Food for thought : designing for critical reflection on food practices

With increasing demands on our time, everyday behaviors such as food purchasing, preparation, and consumption have become habitual and unconscious. Indeed, modern food values are focused on conve- nience and effortlessness, overshad- owing other values such as environ- mental sustainability, health, and pleasure. The rethinking of how we approach everyday food behaviors appears to be a particularly timely concern. In this special section, we explore work carried out and dis- cussed during the recent workshop “Food for Thought: Designing for Critical Reflection on Food Practices,” at the 2012 Designing Interactive Systems Conference in Newcastle upon Tyne, U.K.

Adaptive radiotherapy for virally mediated head and neck cancer : predicting which patients may benefit most

Background: Recent clinical studies have demonstrated an emerging subgroup of head and neck cancers that are virally mediated. This disease appears to be a distinct clinical entity with patients presenting younger and with more advanced nodal disease, having lower tobacco and alcohol exposure and highly radiosensitive tumours. This means they are living longer, often with the debilitating functional side effects of treatment. The primary objective of this study was to determine how virally mediated nasopharyngeal and oropharyngeal cancers respond to radiation therapy treatment. The aim was to determine risk categories and corresponding adaptive treatment management strategies to proactively manage these patients. Method/Results: 121 patients with virally mediated, node positive nasopharyngeal or oropharyngeal cancer who received radiotherapy treatment with curative intent between 2005 and 2010 were studied. Relevant patient demographics including age, gender, diagnosis, TNM stage, pre-treatment nodal size and dose delivered was recorded. Each patient’s treatment plan was reviewed to determine if another computed tomography (re-CT) scan was performed and at what time point (dose/fraction) this occurred. The justification for this re-CT was determined using four categories: tumour and/or nodal regression, weight loss, both or other. Patients who underwent a re-CT were further investigated to determine whether a new plan was calculated. If a re-plan was performed, the dosimetric effect was quantified by comparing dose volume histograms of planning target volumes and critical structures from the actual treatment delivered and the original treatment plan. Preliminary results demonstrated that 25/121 (20.7%) patients required a re-CT and that these re-CTs were performed between fractions 20 to 25 of treatment. The justification for these re-CTs consisted of a combination of tumour and/or nodal regression and weight loss. 16/25 (13.2%) patients had a replan calculated. 9 (7.4%) of these replans were implemented clinically due to the resultant dosimetric effect calculated. The data collected from this assessment was statistically analysed to identify the major determining factors for patients to undergo a re-CT and/or replan. Specific factors identified included nodal size and timing of the required intervention (i.e. how when a plan is to be adapted). This data was used to generate specific risk profiles that will form the basis of a biologically guided adaptive treatment management strategy for virally mediated head and neck cancer. Conclusion: Preliminary data indicates that virally mediated head and neck cancers respond significantly during radiation treatment (tumour and/or nodal regression and weight loss). Implications of this response are the potential underdosing or overdosing of tumour and/or surrounding critical structures. This could lead to sub-optimal patient outcomes and compromised quality of life. Consequently, the development of adaptive treatment strategies that improve organ sparing for this patient group is important to ensure delivery of the prescribed dose to the tumour volume whilst minimizing the dose received to surrounding critical structures. This could reduce side effects and improve overall patient quality of life. The risk profiles and associated adaptive treatment approaches developed in this study will be tested prospectively in the clinical setting in Phase 2 of this investigation.

