Health service pathways for patients with chronic leg ulcers : identifying effective pathways for facilitation of evidence based wound care

Background: Chronic leg ulcers cause long term ill-health for older adults and the condition places a significant burden on health service resources. Although evidence on effective management of the condition is available, a significant evidence-practice gap is known to exist, with many suggested reasons e.g. multiple care providers, costs of care and treatments. This study aimed to identify effective health service pathways of care which facilitated evidence-based management of chronic leg ulcers. Methods: A sample of 70 patients presenting with a lower limb leg or foot ulcer at specialist wound clinics in Queensland, Australia were recruited for an observational study and survey. Retrospective data were collected on demographics, health, medical history, treatments, costs and health service pathways in the previous 12 months. Prospective data were collected on health service pathways, pain, functional ability, quality of life, treatments, wound healing and recurrence outcomes for 24 weeks from admission. Results: Retrospective data indicated that evidence based guidelines were poorly implemented prior to admission to the study, e.g. only 31% of participants with a lower limb ulcer had an ABPI or duplex assessment in the previous 12 months. On average, participants accessed care 2–3 times/week for 17 weeks from multiple health service providers in the twelve months before admission to the study clinics. Following admission to specialist wound clinics, participants accessed care on average once per week for 12 weeks from a smaller range of providers. The median ulcer duration on admission to the study was 22 weeks (range 2–728 weeks). Following admission to wound clinics, implementation of key indicators of evidence based care increased (p<0.001) and Kaplan-Meier survival analysis found the median time to healing was 12 weeks (95% CI 9.3–14.7). Implementation of evidence based care was significantly related to improved healing outcomes (p<0.001). Conclusions: This study highlights the complexities involved in accessing expertise and evidence based wound care for adults with chronic leg or foot ulcers. Results demonstrate that access to wound management expertise can promote streamlined health services and evidence based wound care, leading to efficient use of health resources and improved health.

Analysis of multilateral service conversations in global business networks

The rapid growth of services available on the Internet and exploited through ever globalizing business networks poses new challenges for service interoperability. New services, from consumer “apps”, enterprise suites, platform and infrastructure resources, are vying for demand with quickly evolving and overlapping capabilities, and shorter cycles of extending service access from user interfaces to software interfaces. Services, drawn from a wider global setting, are subject to greater change and heterogeneity, demanding new requirements for structural and behavioral interface adaptation. In this paper, we analyze service interoperability scenarios in global business networks, and propose new patterns for service interactions, above those proposed over the last 10 years through the development of Web service standards and process choreography languages. By contrast, we reduce assumptions of design-time knowledge required to adapt services, giving way to run-time mismatch resolutions, extend the focus from bilateral to multilateral messaging interactions, and propose declarative ways in which services and interactions take part in long-running conversations via the explicit use of state.

Service condition of railroad corridors around the insulated rail joints

Railroad corridors contain large number of Insulated Rail Joints (IRJs) that act as safety critical elements in the circuitries of the signaling and broken rail identification systems. IRJs are regarded as sources of excitation for the passage of loaded wheels leading to high impact forces; these forces in turn cause dips, cross levels and twists to the railroad geometry in close proximity to the sections containing the IRJs in addition to the local damages to the railhead of the IRJs. Therefore, a systematic monitoring of the IRJs in railroad is prudent to mitigate potential risk of their sudden failure (e.g., broken tie plates) under the traffic. This paper presents a simple method of periodic recording of images using time-lapse photography and total station surveying measurements to understand the ongoing deterioration of the IRJs and their surroundings. Over a 500 day period, data were collected to examine the trends in narrowing of the joint gap due to plastic deformation the railhead edges and the dips, cross levels and twists caused to the railroad geometry due to the settlement of ties (sleepers) around the IRJs. The results reflect that the average progressive settlement beneath the IRJs is larger than that under the continuously welded rail, which leads to excessive deviation of railroad profile, cross levels and twists.

