Development and evaluation of an integrated clinical learning model to inform continuing education for acute care nurses

Background Significant ongoing learning needs for nurses have occurred as a direct result of the continuous introduction of technological innovations and research developments in the healthcare environment. Despite an increased worldwide emphasis on the importance of continuing education, there continues to be an absence of empirical evidence of program and session effectiveness. Few studies determine whether continuing education enhances or develops practice and the relative cost benefits of health professionals’ participation in professional development. The implications for future clinical practice and associated educational approaches to meet the needs of an increasingly diverse multigenerational and multicultural workforce are also not well documented. There is minimal research confirming that continuing education programs contribute to improved patient outcomes, nurses’ earlier detection of patient deterioration or that standards of continuing competence are maintained. Crucially, evidence-based practice is demonstrated and international quality and safety benchmarks are adhered to. An integrated clinical learning model was developed to inform ongoing education for acute care nurses. Educational strategies included the use of integrated learning approaches, interactive teaching concepts and learner-centred pedagogies. A Respiratory Skills Update education (ReSKU) program was used as the content for the educational intervention to inform surgical nurses’ clinical practice in the area of respiratory assessment. The aim of the research was to evaluate the effectiveness of implementing the ReSKU program using teaching and learning strategies, in the context of organisational utility, on improving surgical nurses’ practice in the area of respiratory assessment. The education program aimed to facilitate better awareness, knowledge and understanding of respiratory dysfunction in the postoperative clinical environment. This research was guided by the work of Forneris (2004), who developed a theoretical framework to operationalise a critical thinking process incorporating the complexities of the clinical context. The framework used educational strategies that are learner-centred and participatory. These strategies aimed to engage the clinician in dynamic thinking processes in clinical practice situations guided by coaches and educators. Methods A quasi experimental pre test, post test non–equivalent control group design was used to evaluate the impact of the ReSKU program on the clinical practice of surgical nurses. The research tested the hypothesis that participation in the ReSKU program improves the reported beliefs and attitudes of surgical nurses, increases their knowledge and reported use of respiratory assessment skills. The study was conducted in a 400 bed regional referral public hospital, the central hub of three smaller hospitals, in a health district servicing the coastal and hinterland areas north of Brisbane. The sample included 90 nurses working in the three surgical wards eligible for inclusion in the study. The experimental group consisted of 36 surgical nurses who had chosen to attend the ReSKU program and consented to be part of the study intervention group. The comparison group included the 39 surgical nurses who elected not to attend the ReSKU program, but agreed to participate in the study. Findings One of the most notable findings was that nurses choosing not to participate were older, more experienced and less well educated. The data demonstrated that there was a barrier for training which impacted on educational strategies as this mature aged cohort was less likely to take up educational opportunities. The study demonstrated statistically significant differences between groups regarding reported use of respiratory skills, three months after ReSKU program attendance. Between group data analysis indicated that the intervention group’s reported beliefs and attitudes pertaining to subscale descriptors showed statistically significant differences in three of the six subscales following attendance at the ReSKU program. These subscales included influence on nursing care, educational preparation and clinical development. Findings suggest that the use of an integrated educational model underpinned by a robust theoretical framework is a strong factor in some perceptions of the ReSKU program relating to attitudes and behaviour. There were minimal differences in knowledge between groups across time. Conclusions This study was consistent with contemporary educational approaches using multi-modal, interactive teaching strategies and a robust overarching theoretical framework to support study concepts. The construct of critical thinking in the clinical context, combined with clinical reasoning and purposeful and collective reflection, was a powerful educational strategy to enhance competency and capability in clinicians.

