The acute response of tendon to loading: implications for rehabilitation

Achilles tendinopathy is a common disorder involving physically active and sedentary individuals alike. Although the processes underlying its development are poorly understood, tendinopathy is widely regarded as an ‘overuse’ injury in which the tendon fails to adapt to prevalent loading conditions. Paradoxically, there is emerging evidence that heavy eccentric loading of the Achilles tendon may be an effective conservative approach for treatment of tendinopathy, with success rates of 60–80% reported. Interestingly, loading exercises involving other forms of muscle action, such as concentric activation, have been shown to be less effective treatment options. However, little is known about the acute response of tendon to exercise at present, and there are few plausible explanatory mechanisms for the observed beneficial effects of eccentric exercise, as opposed to other forms of strain stimuli. This paper presents the findings from a series of experiments undertaken to evaluate the effect of various strain stimuli on the time-dependent response of human Achilles tendon in vivo. It was shown for the first time, that heavy resistive ankle plantarflexion/ dorsiflexion exercises induced an immediate and significant decrease in Achilles tendon thickness (~15%). While thickness returned to pre-exercise levels within 24 hours, the recovery was exponential, with primary recovery occurring in less than 6 hours post-exercise. We proposed that such a diametral strain response with tensile loading reflects collagen realignment, Poison’s effects and radial extrusion of water from the tendon core. With unloading, the recovery of tendon dimensions likely reflects the re-diffusion of water via osmotic and/or inflammatory driven processes. Interestingly, prolonged walking was found to induce a similar diametral strain response. In subsequent studies, we demonstrated that eccentric exercise resulted in a greater reduction (-21%) in Achilles tendon thickness than isolated concentric exercise alone (-5%), despite a similar loading impulse. These novel findings, coupled with observations of a reduced diametral strain response with tendon pathology, highlight the importance of fluid movement to tendon function, nutrition and health. They also provide new insights into potential mechanisms underlying Achilles tendinopathy that impact rehabilitation strategies.

Circulating microRNAs involved in multiple sclerosis

Multiple sclerosis (MS) is an immune-mediated, demyelinating and neurodegenerative disease of the central nervous system. After traumatic brain injury, it is the leading cause of neurology disability in young adults. Considerable advances have been made in identifying genes involved in MS but the genetic and phenotypic complexity associated with this disease significantly hinders any progress. A novel class of small RNA molecules, microRNAs (miRNAs) has acquired much attention because they regulate the expression of up to 30% of protein-coding genes and may play a pivotal role in the development of many, if not all, complex diseases. Seven published studies investigated miRNAs from peripheral blood mononuclear cells, CD4+, CD8+ T cell, B lymphocytes, peripheral blood leukocytes, whole blood and brain astrocytes with MS risk. The absence of MS studies investigating plasma miRNA prompted the current investigation of identifying a circulating miRNA signature in MS. We conducted a microarray analysis of over 900 known miRNA transcripts from plasma samples collected from four MS individuals and four sex-aged and ethnicity matched healthy controls. We identified six plasma miRNA (miR-614, miR-572, miR-648, miR-1826, miR-422a and miR-22) that were significantly up-regulated and one plasma miRNA (miR-1979) that was significantly down-regulated in MS individuals. Both miR-422a and miR-22 have previously been implicated in MS. The present study is the first to show a circulating miRNA signature involved in MS that could serve as a potential prognostic and diagnostic biomarker for MS.

The voices of the exegesis : Composing the speech genres of the practitioner-researcher into a connective thesis

