Patient perspectives of using a web based intervention program for patients with type 2 diabetes and acute coronary syndrome

Introduction Research highlights patients with dual diagnoses of type 2 diabetes and acute coronary syndrome (ACS) have higher readmission rates and poorer health outcomes than patients with singular chronic conditions. Despite this, there is a lack of education programs targeted for this dual diagnosis population to improve self-management and decrease negative health outcomes. There is evidence to suggest that internet based interventions may improve health outcomes for patients with singular chronic conditions, however there is a need to develop an evidence base for ACS patients with comorbid diabetes. There is a growing awareness of the importance of a participatory model in developing effective online interventions. That is, internet interventions are more effective if end users’ perceptions of the intervention are incorporated in their final development prior to testing in large scale trials. Objectives This study investigated patients’ perspectives of the web-based intervention designed to promote self-management of the dual conditions in order to refine the intervention prior to clinical trial evaluation. Methods An interpretive approach with thematic analysis was used to obtain deeper understanding regarding participants’ experience when using web-application interventions for patients with ACS and type 2 diabetes. Semi-structured interviews were undertaken on a purposive sample of 30 patients meeting strict inclusion and exclusion criteria to obtain their perspectives on the program. Results Preliminary results indicate patients with dual diagnoses express more complex needs than those with a singular condition. Participants express a positive experience with the proposed internet intervention and emerging themes include that the web page is seen as easy to use and comforting as a support, in that patients know they are not alone. Further results will be reported as they become available. Conclusion The results indicate potential for patient acceptability of the newly developed internet intervention for patients with ACS and comorbid diabetes. Incorporation of patient perspectives into the final development of the intervention is likely to maximise successful outcomes of any future trials that utilise this intervention. Future quantitative evaluation of the effectiveness of the intervention is being planned.

Promiscuity, pheromones and pathogenicity : why all Enterococci are not created equal

Enterococcus faecalis is a Gram-positive, coccus shaped, lactic acid bacterium, with demonstrated ubiquity across multiple anatomical sites. Enterococcus faecalis isolates have been isolated from clinical samples as the etiological agent in patients with overt infections, and from body sites previously thought to be sterile but absent of signs and symptoms of infection. E. faecalis is implicated in both human health and disease, recognized as a commensal, a probiotic and an opportunistic multiply resistant pathogen. E. faecalis has emerged as a key pathogen in nosocomial infections. E. faecalis is well equipped to avert recognition by host cell immune mediators. Antigenic cell wall components including lipotechoic acids are concealed from immune detection by capsular polysaccharides produced by some strains. Thereby preventing complement activation, the pro-inflammatory response, opsonisation and phagocytosis. E. faecalis also produces a suite of enzymes including gelatinase and cytolysin, which aid in both virulence and host immune evasion. The ability of enterococci to form biofilms in vivo further increases virulence, whilst simultaneously preventing detection by host cells. E. faecalis exhibits high levels of both intrinsic and acquired antimicrobial resistance. The mobility of the E. faecalis genome is a significant contributor to antimicrobial resistance, with this species also transferring resistance to other Gram-positive bacteria. Whilst E. faecalis is of increasing concern in nosocomial infections, its role as a member of the endogenous microbiota cannot be underestimated. As a commensal and probiotic, E. faecalis plays an integral role in modulating the immune response, and in providing endogenous antimicrobial activity to enhance exclusion or inhibition of opportunistic pathogens in certain anatomical niches. In this chapter we will review possible mediators of enterococcal transition from commensal microbe to opportunistic pathogen, considering isolates obtained from patients diagnosed with pathogenic infections and those obtained from asymptomatic patients.