Adding a receding horizon to Locally Weighted Regression for learning robot control

There have been notable advances in learning to control complex robotic systems using methods such as Locally Weighted Regression (LWR). In this paper we explore some potential limits of LWR for robotic applications, particularly investigating its application to systems with a long horizon of temporal dependence. We define the horizon of temporal dependence as the delay from a control input to a desired change in output. LWR alone cannot be used in a temporally dependent system to find meaningful control values from only the current state variables and output, as the relationship between the input and the current state is under-constrained. By introducing a receding horizon of the future output states of the system, we show that sufficient constraint is applied to learn good solutions through LWR. The new method, Receding Horizon Locally Weighted Regression (RH-LWR), is demonstrated through one-shot learning on a real Series Elastic Actuator controlling a pendulum.

Exploiting the 1,2,3-triazolium motif in anion-templated formation of a bromide-selective rotaxane host assembly

Stimulated by the efficacy of copper (I) catalysed Huisgen-type 1,3-dipolar cycloaddition of terminal alkynes and organic azides to generate 1,4-disubstituted 1,2,3-triazole derivatives, the importance of ‘click’ chemistry in the synthesis of organic and biological molecular systems is ever increasing.[1] The mild reaction conditions have also led to this reaction gaining favour in the construction of interlocked molecular architectures.[2-4] In the majority of cases however, the triazole group simply serves as a covalent linkage with no function in the resulting organic molecular framework. More recently a renewed interest has been shown in the transition metal coordination chemistry of triazole ligands.[3, 5, 6] In addition novel aryl macrocyclic and acyclic triazole based oligomers have been shown to recognise halide anions via cooperative triazole C5-H….anion hydrogen bonds.[7] In light of this it is surprising the potential anion binding affinity of the positively charged triazolium motif has not, with one notable exception,[8] been investigated. With the objective of manipulating the unique topological cavities of mechanically bonded molecules for anion recognition purposes, we have developed general methods of using anions to template the formation of interpenetrated and interlocked structures.[9-13] Herein we report the first examples of exploiting the 1,2,3-triazolium group in the anion templated formation of pseudorotaxane and rotaxane assemblies. In an unprecedented discovery the bromide anion is shown to be a superior templating reagent to chloride in the synthesis of a novel triazolium axle containing [2]rotaxane. Furthermore the resulting rotaxane interlocked host system exhibits the rare selectivity preference for bromide over chloride...

Inactivation of the Huntington's disease gene (Hdh) impairs anterior streak formation and early patterning of the mouse embryo

Background Huntingtin, the HD gene encoded protein mutated by polyglutamine expansion in Huntington's disease, is required in extraembryonic tissues for proper gastrulation, implicating its activities in nutrition or patterning of the developing embryo. To test these possibilities, we have used whole mount in situ hybridization to examine embryonic patterning and morphogenesis in homozygous Hdhex4/5 huntingtin deficient embryos. Results In the absence of huntingtin, expression of nutritive genes appears normal but E7.0–7.5 embryos exhibit a unique combination of patterning defects. Notable are a shortened primitive streak, absence of a proper node and diminished production of anterior streak derivatives. Reduced Wnt3a, Tbx6 and Dll1 expression signify decreased paraxial mesoderm and reduced Otx2 expression and lack of headfolds denote a failure of head development. In addition, genes initially broadly expressed are not properly restricted to the posterior, as evidenced by the ectopic expression of Nodal, Fgf8 and Gsc in the epiblast and T (Brachyury) and Evx1 in proximal mesoderm derivatives. Despite impaired posterior restriction and anterior streak deficits, overall anterior/posterior polarity is established. A single primitive streak forms and marker expression shows that the anterior epiblast and anterior visceral endoderm (AVE) are specified. Conclusion Huntingtin is essential in the early patterning of the embryo for formation of the anterior region of the primitive streak, and for down-regulation of a subset of dynamic growth and transcription factor genes. These findings provide fundamental starting points for identifying the novel cellular and molecular activities of huntingtin in the extraembryonic tissues that govern normal anterior streak development. This knowledge may prove to be important for understanding the mechanism by which the dominant polyglutamine expansion in huntingtin determines the loss of neurons in Huntington's disease.

