Evaluation in health outcomes research : linking theories, methodologies and practice in health promotion.

Health outcomes research has developed as a means of evaluating the effectiveness of health care interventions and as an approach to informing resource allocation. The use of a health outcomes approach in health promotion has made increasing demands on evaluation methodologies to demonstrate program effectiveness. However, criticism of the contribution of health promotion to outcomes research has made several assumptions about the use of qualitative methodologies and the content of program objectives largely derived from a biomedical approach. In contrast to the measurement of biomedical interventions in clinical health care, health promotion practice involves social phenomena, wide-reaching cultural, psychological, political and ideological problems and issues. The integration of methodologies of health promotion evaluation will inform further conceptualisation of the health outcomes approach with the differentiation of three types of outcomes: health development outcomes; social health outcomes; and biomedical health outcomes. It is concluded that this differentiation moves away from dualist concepts that advocate the replacement of goals and targets with regional and locally based approaches. Rather, the future direction for health promotion evaluation needs to employ a framework that elaborates multiple methodologies and approaches necessary for establishing what relationships exist between morbidity, mortality, health advancement and equity.

Inside the boardroom : exploring board member interactions

This study aims to open-up the black box of the boardroom by directly observing directors’ interactions during meetings to better understand board processes. Design/methodology/approach: We analyse videotaped observations of board meetings at two Australian companies to develop insights into what directors do in meetings and how they participate in decision-making processes. The direct observations are triangulated with semi-structured interviews, mini-surveys and document reviews. Findings: Our analyses lead to two key findings: (i) while board meetings appear similar at a surface-level, boardroom interactions vary significantly at a deeper level (i.e. board members participate differently during different stages of discussions) and (ii) factors at multiple levels of analysis explain differences in interaction patterns, revealing the complex and nested nature of boardroom discussions. Research implications: By documenting significant intra- and inter-board meeting differences our study (i) challenges the widespread notion of board meetings as rather homogeneous and monolithic, (ii) points towards agenda items as a new unit of analysis (iii) highlights the need for more multi-level analyses in a board setting. Practical implications: While policy makers have been largely occupied with the “right” board composition, our findings suggest that decision outcomes or roles’ execution could be potentially affected by interactions at a board level. Differences in board meeting styles might explain prior ambiguous board structure-performance results, enhancing the need for greater normative consideration of how boards do their work. Originality/value: Our study complements existing research on boardroom dynamics and provides a systematic account of director interactions during board meetings.

Unnatural selection : curricular conversations in TIP 1962–2012

Our task is to consider the evolving perspectives around curriculum documented in the Theory Into Practice (TIP) corpus to date. The 50 years in question, 1962–2012, account for approximately half the history of mass institutionalized schooling. Over this time, the upper age of compulsory schooling has crept up, stretching the school curriculum's reach, purpose, and clientele. These years also span remarkable changes in the social fabric, challenging deep senses of the nature and shelf-life of knowledge, whose knowledge counts, what science can and cannot deliver, and the very purpose of education. The school curriculum is a key social site where these challenges have to be addressed in a very practical sense, through a design on the future implemented within the resources and politics of the present. The task's metaphor of ‘evolution’ may invoke a sense of gradual cumulative improvement, but equally connotes mutation, hybridization, extinction, survival of the fittest, and environmental pressures. Viewed in this way, curriculum theory and practice cannot be isolated and studied in laboratory conditions—there is nothing natural, neutral, or self-evident about what knowledge gets selected into the curriculum. Rather, the process of selection unfolds as a series of messy, politically contaminated, lived experiments; thus curriculum studies require field work in dynamic open systems. We subscribe to Raymond Williams' approach to social change, which he argues is not absolute and abrupt, one set of ideas neatly replacing the other. For Williams, newly emergent ideas have to compete against the dominant mindset and residual ideas “still active in the cultural process'” (Williams, 1977, p. 122). This means ongoing debates. For these reasons, we join Schubert (1992) in advocating “continuous reconceptualising of the flow of experience” (p. 238) by both researchers and practitioners.