Urban citizenship in a sensor rich society

Urban public spaces are sutured with a range of surveillance and sensor technologies that claim to enable new forms of ‘data based citizen participation’, but also increase the tendency for ‘function-creep’, whereby vast amounts of data are gathered, stored and analysed in a broad application of urban surveillance. This kind of monitoring and capacity for surveillance connects with attempts by civic authorities to regulate, restrict, rebrand and reframe urban public spaces. A direct consequence of the increasingly security driven, policed, privatised and surveilled nature of public space is the exclusion or ‘unfavourable inclusion’ of those considered flawed and unwelcome in the ‘spectacular’ consumption spaces of many major urban centres. In the name of urban regeneration, programs of securitisation, ‘gentrification’ and ‘creative’ and ‘smart’ city initiatives refashion public space as sites of selective inclusion and exclusion. In this context of monitoring and control procedures, in particular, children and young people’s use of space in parks, neighbourhoods, shopping malls and streets is often viewed as a threat to the social order, requiring various forms of remedial action. This paper suggests that cities, places and spaces and those who seek to use them, can be resilient in working to maintain and extend democratic freedoms and processes enshrined in Marshall’s concept of citizenship, calling sensor and surveillance systems to account. Such accountability could better inform the implementation of public policy around the design, build and governance of public space and also understandings of urban citizenship in the sensor saturated urban environment.

Urban citizenship in a sensor rich society

Urban public spaces are sutured with a range of surveillance and sensor technologies that claim to enable new forms of ‘data based citizen participation’, but also increase the tendency for ‘function-creep’, whereby vast amounts of data are gathered, stored and analysed in a broad application of urban surveillance. This kind of monitoring and capacity for surveillance connects with attempts by civic authorities to regulate, restrict, rebrand and reframe urban public spaces. A direct consequence of the increasingly security driven, policed, privatised and surveilled nature of public space is the exclusion or ‘unfavourable inclusion’ of those considered flawed and unwelcome in the ‘spectacular’ consumption spaces of many major urban centres. This paper suggests that cities, places and spaces and those who seek to use them, can be resilient in working to maintain and extend democratic freedoms and processes enshrined in Marshall’s concept of citizenship, calling sensor and surveillance systems to account. Such accountability could better inform the implementation of public policy around the design, build and governance of public space and also understandings of urban citizenship in the sensor saturated urban environment.

Method for planning and executing obstacle-free paths for rotating excavation machinery

This invention concerns the control of rotating excavation machinery, for instance to avoid collisions with obstacles. In a first aspect the invention is a control system for autonomous path planning in excavation machinery, comprising: A map generation subsystem to receive data from an array of disparate and complementary sensors to generate a 3-Dimensional digital terrain and obstacle map referenced to a coordinate frame related to the machine's geometry, during normal operation of the machine. An obstacle detection subsystem to find and identify obstacles in the digital terrain and obstacle map, and then to refine the map by identifying exclusion zones that are within reach of the machine during operation. A collision detection subsystem that uses knowledge of the machine's position and movements, as well as the digital terrain and obstacle map, to identify and predict possible collisions with itself or other obstacles, and then uses a forward motion planner to predict collisions in a planned path. And, a path planning subsystem that uses information from the other subsystems to vary planned paths to avoid obstacles and collisions. In other aspects the invention is excavation machinery including the control system; a method for control of excavation machinery; and firmware and software versions of the control system.

Sensorineural hearing loss after treatment for head and neck cancer : a review of the literature

Background Definitive cisplatin-based is increasingly delivered as the treatment of choice for patients with head and neck cancer. Sensorineural hearing loss is a significant long term side effect of cisplatin-based chemoradiation and is associated with potential major quality of life issues for patients. Purpose The purpose of this manuscript was to review the mechanism behind sensorineural hearing loss in patients treated with cisplatin-based chemoradiation, including incidence, the contributions of radiotherapy and cisplatin to sensorineural hearing loss and the impact of the toxicity on patient quality of life. Methods Database searches were conducted through PubMed (National Centre for Biotechnology Information) and OvidSP Medline via the Queensland University of Technology Library website. General article searches were conducted through the online search engine Google Scholar. Articles were excluded if the full-text was unavailable, they were not in English or if they were published prior to 1990. Keywords included hearing loss, ototoxicity, cancer, quality of life, cisplatin and radiotherapy. Results/Discussion The total number of journal articles accessed was 290. Due to exclusion criteria, 129 articles were deemed appropriated for review. Findings indicated that sensorineural hearing loss is a significant, long term complication for patients treated with cisplatin-based chemoradiation. Current literature recognises the ototoxic effects of cisplatin and cranial irradiation as separate entities, however the impact of combined modality therapy on sensorineural hearing loss is seldom reported. Multiple risk factors for hearing loss are described, however there are contradictory opinions on incidence and severity and the exact radiation dose threshold responsible for inducing hearing loss in patients receiving combined modality therapy. Sensorineural hearing loss creates a subset of complexities for patients with head and neck cancer and that these patients face significant quality of life impairment. Conclusion The literature review identified that sensorineural hearing loss is a major quality of life issue for patients treated with cisplatin-based chemoradiation for head and neck cancer. Further investigation evaluating the contribution of cisplatin-based chemoradiation to sensorineural hearing loss and the subsequent effect on patient quality of life is warranted.

