903 resultados para Institution of long stay for the aged


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The current gold standard for the design of orthopaedic implants is 3D models of long bones obtained using computed tomography (CT). However, high-resolution CT imaging involves high radiation exposure, which limits its use in healthy human volunteers. Magnetic resonance imaging (MRI) is an attractive alternative for the scanning of healthy human volunteers for research purposes. Current limitations of MRI include difficulties of tissue segmentation within joints and long scanning times. In this work, we explore the possibility of overcoming these limitations through the use of MRI scanners operating at a higher field strength. We quantitatively compare the quality of anatomical MR images of long bones obtained at 1.5 T and 3 T and optimise the scanning protocol of 3 T MRI. FLASH images of the right leg of five human volunteers acquired at 1.5 T and 3 T were compared in terms of signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). The comparison showed a relatively high CNR and SNR at 3 T for most regions of the femur and tibia, with the exception of the distal diaphyseal region of the femur and the mid diaphyseal region of the tibia. This was accompanied by an ~65% increase in the longitudinal spin relaxation time (T1) of the muscle at 3 T compared to 1.5 T. The results suggest that MRI at 3 T may be able to enhance the segmentability and potentially improve the accuracy of 3D anatomical models of long bones, compared to 1.5 T. We discuss how the total imaging times at 3 T can be kept short while maximising the CNR and SNR of the images obtained.

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The nature and value of ‘professionalism’ has long been contested by both producers and consumers of policy. Most recently, governments have rewritten and redefined professionalism as compliance with externally imposed ‘standards’. This has been achieved by silencing the voices of those who inhabit the professional field of education. This paper uses Foucauldian archaeology to excavate the enunciative field of professionalism by digging through the academic and institutional (political) archive, and in doing so identifies two key policy documents for further analysis. The excavation shows that while the voices of (academic) authority speak of competing discourses emerging, with professional standards promulgated as the mechanism to enhance professionalism, an alternative regime of truth identifies the privileged use of (managerial) voices from outside the field of education to create a discourse of compliance. There has long been a mismatch between the voices of authority on discourses around professionalism from the academic archive and those that count in contemporary and emerging Australian educational policy. In this paper, we counter this mismatch and argue that reflexive educators’ regimes of truth are worthy of attention and should be heard and amplified.

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Non-traditional maritime security concerns have become more importantthan ever in the post-Cold War era. Naval forces of most developedcountries are more concerned about these threats than conventional war.One of the main maritime security issues for many countries in the world isillegal, unreported and unregulated (IUU) fishing in the marine area. Withthese burgeoning issues comes the potential for a large number of disputesinvolving international law. In early 2002, a long-line fishing vessel under aRussian flag –the Volga, was detained by Australian authorities a few hundred meters outside the Exclusive Economic Zone of Australia’s Heard and McDonald Islands in the Southern Ocean. The vessel was reportedly engaged in illegal fishing. This incident gave birth to litigation in international and Australian courts. Apart from these cases, Russia also announced separate litigation against Australia for violation of Articles 111and 87 of the United Nations Convention on the Law of the Sea (NCLOS).Considering the outcome of these cases, this article critically examines thecharacteristics of litigation as a strategy for pacific settlement of disputesover marine living resources. Using the Volga Case as an example, thisarticle explores some issues related to the judicial settlement of disputes over marine living resources. This article demonstrates that the legal certainty of winning a case may not be the only factor influencing the strategy for settlement of an international dispute.

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Background: Few longitudinal studies have examined the mental health outcomes of women after abortion and the results are controversial. Despite falling birth rates, teenage pregnancies remain high and over half (53%) of teenage and a third (36%) of young adult (20_24 years) pregnancies are aborted. Recent findings from a NewZealand longitudinal birth cohort linked abortion and subsequent psychiatric disorders in young women. Limited Australian data is available examining this association. Methods: Data were taken from the Mater-University Study of Pregnancy (MUSP). Running since 1981, this is a prospective birth cohort study of 7223 mothers and children. At the 21-year follow-up 3775 (52.3% of the original cohort) participants were surveyed, of these 1132 young women had complete data on pregnancy outcomes and psychiatric diagnoses from a structured interview. Binary logistic regression examined the association between five lifetime psychiatric disorders (nicotine, alcohol, cannabis, affective and anxiety disorders) and ever having an abortion or birth. Analyses adjusted for age, concurrent and maternal sociodemographic factors, and factors related to adolescent behaviour, previous mental health and family functioning. Results: A quarter of the young women (n_261) reported at least one pregnancy and 32.6% had an abortion. Abortion was significantly associated with age-adjusted OR for all the lifetime disorders. After full adjustment abortion remained significantly associated with nicotine (OR_2.1, 1.2_3.6) and alcohol disorders (OR_2.0, 1.3_3.3). Conclusion: The findings suggest that abortion in young women is independently associated with an increased risk of nicotine and alcohol disorders.