Simultaneous determination of 6,7-dimethylesculetin and geniposide in rat plasma and its application to pharmacokinetic studies of Yin Chen Hao Tang preparation

A method for the rapid and simultaneous determination of 6,7-dimethylesculetin (CAS 120-08-1) and geniposide (CAS 24512-63-8) in rat plasma has been developed, using validated high performance liquid chromatography (HPLC) with solid phase extraction (SPE). The HPLC analysis was performed on a commercially available column (200 mm x 4.6 mm, 5 microm) with acetonitrile-methanol-0.1% aqueous formic acid as mobile phase and the UV detection at 343 nm and 238 nm for 6,7-dimethylesculetin and geniposide, respectively. The calibration curves for 6,7-dimethylesculetin and geniposide were linear over the range 0.4-25.6 microg/mL and 1.12-71.68 microg/mL, respectively. The lower limits of quantitation were 0.40 microg/ mL and 1.12 microg/mL, and the lower limits of detection were 0.06 microg/mL and 0.09 microg/ mL, respectively. The intra-day and inter-day precision for 6,7-dimethylesculetin and geniposide were < 5%, whereas the absolute recovery percentages were > 74%. A successful application of the developed HPLC analysis was demonstrated for the pharmacokinetic study of a Traditional Chinese Medicine formula of Yin Chen Hao Tang preparation.

Harmonic quality of multilevel cascade inverters with random carrier phase pulse width modulation

The output harmonic quality of N series connected full-bridge dc-ac inverters is investigated. The inverters are pulse width modulated using a common reference signal but randomly phased carrier signals. Through analysis and simulation, probability distributions for inverter output harmonics and vector representations of N carrier phases are combined and assessed. It is concluded that a low total harmonic distortion is most likely to occur and will decrease further as N increases.

Social technologies in public libraries : exploring best practice

Purpose This article reports on a research project that explored social media best practice in the public library sector. Design/methodology/approach The primary research approach for the project was case study. Two organisations participated in case studies that involved interviews, document analysis, and social media observation. Findings The two case study organisations use social media effectively to facilitate participatory networks, however, there have been challenges surrounding its implementation in both organisations. Challenges include negotiating requirements of governing bodies and broader organisational environments, and managing staff reluctance around the implementations. As social media use continues to grow and libraries continue to take up new platforms, social media must be considered to be another service point of the virtual branch, and indeed, for the library service as a whole. This acceptance of social media as being core business is critical to the successful implementation of social media based activities. Practical implications The article provides an empirically grounded discussion of best practice and the conditions that support it. The findings are relevant for information organisations across all sectors and could inform the development of policy and practice in other organisations. This paper contributes to the broader dialogue around best practice in participatory service delivery and social media use in library and information organisations.

Diurnal rhythm and effects of feeding, exercise and recombinant equine growth hormone on serum insulin concentrations in the horse

Reasons for performing the study As growth hormone increases lean body mass, it could be a therapy for obese horses. However, growth hormone use induces hyperinsulinaemia in some species, so further investigation is warranted. Objectives To investigate the effects of feeding, exercise and growth hormone therapy on basal insulin concentrations in healthy horses. Study design In vivo experimental study. Methods Blood samples were obtained every 30 min from 12 geldings over 24 h, to establish basal serum insulin concentrations, before they underwent a 3-week exercise programme. Horses were allocated into 2 groups and exercised for another 4 weeks. Group A received daily i.m. injections of recombinant equine growth hormone; 5 mg/day for 5 days, then 12.5 mg/day for 16 days. Blood samples were taken daily before feeding. Insulin vs. time area under curve of Groups A and B were compared using a Student's unpaired t test. Results Horses demonstrated insulin peaks within 2 h of feeding of 577 ± 108.3 pmol/l at 09.30 h and 342.4 ± 75.7 pmol/l at 17.30 h, despite receiving the same meal. The nadir was between midnight and 07.30 h. Exercise had no effect on basal insulin concentrations prior to equine growth hormone administrations. The equine growth hormone injections increased serum insulin concentrations (P = 0.01) within Group A, from 44.4 ± 15.3 pmol/l initially to 320.9 ± 238.2 pmol/l by Day 12. Exogenous growth hormone caused variable hyperinsulinaemia, which was alleviated once equine growth hormone administration ceased. Conclusions Single serum samples taken prior to the morning meal provide basal insulin concentrations. Exercise did not change basal insulin concentrations. However, equine growth hormone injections increased basal insulin concentrations, which were not ameliorated by exercise. Potential relevance This therapy is not recommended to address obesity in insulin-resistant equids.