Gender equity in the professoriate : a cohort study of new women professors in Australia

According to statistics and trend data, women continue to be substantially under- represented in the Australian professoriate, and growth in their representation has been slow despite the plethora of equity programs. While not disputing these facts, we propose that examining gender equity by cohort provides a complementary perspective on the status of gender equity in the professoriate. Based on over 500 survey responses, we detected substantial similarities between women and men who were appointed as professors or associate professors between 2005 and 2008. There were similar proportions of women and men appointed via external or internal processes or by invitation. Additionally, similar proportions of women and men professors expressed a marked preference for research over teaching. Furthermore, there were similar distributions between the genders in the age of appointment to the professoriate. However, a notable gender difference was that women were appointed to the professoriate on average 1.9 years later than mens. This later appointment provides one reason for the lower representation of women compared to men in the professoriate. It also raises questions of the typical length of time that women and men remain in the (paid) professoriate and reasons why they might leave it. A further similarity between women and men in this cohort was their identification of motivation and circumstances as key factors in their career orientation. However, substantially more women identified motivation than circumstances and the situation was reversed for men. The open-ended survey responses also provided confirmation that affirmative action initiatives make a difference to women’s careers.

Reorienting diaspora : China and India as franchise nations

In this paper, I outline a new approach towards media and diaspora using the concept of the ‘franchise nation’. It is my contention that current theories on migration, media and diaspora with their emphasis on exile, multiple belongings, hybrid identities and their representations are inadequate to the task of explaining the emergence of a new trend in diaspora, home and host nation relationship. This, I suggest, is a recent shift most notable in the attitudes of the Chinese and Indian governments toward their diasporas. From earlier eras where Chinese sojourners were regarded as disloyal and Indians overseas left to fend for themselves, Chinese and Indian migrants are today directly addressed and wooed by their nations of origin. This change is motivated in part by the realisation that diasporic populations are, in fact, resources that can bring significant influence to bear on home nation interests within host nations. Such sway in foreign lands gains greater importance as China and India are, by virtue of their economic rise and prominence on the world stage, subject to ever more intense international scrutiny. Members of these diasporas have willingly responded to these changes by claiming and cultivating pivotal roles for themselves within host nations as spokespersons, informants and representatives, trading on their assumed familiarity with home cultures, language and commerce. As a result, China and India have initiated a number of statecraft strategies in recent years to (re)engage their diasporas. Both nations have identified media as amongst the key instruments of their strategies. New media enhances the ability of all parties—home and host states, institutions and individuals—to participate, interact and reciprocate. While China’s centralised government has utilised the notion of soft power (ruan shili) to describe its practices, India’s efforts are diffused along the lines of nation branding via myriad labels like India Inc. and the Global Indian. To explain this emergent trend, I propose a new framework, franchise nation, defined as a reciprocal relationship between nation and diaspora that is characterised by mutual obligations and benefits. In appropriating this phrase from Stephenson, I liken contemporary statecraft operating in China and India to a business franchising system wherein benefits may be economic or cultural and; those thus connected signal their willingness for mutual exchange and concede a sense of obligation. As such, franchise nation is not concerned with remote, unidirectional interference in home nation affairs a la Anderson’s ‘long-distance nationalism’. Rather, it is a framework that seeks to reflect more closely the dynamism of the relationship between diaspora, home and host nations.

#Ausvotes : how Twitter covered the 2010 Australian federal election

While the 2007 Australian federal election was notable for the use of social media by the Australian Labor Party in campaigning, the 2010 election took place in a media landscape in which social media–especially Twitter–had become much more embedded in both political journalism and independent political commentary. This article draws on the computer-aided analysis of election-related Twitter messages, collected under the #ausvotes hashtag, to describe the key patterns of activity and thematic foci of the election’s coverage in this particular social media site. It introduces novel metrics for analysing public communication via Twitter, and describes the related methods. What emerges from this analysis is the role of the #ausvotes hashtag as a means of gathering an ad hoc ‘issue public’– a finding which is likely to be replicated for other hashtag communities.