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Background Falls are one of the most frequently occurring adverse events that impact upon the recovery of older hospital inpatients. Falls can threaten both immediate and longer-term health and independence. There is need to identify cost-effective means for preventing falls in hospitals. Hospital-based falls prevention interventions tested in randomized trials have not yet been subjected to economic evaluation. Methods Incremental cost-effectiveness analysis was undertaken from the health service provider perspective, over the period of hospitalization (time horizon) using the Australian Dollar (A$) at 2008 values. Analyses were based on data from a randomized trial among n = 1,206 acute and rehabilitation inpatients. Decision tree modeling with three-way sensitivity analyses were conducted using burden of disease estimates developed from trial data and previous research. The intervention was a multimedia patient education program provided with trained health professional follow-up shown to reduce falls among cognitively intact hospital patients. Results The short-term cost to a health service of one cognitively intact patient being a faller could be as high as A$14,591 (2008). The education program cost A$526 (2008) to prevent one cognitively intact patient becoming a faller and A$294 (2008) to prevent one fall based on primary trial data. These estimates were unstable due to high variability in the hospital costs accrued by individual patients involved in the trial. There was a 52% probability the complete program was both more effective and less costly (from the health service perspective) than providing usual care alone. Decision tree modeling sensitivity analyses identified that when provided in real life contexts, the program would be both more effective in preventing falls among cognitively intact inpatients and cost saving where the proportion of these patients who would otherwise fall under usual care conditions is at least 4.0%. Conclusions This economic evaluation was designed to assist health care providers decide in what circumstances this intervention should be provided. If the proportion of cognitively intact patients falling on a ward under usual care conditions is 4% or greater, then provision of the complete program in addition to usual care will likely both prevent falls and reduce costs for a health service.

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Insulin has cardiovascular actions and patients with essential hypertension display insulin resistance. A cross-sectional study of the R1 RFLP of the insulin receptor gene (INSR) was carried out in 67 hypertensive (HT) and 75 normotensive (NT) subjects whose parents had a similar blood pressure status at age ≥50. The frequency of the minor (+) allele was 0.31 in HTs and 0.44 in NTs, and the difference between observed alleles in all subjects in each group was significant (χ2 = 4.8, P<0.05). Allele frequencies of a BglI RFLP of the insulin gene, however, did not differ between the HT and NT groups. The data thus provide evidence in favour of an association of HT with a polymorphism at the INSR locus (19p 13.3-13.2), so implicating this locus, and possibly a genetic variant of the insulin receptor itself, in HT.

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In 2009, Mark Deuze proposed an updated approach to media studies to incorporate ‘media life’, a concept he suggests addresses the invisibleness of ubiquitous media. Media life provides a useful lens for researchers to understand the human condition in media and not with media. At a similar time, public service media (PSM) strategies have aligned audience participation with the so‐called Reithian trinity which suggest the PSB should inform, educate and entertain while performing its core values of public service broadcasting (Enli 2008). Remix within the PSM institution relies on audience participation, employing ‘the people formerly known as the audience’ (Rosen 2006) as cultural artifact producers, and draws on their experience from within the media. Remix as a practice then enables us to examine the shift of the core PSM values by understanding how audience participation, informed by a human condition mobilised from our existence of being in media and not merely with media. However, remix within PSM challenges the once elitist construction of meaning models with an egalitarian approach towards socially reappropriated texts, questioning its affect on the cultural landscape. This paper draws on three years of ethnographic data from within the Australian Broadcasting Corporation (ABC), exploring the remix culture of ABC Pool. ABC Pool operates under a Creative Commons licensing regime to enable remix practice under the auspices of the ABC. ABC Pool users provide a useful group of remix practitioners to examine as they had access to a vast ABC archival collection and were invited to remix those cultural artefacts, often adding cultural and fiscal value. This paper maintains a focus on the audience participation within PSM through remix culture by applying media dependency theory to remix as cultural practice and calls to expand and update the societal representation within the ABC.