Fresh ideas : services thinking for social marketing

Purpose The social marketing literature tends to focus on upstream marketing (policy) and downstream (individual behaviour change) and has a limited view on midstream (working with partners and community groups) social marketing. The paper proposes midstream social marketing should also include an understanding of how services and service employees influence and support individual behaviour change goals. The paper presents four key services marketing principles - derived from services theory and thinking - which the paper believes to be essential for implementing effective midstream social marketing. Design/methodology/approach This is a conceptual paper that uses service theory and case-examples to show how service thinking can be used as a midstream social marketing approach. Findings For effective uptake and impact of social marketing services amongst people and populations, social marketers need to design programs that consider the service experience, the service employee, service quality/customer value and the active role of the customer in value creation. Research limitations/implications Services marketing is a well-established sub-discipline of marketing which, until recently, has not interacted with social marketing. The extension and application of services theory for social marketing can enrich and propel the social marketing discipline forward. Further research is recommended to evaluate how service principles can be applied in practice. Social implications Given that social marketing services tend not to be accessed in sufficient numbers by the people who most need them, social marketers need to think beyond the technical, cognitive, and organisational-focused goals when designing social services. Originality/value This paper identifies key service theories that social marketers should understand and use and is thus a source of fresh ideas for theory and practice.

Molecular biomarkers in non-small-cell lung cancer : a retrospective analysis of data from the phase 3 FLEX study

Background: Findings from the phase 3 FLEX study showed that the addition of cetuximab to cisplatin and vinorelbine significantly improved overall survival, compared with cisplatin and vinorelbine alone, in the first-line treatment of EGFR-expressing, advanced non-small-cell lung cancer (NSCLC). We investigated whether candidate biomarkers were predictive for the efficacy of chemotherapy plus cetuximab in this setting. Methods: Genomic DNA extracted from formalin-fixed paraffin-embedded (FFPE) tumour tissue of patients enrolled in the FLEX study was screened for KRAS codon 12 and 13 and EGFR kinase domain mutations with PCR-based assays. In FFPE tissue sections, EGFR copy number was assessed by dual-colour fluorescence in-situ hybridisation and PTEN expression by immunohistochemistry. Treatment outcome was investigated according to biomarker status in all available samples from patients in the intention-to-treat population. The primary endpoint in the FLEX study was overall survival. The FLEX study, which is ongoing but not recruiting participants, is registered with ClinicalTrials.gov, number NCT00148798. Findings: KRAS mutations were detected in 75 of 395 (19%) tumours and activating EGFR mutations in 64 of 436 (15%). EGFR copy number was scored as increased in 102 of 279 (37%) tumours and PTEN expression as negative in 107 of 303 (35%). Comparisons of treatment outcome between the two groups (chemotherapy plus cetuximab vs chemotherapy alone) according to biomarker status provided no indication that these biomarkers were of predictive value. Activating EGFR mutations were identified as indicators of good prognosis, with patients in both treatment groups whose tumours carried such mutations having improved survival compared with those whose tumours did not (chemotherapy plus cetuximab: median 17·5 months [95% CI 11·7-23·4] vs 8·5 months [7·1-10·8], hazard ratio [HR] 0·52 [0·32-0·84], p=0·0063; chemotherapy alone: 23·8 months [15·2-not reached] vs 10·0 months [8·7-11·0], HR 0·35 [0·21-0·59], p<0·0001). Expression of PTEN seemed to be a potential indicator of good prognosis, with patients whose tumours expressed PTEN having improved survival compared with those whose tumours did not, although this finding was not significant (chemotherapy plus cetuximab: median 11·4 months [8·6-13·6] vs 6·8 months [5·9-12·7], HR 0·80 [0·55-1·16], p=0·24; chemotherapy alone: 11·0 months [9·2-12·6] vs 9·3 months [7·6-11·9], HR 0·77 [0·54-1·10], p=0·16). Interpretation: The efficacy of chemotherapy plus cetuximab in the first-line treatment of advanced NSCLC seems to be independent of each of the biomarkers assessed. Funding: Merck KGaA. © 2011 Elsevier Ltd.

