Tailoring Consumer Resources to Enhance Self-Care in Chronic Heart Failure

Background Chronic heart failure (CHF) is associated with high hospitalisation and mortality rates and debilitating symptoms. In an effort to reduce hospitalisations and improve symptoms individuals must be supported in managing their condition. Patients who can effectively self-manage their symptoms through lifestyle modification and adherence to complex medication regimens will experience less hospitalisations and other adverse events. Aim The purpose of this paper is to explain how providing evidence-based information, using patient education resources, can support self-care. Discussion Self-care relates to the activities that individuals engage in relation to health seeking behaviours. Supporting self-care practices through tailored and relevant information can provide patients with resources and advice on strategies to manage their condition. Evidence-based approaches to improve adherence to self-care practices in patients with heart failure are not often reported. Low health literacy can result in poor understanding of the information about CHF and is related to adverse health outcomes. Also a lack of knowledge can lead to non-adherence with self-care practices such as following fluid restriction, low sodium diet and daily weighing routines. However these issues need to be addressed to improve self-management skills. Outcome Recently the Heart Foundation CHF consumer resource was updated based on evidence-based national clinical guidelines. The aim of this resource is to help consumers improve understanding of the disease, reduce uncertainty and anxiety about what to do when symptoms appear, encourage discussions with local doctors, and build confidence in self-care management. Conclusion Evidence-based CHF patient education resources promote self-care practices and early detection of symptom change that may reduce hospitalisations and improve the quality of life for people with CHF.

Halogen bonding between an isoindoline nitroxide and 1,4-diiodotetrafluorobenzene: new tools and tectons for self-assembling organic spin systems

Halogen bonding has been observed for the first time between an isoindoline nitroxide and an iodoperfluorocarbon (see figure), which cocrystallize to form a discrete 2:1 supramolecular compound in which NO.⋅⋅⋅I halogen bonding is the dominant intermolecular interaction. This illustrates the potential use of halogen bonding and isoindoline nitroxide tectons for the assembly of organic spin systems...

Attachment, fear of intimacy and differentiation of self among clients in substance disorder treatment facilities

Attachment, fear of intimacy and differentiation of self were examined by means of self-report questionnaires in 158 volunteers, including 99 clients enrolled in addiction treatment programs. As expected, clients (who were undergoing treatment for alcoholism, heroin addiction, amphetamine/cocaine addiction or cannabis abuse) reported higher levels of insecure attachment and fear of intimacy, and lower levels of secure attachment and differentiation of self, compared to controls. Insecure attachment, high fear of intimacy and low self-differentiation appear to characterize clients enrolled in addiction treatment programs. Such characteristics may reflect a predisposition to substance problems, an effect of chronic substance problems, or conceivably both.

Gifted young adolescents : voices of self

Despite the challenges that giftedness can add to self-formation during early adolescence, gifted young adolescents seldom are asked about their lives outside of counselling and educational contexts. The study considers the complexities that face gifted young adolescents in the process of self-discovery and self-representation, thereby building a case for seeking their own viewpoints. A guiding assumption for the study was that gifted young adolescents may respond positively to the opportunity to share their own perspectives and their own versions of “who they are”. The theoretical underpinnings for this study drew from Dialogical Self Theory. The study resides within an interactive view of self as a dynamic construction rather than a static state, where “who we are” is formed in everyday exchanges with self and others. Self-making as a process among gifted young adolescents is presented as an interactive network of “I” voices interpreted to reflect internal and external dialogue. In this way, self is understood within dialogical concepts of voices as multiple expressions. The study invited twelve gifted young adolescents to write freely about themselves over a six month period in an email journal project. Participants were recruited online and by word-of-mouth and they were able to negotiate their own levels of involvement. Access to the lives of individual young adolescents was sought in an out-of-school setting using narrative methods of personal writing in the form of journals sent as emails to the researcher. The role of the researcher was to act as a supportive listener who responded to participant-led emails and thereby facilitated the process of authoring that occurred across the data-gathering phase. The listening process involved responses that were affirming and designed to build trust. Data in the form of email texts were analysed using a close listening method that uncovered patterns of voices that were explicitly or subtly expressed by participants. The interpretation of voices highlighted the tensions and contradictions involved in the process of participants forming a “self” that emerged as multiple “I” voices. There were three key findings of the study. First, the gifted young adolescent participants each constructed a self around four key voices of Author, Achiever, Resistor/Co-operator and Self-Innovator. These voices were dialogical selfconstructions that showed multiplicity as a normal way of being. Second, the selfmaking processes of the gifted young adolescent participants were guided by a hierarchy of voices that were directed through self-awareness. Third, authoring in association with a responsive adult listener emerged as a dialogic space for promoting self-awareness and a language of self-expression among gifted young adolescents. The findings of the study contribute to knowledge about gifted young adolescents by presenting their own versions of “who” they are, perspectives that might differ from mainstream perceptions. Participants were shown to have highly diverse, complex and individual expressions that have implications for how well they are understood and supported by others. The use of email journals helped to create a synergy for self-disclosure and a safe space for self-expression where participants’ abilities to be themselves were encouraged. Increased self-awareness and selfknowledge among gifted young adolescents is vital to their self-formation and their management of self and others’ expectations. This study makes an original contribution to the field of self-study by highlighting the processes and complexities of young adolescents’ self-constructions. Through the innovative use of narrative methods and an inter-disciplinary approach, the voices of gifted young adolescents were privileged. At a practical level, the study can inform educators, policy-makers, parents and all those who seek to contribute to the well-being of gifted young adolescents.

