Focusing on patients : differences between the practice of expert and non-expert nephrology nurses

Specialisation in nursing enables a nurse to focus, in much greater depth, on the requisite knowledge and skills for providing patients with the best possible care. Nephrology nursing is one such area where specialisation has evolved. The characteristic focus of practice emerged as an important feature during a study into the process of expertise acquisition in nephrology nursing practice. Using grounded theory methodology, this study involved 6 non-expert and 11 expert nurses and took place in one renal unit in New South Wales. Nephrology nursing practice was observed for 103 hours, and this was immediately followed by semi-structured interviews. The characteristic of focus was conceptualised as the nurses' centre of attention or concentration while they were undertaking nursing activities. Focus ranged from inexperienced non-expert nurses concentrating predominantly on the immediate task at hand, experienced non-expert nurses who focussed on the medium term to expert nurses who viewed actions (and their possible consequences) more broadly and in the longer term. Of significance to nursing, is how nephrology nurses alter their focus of practice as they acquire and exercise their developing expertise in this specialty.

Schooling and refugees : engaging with the complex trajectories of globalisation

This paper examines the complexities associated with educating a mobile and politically marginalised population, refugee students, in the state of Queensland, Australia. Historically, schools have been national institutions concerned with social reproduction and citizenship formation with a focus on spatially fixed populations. While education authorities in much of the developed world now acknowledge the need to prepare students for a more interconnected world of work and opportunity, they have largely failed to provide systemic support for one category of children on the move - refugees. We begin this paper with a discussion of forced migration and its links with ‘globalisation’. We then present our research findings about the educational challenges confronting individual refugee youth and schools in Queensland. This is followed with a summary of good practice in refugee education. The paper concludes with a discussion of how nation-states might play a more active role in facilitating transitions to citizenship for refugee youth.

Stochastic models for regulatory networks of the genetic toggle switch

Bistability arises within a wide range of biological systems from the λ phage switch in bacteria to cellular signal transduction pathways in mammalian cells. Changes in regulatory mechanisms may result in genetic switching in a bistable system. Recently, more and more experimental evidence in the form of bimodal population distributions indicates that noise plays a very important role in the switching of bistable systems. Although deterministic models have been used for studying the existence of bistability properties under various system conditions, these models cannot realize cell-to-cell fluctuations in genetic switching. However, there is a lag in the development of stochastic models for studying the impact of noise in bistable systems because of the lack of detailed knowledge of biochemical reactions, kinetic rates, and molecular numbers. In this work, we develop a previously undescribed general technique for developing quantitative stochastic models for large-scale genetic regulatory networks by introducing Poisson random variables into deterministic models described by ordinary differential equations. Two stochastic models have been proposed for the genetic toggle switch interfaced with either the SOS signaling pathway or a quorum-sensing signaling pathway, and we have successfully realized experimental results showing bimodal population distributions. Because the introduced stochastic models are based on widely used ordinary differential equation models, the success of this work suggests that this approach is a very promising one for studying noise in large-scale genetic regulatory networks.

The influence of sensitivity to reward and punishment, propensity for sensation seeking, depression, and anxiety on the risky behaviour of novice drivers : a path model

Young novice drivers are significantly more likely to be killed or injured in car crashes than older, experienced drivers. Graduated driver licensing (GDL), which allows the novice to gain driving experience under less-risky circumstances, has resulted in reduced crash incidence; however, the driver's psychological traits are ignored. This paper explores the relationships between gender, age, anxiety, depression, sensitivity to reward and punishment, sensation-seeking propensity, and risky driving. Participants were 761 young drivers aged 17–24 (M= 19.00, SD= 1.56) with a Provisional (intermediate) driver's licence who completed an online survey comprising socio-demographic questions, the Impulsive Sensation Seeking Scale, Kessler's Psychological Distress Scale, the Sensitivity to Punishment and Sensitivity to Reward Questionnaire, and the Behaviour of Young Novice Drivers Scale. Path analysis revealed depression, reward sensitivity, and sensation-seeking propensity predicted the self-reported risky behaviour of the young novice drivers. Gender was a moderator; and the anxiety level of female drivers also influenced their risky driving. Interventions do not directly consider the role of rewards and sensation seeking, or the young person's mental health. An approach that does take these variables into account may contribute to improved road safety outcomes for both young and older road users.