Health and guardianship law : the decision of X v the Sydney Children's Hospitals Network [2013] NSWCA 320 : mature minors and the refusal of blood products

This recent decision of the New South Wales Court of Appeal considers the scope of the parens patriae jurisdiction in cases where the jurisdiction is invoked for the protection of a Gillick competent minor. As outlined below, in certain circumstances the law recognises that mature minors are able to make their own decisions concerning medical treatment. However, there have been a number of Commonwealth decisions which have addressed the issue of whether mature minors are able to refuse medical procedures in circumstances where refusal will result in the minor dying. Ultimately, this case confirms that the minor does not necessarily have a right to make autonomous decisions; the minor’s right to exercise his or her autonomous decision only exists when such decision accords with what is deemed to be in his or her best interests.

Efficacy of a children's procedural preparation and distraction device on healing in acute burn wound care procedures : study protocol for a randomized controlled trial

BACKGROUND: The intense pain and anxiety triggered by burns and their associated wound care procedures are well established in the literature. Non-pharmacological intervention is a critical component of total pain management protocols and is used as an adjunct to pharmacological analgesia. An example is virtual reality, which has been used effectively to dampen pain intensity and unpleasantness. Possible links or causal relationships between pain/anxiety/stress and burn wound healing have previously not been investigated. The purpose of this study is to investigate these relationships, specifically by determining if a newly developed multi-modal procedural preparation and distraction device (Ditto) used during acute burn wound care procedures will reduce the pain and anxiety of a child and increase the rate of re-epithelialization. METHODS/DESIGN: Children (4 to 12 years) with acute burn injuries presenting for their first dressing change will be randomly assigned to either the (1) Control group (standard distraction) or (2) Ditto intervention group (receiving Ditto, procedural preparation and Ditto distraction). It is intended that a minimum of 29 participants will be recruited for each treatment group. Repeated measures of pain intensity, anxiety, stress and healing will be taken at every dressing change until complete wound re-epithelialization. Further data collection will aid in determining patient satisfaction and cost effectiveness of the Ditto intervention, as well as its effect on speed of wound re-epithelialization. DISCUSSION: Results of this study will provide data on whether the disease process can be altered by reducing stress, pain and anxiety in the context of acute burn wounds. TRIAL REGISTRATION: ACTRN12611000913976.

Why fit contact lenses? Part 1 - clinical reasons

There are probably two main reasons why some practitioners do not bother fitting contact lenses – that it is not profitable and it is clinically too difficult. Although this article will concentrate on clinical issues rather than questions of profitability, I feel that the belief that contact lens fitting is not as profitable as prescribing spectacles is unfounded.