Resonance : a music director’s theomusicological study of ‘praise’ and ‘glory’ in a selection of four liturgical music excerpts

Some of my most powerful spiritual experiences have come from the splendorous and sublime sounding hymns performed by a choir and church organ at the traditional Anglican church I’ve attended since I was very young. In the later stage of my life, my pursuit of education in the field of engineering caused me to move to Australia where I regularly attended a contemporary evangelical church and subsequently became a music director in the faith community. This environmental and cultural shift altered my perception and musical experiences of Christian music and led me to enquire about the relationship between Christian liturgy and church music. Throughout history church musicians and composers have synthesised the theological, congregational, cultural and musical aspects of church liturgy. Many great composers have taken into account the conditions surrounding the process of sacred composition and arrangement of music to enhance the experience of religious ecstasy – they sought resonances with Christian values and beliefs to draw congregational participation into the light of praising and glorifying God. As a music director in an evangelical church this aspiration has become one I share. I hope to identify and define the qualities of these resonances that have been successful and apply them to my own practice. Introduction and Structure of the Thesis In this study I will examine four purposively selected excerpts of Christian church vocal music combining theomusicological and semiotic analysis to help identify guidelines that might be useful in my practice as a church music director. The four musical excerpts have been selected based upon their sustained musical and theological impact over time, and their ability to affect ecstatic responses from congregations. This thesis documents a personal journey through analysis of music and uses a context that draws upon ethno-musicological, theological and semiotic tools that lead to a preliminary framework and principles which can then be applied to the identified qualities of resonance in church music today. The thesis is comprised of four parts. Part 1 presents a literature study on the relationship between sacred music, the effects of religious ecstasy and the Christian church. Multiple lenses on this phenomenon are drawn from the viewpoints of prominent western church historians, Biblical theologians, and philosophers. The literature study continues in Part 2, where the role of embodiment is examined from the current perspective of cognitive learning environments. This study offers a platform for a critical reflection on two distinctive musical liturgical systems that have treated differently the notion of embodied understanding amidst a shifting church paradigm. This allows an in-depth theological and philosophical understanding of the liturgical conditions around sacred music-making that relates to the monistic and dualistic body/mind. Part 3 involves undertaking a theomusicological methodology that utilises creative case studies of four purposively selected spiritual pieces. A semiotic study focuses on specific sections of sacred vocal works that express the notions of ‘praise’ and ‘glorification’, particularly in relation to these effects,which combine an analysis of theological perspectives around religious ecstasy and particular spiritual themes. Part 4 presents the critiques and findings gathered from the study that incorporate theoretical and technological means to analyse the purposive selected musical artefact, particularly with the sonic narratives expressing notions of ‘Praise' and 'Glory’. The musical findings are further discussed in relation to the notion of resonance, and then a conceptual framework for the role of contemporary musicdirector is proposed. The musical and Christian terminologies used in the thesis are explained in the glossary, and the appendices includes tables illustrating the musical findings, conducted surveys, written musical analyses and audio examples of selected sacred pieces available on the enclosed compact disc.

Live my work : rural nurses and their multiple perspectives of self

Aim. This paper is a report of a study to explore rural nurses' experiences of mentoring. Background. Mentoring has recently been proposed by governments, advocates and academics as a solution to the problem for retaining rural nurses in the Australian workforce. Action in the form of mentor development workshops has changed the way that some rural nurses now construct supportive relationships as mentoring. Method. A grounded theory design was used with nine rural nurses. Eleven semi-structured interviews were conducted in various states of Australia during 2004-2005. Situational analysis mapping techniques and frame analysis were used in combination with concurrent data generation and analysis and theoretical sampling. Findings. Experienced rural nurses cultivate novices through supportive mentoring relationships. The impetus for such relationships comes from their own histories of living and working in the same community, and this was termed 'live my work'. Rural nurses use multiple perspectives of self in order to manage their interactions with others in their roles as community members, consumers of healthcare services and nurses. Personal strategies adapted to local context constitute the skills that experienced rural nurses pass-on to neophyte rural nurses through mentoring, while at the same time protecting them through troubleshooting and translating local cultural norms. Conclusion. Living and working in the same community creates a set of complex challenges for novice rural nurses that are better faced with a mentor in place. Thus, mentoring has become an integral part of experienced rural nurses' practice to promote staff retention. © 2007 The Authors.

