Comparing the cost-effectiveness of MRSA control strategies between ICU and non-ICU settings

Introduction / objectives Many strategies are used to control MRSA in hospitals. Only a few have been assessed in clinical trials and it is not obvious how findings should be generalised between settings. Uncertainty remains about which strategies represent the most appropriate use of scarce resources. We assess the cost-effectiveness of alternative MRSA screening and infection control strategies in England and Wales and discuss international relevance. Methods Models of MRSA transmission in ICUs and general medical (GM) wards were developed and used to evaluate different screening methods combined with decolonisation or isolation. Strategies were compared in terms of costs and health benefits (quality adjusted life years, QALYs). Different prevalences, proportions of high risk patients and ward sizes were investigated, and probabilistic sensitivity analyses (PSA) conducted. Results Decolonisation strategies were cost-saving in ICUs at a 5% admission prevalence, with admission and weekly PCR screening the most cost-effective (£3,929/QALY). In ICUs, screening and isolation reduced infection rates by ~10%. With admission prevalence ≤5%, targeting screening and isolation to high risk patients was optimal. In GM wards decolonisation and isolation strategies, though able to reduce MRSA infection rates up to ~50%, were not cost-effective. Conclusion The largest reductions in MRSA infection were achieved by screening and decolonisation strategies, and were cost-effective in ICU settings. In comparison, there is limited potential for screening and control strategies to be cost-effective in GM wards due to lower infection and mortality rates.

Converting theory to practice : university-school collaboration on devising strategies for mentoring pedagogical knowledge

There appears no shortage of theorists for preservice teacher education; however many ideas are abandoned without practical applications. Indeed, it can take years for theories to materialise into practice, if they materialise at all. The quality of preservice teacher education is central for enhancing an education system, and mentors’ roles can assist to shape preservice teachers’ development within the school context. Yet mentoring can be haphazard without being underpinned by a theoretical framework. A mentoring model (personal attributes, system requirements, pedagogical knowledge, modelling, and feedback) has emerged from research and the literature to guide mentors’ practices. This qualitative study investigates mentors’ pedagogical knowledge as one factor crucial to the mentoring process. More specifically, this study involves a questionnaire and audio-recorded focus group meetings with experienced mentors (n=14) who deliberated on devising practical applications for mentoring pedagogical knowledge. Findings revealed that these experienced mentors pinpointed practical applications around a mentor’s role for providing pedagogical knowledge to the mentee. These strategies were varied and demonstrated that any one mentoring practice may be approached from a number of different angles. Nevertheless, there were core mentoring practices in pedagogical knowledge such as showing the mentee how to plan for teaching, articulating classroom management approaches, and talking about how to connect learning to assessment. Mentors may require education on current mentoring practices with practical strategies that are linked to theoretical underpinnings.

Falls in Parkinson’s disease : evidence for altered stepping strategies on compliant surfaces

Background: Real-world environments comprise surfaces of different textures, densities and gradients, which can threaten postural stability and increase falls risk. However, there has been limited research that has examined how walking on compliant surfaces influences gait and postural stability in older people and PD patients. Methods: PD patients (n = 49) and age-matched controls (n = 32) were assessed using three dimensional motion analysis during self-paced walking on both firm and foam walkways. Falls were recorded prospectively over 12 months using daily falls calendars. Results: Walking on a foam surface influenced the temporospatial characteristics for all groups, but PD fallers adopted very different joint kinematics compared with controls. PD fallers also demonstrated reduced toe clearance and had increased mediolateral head motion(relative to walking velocity) compared with control participants. Conclusions: Postural control deficits in PD fallers may impair their capacity to attenuate surface-related perturbations and control head motion. The risk of falling for PD patients may be increased on less stable surfaces.

Employee perceived workplace stress : examining core self-evaluations, political skill, coping strategies and support

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Learning by design workshop

The Learning by Design Workshop Program 2010, a part of the Queensland Government Unlimited: Designing for the Asia Pacific Event Program, was a one-day professional development design thinking workshop run on October 9, 2011 at The Edge, State Library of Queensland for self-selected public and private secondary school teachers from the subject areas of Visual Art, Graphics and Industrial Technology and Design. Participants were drawn from a database of Brisbane and regional Queensland schools from the goDesign and Living City Workshop Programs. It aimed to generate leadership within schools for design-led education and creative thinking and give teachers a rare opportunity to work with professional designers to generate future strategies for design-based learning. Teachers were introduced to the concept of design thinking in education by international keynote speakers CJ Lim (Studio 8 Architects) and Jeb Brugmann (The Next Practice), national speaker Oliver Freeman (NevilleFreeman Agency) and three Queensland speakers, Alexander Loterztain, David Williams and Keith Holledge. Inspired by the Unlimited showcase exhibition Make Change: Design Thinking in Action and ‘Idea Starters’/teaching resources provided, teachers worked with a professional designer (from a discipline of architecture, interior design, industrial design, urban design, graphic design or landscape architecture) in ten random teams, to generate optimistic ideas for the Ideal City of tomorrow, each considering a theme – Food, Water, Transport, Ageing, Growth, Employment, Shelter, Health, Education and Energy. They then discussed how this process could be best activated and expanded on to build interest and knowledge in design thinking in the classroom. Assisted by illustrators, the teams prepared a visual presentation of their ideas and process from art materials provided. The workshop culminated in a video-taped interactive design charette to the larger group, which is intended to be utilised as a toolkit and praxis for teachers as part of the State Library of Queensland Design Minds Website Project.

