Challenging endoscopy reprocessing guidelines: a prospective study investigating the safe shelf life of flexible endoscopes in a tertiary gastroenterology unit.

Professional prac− tice guidelines for endoscope reprocessing re− commend reprocessing endoscopes between each case and proper storage following repro− cessing after the last case of the list. There is lim− ited empirical evidence to support the efficacy of endoscope reprocessing prior to use in the first case of the day; however, internationally, many guidelines continue to recommend this practice. The aim of this study is to estimate a safe shelf life for flexible endoscopes in a high−turnover gastroenterology unit. Materials and methods: In a prospective obser− vational study, all flexible endoscopes in active service during the 3−week study period were mi− crobiologically sampled prior to reprocessing be− fore the first case of the day (n = 200). The main outcome variables were culture status, organism cultured, and shelf life. Results: Among the total number of useable samples (n = 194), the overall contamination rate was 15.5 %, with a pathogenic contamination rate of 0.5 %. Mean time between last case one day and reprocessing before the first case on the next day (that is, shelf life) was 37.62 h (SD 36.47). Median shelf life was 18.8 h (range 5.27± 165.35 h). The most frequently identified organ− ism was coagulase−negative Staphylococcus, an environmental nonpathogenic organism. Conclusions: When processed according to es− tablished guidelines, flexible endoscopes remain free from pathogenic organisms between last case and next day first case use. Significant re− ductions in the expenditure of time and resources on reprocessing endoscopes have the potential to reduce the restraints experienced by high−turnover endoscopy units and improve ser− vice delivery.

The role of intermediaries in the implementation and development of asynchronous rural access

In Orissa state, India, the DakNet system supports asynchronous Internet communication between an urban hub and rural nodes. DakNet is noteworthy in many respects, not least in how the system leverages existing transport infrastructure. Wi-Fi transceivers mounted on local buses send and receive user data from roadside kiosks, for later transfer to/from the Internet via wireless protocols. This store-and-forward system allows DakNet to offer asynchronous communication capacity to rural users at low cost. The original ambition of the DakNet system was to provide email and SMS facilities to rural communities. Our 2008 study of the communicative ecology surrounding the DakNet system revealed that this ambition has now evolved – in response to market demand – to the extent that e-shopping (rather than email) has become the primary driver behind the DakNet offer.

Age-related differences in exercise and quality of life among breast cancer survivors

Purpose: Physical activity has become a focus of cancer recovery research as it has the potential to reduce treatment-related burden and optimize health-related quality of life (HRQoL). However, the potential for physical activity to influence recovery may be age-dependent. This paper describes physical activity levels and HRQoL among younger and older women after surgery for breast cancer and explores the correlates of physical inactivity. Methods: A population-based sample of breast cancer patients diagnosed in South-East Queensland, Australia, (n=287) were assessed once every three months, from 6 to 18 months post-surgery. The Functional Assessment of Cancer Therapy-Breast questionnaire (FACTB+4) and items from the Behavioral Risk Factor Surveillance System (BRFSS) questionnaire were used to measure HRQoL and physical activity, respectively. Physical activity was assigned metabolic equivalent task (MET) values, and categorized as < 3, 3 to 17.9 and 18+ MET-hours/weeks. Descriptive statistics, generalized linear models with age stratification (<50 years versus 50+ years), and logistic regression were used for analyses (p=0.05, two-tailed). Results: Younger women who engaged in 3 or more MET-hours/week of physical activity reported a higher HRQoL at 18 months compared to their more sedentary counterparts (p<0.05). Older women reported similar HRQoL irrespective of activity level and consistently reported clinically higher HRQoL than younger women. Increasing age, being overweight or obese, and restricting use of the treated side at six months post-surgery increased the likelihood of sedentary behavior (OR>3, p<0.05). Conclusions: Age influences the potential to observe HRQoL benefits related to physical activity participation. These results also provide relevant information for the design of exercise interventions for breast cancer survivors and highlights that some groups of women are at greater risk of long-term sedentary behavior.

