Experience of overseas-trained health professionals in rural and remote areas of destination countries: A literature review

This study aimed to review and synthesise existing literature that investigated the experience of overseastrained health professionals (OTHPs) in rural and remote areas of destination countries. A systematic literature review was conducted using electronic databases and manual search of studies published from January 2004 to February 2011. Data were analysed from the final 17 original report articles that met the inclusion criteria. The reviewed research studies were conducted in Australia, Canada, New Zealand, the UK and the USA. Overseas-trained medical practitioners were the most frequently researched (n = 14); two studies involved nurses and one study included several health professionals. Three main themes emerged from the review and these were: (i) expectations; (ii) cultural diversity; and (iii) orientation and integration to rural and remote health work environment. The OTHPs were expected to possess the appropriate professional and cultural skills while they themselves expected recognition of their previous experiences and adequate organisational orientation and support. A welcoming and accepting community coupled with a relaxed rural lifestyle and the joy of continued patient care resulted in successful integration and contributed to increased staff retention rates. Recognition of expectations and cultural diversity by all parties and comprehensive orientation with sufficient organisational support are important elements in the integration of OTHPs and subsequent delivery of quality health care to people living in rural and remote areas.

Scaffolds for growth factor delivery as applied to bone tissue engineering

There remains a substantial shortfall in treatment of severe skeletal injuries. The current gold standard of autologous bone grafting from the same patient, has many undesirable side effects associated such as donor site morbidity. Tissue engineering seeks to offer a solution to this problem. The primary requirements for tissue engineered scaffolds have already been well established, and many materials, such as polyesters, present themselves as potential candidates for bone defects; they have comparable structural features, but they often lack the required osteoconductivity to promote adequate bone regeneration. By combining these materials with biological growth factors; which promote the infiltration of cells into the scaffold as well as the differentiation into the specific cell and tissue type, it is possible to increase the formation of new bone. However cost and potential complications associated with growth factors means controlled release is an important consideration in the design of new bone tissue engineering strategies. This review will cover recent research in the area of encapsulation and release of growth factors within a variety of different polymeric scaffolds.

HACC food service client cultural food preferences assessment tool

This assessment form is designed to help your HACC service provider arrange for the most appropriate food and meal services that they can. It includes questions relating to food preferences, health and nutrition, abilities to source and prepare foods as well as questions to highlight if you are at risk of not having adequate access to appropriate foods. It is understood that some people from certain cultures may not feel comfortable answering some of these questions. Therefore, please do not answer those questions with which you are not comfortable.

Micromarrows—Three-dimensional coculture of hematopoietic stem cells and mesenchymal stromal cells

Hematopoietic stem cell (HSC) transplant is a well established curative therapy for some hematological malignancies. However, achieving adequate supply of HSC from some donor tissues can limit both its application and ultimate efficacy. The theory that this limitation could be overcome by expanding the HSC population before transplantation has motivated numerous laboratories to develop ex vivo expansion processes. Pioneering work in this field utilized stromal cells as support cells in cocultures with HSC to mimic the HSC niche. We hypothesized that through translation of this classic coculture system to a three-dimensional (3D) structure we could better replicate the niche environment and in turn enhance HSC expansion. Herein we describe a novel high-throughput 3D coculture system where murine-derived HSC can be cocultured with mesenchymal stem/stromal cells (MSC) in 3D microaggregates—which we term “micromarrows.” Micromarrows were formed using surface modified microwells and their ability to support HSC expansion was compared to classic two-dimensional (2D) cocultures. While both 2D and 3D systems provide only a modest total cell expansion in the minimally supplemented medium, the micromarrow system supported the expansion of approximately twice as many HSC candidates as the 2D controls. Histology revealed that at day 7, the majority of bound hematopoietic cells reside in the outer layers of the aggregate. Quantitative polymerase chain reaction demonstrates that MSC maintained in 3D aggregates express significantly higher levels of key hematopoietic niche factors relative to their 2D equivalents. Thus, we propose that the micromarrow platform represents a promising first step toward a high-throughput HSC 3D coculture system that may enable in vitro HSC niche recapitulation and subsequent extensive in vitro HSC self-renewal.

Applying market design theory to 'greyfields' housing supply

This paper examines whether innovation in market design can address persistent problems of housing choice and affordability in the ageing inner and middle suburbs of Australian cities. Despite policy consensus that urban intensification of these low density, ‘greyfield’ areas should be able to deliver positive social, economic and environmental outcomes, existing models of development have not increased housing stock or delivered adequate gains in sustainability, affordability or diversity of dwellings in greyfield localities. We argue that application of smart market and matching market principles to the supply of multi-unit housing can unlock land, reduce development costs and improve design.