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In early April 1998 the Centre for Disease Control (CDC) in Darwin was notified of a case with positive dengue serology. The illness appeared to have been acquired in the Northern Territory (NT). Because dengue is not endemic to the NT, locally acquired infection has significant public health implications, particularly for vector identification and control to limit the spread of infection. Dengue IgM serology was positive on two occasions but the illness was eventually presumptively identified as Kokobera infection. This case illustrates some important points about serology. The interpretation of flavivirus serology is complex and can be misleading, despite recent improvements. The best method of determining the cause of infection is still attempting to reconcile clinical illness details with incubation times and vector presence, as well as laboratory results. This approach ultimately justified the initial period of waiting for confirmatory results in this case, before the institution of public health measures necessary for a true case of dengue.

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One in five Australian workers believes that work doesn’t fit well with their family and social commitments. Concurrently, organisations are recognising that to stay competitive they need policies and practices that support the multiple aspects of employees’ lives. Many employees work in group environments yet there is currently little group level work-life balance research. This paper proposes a new theoretical framework developed to understand the design of work groups to better facilitate work-life balance. This new framework focuses on task and relational job designs, group structures and processes and workplace culture.

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In order to establish the influence of the drying air characteristics on the drying performance and fluidization quality of bovine intestine for pet food, several drying tests have been carried out in a laboratory scale heat pump assisted fluid bed dryer. Bovine intestine samples were heat pump fluidized bed dried at atmospheric pressure and at temperatures below and above the materials freezing points, equipped with a continuous monitoring system. The investigation of the drying characteristics have been conducted in the temperature range −10 to 25 ◦C and the airflow in the range 1.5–2.5 m/s. Some experiments were conducted as single temperature drying experiments and others as two stage drying experiments employing two temperatures. An Arrhenius-type equation was used to interpret the influence of the drying air temperature on the effective diffusivity, calculated with the method of slopes in terms of energy activation, and this was found to be sensitive to the temperature. The effective diffusion coefficient of moisture transfer was determined by the Fickian method using uni-dimensional moisture movement in both moisture, removal by evaporation and combined sublimation and evaporation. Correlations expressing the effective moisture diffusivity and drying temperature are reported. Bovine particles were characterized according to the Geldart classification and the minimum fluidization velocity was calculated using the Ergun Equation and generalized equation for all drying conditions at the beginning and end of the trials. Walli’s model was used to categorize stability of the fluidization at the beginning and end of the dryingv for each trial. The determined Walli’s values were positive at the beginning and end of all trials indicating stable fluidization at the beginning and end for each drying condition.

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The goals of this project were to determine the education and training needs of health consumers and the relevant health workforce and to identify and map the available education and training activities and resources. The methods used to collect the data included online surveys and one on one interviews of relevant patients and their carers. The project manager actively sought to engage with the key wound management leaders and advanced clinicians to gain their support and views on the priority education and training issues. The response to all data collection methods was pleasing with almost five hundred responses to the general wound workforce online survey. The data supported the need for more wound management education and training and identified some particular topics of need, such as utilising wound investigations and understanding wound products, pharmaceuticals and devices. The occupational groups with the highest need appear to be those working in primary health care, such as practice nurses and GPs, and those working in residential aged care facilities. The education and training stocktake identified a wide range of activities currently available, the majority being provided in a face to face format. The next stage of the project will be to form some clear and achievable priority action areas based on the available data. An online directory of wound management education and training activities and resources will be developed and further development will be undertaken on a knowledge and skills framework for the wound management workforce. Additionally, transfer of learning factors in the general practice environment will be assessed and strategies will be developed to improve the pre-entry or undergraduate wound management training within relevant higher education programs.

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Lung cancer is the most important cause of cancer-related mortality. Resectability and eligibility for treatment with adjuvant chemotherapy is determined by staging according to the TNM classification. Other determinants of tumour behaviour that predict disease outcome, such as molecular markers, may improve decision-making. Activation of the gene encoding human telomerase reverse transcriptase (hTERT) is implicated in the pathogenesis of lung cancer, and consequently detection of hTERT mRNA might have prognostic value for patients with early stage lung cancer. A cohort of patients who underwent a complete resection for early stage lung cancer was recruited as part of the European Early Lung Cancer (EUELC) project. In 166 patients expression of hTERT mRNA was determined in tumour tissue by quantitative real-time RT-PCR and related to that of a house-keeping gene (PBGD). Of a subgroup of 130 patients tumour-distant normal tissue was additionally available for hTERT mRNA analysis. The correlation between hTERT levels of surgical samples and disease-free survival was determined using a Fine and Gray hazard model. Although hTERT mRNA positivity in tumour tissue was significantly associated with clinical stage (Fisher's exact test p=0.016), neither hTERT mRNA detectability nor hTERT mRNA levels in tumour tissue were associated with clinical outcome. Conversely, hTERT positivity in adjacent normal samples was associated with progressive disease, 28% of patients with progressive disease versus 7.5% of disease-free patients had detectable hTERT mRNA in normal tissue [adjusted HR: 3.60 (1.64-7.94), p=0.0015]. hTERT mRNA level in tumour tissue has no prognostic value for patients with early stage lung cancer. However, detection of hTERT mRNA expression in tumour-distant normal lung tissue may indicate an increased risk of progressive disease.