Problem solving in the primary school (K-2)

This article focuses on problem solving activities in a first grade classroom in a typical small community and school in Indiana. But, the teacher and the activities in this class were not at all typical of what goes on in most comparable classrooms; and, the issues that will be addressed are relevant and important for students from kindergarten through college. Can children really solve problems that involve concepts (or skills) that they have not yet been taught? Can children really create important mathematical concepts on their own – without a lot of guidance from teachers? What is the relationship between problem solving abilities and the mastery of skills that are widely regarded as being “prerequisites” to such tasks?Can primary school children (whose toolkits of skills are limited) engage productively in authentic simulations of “real life” problem solving situations? Can three-person teams of primary school children really work together collaboratively, and remain intensely engaged, on problem solving activities that require more than an hour to complete? Are the kinds of learning and problem solving experiences that are recommended (for example) in the USA’s Common Core State Curriculum Standards really representative of the kind that even young children encounter beyond school in the 21st century? … This article offers an existence proof showing why our answers to these questions are: Yes. Yes. Yes. Yes. Yes. Yes. And: No. … Even though the evidence we present is only intended to demonstrate what’s possible, not what’s likely to occur under any circumstances, there is no reason to expect that the things that our children accomplished could not be accomplished by average ability children in other schools and classrooms.

ECMO : the clinician’s view

Background: Extra corporeal membrane oxygenation (ECMO) is a complex rescue therapy used to provide cardiac and/or respiratory support for critically ill patients who have failed maximal conventional medical management. ECMO is based on a modified cardiopulmonary bypass (CPB) circuit, and can provide cardiopulmonary support for up-to several months. It can be used in a veno venous configuration for isolated respiratory failure, (VV-ECMO), or in a veno arterial configuration (VA-ECMO) where support is necessary for cardiac +/- respiratory failure. The ECMO circuit consists of five main components: large bore cannulae (access cannulae) for drainage of the venous system, and return cannulae to either the venous (in VV-ECMO) or arterial (in VA ECMO) system. An oxygenator, with a vast surface area of hollow filaments, allows addition of oxygen and removal of carbon dioxide; a centrifugal blood pump allows propulsion of blood through the circuit at upto 10 L/minute; a control module and a thermoregulatory unit, which allows for exact temperature control of the extra corporeal blood. Methods: The first successful use of ECMO for ARDS in adults occurred in 1972, and its use has become more commonplace over the last 30 years, supported by the improvement in design and biocompatibility of the equipment, which has reduced the morbidity associated with this modality. Whilst the use of ECMO in neonatal population has been supported by numerous studies, the evidence upon which ECMO was integrated into adult practice was substantially less robust. Results: Recent data, including the CESAR study (Conventional Ventilatory Support versus Extra corporeal membrane oxygenation for Severe Respiratory failure) has added a degree of evidence to the role of ECMO in such a patient population. The CESAR study analysed 180 patients, and confirmed that ECMO was associated with an improved rate of survival. More recently, ECMO has been utilized in numerous situations within the critical care area, including support in high-risk percutaneous interventions in cardiac catheter lab; the operating room, emergency department, as well in specialized inter-hospital retrieval services. The increased understanding of the risk:benefit profile of ECMO, along with a reduction in morbidity associated with its use will doubtless lead to a substantial rise in the utilisation of this modality. As with all extra-corporeal circuits, ECMO opposes the basic premises of the mammalian inflammation and coagulation cascade where blood comes into foreign circulation, both these cascades are activated. Anti-coagulation is readily dealt with through use of agents such as heparin, but the inflammatory excess, whilst less macroscopically obvious, continues un-abated. Platelet consumption and neutrophil activation occur rapidly, and the clinician is faced with balancing the need of anticoagulation for the circuit, against haemostasis in an acutely bleeding patient. Alterations in pharmacokinetics may result in inadequate levels of disease modifying therapeutics, such as antibiotics, hence paradoxically delaying recovery from conditions such as pneumonia. Key elements of nutrition and the innate immune system maysimilarly be affected. Summary: This presentation will discuss the basic features of ECMO to the nonspecialist, and review the clinical conundrum faced by the team treating these most complex cases.

Ranked critical factors in PPP briefings

Public-private partnerships (PPPs) are increasingly used to procure Australian infrastructure projects. As with all construction projects, the early briefing stages are often the most crucial in determining a successful outcome. There is, however, a lack of systematic research on the type and nature of the critical factors affecting the effectiveness and efficiency of PPP during this period. A literature review is presented of PPP usage in Australia, in which four main categories of factors (procurement, stakeholder, risk, and finance) are identified, each with several subfactors. A questionnaire survey involving state government stakeholders is also described, and a mathematical model that ranks the factors involved is developed. This is followed by an examination of the potential of the factors to help improve the PPP briefing stage for both public and private sectors.