The influence of online reviews on consumers’ attributions of service quality and control for service standards in hotels

Online travel reviews are emerging as a powerful source of information affecting tourists' pre-purchase evaluation of a hotel organization. This trend has highlighted the need for a greater understanding of the impact of online reviews on consumer attitudes and behaviors. In view of this need, we investigate the influence of online hotel reviews on consumers' attributions of service quality and firms' ability to control service delivery. An experimental design was used to examine the effects of four independent variables: framing; valence; ratings; and target. The results suggest that in reviews evaluating a hotel, remarks related to core services are more likely to induce positive service quality attributions. Recent reviews affect customers' attributions of controllability for service delivery, with negative reviews exerting an unfavorable influence on consumers' perceptions. The findings highlight the importance of managing the core service and the need for managers to act promptly in addressing customer service problems.

Characterization of in vitro Chlamydia muridarum persistence and utilization in an in vivo mouse model of Chlamydia vaccine

Problem: Chlamydia trachomatis genital tract infections are easily treated with antibiotics, however the majority of infections are asymptomatic and therefore untreated, highlighting the need for a vaccine. Because most infections are asymptomatic, vaccination could potentially be administered to individuals who may have an acute infection at that time. In such individuals the effect of vaccination on the existing infection is unknown; however one potential outcome could be the development of a persistent infection. In vitro chlamydial persistence has been well characterized in various strains, however there have been no reported studies in C. muridarum. Method of Study: We performed ultrastructural characterization, and transcriptome analysis of selected genes. We then used the transcriptional profiles of the selected genes to examine whether intranasal immunization of mice during an active genital infection would induce persistence in the upper reproductive tract of female mice. Results and Conclusions: We found that persistence developed in the oviducts of mice as a result of immunization. This is a significant finding, not only because it is the first time that C. muridarum persistence has been characterized in vitro, but also due to the fact that there is minimal characterization of in vivo persistence of any chlamydial species. This highlights the importance of the timing of vaccination in individuals.

Mentoring pre-service teachers on school students’ differentiated learning

This Australian study explores the mentoring of pre-service teachers in selecting and implementing teaching strategies to meet students‟ learning needs. Two case studies involving 28 mentor teachers in a professional development program and a mentor-mentee partnership during a four week practicum provided data about mentoring teaching strategies for differentiated learning. Findings showed that contexts for learning about differentiation occurred at the pre action, in-action, and post-action stages. Central to each stage were pedagogical knowledge practices such as planning, preparation, classroom management, assessment, and problem solving (reflection-in-action to present solutions to problems) as key to in-action strategising and the mentoring processes. Mentoring pre-service teachers on how to devise teaching strategies for differentiated learning needs to be researched with a wider range of mentors and pre-service teachers, including those at different stages of development.

Utilization and optimization of a waste stream cellulose culture medium for pigment production by Penicillium spp

Aims This research sought to determine optimal corn waste stream–based fermentation medium C and N sources and incubation time to maximize pigment production by an indigenous Indonesian Penicillium spp., as well as to assess pigment pH stability. Methods and Results A Penicillium spp. was isolated from Indonesian soil, identified as Penicillium resticulosum, and used to test the effects of carbon and nitrogen type and concentrations, medium pH, incubation period and furfural on biomass and pigment yield (PY) in a waste corncob hydrolysate basal medium. Maximum red PY (497·03 ± 55·13 mg l−1) was obtained with a 21 : 1 C : N ratio, pH 5·5–6·0; yeast extract-, NH4NO3-, NaNO3-, MgSO4·7H2O-, xylose- or carboxymethylcellulose (CMC)-supplemented medium and 12 days (25°C, 60–70% relative humidity, dark) incubation. C source, C, N and furfural concentration, medium pH and incubation period all influenced biomass and PY. Pigment was pH 2–9 stable. Conclusions Penicillium resticulosum demonstrated microbial pH-stable-pigment production potential using a xylose or CMC and N source, supplemented waste stream cellulose culture medium. Significance and Impact of the Study Corn derived, waste stream cellulose can be used as a culture medium for fungal pigment production. Such application provides a process for agricultural waste stream resource reuse for production of compounds in increasing demand.