Building the foundations : skill acquisition in children

Introduction: Why we need to base childrens’ sport and physical education on the principles of dynamical systems theory and ecological psychology As the childhood years are crucial for developing many physical skills as well as establishing the groundwork leading to lifelong participation in sport and physical activities, (Orlick & Botterill, 1977, p. 11) it is essential to examine current practice to make sure it is meeting the needs of children. In recent papers (e.g. Renshaw, Davids, Chow & Shuttleworth, in press; Renshaw, Davids, Chow & Hammond, in review; Chow et al., 2009) we have highlighted that a guiding theoretical framework is needed to provide a principled approach to teaching and coaching and that the approach must be evidence- based and focused on mechanism and not just on operational issues such as practice, competition and programme management (Lyle, 2002). There is a need to demonstrate how nonlinear pedagogy underpins teaching and coaching practice for children given that some of the current approaches underpinning children’s sport and P.E. may not be leading to optimal results. For example, little time is spent undertaking physical activities (Tinning, 2006) and much of this practice is not representative of the competition demands of the performance environment (Kirk & McPhail, 2002; Renshaw et al., 2008). Proponents of a non- linear pedagogy advocate the design of practice by applying key concepts such as the mutuality of the performer and environment, the tight coupling of perception and action, and the emergence of movement solutions due to self organisation under constraints (see Renshaw, et al., in press). As skills are shaped by the unique interacting individual, task and environmental constraints in these learning environments, small changes to individual structural (e.g. factors such as height or limb length) or functional constraints (e.g. factors such as motivation, perceptual skills, strength that can be acquired), task rules, equipment, or environmental constraints can lead to dramatic changes in movement patterns adopted by learners to solve performance problems. The aim of this chapter is to provide real life examples for teachers and coaches who wish to adopt the ideas of non- linear pedagogy in their practice. Specifically, I will provide examples related to specific issues related to individual constraints in children and in particular the unique challenges facing coaches when individual constraints are changing due to growth and development. Part two focuses on understanding how cultural environmental constraints impact on children’s sport. This is an area that has received very little attention but plays a very important part in the long- term development of sporting expertise. Finally, I will look at how coaches can manipulate task constraints to create effective learning environments for young children.

Structured Telephone Support or Telemonitoring Programs for Patients with Chronic Heart Failure

Background: Specialised disease management programmes for chronic heart failure (CHF) improve survival, quality of life and reduce healthcare utilisation. The overall efficacy of structured telephone support or telemonitoring as an individual component of a CHF disease management strategy remains inconclusive. Objectives: To review randomised controlled trials (RCTs) of structured telephone support or telemonitoring compared to standard practice for patients with CHF in order to quantify the effects of these interventions over and above usual care for these patients. Search strategy: Databases (the Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment Database (HTA) on The Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED and Science Citation Index Expanded and Conference Citation Index on ISI Web of Knowledge) and various search engines were searched from 2006 to November 2008 to update a previously published non-Cochrane review. Bibliographies of relevant studies and systematic reviews and abstract conference proceedings were handsearched. No language limits were applied. Selection criteria: Only peer reviewed, published RCTs comparing structured telephone support or telemonitoring to usual care of CHF patients were included. Unpublished abstract data was included in sensitivity analyses. The intervention or usual care could not include a home visit or more than the usual (four to six weeks) clinic follow-up. Data collection and analysis: Data were presented as risk ratio (RR) with 95% confidence intervals (CI). Primary outcomes included all-cause mortality, all-cause and CHF-related hospitalisations which were meta-analysed using fixed effects models. Other outcomes included length of stay, quality of life, acceptability and cost and these were described and tabulated. Main results: Twenty-five studies and five published abstracts were included. Of the 25 full peer-reviewed studies meta-analysed, 16 evaluated structured telephone support (5613 participants), 11 evaluated telemonitoring (2710 participants), and two tested both interventions (included in counts). Telemonitoring reduced all-cause mortality (RR 0.66, 95% CI 0.54 to 0.81, P < 0.0001) with structured telephone support demonstrating a non-significant positive effect (RR 0.88, 95% CI 0.76 to 1.01, P = 0.08). Both structured telephone support (RR 0.77, 95% CI 0.68 to 0.87, P < 0.0001) and telemonitoring (RR 0.79, 95% CI 0.67 to 0.94, P = 0.008) reduced CHF-related hospitalisations. For both interventions, several studies improved quality of life, reduced healthcare costs and were acceptable to patients. Improvements in prescribing, patient knowledge and self-care, and New York Heart Association (NYHA) functional class were observed. Authors' conclusions: Structured telephone support and telemonitoring are effective in reducing the risk of all-cause mortality and CHF-related hospitalisations in patients with CHF; they improve quality of life, reduce costs, and evidence-based prescribing.