Higher degree research at Australian Universities : Responding to diversity in engineering and information technology

BACKGROUND There is increasing enrolment of international students in the Engineering and Information Technology disciplines and anecdotal evidence of a need for additional understanding and support for these students and their supervisors due to differences both in academic and social cultures. While there is a growing literature on supervisory styles and guidelines on effective supervision, there is little on discipline-specific, cross-cultural supervision responding to the growing diversity. In this paper, we report findings from a study of Engineering and Information technology Higher Degree Research (HDR)students and supervision in three Australian universities. PURPOSE The aim was to assess perceptions of students and supervisors of factors influencing success that are particular to international or culturally and linguistically diverse (CaLD) HDR students in Engineering and Information technology. DESIGN/METHOD Online survey and qualitative data was collected from international and CaLD HDR students and supervisors at the three universities. Bayesian network analysis, inferential statistics, and qualitative analysis provided the main findings. RESULTS Survey results indicate that both students and supervisors are positive about their experiences, and do not see language or culture as particularly problematic. The survey results also reveal strong consistency between the perceptions of students and supervisors on most factors influencing success. Qualitative analysis of critical supervision incidents has provided rich data that could help improve support services. CONCLUSIONS In contrast with anecdotal evidence, HDR completion data from the three universities reveal that international students, on average, complete in shorter time periods than domestic students. The analysis suggests that success is linked to a complex set of factors involving the student, supervision, the institution and broader community.

Critical attributes of public-private partnerships : a case study in vocational education

The term ‘partnership’ is increasingly used by governments, industry, community organisations and schools in supporting their daily businesses. Similar to the terms ‘ICT’ and ‘learning’, ‘partnerships’ are now ubiquitous in policy discourse. Yet, the term remains ill-defined and ambiguous. This study reviews and reflects on a government led industry-school partnership initiative in the state of Queensland, Australia, to understand how the term is used in this initiative. Given the frequent use of Public Private Partnership (PPP) language, PPP was used as a framework to review this initiative. The methodology of this qualitative case study involved consultations with stakeholders and an analysis of Gateway schools documents, policy documents, and literature. The review suggests that despite the use of terminology akin to PPP projects in Gateway school and policy documents, the implicit suggestion that this initiative is a public-private partnership is untenable. The majority of principles shaping a PPP have not been considered to a significant extent in the Gateway project. Although the review recognises the legitimate and sincere purpose of the Gateway schools initiative, the adoption of a PPP framework during the design, monitoring, or evaluation stages could have strengthened the initiative in terms of outcomes, benefits, and sustainability.

Critical reflection on the SIA’s professional project and the body of knowledge

Over the last few years the Safety Institute of Australia (SIA) has developed and implemented a number of strategies to gain professional status for the ‘generalist occupational health and safety professional’. Two of the most significant developments have been the publication of the ‘Core Body of Knowledge for the Generalist OHS Professional.’ and the accreditation of university OHS courses. Despite a considerable amount of work aimed at gaining professional status there has not been any public debate or reflection about how the professionalisation project may impact on OHS and how the project is being conducted. Professionalisation has been vigorously promoted as a sign of maturity for the SIA and which will provide unmitigated benefits for workplace health and safety. The aim of this paper is to critically reflect on the processes of professionalisation (the professional project) and discuss some of the ways in which this project may shape the field of occupational health and safety. The implications for the role of universities will also be discussed.