Situational non-flammable control valves for oxygen service

Past work has clearly demonstrated that numerous commonly used metallic materials will support burning in oxygen, especially at higher pressures. An approach to rectify this significant safety problem has been successfully developed and implemented by applying the concept of Situational Non-Flammability. This approach essentially removes or breaks one leg of the conceptual fire triangle, a tool commonly used to define the three things that are required to support burning; a fuel, an ignition source and an oxidizer. Since an oxidiser is always present in an oxygen system as are ignition sources, the concept of Situational Non-Flammability essentially removes the fuel leg of the fire triangle by only utilising materials that will not burn at the maximum pressure, for example, that the control valve is to be used in. The utilisation of this approach has lead to the development of a range of oxygen components that are practically unable to burn while in service at their design pressure thus providing an unparalleled level of first safety while not compromising on the performance or endurance required in the function of these components. This paper describes the concept of Situational Non-Flammability, how it was used to theoretically evaluate designs of components for oxygen service and the outcomes of the actual development, fabrication and finally utilisation of these components in real oxygen systems in a range of flow control devices.

Public service versus private interest : a comparative analysis of the Australian and British debates

This paper will compare and evaluate the effectiveness of commercial media lobbying and advocacy against public service media in two countries, the United Kingdom and Australia. The paper will focus empirically on the commercial media coverage of public service media issues in these countries (relating to the BBC and ABC respectively) over the period since the election of the Conservative-led Coalition in Britain in June 2010, and the election of the Gillard government in Australia in August 2010. Reference will be made to preceding periods as relevant to an understanding of the current environment. In both countries the main commercial media rival to public service media is News Corp and its associated organisations – News Ltd and Sky News in Australia, and News International and BSkyB in the UK. The paper will examine with analysis of print and online news and commentary content how News Corp outlets have reported and commented on the activities and plans of public service media as the latter have developed and extended their presence on digital TV and online platforms. It will also consider the responses of the ABC and BBC to these interventions. It will consider, thirdly, the responses of Australian and British governments to these debates, and the policy outcomes. This section of the paper will seek to evaluate the trajectory of the policy-public-private dynamic in recent years, and to draw conclusions as to the future direction of policy. Particular attention will be devoted to recent key moments in this unfolding dialogue. In Britain, debates around the efforts of News Corp to take over 100% of BSkyB, both before and after the breaking of the phone-hacking scandal in July 2011; in Australia, the debate around the National Broadband Network and the competitive tender process for ABC World, that country’s public service transnational broadcaster; and other key moments where rivalry between News Corp companies and public service media became mainstream news stories provoking wider public debate. The paper will conclude with recommendations as to how public service media organisations might engage constructively with commercial organisations in the future, including News Corp, and taking into account emerging technological and financial challenges to traditional rationales for public service provision.

Developing intercultural competence in pre-service teachers from Australia and Malaysia : insights from the “Patches” programme

Developing intercultural competence in pre-service teachers from Australia and Malaysia: Insights from a Patches program. Innovative pedagogies can offer pre-service teachers the opportunity to develop their intercultural competence and take up more globalised viewpoints. One such innovation is the Patches program which brought together Malaysian and Australian pre-service teachers who were studying at the same university in Brisbane, Australia, to actively explore issues of cultural and linguistic difference. The participants were 14 Australian fourth-year pre-service teachers who were enrolled in a program on inclusive education, and 58 Malaysian pre-service teachers who had recently arrived at the university in Brisbane to commence their second year of an international education program. In peer groupings, these domestic and international pre-service teachers engaged in a series of interactive tasks and reflective writing workshops exploring intercultural experiences, over a period of ten weeks. Each element or ‘patch’ in the program was designed to build up into a mosaic of intercultural learning. The flexible structuring of the Patches Program provided a supportive framework for participant interaction whilst allowing the groups to decide for themselves the nature and extent of their involvement in a series of community-related tasks. The process of negotiating and implementing these activities formed the basis for establishing meaningful relationships between the participants. The development of the participants’ intercultural competence is traced through their reflective narratives and focus group discussions, drawing on Byram’s concept of the five savoirs. Explaining aspects of Australian culture to their newly arrived Malaysian peers, allowed the Australian pre-service teachers to take a perspective of outsideness towards their own familiar social practices. In addition, being unusually positioned as the linguistic other amongst a group of Bahasa Melayu speakers, highlighted for the Australian pre-service teachers the importance of being inclusive. For the Malaysian pre-service teachers, participation in the Patches program helped to extend intercultural understandings, establish social networks with local students, and build a sense of community in their new learning environment. Both groups of pre-service teachers noted the power of “learning directly by interacting rather than through books”. In addition to interacting interculturally, the process of reflecting on these intercultural experiences is seen as integral to the development of intercultural competence.