‘It’s about finding a way’ : children, sites of opportunity, and building everyday peace in Colombia

The multiple forms of violence associated with protracted conflict disproportionately affect young people. Literature on conflict-affected children often focuses on the need to provide stability and security through institutions such as schools but rarely considers how young people themselves see these sites as part of their everyday lives. The enduring, pervasive, and complex nature of Colombia’s conflict means many young Colombians face the challenges of poverty, persistent social exclusion, and violence. Such conditions are exacerbated in ‘informal’ barrio communities such as los Altos de Cazucá, just south of the capital Bogotá. Drawing on field research in this community, particularly through interviews conducted with young people aged 10 to 17 this article explores how young people themselves understand the roles of the local school and ngo in their personal conceptualisations of the violence in their everyday lives. The evidence indicates that children use spaces available to them opportunistically and that these actions can and should be read as contributing to local, everyday forms of peacebuilding. The ways in which institutional spaces are understood and used by young people as ‘sites of opportunity’ challenges the assumed illegitimacy of young people’s voices and experiences in these environments.

Maintaining or changing a drinking behavior? GOKA's short-term outcomes

During the critical neurobiological and social developmental period of adolescence, binge drinking of alcohol increases the risk of mental health problems, school exclusion, convictions, fatal and non-fatal accidents. The present research utilizes a simple cluster randomized control trial design to evaluate a social marketing program, Game On: Know Alcohol (GOKA), employing innovative online edutainment games to target binge drinking. Pre and post data were collected for seven program (942 students, mean age: 14.6 years) and five control schools (578 students, mean age: 14.4 years). Significant improvements in alcohol knowledge and affective attitude toward binge drinking was observed for adolescents who participated in GOKA compared to the control group, with maintenance of desirable subjective norms, instrumental attitudes and intentions. Given considerable external competition from messages promoting the benefits of alcohol use, a one-off program that modifies incorrect knowledge and alters perceptions of binge drinking as a fun, recreational activity represents an important step. This research contributes to current understanding of social marketing’s capacity to change drivers and maintain inhibitors of binge drinking intentions of adolescents and provides an important basis for future research in the domain.

On the symbiosis of law and truth in Christian theology: Reconciling universal and particular through the Pauline law of love

This article argues that the secular liberal and positivist foundations of the modern Western legal system render it violent. In particular, the liberal exclusion of faith and subjectivity in favour of abstract and universal reason in conjunction with its privileging of individual autonomy at the expense of the community leads to alienation of the individual from the community. Similarly, the positivist exclusion of faith and theology from law, with its enforced conformity to the posited law, also results in this violence of alienation. In response, this article proposes a new foundation for law, a natural law based in the truth of Trinitarian theology articulated by John Milbank. In the Trinity, the members exist as a perfect unity in diversity, providing a model for the reconciliation of the legal individual and community: the law of love. Through the law of love as the basic norm, individuals love their neighbours as themselves, reconciling the particular and the universal, and providing a community of peace rather than violence.

Resource allocation in two species systems: Is it worth acknowledging species interactions?

