Student facilitated PBL - A capstone collaborative learning experience in the Griffith University MBBS program

We report on an innovation in teaching and learning designed to extend the collaborative learning of PBL, that occurs during the first two years of a four year graduate entry medical program, to a capstone learning experience to assist the transition to a hospital based year 3. During the last five weeks of Year 2 the PBL sessions consist of an initial student facilitated session early in the week followed by a large format session for the entire class convened by two clinicians. The new format PBL was perceived positively by the students and staff involved and may have advantages over traditional formats in developing students' clinical reasoning and differential diagnosis skills.

HER2 positive gastric and gastroesophageal adenocarcinoma; An Irish tertiary center experience

Background: Trastuzumab has been approved for patients with human epidermal growth factor receptor 2 (HER2) over expression and gene amplification metastatic gastric cancer. Here we present the prevalence of HER2 positive gastric cancer in an Irish population, the use of Trastuzumab in first line and beyond progression. Methods: The study was conducted in St James's Hospital, Dublin. A retrospective analysis of the date of patients with HER2 positive gastric cancer over a period of 3 years was carried out. Her2 positive was defined as immunohistochemistry (IHC) score of +3, of IHC score of +2 and increased gene copy number by fluorescence in situ hybridization (FISH). Overall survival was calculated from the day of initiation of treatment with Trastuzumab until death. Results: During the study period 140 patients with gastric and gastro-esophageal junction adenocarcinoma were treated. Out of those, 30 (21.4%) had HER2 positive disease. Among HER2 positive disease patients 18 (12.8%) were treated with first line Trastuzumab containing regimen with a median overall survival of 13 months. Nine (50%) developed progressive disease while on Trastuzumab and of those, 4 (22.2%) patients continued on Trastuzumab beyond progression, two (11.1%) of whom achieved stable disease and a prolonged survival. Conclusion: HER2 positivity rate in an Irish population with advanced gastric and gastro-esophageal junction adenocarcinoma is 21.4%. Treatment with Trastuzumab in the first line in combination with chemotherapy is a reasonable approach. Continuation of Trastuzumab beyond progression is a feasible strategy that requires further exploration.

Busy auditors, ethical behavior, and discretionary accruals quality in Malaysia

The required professional and ethical pronouncements of accountants mean that auditors need to be competent and exercise due care and skill in the performance of their audits. In this study, we examine what happens when auditors take on more clients than they should, thus raising doubts about their ability to maintain competence and audit quality. Using 2803 observations of Malaysian companies from 2010 to 2013, we find that auditors with multiple clients are associated with lower earnings quality, proxied by total accruals and discretionary accruals. Our results demonstrate that associating client firms’ reported discretionary accruals with individual auditors, rather than their firms or offices, is important in determining audit quality. Moreover, we demonstrate that the disclosure of auditors’ signatures on their reports is useful for assessing auditor quality at the individual level, thus contributing to the debate on the usefulness of having auditor identities on reports.

Emotional experience in psychotherapeutic interaction : Conversation analytical study on cognitive psychotherapy

The dissertation examines how emotional experiences are oriented to in the details of psychotherapeutic interaction. The data (57 audio recorded sessions) come from one therapist-patient dyad in cognitive psychotherapy. Conversation analysis is used as method. The dissertation consists of 4 original articles and a summary. The analyses explicate the therapist s practices of responding to the patient s affective expressions. Different types of affiliating responses are identified. It is shown that the affiliating responses are combined with, or build grounds for, more interpretive and challenging actions. The study also includes a case study of a session with strong misalignment between the therapist s and patient s orientations, showing how this misalignment is managed by the therapist. Moreover, through a longitudinal analysis of the transformation of a sequence type, the study suggests that therapeutic change processes can be located to sequential relations of actions. The practices found in this study are compared to earlier research on everyday talk and on medical encounters. It is suggested that in psychotherapeutic interaction, the generic norms of interaction considering affiliation and epistemic access, are modified for the purposes of therapeutic work. The study also shows that the practices of responding to emotional experience in psychotherapy can deviate from the everyday practices of affiliation. The results of the study are also discussed in terms of concepts arising from clinical theory. These include empathy, validation of emotion, therapeutic alliance, interpretation, challenging beliefs, and therapeutic change. The therapist s approach described in this study involves practical integration of different clinical theories. In general terms, the study suggests that in the details of interaction, psychotherapy recurrently performs a dual task of empathy and challenging in relation to the patient s ways of describing their experiences. Methodologically, the study discusses the problem of identifying actions in conversation analysis of psychotherapy and emotional interaction, and the possibility to apply conversation analysis in the study of therapeutic change.