Generation workshop 2010

The Generation Workshop Program 2010, a part of the Queensland Government Unlimited: Designing for the Asia Pacific Event Program, consisted of two one-day intensive design thinking workshops run on October 7-8, 2011 at The Edge, State Library of Queensland, for 100 senior secondary students and 20 secondary teachers self-selected from the subject areas of Visual Art, Graphics and Industrial Technology and Design. Participants were drawn from a database of Brisbane and regional Queensland private and public schools from the goDesign and Living City Workshop Programs. The workshop aimed to facilitate awareness in young people of the role of design in society and the value of design thinking skills in solving complex problems facing the Asia Pacific Region, and to inspire the generation of strategies for our future cities. It also aimed to encourage the collaboration of professional designers with secondary schools to inspire post-secondary pathways and idea generation for education. Inspired by international and national speakers Bunker Roy (Barefoot College) and Hael Kobayashi (Associate Producer on "Happy Feet" film for Australia's Animal Logic), the Unlimited showcase exhibition Make Change: Design Thinking in Action and ‘Idea Starters’/teaching resources provided, students worked with a teacher in ten random teams, to generate optimistic strategies for the Ideal City of tomorrow, each considering a theme – Food, Water, Transport, Ageing, Growth, Employment, Shelter, Health, Education and Energy. Each team of 6 was led by a professional designer (from the discipline of architecture, interior design, industrial design, urban design, graphic design or landscape architecture) who was a catalyst for driving the student creative thinking process. Assisted by illustrators, the teams prepared a visual presentation of their idea from art materials provided. The workshop culminated in a video-taped interactive design chatter to the larger group, which will be utilised as a toolkit and praxis for teachers as part of the State Library of Queensland Design Minds Project. Photos of student design work were published on the Unlimited website.

Clinical strategies for the alleviation of contractures from a predictive mathematical model of dermal repair

Hypertrophic scars arise when there is an overproduction of collagen during wound healing. These are often associated with poor regulation of the rate of programmed cell death(apoptosis) of the cells synthesizing the collagen or by an exuberant inflammatory response that prolongs collagen production and increases wound contraction. Severe contractures that occur, for example, after a deep burn can cause loss of function especially if the wound is over a joint such as the elbow or knee. Recently, we have developed a morphoelastic mathematical model for dermal repair that incorporates the chemical, cellular and mechanical aspects of dermal wound healing. Using this model, we examine pathological scarring in dermal repair by first assuming a smaller than usual apoptotic rate for myofibroblasts, and then considering a prolonged inflammatory response, in an attempt to determine a possible optimal intervention strategy to promote normal repair, or terminate the fibrotic scarring response. Our model predicts that in both cases it is best to apply the intervention strategy early in the wound healing response. Further, the earlier an intervention is made, the less aggressive the intervention required. Finally, if intervention is conducted at a late time during healing, a significant intervention is required; however, there is a threshold concentration of the drug or therapy applied, above which minimal further improvement to wound repair is obtained.

Power relations and small and medium-sized enterprise strategies for capturing value in global production networks: visual effects (VFX) service firm in the Hollywood film industry

Power relations and small and medium-sized enterprise strategies for capturing value in global production networks: visual effects (VFX) service firms in the Hollywood film industry, Regional Studies. This paper provides insights into the way in which non-lead firms manoeuvre in global value chains in the pursuit of a larger share of revenue and how power relations affect these manoeuvres. It examines the nature of value capture and power relations in the global supply of visual effects (VFX) services and the range of strategies VFX firms adopt to capture higher value in the global value chain. The analysis is based on a total of thirty-six interviews with informants in the industry in Australia, the United Kingdom and Canada, and a database of VFX credits for 3323 visual products for 640 VFX firms.