It is becoming increasingly popular to consider species interactions when managing ecological foodwebs. Such an approach is useful in determining how management can affect multiple species, with either beneficial or detrimental consequences. Identifying such actions is particularly valuable in the context of conservation decision making as funding is severely limited. This paper outlines a new approach that simplifies the resource allocation problem in a two species system for a range of species interactions: independent, mutualism, predator-prey, and competitive exclusion. We assume that both species are endangered and we do not account for decisions over time. We find that optimal funding allocation is to the conservation of the species with the highest marginal gain in expected probability of survival and that, across all except mutualist interaction types, optimal conservation funding allocation differs between species. Loss in efficiency from ignoring species interactions was most severe in predator-prey systems. The funding problem we address, where an ecosystem includes multiple threatened species, will only become more commonplace as increasing numbers of species worldwide become threatened. © 2011 Elsevier B.V.

Evaluation of intra- and extra-epithelial secretory IgA in chlamydial infections

IgA is an important mucosal antibody that can neutralize mucosal pathogens by either preventing attachment to epithelia (immune exclusion) or alternatively inhibit intraepithelial replication following transcytosis by the polymeric immunoglobulin receptor (pIgR). Chlamydia trachomatis is a major human pathogen that initially targets the endocervical or urethral epithelium in women and men, respectively. As both tissues contain abundant SIgA we assessed the protection afforded by IgA targeting different chlamydial antigens expressed during the extra and intraepithelial stages of infection. We developed an in vitro model utilizing polarizing cells expressing the murine pIgR together with antigen-specific mouse IgA, and an in vivo model utilizing pIgR-/- mice. SIgA targeting the extraepithelial chlamydial antigen, the major outer membrane protein (MOMP), significantly reduced infection in vitro by 24 % and in vivo by 44 %. Conversely, pIgR-mediated delivery of IgA targeting the intraepithelial inclusion membrane protein A (IncA) bound to the inclusion but did not reduce infection in vitro or in vivo. Similarly, intraepithelial IgA targeting the secreted protease Chlamydia protease-like activity factor (CPAF) also failed to reduce infection. Together, these data suggest the importance of pIgR-mediated delivery of IgA targeting extra but not intraepithelial chlamydial antigens for protection against a genital tract infection.

Exploring with Grammar in the Primary Years: Learning about Language in the Australian Curriculum: English