Susceptibility of the critical structural components of railway bridges to the changes in train speed

Modern trains with different axle configurations, speeds and loads are used in railway networks. As a result, one of the most important questions of the mangers involved in bridge managements systems (BMS) is how these changes affect the structural behavior of the critical components of the railway bridges. Although researchers have conducted, many investigations on the dynamic effects of the moving loads on bridges, the influence of the changes in the speed of the train on the demand by capacity ratios of the different critical components of the bridge have not yet been properly studied. This study is important, because different components with different capacities and roles for carrying loads in the structure may be affected differently. To investigate the above phenomenon in this research, a structural model of a simply supported bridge is developed. It will be verified that the dynamic behavior of this bridge is similar to a group of railway bridges in Australia. Demand by capacity ratios of the critical components of the bridge, when it is subjected to a train load with different speeds will be calculated. The results show that the effect of increase or decrease of speed should not be underestimated. The outcome is very significant as it is contrary to what is currently expected, i.e. by reducing the speed of the train, the demand by capacity ratio of components may increase and make the bridge unsafe for carrying live load.

A Critical Perspective of the Indonesian Institutional Framework for PPP Toll Roads

The development of toll roads in Indonesia started around 1978. Initially, the management and development of toll roads sat directly under the Government of Indonesia (GoI) being undertaken through PT JasaMarga, a state owned enterprise specifically established to provide toll roads. Due to the slow growth and low capability of toll roads to fulfil infrastructure needs in the first ten years of operation (only 2.688kms/year), GoI changed its strategy in 1989 to one of using private sector participation for roads delivery through a Public Private Partnership (PPP) scheme. In this latter period, PT JasaMarga had two roles, both as regulator on behalf of the private sector as well as being the operator. However, from 1989 to 2004 the growth rate of toll roads actually decreased further to 2.300kms/year. Facing this challenge of low growth rate of toll roads, in 2004GoI changed the toll road management system and the role of regulator was returned to the Government through the establishment of the Toll Road Regulatory Agency (BPJT). GoI also amended the institutional framework to strengthen the toll road management system. Despite the introduction of this new institutional framework, the growth of toll roads still showed insignificant change. This problem in toll road development has generated an urgent need for research into this issue. The aim of the research is to understand the performance of the new institutional framework in enhancing PPP procured toll road development. The methodology of the research was to undertake a questionnaire survey distributed to private sector respondents involved in toll road development. The results of this study show that there are several problems inherent in the institutional framework, but the most significant problem comes from the uncertainty of the function of the strategic executive body in the land expropriation process.