Understanding learning and teaching : elementary teacher trainers in Papua New Guinea engaged in cultural authorship in the context of national educational reform

Over the last decade, Papua New Guinea (PNG) has pursued educational reform in elementary teacher education. Because elementary teachers and teacher education are central to the reform agenda, there is a need to gain empirical evidence about how PNG teacher trainers’ understandings about learning and teaching impact on their practice. The study uses cultural-authorship as a theoretical framework to investigate the nature of changes in understanding about learning and teaching for 18 teacher trainers as they progressed through a two-year Bachelor of Early Childhood upgrade course. It addresses the research question: What do elementary teacher trainers in PNG understanding about learning and teaching and how has this changed during their course? The focus on such understandings provides valuable insights into their professional identities at a critical time in PNG’s education reform agenda. Analysis of journal entries at the beginning and end of the course showed that, over time, teacher trainers described increasingly more complex ways of understanding learning and teaching. These views shifted from a focus on learning and teaching as transmission of ideas to one in which the critical role played by communities and families in educational processes and the teacher as a change agent became focal. This watershed finding demonstrates notable shifts in teacher trainers’ professional identities from trainers to community leaders in elementary education.

Learning English in an English speaking world : examining opportunities for intercultural understandings and connectedness through representations of identities in English language textbooks

With the recognition that language both reflects and constructs culture and English now widely acknowledged as an international language, the cul-tural content of language teaching materials is now being problematised. Through a quantitative analysis, this chapter focuses on opportunities for intercultural understanding and connectedness through representations of the identities that appear in two leading English language textbooks. The analyses reveal that the textbooks orientate towards British and western identities with representations of people from non-European/non-Western backgrounds being notable for their absence, while others are hidden from view. Indeed there would appear to be a neocolonialist orientation in oper-ation in the textbooks, one that aligns English with the West. The chapter proposes arguments for the consideration of cultural diversity in English language teaching (ELT) textbook design, and promoting intercultural awareness and acknowledging the contexts in which English is now being used. It also offers ways that teachers can critically reflect on existing ELT materials and proposes arguments for including different varieties of Eng-lish in order to ensure a level of intercultural understanding and connect-edness.

Design for Manufacturing (DFM) – A case study of repetitive measures

Design for Manufacturing (DFM) is a highly integral methodology in product development, starting from the concept development phase, with the aim of improving manufacturing productivity and maintaining product quality. While Design for Assembly (DFA) is focusing on elimination or combination of parts with other components (Boothroyd, Dewhurst and Knight, 2002), which in most cases relates to performing a function and manufacture operation in a simpler way, DFM is following a more holistic approach. During DFM, the considerable background work required for the conceptual phase is compensated for by a shortening of later development phases. Current DFM projects normally apply an iterative step-by-step approach and eventually transfer to the developer team. Although DFM has been a well established methodology for about 30 years, a Fraunhofer IAO study from 2009 found that DFM was still one of the key challenges of the German Manufacturing Industry. A new, knowledge based approach to DFM, eliminating steps of DFM, was introduced in Paul and Al-Dirini (2009). The concept focuses on a concurrent engineering process between the manufacturing engineering and product development systems, while current product realization cycles depend on a rigorous back-and-forth examine-and-correct approach so as to ensure compatibility of any proposed design to the DFM rules and guidelines adopted by the company. The key to achieving reductions is to incorporate DFM considerations into the early stages of the design process. A case study for DFM application in an automotive powertrain engineering environment is presented. It is argued that a DFM database needs to be interfaced to the CAD/CAM software, which will restrict designers to the DFM criteria. Consequently, a notable reduction of development cycles can be achieved. The case study is following the hypothesis that current DFM methods do not improve product design in a manner claimed by the DFM method. The critical case was to identify DFA/DFM recommendations or program actions with repeated appearance in different sources. Repetitive DFM measures are identified, analyzed and it is shown how a modified DFM process can mitigate a non-fully integrated DFM approach.