Postgraduate candidates in the creative arts encounter unique challenges when writing an exegesis (the written document that accompanies creative work as a thesis). As a practitioner-researcher, they must adopt a dual perspective–looking out towards an established field of research, exemplars and theories, as well as inwards towards their experiential creative processes and practice. This dual orientation provides clear benefits, for it enables them to situate the research within its field and make objective claims for the research methodologies and outcomes while maintaining an intimate, voiced relationship with the practice. However, a dual orientation introduces considerable complexities in the writing. It requires a reconciliation of multi-perspectival subject positions: the disinterested academic posture of the observer/ethnographer/analyst/theorist at times; and the invested, subjective stance the practitioner/producer at others. It requires the author to negotiate a range of writing styles and speech genres–from the formal, polemical style of the theorist to the personal, questioning and emotive voice of reflexivity. Moreover, these multi-variant orientations, subject positions, styles and voices must be integrated into a unified and coherent text. In this chapter I offer a conceptual framework and strategies for approaching this relatively new genre of thesis. I begin by summarizing the characteristics of what has begun to emerge as the predominant model of exegesis (the dual-oriented ‘Connective’ exegesis). Framing it against theoretical and philosophical understandings of polyvocality and matrixicality, I go on to point to recent textual models that provide precedents for connecting differently oriented perspectives, subjectivities and voices. I then turn to emergent archives of practice-led research to explain how the challenge of writing a ‘Connective’ exegesis has so far been resolved by higher degree research (HDR) candidates. Exemplars illustrate a range of strategies they have used to compose a multi-perspectival text, reconcile the divergent subject positions of the practitioner researcher, and harmonize the speech genres of a ployvocal text.

Child-related factors that influence teacher-child relationships using an Australian national sample

This study assessed the extent to which child-related factors had an impact on teacher-child relationships in Australian childcare settings. Analyses used data from Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC). The sample consisted of 1577 two to three year old children (M= 33.9 months, SD=2.93; 51.5% male). Two separate hierarchical multiple regression analyses were conducted to examine the relation between teachers’ perceptions of their relationships with children and (a) gender, (b), indigenous status, (c), language background other than English, (d), socio-economic position, (e) special health care needs, (f) expression and receptive language concerns, (g) psychosocial competence and problems and (h) temperament factors (approach, persistence and reactivity). Results indicated that special health care needs, receptive language concerns and all three temperament scales (approach, persistence and reactivity) significantly predicted conflict in teacher-child relationships. Close relationships were predicted by being female, indigenous status, higher socio-economic position, not having a special health care need and no expressive language concerns.

Association of estrogen receptor and glucocorticoid receptor gene polymorphisms with sporadic breast cancer

We have utilized a cross-sectional association approach to investigate sporadic breast cancer. Polymorphisms in 2 candidate genes, ESRalpha and GRL, were examined in an unrelated breast cancer-affected and age-matched control population. Several polymorphic regions within the ESRalpha gene have been identified, and some alleles of these polymorphisms have been found to occur at increased levels in breast-cancer patients. Additionally, variations in GRL have the potential to disrupt cell transcription and may be associated with cancer formation. We analyzed 3 polymorphisms, from codons 10 (TCT to TCC), 325 (CCC to CCG) and 594 (ACA to ACG) of ESRalpha, and a highly polymorphic dinucleotide repeat, D5S207, located within 200 kb of the GRL. When allelic frequencies of the codon 594 (exon 8) ESR polymorphism were compared between affected and unaffected populations, a significant difference was observed (p = 0.005). Results from the D5S207 dinucleotide repeat located near GRL also indicated a significant difference between the tested case and control populations (p = 0.001). Allelic frequencies of the codon 10 and codon 325 ESR polymorphisms were not significantly different between populations (p = 0.152 and 0.181, respectively). Our results indicate that specific alleles of the ESR gene (alpha subtype) and a marker for the GRL gene locus are associated with sporadic breast-cancer development in the tested Caucasian population and justify further investigation of the role of these and other nuclear steroid receptors in the etiology of breast cancer.

Chromosome 17 and the inducible nitric oxide synthase gene in human essential hypertension