E-learning in traditional industries: balancing the preferences of an ageing workforce with the expectations of a technoloigy-savvy generation

There is widespread argument that traditional organisations and industries with a predominantly older workforce who are not using computers as an integral part of their work, are unlikely to embrace the opportunities afforded by e-learning. However, the challenge remains to engage a younger generation of learners who seem comfortable learning with technology, whilst not alienating those older learners who may prefer to learn in more traditional ways. This paper analyses data from five case organisations within the Australian rail industry to identify how the potential of e-learning can be realised whilst acknowledging the technological divide between younger and older workers.

Active ageing : developing a quantitative multi-dimensional measure

With estimates that two billion of the world’s population will be 65 years or older by 2050, ensuring that older people ‘age well’ is an international priority. To date, however, there is significant disagreement and debate about how to define and measure ‘ageing well’, with no consensus on either terminology or measurement. Thus, this chapter describes the research rationale, methodology and findings of the Australian Active Ageing Study (Triple A Study), which surveyed 2620 older Australians to identify significant contributions to quality of life for older people: work, learning, social participation, spirituality, emotional wellbeing, health, and life events. Exploratory factor analyses identified eight distinct elements (grouped into four key concepts) which appear to define ‘active ageing’ and explained 55% of the variance: social and life participation (25%), emotional health (22%), physical health and functioning (4%) and security (4%). These findings highlight the importance of understanding and supporting the social and emotional dimensions of ageing, as issues of social relationships, life engagement and emotional health dominated the factor structure. Our intension is that this paper will prompt informed debate and discussion on defining and measuring active ageing, facilitating exploration and understanding of the complexity of issues that intertwine, converge and enhance the ageing experience.

Moral and social development: teachers’ knowledge of children’s learning and teaching strategies in the early years

The intention of the analysis in this paper was to determine, from interviews with 11 early years’ teachers, what informed their knowledge of children’s learning and teaching strategies regarding moral development. Overall, the analysis revealed four main categories: definitions of moral behaviour, understanding of children’s learning, pedagogy for moral learning, and the source of knowledge for moral pedagogy. Children’s learning was attributed by five of the teachers to incidental/contextual issues. Nine of the teachers reported using pedagogies that involved discussion of issues, in various contexts, as a way of teaching about social and moral issues. The majority of the teachers (n = 7) described the source of their knowledge of pedagogy as practical/observed as opposed to being theoretically informed. There was no clear relationship between teachers’ definitions, understanding of children’s learning, pedagogy or source of knowledge. These results suggests a strong need for the teaching of moral development to be given more prominence and addressed directly in in-service courses so that teachers are clear about their intentions and the most effective ways of achieving them.

Resource acquisition and utilisation strategies of intrapreneurs and entrepreneurs

This paper sets out to investigate differences between intrapreneurs and entrepreneurs with regards to their resource utilisation behaviours through social capital and bricolage. In particular we were interested in those entrepreneurs who start their business while still being employed, as it allows us to compare how intrapreneurs and entrepreneurs make use of social capital within their employer. Our findings challenge some existing wisdoms in that it seems intrapreneurs make more use of social capital external to their employer than entrepreneurs, while the use of social capital internal to the company is similar to the use by entrepreneurs. Yet, internal organizational social capital seems to have a positive effect on performance for intrapreneurial efforts only, while external social capital is not related to performance. This suggests both intrapreneurs and entrepreneurs may benefit from reconsidering the focus they place on respectively external and internal organizational social capital. Bricolage behaviours were extremely prevalent amongst both intrapreneurs and entrepreneurs as well as being the strongest predictor of performance. This strong effect on performance for intrapreneurial ventures may suggest that bricolage behaviours need to be rethought when it comes to intrapreneurs.

Development of novel vaccine strategies to prevent genital tract chlamydial infections