A comprehensive literature review of the pelvis and the lower extremity digital human models under quasi-static conditions

Finite Element Modeling (FEM) has become a vital tool in the automotive design and development processes. FEM of the human body is a technique capable of estimating parameters that are difficult to measure in experimental studies with the human body segments being modeled as complex and dynamic entities. Several studies have been dedicated to attain close-to-real FEMs of the human body (Pankoke and Siefert 2007; Amann, Huschenbeth et al. 2009; ESI 2010). The aim of this paper is to identify and appraise the state of-the art models of the human body which incorporate detailed pelvis and/or lower extremity models. Six databases and search engines were used to obtain literature, and the search was limited to studies published in English since 2000. The initial search results identified 636 pelvis-related papers, 834 buttocks-related papers, 505 thigh-related papers, 927 femur-related papers, 2039 knee-related papers, 655 shank-related papers, 292 tibia-related papers, 110 fibula-related papers, 644 ankle related papers, and 5660 foot-related papers. A refined search returned 100 pelvis-related papers, 45 buttocks related papers, 65 thigh-related papers, 162 femur-related papers, 195 kneerelated papers, 37 shank-related papers, 80 tibia-related papers, 30 fibula-related papers and 102 ankle-related papers and 246 foot-related papers. The refined literature list was further restricted by appraisal against a modified LOW appraisal criteria. Studies with unclear methodologies, with a focus on populations with pathology or with sport related dynamic motion modeling were excluded. The final literature list included fifteen models and each was assessed against the percentile the model represents, the gender the model was based on, the human body segment/segments included in the model, the sample size used to develop the model, the source of geometric/anthropometric values used to develop the model, the posture the model represents and the finite element solver used for the model. The results of this literature review provide indication of bias in the available models towards 50th percentile male modeling with a notable concentration on the pelvis, femur and buttocks segments.

Tax expenditures in Australia : the elevation from ‘disguised’ expenditures to architectural pillars of the 21st century

The current Australian Treasury approach to tax expenditures management and reporting is a culmination of 36 years of Government and Parliamentary reviews and reports. The most notable outcome of these reviews and reports is the publication of the annual tax expenditures statement, which commenced in 1986. Since its inception, the Australian annual tax expenditures statements have themselves been the subject of review. Most recently, the Australian National Audit Office has undertaken a performance audit in the Department of the Treasury and released its report entitled Preparation of the Tax Expenditures Statement. In addition to this 2008 report, a second recent opportunity to consider tax expenditures within the Australian tax regime has arisen. The Australian tax system is currently undergoing a comprehensive and broad review with the terms of reference requiring a consideration of all relevant tax expenditures. While the recommendations of the Australian National Audit Office are not novel, and it is not unusual for a broader review to consider the role of tax expenditures within the Australian tax system, both the recommendations of the Australian National Audit Office and the views of the current Review Panel take on a renewed sense of importance given the proliferation of tax expenditures in Australia. Tax expenditures, in terms of number and pecuniary value, have increased significantly in Australia in recent years. The latest Tax Expenditures Statement lists around 320 tax expenditures with the pecuniary value of those expenditures estimated at $73.69 billion or 7.1% of GDP. The largest category of tax expenditures listed in the 2008 Tax Expenditures Statement, totalling $29.23 billion, relate to concessions aimed at retirement savings.

Statistical modelling of wind effects on signal propagation for wireless sensor networks

