesian schools often lack one or more of these aspects, it seemed likely that Student Active Learning principles might not be ‘fully’ implemented in Indonesian primary mathematics classrooms. Thus a smaller scale, parallel study was carried out in Australian schools where there is no policy of Student Active Learning, but where its underlying principles are compatible with the stated views about learning and teaching mathematics. The study employed a qualitative interpretive methodology. Sixteen primary teachers from four urban and four rural Indonesian schools and four teachers from two Victorian schools were observed for four mathematics lessons each. The twenty teachers, as well as fourteen Indonesian headteachers and other education professionals, were interviewed in order to establish links between the background and beliefs of participants, and their implementation of Student Active Learning. Information on perceived constraints on the implementation of SAL was also sought. The results of this study suggest that Student Active learning has been implemented at four levels in Indonesian primary mathematics classrooms, ranging from essentially no implementation to a relatively high level of implementation, with an even higher level of implementation in three of the four Australian classrooms observed. Indonesian teachers, headteachers and supervisors hold a range of views of SAL and also of mathematics learning and teaching. These views largely depended on their in-service training in SAL and, more particularly, on their participation in the PEQIP project Typically, participants’ expressed views of SAL were at the same or higher level as their views of mathematics learning and teaching, with a similar pattern being observed in the relationship between these latter views and their implementation of SAL principles. Three factors were identified as influencing teacher change in terms of implementation of SAL: policy, curricular and organisational, and attitudes. Recommendations arising from this study include the adoption of reflection as an underlying principle in the theory of SAL, the continuation and extension of PEQIP type projects, changes in government policy on curriculum coverage and pre-service teacher training, and more support for teachers at the school and local authority levels.

Lesbian and gay experiences of primary care in one borough in North London, UK

This paper reports the findings of a research study which explored the experiences of lesbians and gay men in relation to primary care services in general practice in a multiracial borough in North London, UK. The research took a qualitative approach and used several methods including a literature review, interviews with stakeholders (n = 6), focus group discussions (n = 27) and completion (n = 42) of a survey distributed to lesbians and gay men locally. The process facilitated the development of a grounded theory. The important themes to emerge were finding a GP and coming out, sexual health issues, mental health issues and communication with the GP. Given the high level of mobility among this population, there were problems in maintaining continuity of care, and a lack of protocols to facilitate the sharing of knowledge between patients and practitioners while reducing reliance on heterosexual assumptions. There were clear differences between the treatment of women and men in relation to sexual health, and neither approach could be said to be patient centred or inclusive of diversity of need. The fact that many informants accessed alternative sources of healthcare indicated that they were concerned to promote and maintain their health and wellbeing in a holistic manner. The lack of transparent protocols within general practice inhibited some informants from being as open and honest about their sexuality with their GPs as they were with their families or their employers. The findings highlight (1) the need for organisational development within primary care to improve sensitivity to the needs of lesbians and gay men; (2) the value of research to engage with the social experiences of lesbians and gay men; (3) the importance of engaging with the differing experiences of lesbians and gay men in relation to sexual health concerns.

Relationships between maturity status, physical activity and physical self-perceptions in primary school children

The aim of this study was to examine the influence of maturity status on primary school children's physical activity and physical self-perceptions. Altogether, 175 children (97 girls, 78 boys) aged 10.6 ± 0.3 years completed the Children and Youth Physical Self-Perception Profile and wore an ActiGraph accelerometer for five consecutive days to assess moderate-to-vigorous physical activity. Anthropometric measures were completed to estimate maturity status. A two-level, multi-level analysis was used to assess the influence of maturity status on moderate-to-vigorous physical activity and physical self-perceptions. Boys performed more moderate-to-vigorous physical activity than girls (P < 0.0001), but when the effect of maturity status was controlled the difference was reduced (P = 0.02). Significant differences between the sexes were also observed for physical self-perception sub-domains (boys > girls, P = 0.02 to 0.0001). When maturity status was added to the model, significant differences were no longer apparent for each sub-domain, with the exception of perceived strength. Significant interactions between gender and maturity status revealed that boys' physical self-perceptions improved with more advanced maturity status, whereas girls' self-perceptions decreased (P = 0.07 to 0.002). Significant differences between the sexes in moderate-to-vigorous physical activity and some domains of physical self-perceptions were reduced or no longer evident when the effect of maturity status was controlled. Maturity status may differentially influence boys' and girls' physical self-perceptions.

MAAGs: the next generation. A study of the development of medical audit advisory groups and the arrangements for supporting clinical audit in primary care

Background: MAAGs have, historically, been disparate organisations with a lack of central direction, albeit with the same goal: to develop and support the performance of audit in primary care. This goal has been (and is being) achieved in a number of ways all over the country. In the last two years, MAAGs have witnessed many changes in primary care and are adapting themselves to suit these new arrangements at a local level.

Aim: To formalise our knowledge of where MAAGs are going, how they are getting there and the support they are receiving.