Selection of solar energy for green building using superiority and inferiority multi-criteria ranking (SIR) method

Green energy is one of the key factors, driving down electricity bill and zero carbon emission generating electricity to green building. However, the climate change and environmental policies are accelerating people to use renewable energy instead of coal-fired (convention type) energy for green building that energy is not environmental friendly. Therefore, solar energy is one of the clean energy solving environmental impact and paying less in electricity fee. The method of solar energy is collecting sun from solar array and saves in battery from which provides necessary electricity to whole house with zero carbon emission. However, in the market a lot of solar arrays suppliers, the aims of this paper attempted to use superiority and inferiority multi-criteria ranking (SIR) method with 13 constraints establishing I-flows and S-flows matrices to evaluate four alternatives solar energies and determining which alternative is the best, providing power to sustainable building. Furthermore, SIR is well-known structured approach of multi-criteria decision support tools and gradually used in construction and building. The outcome of this paper significantly gives an indication to user selecting solar energy.

Self-reported driving difficulty by persons with Hemianopia and Quadrantanopia

Purpose: To compare self-reported driving difficulty by persons with hemianopic or quadrantanopic field loss with that reported by age-matched drivers with normal visual fields; and to examine how their self- reported driving difficulty compares to ratings of driving performance provided by a certified driving rehabilitation specialist(CDRS). Method: Participants were 17 persons with hemianopic field loss, 7 with quadrantanopic loss, and 24 age-matched controls with normal visual fields, all of whom had current drivers’ licenses. Information was collected via questionnaire regarding driving difficulties experienced in 21 typical driving situations grouped into 3 categories(involvement of peripheral vision, low visibility conditions, and independent mobility). On-road driving performance was evaluated by a CDRS using a standard assessment scale. Results: Drivers with hemianopic and quadrantanopic field loss expressed significantly more difficulty with driving maneuvers involving peripheral vision and independent mobility, compared to those with normal visual fields. Drivers with hemianopia and quadrantanopia who were rated as unsafe to drive based upon an on-road assessment by the CDRS were no more likely to report driving difficulty than those rated as safe. Conclusion: This study highlights aspects of driving that hemianopic or quadrantanopic persons find particularly problematic, thus suggesting areas that could be focused on driving rehabilitation. Some drivers with hemianopia or quadrantanopia may inappropriately view themselves as good drivers when in fact their driving performance is unsafe as judged by a driving professional.

Israel's airstrike on Syria's Al-Kibar facility : a test case for the doctrine of pre-emptive self-defence?

This article analyses the legality of Israel’s 2007 airstrike on an alleged Syrian nuclear facility at Al-Kibar—an incident that has been largely overlooked by international lawyers to date. The absence of a threat of imminent attack from Syria means Israel’s military action was not a lawful exercise of anticipatory self-defence. Yet, despite Israel’s clear violation of the prohibition on the use of force there was remarkably little condemnation from other states, suggesting the possibility of growing international support for the doctrine of pre-emptive self-defence. This article argues that the muted international reaction to Israel’s pre-emptive action was the result of political factors, and should not be seen as endorsement of the legality of the airstrike. As such, a lack of opinio juris means the Al-Kibar episode cannot be viewed as extending the scope of the customary international law right of self-defence so as to permit the use of force against non-imminent threats. However, two features of this incident—namely, Israel’s failure to offer any legal justification for its airstrike, and the international community’s apparent lack of concern over legality—are also evident in other recent uses of force in the ‘war on terror’ context. These developments may indicate a shift in state practice involving a downgrading of the role of international law in discussions of the use of force. This may signal a declining perception of the legitimacy of the jus ad bellum, at least in cases involving minor uses of force.

Self-authorship in child care student teachers

Research related to personal epistemology in teacher education indicates that teachers’ beliefs about knowing and learning influence their pedagogical practices. In the current study, we interviewed 31 child care students to investigate the relationship between personal epistemology and beliefs about children’s learning as they engaged in teaching practices with young children. We drew on self authorship theory to analyze this data, which considers the evolving capacity of learners to analyze and make informed judgments about knowledge (personal epistemology)in the light of their professional identity (intrapersonal beliefs) and interdependent social relationships (interpersonal beliefs). The majority of students described practical personal epistemologies which involved either modeling, reflection on, or evaluation of practical strategies. These epistemologies have implications for child care teachers’ professional identities and their relationships with families, children, and staff in child care contexts.