Chlamydia trachomatis is the most prevalent bacterial sexually transmitted infection in the developed world and the leading cause of preventable blindness worldwide. As reported by the World Health Organization in 2001, there are approximately 92 million new infections detected annually, costing health systems billions of dollars to treat not only the acute infection, but also to treat infection-associated sequelae. The majority of genital infections are asymptomatic, with 50-70% going undetected. Genital tract infections can be easily treated with antibiotics when detected. Lack of treatment can lead to the development of pelvic inflammatory disease, ectopic pregnancies and tubal factor infertility in women and epididymitis and prostatitis in men. With infection rates on the continual rise and the large number of infections going undetected, there is a need to develop an efficacious vaccine which prevents not only infection, but also the development of infection-associated pathology. Before a vaccine can be developed and administered, the pathogenesis of chlamydial infections needs to be fully understood. This includes the kinetics of ascending infection and the effects of inoculating dose on ascension and development of pathology. The first aim in this study was to examine these factors in a murine model. Female BALB/c mice were infected intravaginally with varying doses of C. muridarum, the mouse variant of human C. trachomatis, and the ascension of infection along the reproductive tract and the time-course of infection-associated pathology development, including inflammatory cell infiltration, pyosalpinx and hydrosalpinx, were determined. It was found that while the inoculating dose did affect the rate and degree of infection, it did not affect any of the pathological parameters examined. This highlighted that the sexual transmission dose may have minimal effect on the development of reproductive sequelae. The results of the first section enabled further studies presented here to use an optimal inoculating dose that would ascend the reproductive tract and cause pathology development, so that vaccine efficacy could be determined. There has been a large amount of research into the development of an efficacious vaccine against genital tract chlamydial infections, with little success. However, there have been no studies examining the effects of the timing of vaccination, including the effects of vaccination during an active genital infection, or after clearance of a previous infection. These are important factors that need to be examined, as it is not yet known whether immunization will enhance not only the individual's immune response, but also pathology development. It is also unknown whether any enhancement of the immune responses will cause the Chlamydia to enter a dormant, persistent state, and possibly further enhance any pathology development. The second section of this study aimed to determine if vaccination during an active genital tract infection, or after clearance of a primary infection, enhanced the murine immune responses and whether any enhanced or reduced pathology occurred. Naïve, actively infected, or previously infected animals were immunized intranasally or transcutaneously with the adjuvants cholera toxin and CpG-ODN in combination with either the major outer membrane protein (MOMP) of C. muridarum, or MOMP and ribonucleotide reductase small chain protein (NrdB) of C. muridarum. It was found that the systemic immune responses in actively or previously infected mice were altered in comparison to animals immunized naïve with the same combinations, however mucosal antibodies were not enhanced. It was also found that there was no difference in pathology development between any of the groups. This suggests that immunization of individuals who may have an asymptomatic infection, or may have been previously exposed to a genital infection, may not benefit from vaccination in terms of enhanced immune responses against re-exposure. The final section of this study aimed to determine if the vaccination regimes mentioned above caused in vivo persistence of C. muridarum in the upper reproductive tracts of mice. As there has been no characterization of C. muridarum persistence in vitro, either ultrastructurally or via transcriptome analysis, this was the first aim of this section. Once it had been shown that C. muridarum could be induced into a persistent state, the gene transcriptional profiles of the selected persistent marker genes were used to determine if persistent infections were indeed present in the upper reproductive tracts of the mice. We found that intranasal immunization during an active infection induced persistent infections in the oviducts, but not the uterine horns, and that intranasal immunization after clearance of infection, caused persistent infections in both the uterine horns and the oviducts of the mice. This is a significant finding, not only because it is the first time that C. muridarum persistence has been characterized in vitro, but also due to the fact that there is minimal characterization of in vivo persistence of any chlamydial species. It is possible that the induction of persistent infections in the reproductive tract might enhance the development of pathology and thereby enhance the risk of infertility, factors that need to be prevented by vaccination, not enhanced. Overall, this study has shown that the inoculating dose does not affect pathology development in the female reproductive tract of infected mice, but does alter the degree and rate of ascending infection. It has also been shown that intranasal immunization during an active genital infection, or after clearance of one, induces persistent infections in the uterine horns and oviducts of mice. This suggests that potential vaccine candidates will need to have these factors closely examined before progressing to clinical trials. This is significant, because if the same situation occurs in humans, a vaccine administered to an asymptomatic, or previously exposed individual may not afford any extra protection and may in fact enhance the risk of development of infection-associated sequelae. This suggests that a vaccine may serve the community better if administered before the commencement of sexual activity.

Sustaining a healthy workforce

The changing demographics of the mining workforce and the increasing demand for skilled workers increases the importance of sustaining a healthy workforce now and for the future. Although health is strongly related to safety, the two areas are not well integrated and the relationship is poorly understood. As such there is an important need to raise the profile of health within the Occupational Health and Safety (OH&S) domain. The mining industry carries health and safety risks, often greater than other occupations. Whilst the mining industry is regulated by stringent OH&S controls, the very nature of the work and environmental influences expose employees to a greater number of injury risk factors than many other industries. In contrast to its excellent safety record, compared to most other industries, the mining workforce has a high proportion of chronic health problems. These problems can be exacerbated by the ageing of the workforce, regional location of sites and organisational issues influencing work demands. A major focus has been on the treatment of these conditions with relatively limited attention to prevention strategies. An important prevention strategy is the raising of awareness among the workforce of health issues and the significant increase in the volume of health related information has provided an excellent opportunity to access relevant information. Unfortunately, this information is of varying quality, may not be evidence based, and may provide the wrong guidance to the development of interventions designed to improve health. Limited time of most employees and potential lack of knowledge of ability to differentiate quality information presents additional problems or barriers to increasing awareness of health issues...