Service Experience in an Innovation Context

Service researchers and practitioners have repeatedly claimed that customer service experiences are essential to all businesses. Therefore comprehension of how service experience is characterised in research is an essential element for its further development through research. The importance of greater in-depth understanding of the phenomenon of service experience has been acknowledged by several researchers, such as Carú and Cova and Vargo and Lusch. Furthermore, Service-Dominant (S-D) logic has integrated service experience to value by emphasising in its foundational premises that value is phenomenologically (experientially) determined. The present study analyses how the concept of service experience has been characterised in previous research. As such, it puts forward three ways to characterise it in relation to that research: 1) phenomenological service experience relates to the value discussion in S-D logic and interpretative consumer research, 2) process-based service experience relates to understanding service as a process, and 3) outcome-based service experience relates to understanding service experience as one element in models linking a number of variables or attributes to various outcomes. Focusing on the phenomenological service experience, the theoretical purpose of the study is to characterise service experience based on the phenomenological approach. In order to do so, an additional methodological purpose was formulated: to find a suitable methodology for analysing service experience based on the phenomenological approach. The study relates phenomenology to a philosophical Husserlian and social constructionist tradition studying phenomena as they appear in our experience in a social context. The study introduces Event-Based Narrative Inquiry Technique (EBNIT), which combines critical events with narratives and metaphors. EBNIT enabled the analysis of lived and imaginary service experiences as expressed in individual narratives. The study presents findings of eight case studies within service innovation of Web 2.0, mobile service, location aware service and public service in the municipal sector. Customers’ and service managers’ stories about their lived private and working lifeworld were the foundation for their ideal service experiences. In general, the thesis finds that service experiences are (1) subjective, (2) context-specific, (3) cumulative, (4) partially socially constructed, (5) both lived and imaginary, (6) temporally multiple-dimensional, and (7) iteratively related to perceived value. In addition to customer service experience, the thesis brings empirical evidence of managerial service experience of front-line managers experiencing the service they manage and develop in their working lifeworld. The study contributes to S-D logic, service innovation and service marketing and management in general by characterising service experience based on the phenomenological approach and integrating it to the value discussion. Additionally, the study offers a methodological approach for further exploration of service experiences. The study discusses managerial implications in conjunction with the case studies and discusses them in relation to service innovation.

Five-kilowatt wood gasifier technology: Evolution and field experience

Various elements of an efficient and reliable 5k W wood gasifier system developed over the last ten years are described. The good performance obtained from the system is related to the careful design of its components and sub-systems. Results from extensive testing of gasifier prototypes at two national centres are discussed along with the experience gained in the field from their use at more than one hundred and fifty locations spread over five states in the country. Issues related to acceptance of the technology are also included. Improvements in design to extend the life, to reduce the cost, and to reduce the number of components are also discussed. A few variants of the design to meet the specific requirements of water pumping, power generation and to exploit specific site characteristics are presented.

Price Inflation, Unemployment and Devaluations: The Finnish Experience of the 1990s

In this paper I provide some empirical answers to important questions such as the determinants of price inflation and the role of inflation polices. The results indicate that monetary policy is surprisingly impotent as a device for controlling inflation and there is little support that it influences the real variables. The low inflation after the Finnish devaluations in the beginning of 90s is foremost due to a previous imbalance in the labor markets and depressed aggregate demand.

“Aivan sama vaikkei ne olis edes pelannut” – Jalkapallo elämyskulutuksen kohteena