A Survey-based Study of Knowledge of Alzheimer's Disease among Health Care Staff

Background Continued aging of the population is expected to be accompanied by substantial increases in the number of people with dementia and in the number of health care staff required to care for them. Adequate knowledge about dementia among health care staff is important to the quality of care delivered to this vulnerable population. The purpose of this study was to assess knowledge about dementia across a range of health care staff in a regional health service district. Methods Knowledge levels were investigated via the validated 30-item Alzheimer's Disease Knowledge Scale (ADKS). All health service district staff with e-mail access were invited to participate in an online survey. Knowledge levels were compared across demographic categories, professional groups, and by whether the respondent had any professional or personal experience caring for someone with dementia. The effect of dementia-specific training or education on knowledge level was also evaluated. Results A diverse staff group (N = 360), in terms of age, professional group (nursing, medicine, allied health, support staff) and work setting from a regional health service in Queensland, Australia responded. Overall knowledge about Alzheimer's disease was of a generally moderate level with significant differences being observed by professional group and whether the respondent had any professional or personal experience caring for someone with dementia. Knowledge was lower for some of the specific content domains of the ADKS, especially those that were more medically-oriented, such as 'risk factors' and 'course of the disease.' Knowledge was higher for those who had experienced dementia-specific training, such as attendance at a series of relevant workshops. Conclusions Specific deficits in dementia knowledge were identified among Australian health care staff, and the results suggest dementia-specific training might improve knowledge. As one piece of an overall plan to improve health care delivery to people with dementia, this research supports the role of introducing systematic dementia-specific education or training.

Using the Donabedian framework to examine the quality and safety of nursing service innovation

Aims and objectives To evaluate the safety and quality of nurse practitioner service using the audit framework of Structure,Process and Outcome. Background Health service and workforce reform are on the agenda of governments and other service providers seeking to contain healthcare costs whilst providing safe and effective health care to communities. The nurse practitioner service is one health workforce innovation that has been adopted globally to improve timely access to clinical care, but there is scant literature reporting evaluation of the quality of this service innovation. Design. A mixed-methods design within the Donabedian evaluation framework was used. Methods The Donabedian framework was used to evaluate the Structure, Process and Outcome of nurse practitioner service. A range of data collection approaches was used, including stakeholder survey (n=36), in-depth interviews (11 patients and 13 nurse practitioners) and health records data on service processes. Results The study identified that adequate and detailed preparation of Structure and Process is essential for the successful implementation of a service innovation. The multidisciplinary team was accepting of the addition of nurse practitioner service, and nurse practitioner clinical care was shown to be effective, satisfactory and safe from the perspective of the clinician stakeholders and patients. Conclusions This study demonstrated that the Donabedian framework of Structure, Process and Outcome evaluation is a valuable and validated approach to examine the safety and quality of a service innovation. Furthermore, in this study, specific Structure elements were shown to influence the quality of service processes further validating the framework and the interdependence of the Structure, Process and Outcome components. Relevance to clinical practice Understanding the structure and process requirements for establishing nursing service innovation lays the foundation for safe, effective and patient-centred clinical care.

Flexural-torsional buckling tests of cold-formed steel compression members at elevated temperatures

Current design standards do not provide adequate guidelines for the fire design of cold-formed steel compression members subject to flexural-torsional buckling. Eurocode 3 Part 1.2 (2005) recommends the same fire design guidelines for both hot-rolled and cold-formed steel compression members subject to flexural-torsional buckling although considerable behavioural differences exist between cold-formed and hot-rolled steel members. Past research has recommended the use of ambient temperature cold-formed steel design rules for the fire design of cold-formed steel compression members provided appropriately reduced mechanical properties are used at elevated temperatures. To assess the accuracy of flexural-torsional buckling design rules in both ambient temperature cold-formed steel design and fire design standards, an experimental study of slender cold-formed steel compression members was undertaken at both ambient and elevated temperatures. This paper presents the details of this experimental study, its results, and their comparison with the predictions from the current design rules. It was found that the current ambient temperature design rules are conservative while the fire design rules are overly conservative. Suitable recommendations have been made in relation to the currently available design rules for flexural-torsional buckling including methods of improvement. Most importantly, this paper has addressed the lack of experimental results for slender cold-formed steel columns at elevated temperatures.