Safeguarding Rural Australia : Introduction, Framework and Background to Secondary Data Analysis

This report provides an introduction to our analyses of secondary data with respect to violent acts and incidents relating to males living in rural settings in Australia. It clarifies important aspects of our overall approach primarily by concentrating on three elements that required early scoping and resolution. Firstly, a wide and inclusive view of violence which encompasses measures of violent acts and incidents and also data identifying risk taking behaviour and the consequences of violence is outlined and justified. Secondly, the classification used to make comparisons between the city and the bush together with associated caveats is outlined. The third element discussed is in relation to national injury data. Additional commentary resulting from exploration, examination and analyses of secondary data is published online in five subsequent reports in this series.

Safeguarding Rural Australia : Data Report No. 2 - Intentional Violence

This report focuses on our examination of extant data which have been sourced with respect to intentional violence perpetrated or experienced by males in regional and remote Australia. The nature of intentional violent acts can be physical, sexual or psychological or involve deprivation or neglect. We have presented under the headings of: self-harm including suicide; homicide; assault, sexual assault and the threat of assault; child abuse; other family and intimate partner violence; harassment, stalking and bullying; alcohol related social violence; and animal abuse. State variations in interpersonal violence are also presented. Additional commentary resulting from exploration, examination and analyses of secondary data is published online in complementary reports in this series.

Safeguarding Rural Australia: Data Report No. 3 - Unintentional Violence

This report focuses on our examination of extant data which have been sourced with respect to unintentional serious and violent injuries to males living in regional and remote Australia. Such injuries typically might be caused by, for example, transport accidents, occupational exposures and hazards, burns and so on. Thus unintentional violent incidents cause physical trauma the consequences of which can sometimes lead to chronic conditions including psychological harm or substance abuse. Additional commentary resulting from exploration, examination and analyses of secondary data is published online in complementary reports in this series.

Safeguarding rural Australia : addressing masculinity and violence in rural settings. Data report No. 4 - Risky behaviour - misuse of alcohol, illicit drugs, firearms use and abuse, other risky behaviour

This report focuses on our examination of extant data which have been sourced with respect to personally and socially risky behaviour associated with males living in regional and remote Australia . The AIHW (2008: PHE 97:89) defines personally risky behaviour, on the one hand, as working, swimming, boating, driving or operating hazardous machinery while intoxicated with alcohol or an illicit drug. Socially risky behaviour, on the other hand, is defined as creating a public disturbance, damaging property, stealing or verbally or physically abusing someone while intoxicated with alcohol or an illicit drug. Additional commentary resulting from exploration, examination and analyses of secondary data is published online in complementary reports in this series.

Safeguarding rural Australia : addressing masculinity and violence in rural settings. Data report no. 5. Consequences of violence - juvenile offenders, long-term health consequences, anxiety and repression, other chronic disabilities

This report considers extant data which have been sourced with respect to some of the consequences of violent acts and incidents and risky behaviour for males living in regional and remote Australia . This has been collated and presented under the headings: juvenile offenders; long-term health consequences; anxiety and repression; and other chronic disabilities. Additional commentary resulting from exploration, examination and analyses of secondary data is published online in complementary reports in this series.

Health-related quality of life in obese children and adolescents

Objective: This review addresses the effect of overweight and obese weight status on pediatric health-related quality of life (HRQOL). Method: Web of Science, Medline, CINAHL, Cochrane Library, EMBASE, AMED and PubMed were searched for peer-reviewed studies in English reporting HRQOL and weight status in youth (<21 years), published before March 2008. Results: Twenty-eight articles were identified. Regression of HRQOL against body mass index (BMI) using pooled data from 13 studies utilizing the Pediatric Quality of Life Inventory identified an inverse relationship between BMI and pediatric HRQOL (r=−0.7, P=0.008), with impairments in physical and social functioning consistently reported. HRQOL seemed to improve with weight loss, but randomized controlled trials were few and lacked long-term follow-up. Conclusions: Little is known about the factors associated with reduced HRQOL among overweight or obese youth, although gender, age and obesity-related co-morbidities may play a role. Few studies have examined the differences in HRQOL between community and treatment-seeking samples. Pooled regressions suggest pediatric self-reported HRQOL can be predicted from parent proxy reports, although parents of obese youths tend to perceive worse HRQOL than children do about themselves. Thus, future research should include both pediatric and parent proxy perspectives.