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In plants, silencing of mRNA can be transmitted from cell to cell and also over longer distances from roots to shoots. To investigate the long-distance mechanism, WT and mutant shoots were grafted onto roots silenced for an mRNA. We show that three genes involved in a chromatin silencing pathway, NRPD1a encoding RNA polymerase IVa, RNA-dependent RNA polymerase 2 (RDR2), and DICER-like 3 (DCL3), are required for reception of long-distance mRNA silencing in the shoot. A mutant representing a fourth gene in the pathway, argonaute4 (ago4), was also partially compromised in the reception of silencing. This pathway produces 24-nt siRNAs and resulted in decapped RNA, a known substrate for amplification of dsRNA by RDR6. Activation of silencing in grafted shoots depended on RDR6, but no 24-nt siRNAs were detected in mutant rdr6 shoots, indicating that RDR6 also plays a role in initial signal perception. After amplification of decapped transcripts, DCL4 and DCL2 act hierarchically as they do in antiviral resistance to produce 21- and 22-nt siRNAs, respectively, and these guide mRNA degradation. Several dcl genotypes were also tested for their capacity to transmit the mobile silencing signal from the rootstock. dcl1-8 and a dcl2 dcl3 dcl4 triple mutant are compromised in micro-RNA and siRNA biogenesis, respectively, but were unaffected in signal transmission. © 2007 by The National Academy of Sciences of the USA.

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For the last decade, one question has haunted me: what helps people to cope with large-scale organisational change in their workplace? This study explores the construct of personal change resilience, and its potential for identifying solutions to the problems of change fatigue and change resistance. The thesis has emerged from the fields of change management, leadership, training, mentoring, evaluation, management and trust within the context of higher education in Australia at the beginning of the twenty-first century. In this thesis I present a theoretical model of the factors to consider in increasing peoples’ personal change resilience as they navigate large-scale organisational change at work, thereby closing a gap in the literature on the construct of change resilience. The model presented is based on both the literature in the realms of business and education, and on the findings of the research. In this thesis, an autoethnographic case study of two Australian university projects is presented as one narrative, resulting in a methodological step forward in the use of multiple research participants’ stories in the development of a single narrative. The findings describe the experiences of workers in higher education and emphasise the importance of considerate management in the achievement of positive experiences of organisational change. This research makes a significant contribution to new knowledge in three ways. First, it closes a gap in the literature in the realm of change management around personal change resilience as a solution to the problem of change fatigue by presenting models of both change failure and personal change resilience. Second, it is methodologically innovative in the use of personae to tell the stories of multiple participants in one coherent tale presented as a work of ethnographic fiction seen through an autoethnographic lens. By doing so, it develops a methodology for giving a voice to those to whom change is done in the workplace. Third, it provides a perspective on organisational change management from the view of the actual workers affected by change, thereby adding to the literature that currently exists, which is based on the views of those with responsibility for leading or managing change rather than those it affects. This thesis is intended as a practical starting point for conversations by actual change managers in higher education, and it is written in such a way as to help them see how theory can be applied in real life, and how empowering and enabling the actual working staff members, and engaging with them in a considerate way before, during and even after the change process, can help to make them resilient enough to cope with the change, rather than leaving them burned out or disengaged and no longer a well-functioning member of the institution. This thesis shows how considerately managed large-scale organisational change can result in positive outcomes for both the organisation and the individuals who work in it.

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This research has taken the first step to study child-feeding practices of Indian mothers in relation to childhood obesity. It compares feeding practices of Indian mothers with children aged 1-5 years living in Australia and Mumbai. Mothers in the Australian sample were more likely to use 'positive' feeding practices hypothesized to promote healthy growth and weight status. However, mothers in both samples commonly used coercive feeding practices that potentially increase the risk of childhood obesity. These results will inform interventions designed to promote healthy weight status in this cultural group.