Submission to the ALRC copyright exceptions review issues paper

Australia should introduce a transformative use exception. Transformative use is an important part of the copyright balance: it provides a mechanism through which to balance the rights of past authors against the interests of future authors. In the interests of promoting creativity and innovation, the impact of copyright law on the ability of Australians to create new works should be minimised. The scope of a transformative use exception should be based primarily on demonstrable harm to the direct licensing interests of copyright owners – the core of copyright. Importantly, however, there are unresolved questions about fairness that need to be more clearly addressed before the appropriate scope of a transformative use exception can be determined. This submission does not directly address the desirability of introducing a broader fair use right. It is likely that an open ended fair use exception is required to provide a more adequate balance between copyright owners and non-transformative users of copyright. If a broad fair use style exception is introduced, it would likely be desirable to include transformative uses within that exception. This submission, however, takes the more limited position that regardless of whether a fair use exception is introduced, an exception that permits unlicensed transformative uses is required in Australian copyright law.

Finite element shoulder models

Shoulder joint is a complex integration of soft and hard tissues. It plays an important role in performing daily activities and can be considered as a perfect compromise between mobility and stability. However, shoulder is vulnerable to complications such as dislocations and osteoarthritis. Finite element (FE) models have been developed to understand shoulder injury mechanisms, implications of disease on shoulder complex and in assessing the quality of shoulder implants. Further, although few, Finite element shoulder models have also been utilized to answer important clinical questions such as the difference between a normal and osteoarthritic shoulder joint. However, due to the absence of experimental validation, it is questionable whether the constitutive models applied in these FE models are adequate to represent mechanical behaviors of shoulder elements (Cartilages, Ligaments, Muscles etc), therefore the confidence of using current models in answering clinically relevant question. The main objective of this review is to critically evaluate the existing FE shoulder models that have been used to investigate clinical problems. Due concern is given to check the adequacy of representative constitutive models of shoulder elements in drawing clinically relevant conclusion. Suggestions have been given to improve the existing shoulder models by inclusion of adequate constitutive models for shoulder elements to confidently answer clinically relevant questions.

Sustainable, safe, smart—three key elements of Singapore’s evolving transport policies

Sustainability, safety and smartness are three key elements of a modern transportation system. This study illustrates various policy directions and initiatives of Singapore to address how its transportation system is progressing in light of these three components. Sustainability targets economical efficiency, environmental justice and social equity by including policies for integrating land use and transport planning, ensuring adequate transport supply measures, managing travel demand efficiently, and incorporating environment-friendly strategies. Safety initiatives of its transportation system aim to minimize injuries and incidents of all users including motorists, public transport commuters, pedestrians, and bicyclists. Smartness incorporates qualities like real time sensing, fast processing and decision making, and automated action-taking into its control, monitoring, information management and revenue collection systems. Various policy implications and technology applications along these three directions reveal that smart technologies facilitate implementation of policies promoting sustainability and safety. The Singapore experience could serve as a good reference for other cities in promoting a transportation system that is sustainable, safe and smart.

Climate Change and Human Displacement

This paper will focus on the legal issues associated with people displaced as a result of water scarcity. Human displacement can lead to internal displacement (displacement of people within their country) and external displacement (displacement of people into another country). If the displacement takes place as a result of climate change these people may be referred to as climate refugees. The majority of work on climate refugees has focused on those people that will lose their homes as a result of sea –level rise. The number of people that could be displaced as a result of prolonged drought and lack of adequate water supplies is likely to be far more significant in number. There are estimates that around 2.8 billion people will suffer water shortages by 2025 and many of these people are at increased risk of internal or external displacement. Certain groups are more likely to be displaced as a result of prolonged drought or water scarcity. These groups include indigenous and minorities groups living in areas that are more susceptible to climate change and groups living in areas with a history of water shortage and supply issues. People displaced as a result of water scarcity are at increased risks of malnutrition and of dehydration. Furthermore the lack of adequate water supplies in such areas increases the risk and spread of disease among the population. In certain instances internal and external displacement may lead to escalation of conflict and competition for water resources in newly settled territories. This paper will use case studies from Australia (indigenous groups and rural landholders) and East Africa (Ethiopia, Sudan and Kenya) to demonstrate the significance of human displacement arising as a result of water scarcity. Climate adaptation policy frameworks will need to address a number of legal issues, arising as a result of climate displacement from water scarcity. There are a number of unresolved legal issues for both categories of environmental displaced people. The major legal issue for externally environmentally displaced people is lack of international recognition and support for these people. The Climate Change Convention, the Refugee Convention, the Desertification Convention and Human Rights instruments all fail to provide recognition for people externally displaced as a result of environmental conditions. Similarly there is a lack of legal recognition and legal support mechanisms to assist those people internally displaced by environmental conditions. The lack of developed environmental rights in most countries contributes to this problem. Polices and governance frameworks must be put in place which aims to prevent such displacement through programs identifying populations at risk and instigating damage mitigation and relocation programs. In addition there are a number of legal issues which may arise such as; rights of compensation, property and tenure disputes, increases on the water demand and environmental degradation in places of relocation and jurisdictional issues arising in federal countries. This paper will provide an overview of the legal issues at the international and national levels arising as a result of climate displacement from water scarcity.  