End-of-life care pathways for improving outcomes in caring for the dying (Review)

Background In many clinical areas, integrated care pathways are utilised as structured multidisciplinary care plans which detail essential steps in caring for patients with specific clinical problems. Particularly, care pathways for the dying have been developed as a model to improve the end-of-life care of all patients. They aim to ensure that the most appropriate management occurs at the most appropriate time and that it is provided by the most appropriate health professional. Clinical pathways for end-of-life care management are used widely around the world and have been regarded as the gold standard. Therefore, there is a significant need for clinicians to be informed about the utilisation of end-of-life care pathways with a systematic review. Objectives To assess the effects of end-of-life care pathways, compared with usual care (no pathway) or with care guided by another end-of-life care pathway across all healthcare settings (e.g. hospitals, residential aged care facilities, community). Search strategy The Cochrane Register of controlled Trials (CENTRAL), the Pain, Palliative and Supportive Care Review group specialised register,MEDLINE, EMBASE, review articles and reference lists of relevant articles were searched. The search was carried out in September 2009. Selection criteria All randomised controlled trials (RCTs), quasi-randomised trial or high quality controlled before and after studies comparing use versus non-use of an end-of-life care pathway in caring for the dying. Data collection and analysis Results of searches were reviewed against the pre-determined criteria for inclusion by two review authors. Main results The search identified 920 potentially relevant titles, but no studies met criteria for inclusion in the review. Authors’ conclusions Without further available evidence, recommendations for the use of end-of-life pathways in caring for the dying cannot be made. RCTs or other well designed controlled studies are needed for evaluating the use of end-of-life care pathways in caring for dying people.

Troubling Empowerment : A feminist critique of a rural women and communication technology project

Participatory research methodologies and interactive communication technologies (ICTs) are increasingly seen as offering ways of enhancing women’s empowerment and rural community development. However, some researchers suggest the need for caution about such claims. This book details findings from an evaluation of a feminist action research project that explored the impacts of ICTs for rural women in Queensland, Australia, in terms of personal, business and community development. Using praxis and poststructuralist feminist theories and methodologies, this innovative study presents a rigorous analysis and critique of women's empowerment and participation. This study demonstrates the value of adopting a critical yet pragmatic approach that takes diversity and difference, power-knowledge relations, and the contradictory effects of participation into account. This is argued to enable the development of more effective strategies for women’s empowerment, participation and inclusion. This book should be of particular interest to researchers, postgraduate students, and others working in the fields of communication, gender, and rural development, and feminist evaluation and ethnography.

MoBlogs, Sharing Situations, and Lived Life

This chapter considers shared encounters through blogging in the light of John Urry’s new mobilities paradigm. We review relevant literature on mobile blogging (moblogging) – blogging, pervasive image capture and sharing, moblogging and video blogging – and describe common issues with these digital content sharing practices. We then document some features of how technology affords “reflexive encounters” through the description of a blogging study involving smokers trying to quit, describing important connections between mobilities – physical, object, and communicative mobility. Finally, we present some challenges for new blogging technologies, their relevance to social encounters, and possible future directions through considering the mobile self; the new digital life document; and digital content sharing practices.

Retiring to the good life? The short-term effects of retirement on health

We estimate the impact of retirement on three subjective and objective measures of health using a regression discontinuity design. The results indicate that retirement increases an individual's sense of well-being and their mental health but not necessarily their physical health. Specifications tests suggest that the results are robust.

Reliability driven reconfiguration of rural power distribution systems

This paper presents a reliability-based reconfiguration methodology for power distribution systems. Probabilistic reliability models of the system components are considered and Monte Carlo method is used while evaluating the reliability of the distribution system. The reconfiguration is aimed at maximizing the reliability of the power supplied to the customers. A binary particle swarm optimization (BPSO) algorithm is used as a tool to determine the optimal configuration of the sectionalizing and tie switches in the system. The proposed methodology is applied on a modified IEEE 13-bus distribution system.