Essential hypertension is a common multifactorial trait that results in a significantly increased risk for heart attack and stroke. The condition has a genetic basis, although at present the number of genes is unknown. In order to identify such genes, we are utilising a linkage scanning approach using microsatellite markers and affected sibships. Here we provide evidence for the location of at least one hypertension susceptibility locus on chromosome 17. Analysis of 177 affected sibpairs gave evidence for significant excess allele sharing to D17S949 (SPLINK: P=0.0029; MAPMAKER SIBS: P=0.0033; ASPEX: P=0.0061; GENEHUNTER: P=0.0096; ANALYZE (SIBPAIR): P=0.0025) on 17q22–24, with significant allele sharing also indicated for an additional marker, D17S799 (SPLINK: P=0.025; MAPMAKER SIBS: P= 0.025) located close to the centromere. Since these two genomic regions are well separated, our results indicate that there may be more than one chromosome 17 locus affecting human blood pressure. Moreover, further investigation of this chromosome, utilizing a polymorphism within the promoter of the iNOS candidate gene, NOS2A, revealed both increased allele sharing among sibpairs (SPLINK: P=0.02; ASPEX: P=0.00004) and positive association (P= 0.034) of NOS2A to essential hypertension. Hence these results indicate that chromosome 17 and, more specifically, the NOS2A gene may play a role in human essential hypertension.

Single-nucleotide polymorphism alleles in the insulin receptor gene are associated with typical migraine

We have identified a migraine locus on chromosome 19p13.3/2 using linkage and association analysis. We isolated 48 single-nucleotide polymorphisms within the locus, of which we genotyped 24 in a Caucasian population comprising 827 unrelated cases and 765 controls. Five single-nucleotide polymorphisms within the insulin receptor gene showed significant association with migraine. This association was independently replicated in a case-control population collected separately. We used experiments with insulin receptor RNA and protein to investigate functionality for the migraine-associated single-nucleotide polymorphisms. We suggest possible functions for the insulin receptor in migraine pathogenesis.

Women from refugee backgrounds and their experiences of attending a specialist antenatal clinic : narratives from an Australian setting

Problem: In response to an identified need, a specialist antenatal clinic for women from refugee backgrounds was introduced in 2008, with an evaluation planned and completed in 2010. Question: Can maternity care experiences for women from refugee backgrounds, attending a specialist antenatal clinic in a tertiary Australian public hospital, be improved? Methods: The evaluation employed mixed methods, generating qualitative and quantitative data from two hospital databases, a chart audit, surveys and interviews with service users, providers and stakeholders. Contributions were received from 202 participants. Findings: The clinic was highly regarded by all participants. Continuity of care throughout the antenatal period was particularly valued by newly arrived women as it afforded them security and support to negotiate an unfamiliar Western maternity system. Positive experiences decreased however; as women transitioned from the clinic to labour and postnatal wards where they reported that their traditional birthing and recuperative practices were often interrupted by the imposition of Western biomedical notions of appropriate care. The centrally located clinic was problematic, frequently requiring complex travel arrangements. Appointment schedules often impacted negatively on traditional spousal and family obligations. Conclusions: Providing comprehensive and culturally responsive maternity care for women from refugee backgrounds is achievable, however it is also resource intensive. The production of translated information which is high quality in terms of production and content, whilst also taking account of languages which are only rarely encountered, is problematic. Cultural competency programmes for staff, ideally online, require regular updating in light of new knowledge and changing political sensitivities.

Patient error : a preliminary taxonomy

PURPOSE Current research on errors in health care focuses almost exclusively on system and clinician error. It tends to exclude how patients may create errors that influence their health. We aimed to identify the types of errors that patients can contribute and help manage, especially in primary care. METHODS Eleven nominal group interviews of patients and primary health care professionals were held in Auckland, New Zealand, during late 2007. Group members reported and helped to classify types of potential error by patients. We synthesized the ideas that emerged from the nominal groups into a taxonomy of patient error. RESULTS Our taxonomy is a 3-level system encompassing 70 potential types of patient error. The first level classifies 8 categories of error into 2 main groups: action errors and mental errors. The action errors, which result in part or whole from patient behavior, are attendance errors, assertion errors, and adherence errors. The mental errors, which are errors in patient thought processes, comprise memory errors, mindfulness errors, misjudgments, and—more distally—knowledge deficits and attitudes not conducive to health. CONCLUSION The taxonomy is an early attempt to understand and recognize how patients may err and what clinicians should aim to influence so they can help patients act safely. This approach begins to balance perspectives on error but requires further research. There is a need to move beyond seeing patient, clinician, and system errors as separate categories of error. An important next step may be research that attempts to understand how patients, clinicians, and systems interact to cocreate and reduce errors.