Functional analysis of missense variants in the TRESK (KCNK18) K+ channel

A loss of function mutation in the TRESK K2P potassium channel (KCNK18), has recently been linked with typical familial migraine with aura. We now report the functional characterisation of additional TRESK channel missense variants identified in unrelated patients. Several variants either had no apparent functional effect, or they caused a reduction in channel activity. However, the C110R variant was found to cause a complete loss of TRESK function, yet is present in both sporadic migraine and control cohorts, and no variation in KCNK18 copy number was found. Thus despite the previously identified association between loss of TRESK channel activity and migraine in a large multigenerational pedigree, this finding indicates that a single non-functional TRESK variant is not alone sufficient to cause typical migraine and highlights the genetic complexity of this disorder. Migraine is a common, disabling neurological disorder with a genetic, environmental and in some cases hormonal component. It is characterized by attacks of severe, usually unilateral and throbbing headache, can be accompanied by nausea, vomiting and photophobia and is clinically divided into two main subtypes, migraine with aura (MA) when a migraine is accompanied by transient and reversible focal neurological symptoms and migraine without aura (MO)1. The multifactorial and clinical heterogeneity of the disorder have considerably hindered the identification of common migraine susceptibility genes and most of our current understanding comes from the studies of familial hemiplegic migraine (FHM), a rare monogenic autosomal dominant form of MA2. So far, the three susceptibility genes that have been convincingly identified in FHM families all encode ion channels or transporters: CACNA1A encoding the α1 subunit of the Cav2.1 calcium channel3, SCN1A encoding the Nav1.1 sodium channel4 and ATP1A2 encoding the α2 subunit of the Na+/K+ pump5. It is believed that mutations in these genes may lead to increased efflux of glutamate and potassium in the synapse and thereby cause migraine by rendering the brain more susceptible to cortical spreading depression (CSD)6 which is thought to play a role in initiating a migraine attack7,8. However, these genes have not to date been implicated in common forms of migraine9. Nevertheless, current opinion suggests that typical migraine, like FHM, is also disorder of neuronal excitability, ion homeostasis and neurotransmitter release10,11,12. Mutations in the SLC4A4 gene encoding the sodium-bicarbonate cotransporter NBCe1, have recently been implicated in several different forms of migraine13, and a variety of genes involved in glutamate homeostasis (PGCP, MTDH14 and LRP115) and a cation channel (TRPM8)15 have also recently been implicated in migraine via genome-wide association studies. Ion channels are therefore highly likely to play an important role in the pathogenesis of typical migraine. TRESK (KCNK18), is a member of the two-pore domain (K2P) family of potassium channels involved in the control of cellular electrical excitability16. Regulation of TRESK activity by the calcium-dependent phosphatase calcineurin17, as well as its expression in dorsal root ganglia (DRG)18 and trigeminal ganglia (TG)19,20 has led to a proposed role for this channel in a variety of pain pathways. In a recent study, a frameshift mutation (F139Wfsx24) in TRESK was identified in a large multigenerational pedigree where it co-segregated perfectly with typical MA and a significant genome-wide linkage LOD score of 3.0. Furthermore, functional analysis revealed that this mutation caused a complete loss of TRESK function and that the truncated subunit was also capable of down regulating wild-type channel function. This therefore highlighted KCNK18 as potentially important candidate gene and suggested that TRESK dysfunction might play a possible role in the pathogenesis of familial migraine with visual aura20. Additional screening for KCNK18 mutations in unrelated sporadic migraine and control cohorts also identified a number of other missense variants; R10G, A34V, C110R, S231P and A233V20. The A233V variant was found only in the control cohort, whilst A34V was identified in a single Australian migraine proband for which family samples were not available, but it was not detected in controls. By contrast, the R10G, C110R, and S231P variants were found in both migraineurs and controls in both cohorts. In this study, we have investigated the functional effect of these variants to further probe the potential association of TRESK dysfunction with typical migraine.

Critical factors for sustainable reconstruction of post natural disasters

While scientists are still debating the level of climate change impact to new weather patterns, there have been some devastating natural disasters worldwide in the last decade. From cyclones to earthquakes and from Tsunamis to landslides, these disasters occur with formidable forces and crushing effects. As one of the most important arrangements to erase the negative influence of natural disasters and help with the recovery and redevelopment of the hit area, reconstruction is of utmost importance in light of sustainable objectives. However, current reconstruction practice confronts quite a lot of criticisms for focusing on providing short-term necessities. How to conduct the post disaster reconstruction in a long-term perspective and achieve sustainable development is thereby a highlight for industry practice and research. This paper introduced an on-going research project which is aimed at establishing an operational framework for improving sustainability performance of post disaster reconstruction by identifying critical sustainable factors and exploring their internal relationships. The research reported in this paper is part of the project. After a comprehensive literature review, 17 potential critical sustainability factors for post disaster reconstruction were identified. Preliminary examination and discussion of the factors was conducted.

End-of-life care in the critical care setting : nurses' practices and factors affecting these practices