Tutkielmassa tarkastellaan jalkapallon seuraamista elämyskuluttamisen näkökulmasta. Elämyskulutuksella tarkoitetaan tässä yhteydessä tapahtumia ja hetkiä, jolloin ihminen kokee tavallisuudesta poikkeavan ja mieleenpainuvan tunnetilan. Elämyksiä tarjoavat palvelut ovat lisänneet jatkuvasti suosiotaan, kun arjessa rationaalisuus ylikorostuu ja sille halutaan vastapainoa. Aihetta taustoitetaan elämysyhteiskunnan, yhteisöllisyyden ja kuluttajaheimojen käsitteiden avulla. Erityishuomion saavat kulttuuritapahtumat elämystuotteina, penkkiurheilu yhteiskunnallisena ilmiönä sekä erilaiset jalkapalloon liittyvät kulutustavat. Tutkielma on luonteeltaan fenomenologis-etnografinen kuvaileva tutkimus. Tutkimusmenetelminä on käytetty osallistuvaa havainnointia ja haastatteluita. Tutkimusperinteen mukaisesti ilmiön ymmärtäminen, kuvaaminen ja kirjoittaminen ovat tärkeässä osassa. Havainnointiaineisto on kerätty kolmessa eri tapahtumassa seuraamalla katsojien käyttäytymistä ja tunnelman syntymiseen vaikuttavia tekijöitä. Haastateltavat on valittu harkinnanvaraisesti jalkapalloa aktiivisesti seuraavista henkilöistä ja menetelmänä on käytetty avoimia teemahaastatteluita. Urheilun vetovoima ajanvietteenä perustuu vahvojen tunteiden herättämiseen, joten penkkiurheilu on elämyskulutusta puhtaimmillaan. Urheilu elämystuotteena on oivallinen, sillä sen lukuisten kulutustapojen lisäksi tapahtumat muodostavat päättymättömän jatkumon. Myös oman aineistoni perusteella osoittautui, että menneiden tapahtumien avulla ankkuroidutaan yhteisöön ja tulevien tapahtumien avulla pidetään innostusta yllä. Pettymysten hetkelläkään koukusta ei haluta irti, sillä jokainen kokemus lisää tunteita omaa urheilulajia ja yhteisöä kohtaan. Urheilutapahtumissa katsojan elämys syntyy subjektiivisen kokemuksen kautta, mutta yhteisö luo elämyksen toteutumisen välttämättömät edellytykset. Jalkapalloyleisöön kuuluvissa henkilöissä yhdistyvät halu kuulua ryhmään ja olla samaan aikaan sen ulkopuolella. Peliä voidaan tarkkailla itsekseen ja keskittyneesti suuren joukon keskellä tai hurrata muiden mukana. Aineistoni perusteella jalkapallofanin innostus pulppuaa kahdesta lähteestä: yhteisöllisyydestä ja kiinnostuksesta lajiin. Yhteisöllisyyden tunne syntyy kuulumisesta globaaliin jalkapalloyhteisöön, oman suosikkijoukkueen kannattajiin ja samaa lajia seuraavien kaverien muodostamaan lähipiiriin. Urheilullinen puoli innostuksesta syntyy kiinnostuksesta jalkapalloa kohtaan lajina, aktiivisesti seuratuista säännöllisistä tapahtumista ja oman joukkueen kannattamisesta. Jalkapallon seuraajiin teoria jatkuvasti muuttuvista uusyhteisöistä pätee melko huonosti, sillä lajille ja seuralle ollaan hyvin uskollisia. Faneille on tärkeää sitoutua pieneen lähiyhteisöön, jonka kanssa heillä on yhteinen historia ja mahdollisuus jakaa kokemuksia keskustelemalla ja muistelemalla.

Improving outcome of childhood bacterial meningitis by simplified treatment : Experience from Angola

Background Acute bacterial meningitis (BM) continues to be an important cause of childhood mortality and morbidity, especially in developing countries. Prognostic scales and the identification of risk factors for adverse outcome both aid in assessing disease severity. New antimicrobial agents or adjunctive treatments - except for oral glycerol - have essentially failed to improve BM prognosis. A retrospective observational analysis found paracetamol beneficial in adult bacteraemic patients, and some experts recommend slow β-lactam infusion. We examined these treatments in a prospective, double-blind, placebo-controlled clinical trial. Patients and methods A retrospective analysis included 555 children treated for BM in 2004 in the infectious disease ward of the Paediatric Hospital of Luanda, Angola. Our prospective study randomised 723 children into four groups, to receive a combination of cefotaxime infusion or boluses every 6 hours for the first 24 hours and oral paracetamol or placebo for 48 hours. The primary endpoints were 1) death or severe neurological sequelae (SeNeSe), and 2) deafness. Results In the retrospective study, the mortality of children with blood transfusion was 23% (30 of 128) vs. without blood transfusion 39% (109 of 282; p=0.004). In the prospective study, 272 (38%) of the children died. Of those 451 surviving, 68 (15%) showed SeNeSe, and 12% (45 of 374) were deaf. Whereas no difference between treatment groups was observable in primary endpoints, the early mortality in the infusion-paracetamol group was lower, with the difference (Fisher s exact test) from the other groups at 24, 48, and 72 hours being significant (p=0.041, 0.0005, and 0.005, respectively). Prognostic factors for adverse outcomes were impaired consciousness, dyspnoea, seizures, delayed presentation, and absence of electricity at home (Simple Luanda Scale, SLS); the Bayesian Luanda Scale (BLS) also included abnormally low or high blood glucose. Conclusions New studies concerning the possible beneficial effect of blood transfusion, and concerning longer treatment with cefotaxime infusion and oral paracetamol, and a study to validate our simple prognostic scales are warranted.