How can Australia sustain middle school education?

Middle school is a crucial area of education where adolescents experiencing physiological and psychological changes, and require expert guidance. As more research evidence is provided about adolescent learning, teachers are considered pivotal to adolescents’ educational development. Reform measures need to be targeted at the inservice and preservice teacher levels. This quantitative study employs a 40-item, five part Likert scale survey to understand preservice teachers’ (n = 142) perceptions of their confidence to teach in a middle school at the conclusion of their tertiary education. The survey instrument was developed from the literature, with connections to the Queensland College of Teachers' professional standards. Results indicated that they perceived themselves as capable of creating a positive classroom environment with seven items greater than 80%, except with behaviour management (< 80% for two items), and they considered their pedagogical knowledge to be adequate (i.e., 7 out of 8 items > 84%). Items associated with implementing a middle school curriculum had varied responses (e.g., implementing literacy and numeracy were 74%, while implementing learning with real world connections was 91%). This information may assist coursework designers. For example, if a significant percentages of preservice teachers indicate that they believe they were not well prepared for assessment and reporting at the middle school level, then course designers can target these areas more effectively.

Enhancing teacher education : the School-Community Intergrated Learning (SCIL) pathway

National Australian reviews advocate exploring new models for preservice teacher education. This study investigates the outcomes of the School-Community Integrated Learning (SCIL) pathway as a model for advancing preservice teachers’ understandings of teaching. Thirty-two final-year preservice teachers were surveyed with extended written responses on how the SCIL pathway advanced their understandings of teaching. Results indicated 100% agreement on 6 of the 27 survey items. Indeed, 78% or more preservice teachers agreed that they had a range of experiences across the five categories (i.e., personal-professional skill development, understandings of system requirements, teaching practices, student behaviour and reflective practices). Extended responses suggested they had developed understandings around setting up classrooms, whole school planning processes with professional development, the allocation of teacher responsibilities (e.g., playground duties), parent-teacher interviews, diagnostic testing for literacy and numeracy, commencing running records of students’ assessment results, and the development of relationships (students, teachers and parents). Although a longitudinal study is required to determine long-term effects, the SCIL pathway may be viewed as a positive step towards preparing final-year preservice teachers for their first year as fully-fledged teachers.

The need for legislative reform of the privity doctrine in commercial contracts in Malaysia : a comparative analysis

This thesis commences with the proposition that the first limb of the doctrine of privity causes injustice to third party beneficiaries in Malaysia, particularly in commercial contracts. The doctrine of privity has been the subject of criticism by the judiciary and academic commentators in common law jurisdictions, mainly directed at the first limb of the doctrine, whereby only parties to a contract can sue and be sued. The first limb prevents a third party from enforcing benefits conferred on them by those contracts thereby resulting in third parties suffering loss and injustice to those parties. In several common law countries, such as England, Australia, New Zealand and Singapore, legislative reform of the doctrine has occurred. The legislative reform has abrogated to a significant extent the doctrine of privity in commercial contracts. Malaysia is a common law country, where the doctrine of privity is still applied to contracts. An analysis of Malaysian case law demonstrates that the most affected third party beneficiaries are those seeking to enforce insurance and construction contracts. While a small number of other third parties to commercial contracts, such as agreements to pay for work done, sale and purchase agreements and tenancy agreements are also affected, the detriment is not as significant. As a consequence, this thesis focuses primarily on the impact of the doctrine of privity on commercial contracts in the areas of insurance and construction in Malaysia The thesis aims to recommend appropriate reforms to address the injustices arising from the privity doctrine for third parties seeking to obtain the benefit of insurance and construction contracts, which may also benefit third parties to other types of commercial contracts. While the Malaysian insurance, consumer protection, negotiable instruments and agency laws allow third party beneficiaries to enforce benefits in contracts, the rights are found to be inadequate. As not all third parties seeking to enforce an insurance or construction contract can rely upon the legislation, the injustice arising from the doctrine of privity remains and needs to be addressed. To achieve this aim, a comparative analysis of the rights of third party beneficiaries under insurance and construction contracts in Malaysia, Australia and England is undertaken. The results of the analysis are used to identify appropriate elements for a legislative framework guided by the three essential criteria for effective law reform developed in the thesis. The three criteria are certainty, public interest and justice. The thesis recommends first the enactment of general legislation applicable to all commercial contracts including insurance contracts. Secondly, the thesis recommends specific targeted legislation to address the injustice faced by third party beneficiaries in construction contracts.