The effect of overnight sleep deprivation after competitive rugby league matches on postmatch physiological and perceptual recovery

PURPOSE: This study examined the effects of overnight sleep deprivation on recovery following competitive rugby league matches. METHODS: Eleven male, amateur rugby league players performed two competitive matches, followed by either a normal night's sleep (~8h; CONT) or a sleep deprived night (~0h; SDEP) in a randomised fashion. Testing was conducted the morning of the match, and immediately post-match, 2h post and the next morning (16h post-match). Measures included counter-movement jump (CMJ) distance, knee extensor maximal voluntary contraction (MVC), voluntary activation (VA), venous blood creatine kinase (CK) and C-reactive protein (CRP), perceived muscle soreness and a word-colour recognition cognitive function test. Percent change between post- and 16h post-match was reported to determine the effect of the intervention the next morning. RESULTS: Large effects indicated a greater post- to 16h post-match percentage decline in CMJ distance following SDEP compared to CONT (P=0.10-0.16; d=0.95-1.05). Similarly, the percentage decline in incongruent word-colour reaction times were increased in SDEP trials (P=0.007; d=1.75). Measures of MVC did not differ between conditions (P=0.40-0.75; d=0.13-0.33), though trends for larger percentage decline in VA were detected in SDEP (P=0.19; d=0.84). Further, large effects indicated higher CK and CRP responses 16h post-match during SDEP compared to CONT (P=0.11-0.87; d=0.80-0.88). CONCLUSIONS: Sleep deprivation negatively affected recovery following a rugby league match, specifically impairing CMJ distance and cognitive function. Practitioners should promote adequate post-match sleep patterns or adjust training demands the next day to accommodate the altered physical and cognitive state following sleep deprivation.

Ruthenium(II) dichloro or dithiocyanato complexes with 4,4′:2′,2″:4″,4‴-quaterpyridinium ligands : towards photosensitisers with enhanced low-energy absorption properties

Fourteen new complexes of the form cis-\[RuIIX2(R2qpy2+)2]4+ (R2qpy2+ = a 4,4′:2′,2″:4″,4‴-quaterpyridinium ligand, X = Cl− or NCS−) have been prepared and isolated as their PF6− salts. Characterisation involved various techniques including 1H NMR spectroscopy and +electrospray or MALDI mass spectrometry. The UV–Vis spectra display intense intraligand π → π∗ absorptions, and also metal-to-ligand charge-transfer (MLCT) bands with two resolved maxima in the visible region. Red-shifts in the MLCT bands occur as the electron-withdrawing strength of the pyridinium groups increases, while replacing Cl− with NCS− causes blue-shifts. Cyclic voltammograms show quasi-reversible or reversible RuIII/II oxidation waves, and several ligand-based reductions that are irreversible. The variations in the redox potentials correlate with changes in the MLCT energies. A single-crystal X-ray structure has been obtained for a protonated form of a proligand salt, \[(4-(CO2H)Ph)2qpyH3+]\[HSO4]3·3H2O. Time-dependent density functional theory calculations give adequate correlations with the experimental UV–Vis spectra for the two carboxylic acid-functionalised complexes in DMSO. Despite their attractive electronic absorption spectra, these dyes are relatively inefficient photosensitisers on electrodes coated with TiO2 or ZnO. These observations are attributed primarily to weak electronic coupling with the surfaces, since the DFT-derived LUMOs include no electron density near the carboxylic acid anchors.

A flexible solid-state pulsed power topology

Advances in solid-state switches and power electronics techniques have led to the development of compact, efficient and more reliable pulsed power systems. This paper proposes an efficient scheme that utilizes modular switch-capacitor units in obtaining high voltage levels with fast rise time (dv/dt) using low voltage solid-state switches. The proposed pulsed power supply has flexibility in terms of controlling energy and generating broad range of voltage levels. The energy flow can be controlled as the stored energy can be adjusted by a current source utilized at the first stage of the system. Desirable voltage level can be obtained by connecting adequate number of switch-capacitor units. Moreover, the proposed topology is load independent. Therefore it can easily supply wide range of applications especially the low impedance ones. The effectiveness of the proposed approach is verified by simulations