Psychologically-Based and Content-Oriented Experience in Entertainment Virtual Environments

In daily life, rich experiences evolve in every environmental and social interaction. Because experience has a strong impact on how people behave, scholars in different fields are interested in understanding what constitutes an experience. Yet even if interest in conscious experience is on the increase, there is no consensus on how such experience should be studied. Whatever approach is taken, the subjective and psychologically multidimensional nature of experience should be respected. This study endeavours to understand and evaluate conscious experiences. First I intro-duce a theoretical approach to psychologically-based and content-oriented experience. In the experiential cycle presented here, classical psychology and orienting-environmental content are connected. This generic approach is applicable to any human-environment interaction. Here I apply the approach to entertainment virtual environments (VEs) such as digital games and develop a framework with the potential for studying experiences in VEs. The development of the methodological framework included subjective and objective data from experiences in the Cave Automatic Virtual Environment (CAVE) and with numerous digital games (N=2,414). The final framework consisted of fifteen factor-analytically formed subcomponents of the sense of presence, involvement and flow. Together, these show the multidimensional experiential profile of VEs. The results present general experiential laws of VEs and show that the interface of a VE is related to (physical) presence, which psychologically means attention, perception and the cognitively evaluated realness and spatiality of the VE. The narrative of the VE elicits (social) presence and involvement and affects emotional outcomes. Psychologically, these outcomes are related to social cognition, motivation and emotion. The mechanics of a VE affect the cognitive evaluations and emotional outcomes related to flow. In addition, at the very least, user background, prior experience and use context affect the experiential variation. VEs are part of many peoples lives and many different outcomes are related to them, such as enjoyment, learning and addiction, depending on who is making the evalua-tion. This makes VEs societally important and psychologically fruitful to study. The approach and framework presented here contribute to our understanding of experiences in general and VEs in particular. The research can provide VE developers with a state-of-the art method (www.eveqgp.fi) that can be utilized whenever new product and service concepts are designed, prototyped and tested.

Liminal Belonging: West African male asylum seekers’ narratives of the asylum experience whilst in Finland

The dominant discourses on the issue of asylum have placed it on a uniquely higher level of scrutiny as a politically very sensitive area for social research. Today, member states within the EU have implemented stricter policies to control new arrivals, whilst instituting statutory procedures to manage the existing asylum claims. In 2010, the number of applicants for asylum in Finland totalled 5988, out of which 1784 were given positive decisions. This thesis endeavour to highlight asylum seekers in the discourses about them by adding their voices to the discussions of them in contemporary Finland. Studies, which has concentrated on asylum seekers in Finland, uses the living conditions within asylum reception centres to assess the impacts of structural barriers on asylum seekers’ efforts to deal with the asylum process. By highlighting the impacts of the entire asylum process, which I believe starts from the country of origin; I focus on examining narratives of dealing with the experience of liminality whilst waiting for asylum, and then explore areas of possible participation within informal social networks for West African asylum seekers in Finland. The overall aim is to place the current research within the broader sociological discussion of ‘belonging’ for asylum seekers who are yet to be recognized as refugees, and who exist in a state of limbo. Methodologically, oral interviews, self-written autobiographical narratives, and ethnographic field work are qualitatively combined as data in this thesis for an empirical study of West African male asylum seekers in Finland. Narrative analysis is employed to analyze the data for this thesis. The ethnographic research data for the study began in May 2009 and ended in August of 2010. Altogether, ten interviews and four self-written narratives were collected as data. In total seven hours of audio recording were made, along eleven pages of hand-written autobiographical narratives. Field observation notes are employed in the study to provide contexts to the active interactional processes of interpretation throughout the analysis. Findings from the study suggest that within the experience of liminality, which surrounds the entire asylum process, participations within informal social networks are found to be important to the process of re-making place and the sense of belonging. My study shows that this is necessary to countering the experience of boredom, stress and social isolation, which permeate all aspects of life for West African asylum seekers, whilst they wait for asylum decisions in Finland.