Exploring retinal markers of diabetic neuropathy

Purpose To investigate the application of retinal nerve fibre layer (RNFL) thickness as a marker for severity of diabetic peripheral neuropathy (DPN) in people with Type 2 diabetes. Methods This was a cross-sectional study whereby 61 participants (mean age 61 [41-75 years], mean duration of diabetes 14 [1-40 years], 70% male) with Type 2 diabetes and DPN underwent optical coherence tomography (OCT) scans. Global and 4 quadrant (TSNI) RNFL thicknesses were measured at 3.45mm around the optic nerve head of one eye. Neuropathy disability score (NDS) was used to assess the severity of DPN on a 0 to 10 scale. Participants were divided into three age-matched groups representing mild (NDS=3-5), moderate (NDS=6-8) and severe (NDS=9-10) neuropathy. Two regression models were fitted for statistical analysis: 1) NDS scores as co-variate for global and quadrant RNFL thicknesses, 2) NDS groups as a factor for global RNFL thickness only. Results Mean (SD) RNFL thickness (µm) was 103(9) for mild neuropathy (n=34), 101(10) for moderate neuropathy (n=16) and 95(13) in the group with severe neuropathy (n=11). Global RNFL thickness and NDS scores were statistically significantly related (b=-1.20, p=0.048). When neuropathy was assessed across groups, a trend of thinner mean RNFL thickness was observed with increasing severity of neuropathy; however, this result was not statistically significant (F=2.86, p=0.065). TSNI quadrant analysis showed that mean RNFL thickness reduction in the inferior quadrant was 2.55 µm per 1 unit increase in NDS score (p=0.005). However, the regression coefficients were not statistically significant for RNFL thickness in the superior (b=-1.0, p=0.271), temporal (b=-0.90, p=0.238) and nasal (b=-0.99, p=0.205) quadrants. Conclusions RNFL thickness was reduced with increasing severity of DPN and the effect was most evident in the inferior quadrant. Measuring RNFL thickness using OCT may prove to be a useful, non-invasive technique for identifying severity of DPN and may also provide additional insight into common mechanisms for peripheral neuropathy and RNFL damage.

High school students' perceptions of school science and science careers : a critical look at a critical issue

Disproportionate representation of males and females in science courses and careers continues to be of concern. This article explores gender differences in Australian high school students’ perceptions of school science and their intentions to study university science courses. Nearly 3800 15-year-old students responded to a range of 5-point Likert items relating to intentions to study science at university, perceptions of career-related instrumental issues such as remuneration and job security, self-rated science ability and enjoyment of school science. Australian boys and girls reported enjoying science to a similar extent, however boys reported enjoying it more in relation to other subjects than did girls, and rated their ability in science compared to others in their class more highly than did girls. There was no significant difference between the mean responses of girls and boys to the item “It is likely I will choose a science-related university course when I leave school” and the strongest predictors of responses to this item were items relating to students’ liking for school science and awareness from school science of new and exciting jobs, followed by their perceived self-ability. These results are discussed in relation to socio-scientific values that interact with identity and career choices, employment prospects in science, and implications for science education.

Hidden credential retrieval from a reusable password

We revisit the venerable question of access credentials management, which concerns the techniques that we, humans with limited memory, must employ to safeguard our various access keys and tokens in a connected world. Although many existing solutions can be employed to protect a long secret using a short password, those solutions typically require certain assumptions on the distribution of the secret and/or the password, and are helpful against only a subset of the possible attackers. After briefly reviewing a variety of approaches, we propose a user-centric comprehensive model to capture the possible threats posed by online and offline attackers, from the outside and the inside, against the security of both the plaintext and the password. We then propose a few very simple protocols, adapted from the Ford-Kaliski server-assisted password generator and the Boldyreva unique blind signature in particular, that provide the best protection against all kinds of threats, for all distributions of secrets. We also quantify the concrete security of our approach in terms of online and offline password guesses made by outsiders and insiders, in the random-oracle model. The main contribution of this paper lies not in the technical novelty of the proposed solution, but in the identification of the problem and its model. Our results have an immediate and practical application for the real world: they show how to implement single-sign-on stateless roaming authentication for the internet, in a ad-hoc user-driven fashion that requires no change to protocols or infrastructure.