This new volume, Exploring with Grammar in the Primary Years (Exley, Kevin & Mantei, 2014), follows on from Playing with Grammar in the Early Years (Exley & Kervin, 2013). We extend our thanks to the ALEA membership for their take up of the first volume and the vibrant conversations around our first attempt at developing a pedagogy for the teaching of grammar in the early years. Your engagement at locally held ALEA events has motivated us to complete this second volume and reassert our interest in the pursuit of socially-just outcomes in the primary years. As noted in Exley and Kervin (2013), we believe that mastering a range of literacy competences includes not only the technical skills for learning, but also the resources for viewing and constructing the world (Freire and Macdeo, 1987). Rather than seeing knowledge about language as the accumulation of technical skills alone, the viewpoint to which we subscribe treats knowledge about language as a dialectic that evolves from, is situated in, and contributes to active participation within a social arena (Halliday, 1978). We acknowledge that to explore is to engage in processes of discovery as we look closely and examine the opportunities before us. As such, we draw on Janks’ (2000; 2014) critical literacy theory to underpin many of the learning experiences in this text. Janks (2000) argues that effective participation in society requires knowledge about how the power of language promotes views, beliefs and values of certain groups to the exclusion of others. Powerful language users can identify not only how readers are positioned by these views, but also the ways these views are conveyed through the design of the text, that is, the combination of vocabulary, syntax, image, movement and sound. Similarly, powerful designers of texts can make careful modal choices in written and visual design to promote certain perspectives that position readers and viewers in new ways to consider more diverse points of view. As the title of our text suggests, our activities are designed to support learners in exploring the design of texts to achieve certain purposes and to consider the potential for the sharing of their own views through text production. In Exploring with Grammar in the Primary Years, we focus on the Year 3 to Year 6 grouping in line with the Australian Curriculum, Assessment and Reporting Authority’s (hereafter ACARA) advice on the ‘nature of learners’ (ACARA, 2014). Our goal in this publication is to provide a range of highly practical strategies for scaffolding students’ learning through some of the Content Descriptions from the Australian Curriculum: English Version 7.2, hereafter AC:E (ACARA, 2014). We continue to express our belief in the power of using whole texts from a range of authentic sources including high quality children’s literature, the internet, and examples of community-based texts to expose students to the richness of language. Taking time to look at language patterns within actual texts is a pathway to ‘…capture interest, stir the imagination and absorb the [child]’ into the world of language and literacy (Saxby, 1993, p. 55). It is our intention to be more overt this time and send a stronger message that our learning experiences are simply ‘sample’ activities rather than a teachers’ workbook or a program of study to be followed. We’re hoping that teachers and students will continue to explore their bookshelves, the internet and their community for texts that provide powerful opportunities to engage with language-based learning experiences. In the following three sections, we have tried to remain faithful to our interpretation of the AC:E Content Descriptions without giving an exhaustive explanation of the grammatical terms. This recently released curriculum offers a new theoretical approach to building students’ knowledge about language. The AC:E uses selected traditional terms through an approach developed in systemic functional linguistics (see Halliday and Matthiessen, 2004) to highlight the dynamic forms and functions of multimodal language in texts. For example, the following statement, taken from the ‘Language: Knowing about the English language’ strand states: English uses standard grammatical terminology within a contextual framework, in which language choices are seen to vary according to the topics at hand, the nature and proximity of the relationships between the language users, and the modalities or channels of communication available (ACARA, 2014). Put simply, traditional grammar terms are used within a functional framework made up of field, tenor, and mode. An understanding of genre is noted with the reference to a ‘contextual framework’. The ‘topics at hand’ concern the field or subject matter of the text. The ‘relationships between the language users’ is a description of tenor. There is reference to ‘modalities’, such as spoken, written or visual text. We posit that this innovative approach is necessary for working with contemporary multimodal and cross-cultural texts (see Exley & Mills, 2012). Other excellent tomes, such as Derewianka (2011), Humphrey, Droga and Feez (2012), and Rossbridge and Rushton (2011) provide more comprehensive explanations of this unique metalanguage, as does the AC:E Glossary. We’ve reproduced some of the AC:E Glossary at the end of this publication. We’ve also kept the same layout for our learning experiences, ensuring that our teacher notes are not only succinct but also prudent in their placement. Each learning experience is connected to a Content Description from the AC:E and contains an experience with an identified purpose, suggested resource text and a possible sequence for the experience that always commences with an orientation to text followed by an examination of a particular grammatical resource. Our plans allow for focused discussion, shared exploration and opportunities to revisit the same text for the purpose of enhancing meaning making. Some learning experiences finish with deconstruction of a stimulus text while others invite students to engage in the design of new texts. We encourage you to look for opportunities in your own classrooms to move from text deconstruction to text design. In this way, students can express not only their emerging grammatical understandings, but also the ways they might position readers or viewers through the creation of their own texts. We expect that each of these learning experiences will vary in the time taken. Some may indeed take a couple if not a few teaching episodes to work through, especially if students are meeting a concept or a pedagogical strategy for the first time. We hope you use as much, or as little, of each experience as is needed for your students. We do not want the teaching of grammar to slip into a crisis of irrelevance or to be seen as a series of worksheet drills with finite answers. We firmly believe that strategies for effective deconstruction and design practice, however, have much portability. We three are very keen to hear from teachers who are adopting and adapting these learning experiences in their classrooms. Please email us on b.exley@qut.edu.au, lkervin@uow.edu.au or jessicam@ouw.edu.au. We’d love to continue the conversation with you over time. Beryl Exley, Lisa Kervin & Jessica Mantei

Unspeakably present: The (un)acknowledgment of diverse sexuality and gender human rights in Australian youth justice systems

A number of international human rights frameworks protect the rights of young people in contact with the criminal justice system in states parties, including Australia. These frameworks inform youth justice policy in Australia’s jurisdictions. While the frameworks protect young people’s right to non-discrimination on the grounds of ‘race’, religion and political opinion, the rights of young people to non-discrimination on the grounds of sexuality and gender diversity are not explicitly protected. This is problematic given that lesbian, gay, bisexual, trans, intersex and queer (LGBTIQ) young people appear over-represented in youth justice systems. This article argues that the exclusion of this group from human rights frameworks has an important flow-on effect: the marginalisation of the right of LGBTIQ young people to non-discrimination in policy and discourse that is informed by international human rights frameworks. After outlining the relevant frameworks, this article examines the evidence about LGBTIQ young people’s interactions with youth justice agencies, particularly police. The evidence indicates that the human rights of LGBTIQ young people are frequently breached in these interactions. We conclude by arguing that it is timely to consider how best to protect the human rights of LBGTIQ young people and keep their rights on the agenda.