A wireless sensor network system must have the ability to tolerate harsh environmental conditions and reduce communication failures. In a typical outdoor situation, the presence of wind can introduce movement in the foliage. This motion of vegetation structures causes large and rapid signal fading in the communication link and must be accounted for when deploying a wireless sensor network system in such conditions. This thesis examines the fading characteristics experienced by wireless sensor nodes due to the effect of varying wind speed in a foliage obstructed transmission path. It presents extensive measurement campaigns at two locations with the approach of a typical wireless sensor networks configuration. The significance of this research lies in the varied approaches of its different experiments, involving a variety of vegetation types, scenarios and the use of different polarisations (vertical and horizontal). Non–line of sight (NLoS) scenario conditions investigate the wind effect based on different vegetation densities including that of the Acacia tree, Dogbane tree and tall grass. Whereas the line of sight (LoS) scenario investigates the effect of wind when the grass is swaying and affecting the ground-reflected component of the signal. Vegetation type and scenarios are envisaged to simulate real life working conditions of wireless sensor network systems in outdoor foliated environments. The results from the measurements are presented in statistical models involving first and second order statistics. We found that in most of the cases, the fading amplitude could be approximated by both Lognormal and Nakagami distribution, whose m parameter was found to depend on received power fluctuations. Lognormal distribution is known as the result of slow fading characteristics due to shadowing. This study concludes that fading caused by variations in received power due to wind in wireless sensor networks systems are found to be insignificant. There is no notable difference in Nakagami m values for low, calm, and windy wind speed categories. It is also shown in the second order analysis, the duration of the deep fades are very short, 0.1 second for 10 dB attenuation below RMS level for vertical polarization and 0.01 second for 10 dB attenuation below RMS level for horizontal polarization. Another key finding is that the received signal strength for horizontal polarisation demonstrates more than 3 dB better performances than the vertical polarisation for LoS and near LoS (thin vegetation) conditions and up to 10 dB better for denser vegetation conditions.

Measuring the realization of benefits from enterprise architecture management

Enterprise architecture management (EAM) has become an intensively discussed approach to manage enterprise transformations. While many organizations employ EAM, a notable insecurity about the value of EAM remains. In this paper, we propose a model to measure the realization of benefits from EAM. We identify EAM success factors and EAM benefits through a comprehensive literature review and eleven explorative expert interviews. Based on our findings, we integrate the EAM success factors and benefits with the established DeLone & McLean IS success model resulting in a model that explains the realization of EAM benefits. This model aids organizations as a benchmark and framework for identifying and assessing the setup of their EAM initiatives and whether and how EAM benefits are materialized. We see our model also as a first step to gain insights in and start a discussion on the theory of EAM benefit realization.

A Fair Go Beyond the School Gate? Systemic factors affecting participation and attainment in tertiary education by Queensland students from LSES backgrounds

The purpose of this project was to conduct an empirical study that would result in findings that inform systemic policy development aimed at improving tertiary participation and attainment by students from low socioeconomic status (LSES) backgrounds in Queensland. The project focuses on systemic policy, initiatives and programs that encourage tertiary education participation and attainment by individuals from LSES backgrounds, rather than on institution-specific initiatives or programs. While the broad remit was to consider tertiary education participation, the study particularly highlights issues pertaining to LSES student participation and attainment in the higher education sector, given the notable under representation of this demographic subgroup in Australian universities. This study supports the strategic priority of addressing professional skills shortages and innovations aiming to improve human and social capital in the state of Queensland. The ultimate goal is to contribute to the enhancement of Queensland’s education and training system by maximising participation and attainment by people from LSES backgrounds in higher education, thereby improving their quality of life and future life choices and opportunities. The study addressed the following five research questions: 1. What are the major factors that promote or inhibit participation and attainment in tertiary education by LSES students in Queensland? 2. To what extent do systemic policies or practices(systemic factors) of Queensland’s tertiary education system promote or inhibit participation and attainment by LSES students? That is, what features of Queensland’s tertiary education system have a significant effect on participation and attainment by LSES students? 3. What system policies or practices are found to boost participation and attainment by LSES students in other jurisdictions? 4. What evidence is there to suggest that policies or practices that have boosted participation and attainment by LSES students in other jurisdictions would be successful if implemented in Queensland? 5. What are the implications of the research findings for Queensland’s tertiary education system to improve participation and attainment by LSES students? The project adopted a mixed methods approach to data collection. A comprehensive review of the literature was conducted to identify relevant state, national and international literature. Both qualitative and quantitative methodologies were used to collect data from a range of key stakeholders.