Setting aside default judgment - whether judgment regularly or irregularly entered - service under Corporations Act 2001 (Cth) s109X(1) - requirements for affadavit of service

In Hill v Robertson Suspension Systems Pty Ltd [2009] QDC 165 McGill DCJ considered the procedural requirements for the service of originating process on a company, and for proving that service for the purpose of obtaining default judgment.The judge’s views adopt a strict and technical construction of the requirements for an affidavit of service under r 120(1)(b). Though clearly obiter, they may well affect the approach taken on applications to enter or set aside default judgments in the lower courts. Pending further judicial consideration of the issue, it is suggested the prudent course is to ensure that the deponent of an affidavit for service effected under s 109X(1)(a) of the Act deposes not only to the location of the registered office of the company but also, at a minimum, provides the source of that information.

Service management and engineering in information systems research

Service research in information systems (IS) has received attention over many years (e.g. Kettinger and Lee, 1994), but more recently has increased substantially in both diversity and volume (Rai and Sambamurthy, 2006). A service-oriented view of information technology (IT) is gradually taking hold in both academia and industry. This is concomitant with the growth of service-related phenomena and concepts (Lusch and Vargo, 2006), stimulating a global discourse about 'service science' as a new, cross-disciplinary field of research (Chesbrough and Spohrer, 2006).

Rates of attendance at a smoking cessation clinic within a cardiac rehabilitation service

Objectives: Smoking cessation has been shown to be an important intervention for preventing cardiovascular events and improving the health of patients with heart disease. However, unaided quit attempts in these patients often leads to high rates of failure and a return to smoking. Outpatient smoking cessation clinics using face-to-face counseling, ongoing behavioral support, advice on smoking pharmacotherapy and objective monitoring, have been found to be one of the most effective interventions for improving quit smoking rates. An outpatient smoking cessation clinic was trialed within a cardiac rehabilitation service in order to explore its effects on smoking rates for patients with or at risk of heart disease. Attendance rates to the clinic were also monitored. Methods: A descriptive exploratory design was used for this newly developed clinic. Patients who currently smoked tobacco and who had a history of either coronary artery disease, heart failure, atrial fibrillation or those seen under a chest pain assessment service were invited to an outpatient ‘Cardiac Patients Smokers Clinic’. Initially patients were offered up to 10 clinic visits over a 3 month period. Follow-up clinic visits were conducted at 3, 6 and 12 months. A portable carbon monoxide meter was used to objectively measure levels of smoking and validate smoking abstinence. Primary outcomes included rates of attendance. Results: Preliminary findings showed 24 per cent of participants (N = 6) completed all their clinic visits and remained smoke free as measured by their ongoing expired carbon monoxide readings. Clinic attendance rates appeared lowest for those with significant mental health issues such as schizophrenia or substance abuse. However, rates of attendance were improved by having an administration officer make reminder telephone calls prior to clinic visits. Conclusions: Early findings indicate the feasibility of providing a specialist smoking cessation clinic within a cardiac rehabilitation service. Further, that reminder telephone calls prior to appointments improved attendance rates in patients with heart disease to this type of clinic. However, future investigations are warranted.

A comparative study of governmental one-stop portals for public service delivery

The continuing need for governments to radically improve the delivery of public services has led to a new, holistic government reform strategy labeled “Transformational Government” that strongly emphasizes customer-centricity. Attention has turned to online portals as a cost effective front-end to deliver services and engage customers as well as to the corresponding organizational approaches for the back-end to decouple the service interface from the departmental structures. The research presented in this paper makes three contributions: Firstly, a systematic literature review of approaches to the evaluation of online portal models in the public sector is presented. Secondly, the findings of a usability study comparing the online presences of the Queensland Government, the UK Government and the South Australian Government are reported and the relative strengths and weaknesses of the different approaches are discussed. And thirdly, the limitations of the usability study in the context of a broader “Transformational Government” approach are identified and service bundling is suggested as an innovative solution to further improve online service delivery.