Overcoming acculturation: Physical education recruits' experiences of an alternative pedagogical approach to games teaching

Background Physical education teacher education (PETE) programmes have been identified as a critical platform to encourage the exploration of alternative teaching approaches by pre-service teachers. However, the socio-cultural constraint of acculturation or past physical education and sporting experiences results in the maintenance of the status quo of a teacher-driven, reproductive paradigm. Previous studies have reported successfully overcoming the powerful influence of acculturation, resulting in a change in PETE students’ custodial teaching beliefs and receptiveness to alternative teaching approaches. However, to date, limited information has been reported about how PETE students’ acculturation shaped their receptiveness to an alternative teaching approach. This is particularly the case for PETE recruits identified in the literature as most resistant to change. Purpose To explore the features and experiences of an alternative games teaching approach that appealed to PETE recruits’ identified as most resistant to change, requiring a specific sample of PETE recruits with strong, custodial, traditional physical education teaching beliefs, and whom are high achieving sporting products of this traditional culture. The alternative teaching approach explored in this study is the constraints-led approach (CLA), which is similar operationally to TGfU, but distinguished by a neurobiological theoretical framework (nonlinear pedagogy) that informs learning design. Participants and Setting A purposive sample of 10 Australian PETE students was recruited for the study. All participants initially had strong, custodial, traditional physical education teaching beliefs, and were successful sporting products of this teaching approach. After experiencing the CLA as learners during a games unit, participants demonstrated receptiveness to the alternative pedagogy. Data Collection and Analysis Semi-structured interviews and written reflections were sources of data collection. Each participant was interviewed separately, once prior to participation in the games unit to explore their positive physical education experiences, and then again after participation to explore the specific games unit learning experiences that influenced their receptiveness to the alternative pedagogy. Participants completed written reflections about their personal experiences after selected practical sessions. Data were qualitatively analysed using grounded theory. Findings: Thorough examination of the data resulted in establishment of two prominent themes related to the appeal of the CLA for the participants: (i) psychomotor (effective in developing skill), and (ii), inclusivity (included students of varying skill level). The efficacy of the CLA in skill development was clearly an important mediator of receptiveness for highly successful products of a traditional culture. This significant finding could be explained by three key factors: the acculturation of the participants, the motor learning theory underpinning the alternative pedagogy and the unit learning design and delivery. The inclusive nature of the CLA provided a solution to the problem of exclusion, which also made the approach attractive to participants. Conclusion PETE educators could consider these findings when introducing an alternative pedagogy aimed at challenging PETE recruits’ custodial, traditional teaching beliefs. To mediate receptiveness, it is important that the learning theory underpinning the alternative approach is operationalised in a research-informed pedagogical learning design that facilitates students’ perceptions of the effectiveness of the approach through experiencing and or observing it working.

Unlocking the learning potential of incarcerated Indigenous and low SES young people; Mathematics outcomes for future success: a discussion paper

This presentation provides a beginning discussion about what the literature reports about incarcerated young people. Incarcerated Indigenous and low SES young people typically have very low literacy and mathematics skills which precludes them from future education and or employment opportunities, thus continuing the cycle of disadvantage, exclusion and despair(Payne, 2007). Being locked out of learning, they are stuck in a cycle of underachievement, a scenario which contributes to unacceptably high levels of recidivism(ACER, 2014). Success at education is considered an important protective factor against delinquent behaviours such as offending, substance abuse and truancy. Youth education and training centres provide educational opportunities for the incarcerated Indigenous youth but achievement continues to be lower than expected, particularly in mathematics. This presentation provides an introductory literature review focusing on incarcerated young people and education. It is also the preliminary writing for a small pilot project currently being conducted in one Youth Education and Training Centre in Australia.