Background: Critical care units are designed and resourced to save lives, yet the provision of end-of-life care is a significant component of nursing work in these settings. Limited research has investigated the actual practices of critical care nurses in the provision of end-of-life care, or the factors influencing these practices. To improve the care that patients at the end of life and their families receive, and to support nurses in the provision of this care, further research is needed. The purpose of this study was to identify critical care nurses' end-of-life care practices, the factors influencing the provision of end-of-life care and the factors associated with specific end-of-life care practices. Methods: A three-phase exploratory sequential mixed-methods design was utilised. Phase one used a qualitative approach involving interviews with a convenience sample of five intensive care nurses to identify their end-of-life care experiences and practices. In phase two, an online survey instrument was developed, based on a review of the literature and the findings of phase one. The survey instrument was reviewed by six content experts and pilot tested with a convenience sample of 28 critical care nurses (response rate 45%) enrolled in a postgraduate critical care nursing subject. The refined survey instrument was used in phase three of this study to conduct a national survey of critical care nurses. Descriptive analyses, exploratory factor analysis and univariate general linear modelling was undertaken on completed survey responses from 392 critical care nurses (response rate 25%). Results: Six end-of-life care practice areas were identified in this study: information sharing, environmental modification, emotional support, patient and family-centred decision making, symptom management and spiritual support. The items most frequently identified as always undertaken by critical care nurses in the provision of end-of-life care were from the information sharing and environmental modification practice areas. Items least frequently identified as always undertaken included items from the emotional support practice area. Eight factors influencing the provision of end-of-life care were identified: palliative values, patient and family preferences, knowledge, preparedness, organisational culture, resources, care planning, and emotional support for nurses. Strong agreement was noted with items reflecting values consistent with a palliative approach and inclusion of patient and family preferences. Variation was noted in agreement for items regarding opportunities for knowledge acquisition in the workplace and formal education, yet most respondents agreed that they felt adequately prepared. A context of nurse-led practice was identified, with variation in access to resources noted. Collegial support networks were identified as a source of emotional support for critical care nurses. Critical care nurses reporting values consistent with a palliative approach and/or those who scored higher on support for patient and family preferences were more likely to be engaged in end-of-life care practice areas identified in this study. Nurses who reported higher levels of preparedness and access to opportunities for knowledge acquisition were more likely to report engaging in interpersonal practices that supported patient and family centred decision making and emotional support of patients and their families. A negative relationship was identified between the explanatory variables of emotional support for nurses and death anxiety, and the patient and family centred decision making practice area. Contextual factors had a limited influence as explanatory variables of specific end-of-life care practice areas. Gender was identified as a significant explanatory variable in the emotional and spiritual support practice areas, with male gender associated with lower summated scores on these practice scales. Conclusions: Critical care nurses engage in practices to share control with and support inclusion of families experiencing death and dying. The most frequently identified end-of-life care practices were those that are easily implemented, practical strategies aimed at supporting the patient at the end of life and the patient's family. These practices arguably require less emotional engagement by the nurse. Critical care nurses' responses reflected values consistent with a palliative approach and a strong commitment to the inclusion of families in end-of-life care, and these factors were associated with engagement in all end-of-life care practice areas. Perceived preparedness or confidence with the provision of end-of-life care was associated with engagement in interpersonal caring practices. Critical care nurses autonomously engage in the provision of end-of-life care within the constraints of an environment designed for curative care and rely on their colleagues for emotional support. Critical care nurses must be adequately prepared and supported to provide comprehensive care in all areas of end-of-life care practice. The findings of this study raise important implications, and informed recommendations for practice, education and further research.

Comments on the phase diagrams and crystallisation paths of Y-Ba-Cu-O materials

Our micro structural characterisation of Y-Ba-Cu-O quenched partial melts shows that the BaCuO2 (BC1) phase is crystalline at temperatures as high as 1100°C, and that the partial melt self-establishes a micro structural gradient from the surface towards the interior of the samples, which can be associated with a gradient in an equivalent partial pressure of O2 (pO2). The extension of the Y2BaCuO5-YBa2Cu3O7-x (Y211-Y123) tie-line intersects the primary crystallisation field of BC1 first. The actual peritectic reaction that takes place is Y2BaCuO5(s) + BaCuO2(s) + 2BaCu2O2(L) + 1/2O2 → 2YBa2Cu3O6(s). Two schematic representations which allow an analysis of the pO2 dependence are given. The gradient in micro structure self-established by the sample acts as a driving force for texturing. With this new perspective gained about the actual peritectic reaction and mechanisms of melt-texturing of Y123, it is possible to explain most of the aspects about partial melt-texturing. In addition, it seems possible to devise heat treatments that may allow for the production of well-oriented single domains with very large diameters. © 1999 Elsevier Science B.V.