Microfinance, Efficiency and Agricultural Production in Bangladesh

The objectives of this study were to make a detailed and systematic empirical analysis of microfinance borrowers and non-borrowers in Bangladesh and also examine how efficiency measures are influenced by the access to agricultural microfinance. In the empirical analysis, this study used both parametric and non-parametric frontier approaches to investigate differences in efficiency estimates between microfinance borrowers and non-borrowers. This thesis, based on five articles, applied data obtained from a survey of 360 farm households from north-central and north-western regions in Bangladesh. The methods used in this investigation involve stochastic frontier (SFA) and data envelopment analysis (DEA) in addition to sample selectivity and limited dependent variable models. In article I, technical efficiency (TE) estimation and identification of its determinants were performed by applying an extended Cobb-Douglas stochastic frontier production function. The results show that farm households had a mean TE of 83% with lower TE scores for the non-borrowers of agricultural microfinance. Addressing institutional policies regarding the consolidation of individual plots into farm units, ensuring access to microfinance, extension education for the farmers with longer farming experience are suggested to improve the TE of the farmers. In article II, the objective was to assess the effects of access to microfinance on household production and cost efficiency (CE) and to determine the efficiency differences between the microfinance participating and non-participating farms. In addition, a non-discretionary DEA model was applied to capture directly the influence of microfinance on farm households production and CE. The results suggested that under both pooled DEA models and non-discretionary DEA models, farmers with access to microfinance were significantly more efficient than their non-borrowing counterparts. Results also revealed that land fragmentation, family size, household wealth, on farm-training and off farm income share are the main determinants of inefficiency after effectively correcting for sample selection bias. In article III, the TE of traditional variety (TV) and high-yielding-variety (HYV) rice producers were estimated in addition to investigating the determinants of adoption rate of HYV rice. Furthermore, the role of TE as a potential determinant to explain the differences of adoption rate of HYV rice among the farmers was assessed. The results indicated that in spite of its much higher yield potential, HYV rice production was associated with lower TE and had a greater variability in yield. It was also found that TE had a significant positive influence on the adoption rates of HYV rice. In article IV, we estimated profit efficiency (PE) and profit-loss between microfinance borrowers and non-borrowers by a sample selection framework, which provided a general framework for testing and taking into account the sample selection in the stochastic (profit) frontier function analysis. After effectively correcting for selectivity bias, the mean PE of the microfinance borrowers and non-borrowers were estimated at 68% and 52% respectively. This suggested that a considerable share of profits were lost due to profit inefficiencies in rice production. The results also demonstrated that access to microfinance contributes significantly to increasing PE and reducing profit-loss per hectare land. In article V, the effects of credit constraints on TE, allocative efficiency (AE) and CE were assessed while adequately controlling for sample selection bias. The confidence intervals were determined by the bootstrap method for both samples. The results indicated that differences in average efficiency scores of credit constrained and unconstrained farms were not statistically significant although the average efficiencies tended to be higher in the group of unconstrained farms. After effectively correcting for selectivity bias, household experience, number of dependents, off-farm income, farm size, access to on farm training and yearly savings were found to be the main determinants of inefficiencies. In general, the results of the study revealed the existence substantial technical, allocative, economic inefficiencies and also considerable profit inefficiencies. The results of the study suggested the need to streamline agricultural microfinance by the microfinance institutions (MFIs), donor agencies and government at all tiers. Moreover, formulating policies that ensure greater access to agricultural microfinance to the smallholder farmers on a sustainable basis in the study areas to enhance productivity and efficiency has been recommended. Key Words: Technical, allocative, economic efficiency, DEA, Non-discretionary DEA, selection bias, bootstrapping, microfinance, Bangladesh.