Beyond compliance : project on an integrated systems approach for pest risk management in South East Asia

The Beyond Compliance project, which began in July 2011 with funding from the Standards and Trade Development Facility for 2 years, aims to enhance competency and confidence in the South East Asian sub-region by applying a Systems Approach for pest risk management. The Systems Approach involves the use of integrated measures, at least two of which are independent, that cumulatively reduce the risk of introducing exotic pests through trade. Although useful in circumstances where single measures are inappropriate or unavailable, the Systems Approach is inherently more complicated than single-measure approaches, which may inhibit its uptake. The project methodology is to take prototype decision-support tools, such as Control Point-Bayesian Networks (CP-BN), developed in recent plant health initiatives in other regions, including the European PRATIQUE project, and to refine them within this sub-regional context. Case studies of high-priority potential agricultural trade will be conducted by National Plant Protection Organizations of participating South East Asian countries in trials of the tools, before further modifications. Longer term outcomes may include: more robust pest risk management in the region (for exports and imports); greater inclusion of stakeholders in development of pest risk management plans; increased confidence in trade negotiations; and new opportunities for trade.

Learning about being effective mentors : professional learning communities and mentoring

This study aimed to explore experienced mentors’ understandings about professional learning communities (PLCs), mentoring and leadership. This research analyses audio-taped transcripts and written responses from 27 experienced mentors who operate in varied roles (e.g., university academics, school executives, teachers, learning support personnel). Findings indicated that PLCs can provide professional renewal for existing teachers and that mentoring within PLCs can further advance knowledge about effective practices. PLCs can include other staff members and key stakeholders (e.g., preservice teachers, teacher aides) who can contribute to the learning within the group. Mentoring and PLCs can be cost-effective strategic levers for advancing professional knowledge.

Evaluation of the alkaline comet assay and urinary 3-methyladenine excretion for monitoring DNA damage in melanoma patients treated with dacarbazine and tamoxifen

Purpose: To develop, using dacarbazine as a model, reliable techniques for measuring DNA damage and repair as pharmacodynamic endpoints for patients receiving chemotherapy. Methods: A group of 39 patients with malignant melanoma were treated with dacarbazine 1 g/m2 i.v. every 21 days. Tamoxifen 20 mg daily was commenced 24 h after the first infusion and continued until 3 weeks after the last cycle of chemotherapy. DNA strand breaks formed during dacarbazine-induced DNA damage and repair were measured in individual cells by the alkaline comet assay. DNA methyl adducts were quantified by measuring urinary 3-methyladenine (3-MeA) excretion using immunoaffinity ELISA. Venous blood was taken on cycles 1 and 2 for separation of peripheral blood lymphocytes (PBLs) for measurement of DNA strand breaks. Results: Wide interpatient variation in PBL DNA strand breaks occurred following chemotherapy, with a peak at 4 h (median 26.6 h, interquartile range 14.75- 40.5 h) and incomplete repair by 24 h. Similarly, there was a range of 3-MeA excretion with peak levels 4-10 h after chemotherapy (median 33 nmol/h, interquartile range 20.448.65 nmol/h). Peak 3-MeA excretion was positively correlated with DNA strand breaks at 4 h (Spearman's correlation coefficient, r = 0.39, P = 0.036) and 24 h (r = 0.46, P = 0.01). Drug-induced emesis correlated with PBL DNA strand breaks (Mann Whitney U-test, P = 0.03) but not with peak 3-MeA excretion. Conclusions: DNA damage and repair following cytotoxic chemotherapy can be measured in vivo by the alkaline comet assay and by urinary 3-MeA excretion in patients receiving chemotherapy.