Method: A postal questionnaire to the 104 MAAGs in England and Wales, addressing 6 main issues of relevance to the development of MAAGs and the support they are receiving.

Results: At least two MAAGs have dissolved, leaving a possible total of 102 still in existence. Of these, 76 (74.5%) responded to the survey. The composition of the MAAG committee has changed dramatically since the inception of MAAGs in 1990, and staffing levels appear to have risen substantially. MAAGs appear to be more adequately funded by their health authorities than has previously been reported and many are actively seeking additional sources of funding. There is still large variation in levels of MAAG funding. Furthermore, funding is unrelated to the number of GPs or practices served. Security for MAAG staff appears to have been addressed in many areas, with 84% of MAAGs having at least one member of staff on a permanent employment contract. Many MAAGs are developing rolling programmes in an attempt to eliminate the short-sighted approach to the development of clinical audit that has existed since MAAGs were first set up.

Conclusion: Many MAAGs (with the obvious exception of those that have been dissolved) appear to be thriving without central direction or initiative. It is now evident that we were a little hasty in our concerns for the future of MAAGs beyond April 1996. It would seem that many organisations have taken the situation which arose two years ago as an opportunity to grow and develop in ways that may not have been possible within the confines of the Health Circular.

Growing community : the impact of the Stephanie Alexander kitchen garden program on the social and learning environment in primary schools

This article presents results from a mixed-method evaluation of a structured cooking and gardening program in Australian primary schools, focusing on program impacts on the social and learning environment of the school. In particular, we address the Stephanie Alexander Kitchen Garden Program objective of providing a pleasurable experience that has a positive impact on student engagement, social connections, and confidence within and beyond the school gates. Primary evidence for the research question came from qualitative data collected from students, parents, teachers, volunteers, school principals, and specialist staff through interviews, focus groups, and participant observations. This was supported by analyses of quantitative data on child quality of life, cooperative behaviors, teacher perceptions of the school environment, and school-level educational outcome and absenteeism data. Results showed that some of the program attributes valued most highly by study participants included increased student engagement and confidence, opportunities for experiential and integrated learning, teamwork, building social skills, and connections and links between schools and their communities. In this analysis, quantitative findings failed to support findings from the primary analysis. Limitations as well as benefits of a mixed-methods approach to evaluation of complex community interventions are discussed.

The influence of job, team and organizational level resources on employee well-being, engagement, commitment and extra-role performance : test of a model

Purpose – Worker well-being continues to be fundamental to the study of work and a primary consideration for how organizations can achieve competitive advantage and sustainable and ethical work practices (Cartwright and Holmes; Harter, Schmidt and Keyes; Wright and Cropanzano). The science and practice of employee engagement, a key indicator of employee well-being, continues to evolve with ongoing incremental refinements to existing models and measures. This study aims to elaborate the Job Demands-Resources model of work engagement (Bakker and Demerouti) by examining how organizational, team and job level factors interrelate to influence engagement and well-being and downstream outcome variables such as affective commitment and extra-role behaviour.

Design/methodology/approach – Structural equations modelling of survey data obtained from 3,437 employees of a large multi-national mining company was used to test the important direct and indirect influence of organizational focused resources (a culture of fairness and support), team focused resources (team climate) and job level resources (career development, autonomy, supervisor support, and role clarity) on employee well-being, engagement, extra-role behaviour and organizational commitment.

Findings – The fit of the proposed measurement and structural models met criterion levels and the structural model accounted for sizable proportions of the variance in engagement/wellbeing (66 percent), extra-role-behaviour (52 percent) and commitment (69 percent).

Research limitations/implications – Study limitations (e.g. cross-sectional research design) and future opportunities are outlined.

Originality/value – The study demonstrates important extensions to the Job Demands-Resources model and provides researchers and practitioners with a simple but powerful motivational framework, a suite of measures, and a map of their inter-relationships which can be used to help understand, develop and manage employee well-being and engagement and their outcomes.

School and individual-level characteristics are associated with children's moderate to vigorous intensity physical activity during school recess

Objective: The objective of this study was to identify school environmental characteristics associated with moderate to vigorous physical activity during school recess, including morning and lunch breaks.

Methods: Accelerometry data, child-level characteristics and school physical activity, policy and socio-cultural data were collected from 408 sixth grade children (mean age 11 years) attending 27 metropolitan primary schools in Perth, Western Australia. Hierarchical modelling identified key characteristics associated with children's recess moderate to vigorous physical activity (RMVPA).

Results: Nearly 40% of variability in children's RMVPA was explained by school environment and individual characteristics identified in this study. Children's higher daily RMVPA was associated with newer schools, schools with a higher number of grassed surfaces per child and fewer shaded grassed surfaces, and the physical education coordinator meeting Australian physical activity guidelines.

Conclusions: Characteristics of the school physical and social environments are strongly correlated with children's MPVA during recess.