Can identified stressors be used to predict profession for mental health professionals?

A difference appears to exist between stressors reported for nurses and allied health professionals working in mental health. Prominent stressors for mental health nurses include workload, administration duties and a lack of resources. Whilst these also appear to be stressors for allied health professionals, the stressor 'professional self-doubt' has also been reported for social workers. This study aimed to examine the extent to which community mental health professionals could be identified as belonging to the nursing profession or an allied health profession based on their perceived sources of stress. Ninety-eight community mental health nurses and 85 allied health professionals working in Victoria's public mental health services completed the Mental Health Professionals Stress Scale. Discriminant analysis was utilised to test the predictive value of stressors to identify profession. The main stressors reported by nurses were workload, a lack of resources and organisational problems. For allied health professionals the highest reported stressors were workload, a lack of resources, client related difficulties and organisational problems. Mental health professionals in this study could not be identified as belonging to the nursing profession or an allied health profession based on their identified sources of stress. It could well be reflective of the shift to homogenous roles in mental health services. With this being the case, there may be benefits in implementing stress reducing strategies at an organisational level.

Different inflections

Australia has often been defined by its landscape – actual, romanticized, imagined – iconic images and experiences taken up by artists in a myriad of ways. This paper examines inter/intra cultural practices of three Australian dance companies and their directors, and how they inflect images of Australia in different ways. Each artist brings perspectives from their particular hybridized cultural and ethnic backgrounds as well as their formative dance experiences. In their practices, notions of landscape embrace physical, metaphorical and spiritual dimensions. Kai Tai Chan, who founded the One Extra Company in 1976, pioneered accessible and confronting intercultural dance theatre in Australia from the 1970s to the 1990s, challenging our notions of what it is to be Australian. A Chinese Malay who came to Australia to study architecture, he stayed to create a significant body of work in which different cultural frameworks became lenses through which to explore stories of ordinary lives and experiences, revealing complexities of the human condition and larger social-political issues. Spiritual connections feature strongly in the practice of another Chinese Malay Australian, Tony Yap. Here the landscape is an inner one influenced by a form of Malaysian trance dance known as the sen-siao (“spirit cloud”) tradition. Yap has forged a unique space in the Australian dance and theatre scene, exploring a movement language informed by psycho-physical research, Asian shamanistic trance dance, Butoh, voice and visual design. Whilst primarily a solo performer, his practice includes collaborations with Asian diasporic as well as Anglo Australian cross-cultural visual and sound artists. His work is situated in a metaphysical rather than socio political context. In contrast, the newest company to emerge on the intercultural Australian stage is Polytoxic, reflecting a Pacific rather than Asian inflection. Key members, Fa’alafi and Efeso Fa’anana (both of Samoan descent) and Leah Shelton (of Anglo-Saxon descent), aim to critique the exoticism and cultural kitsch that often accompanies representations of the Pacific islands, with a pastiche of street dance, cabaret and contemporary techniques, blended with traditional Polynesian vocabulary. A parallel aim is to provide audiences with insights into the traditions and history of Samoa from the perspective of the artists as contemporary Australians. This examination, spanning three decades of inter/intra cultural practices, reveals stylistic, generational and philosophical differences with a commonality of variously inflected notions of landscape, spirituality and identity.

Detection of bacteriophage and respiratory viruses in droplets

Influenza is a widespread disease occurring in seasonal epidemics, and each year is responsible for up to 500,000 deaths worldwide. Influenza can develop into strains which cause severe symptoms and high mortality rates, and could potentially reach pandemic status if the virus’ properties allow easy transmission. Influenza is transmissible via contact with the virus, either directly (infected people) or indirectly (contaminated objects); via reception of large droplets over short distances (one metre or less); or through inhalation of aerosols containing the virus expelled by infected individuals during respiratory activities, that can remain suspended in the air and travel distances of more than one metre (the aerosol route). Aerosol transmission of viruses involves three stages: production of the droplets containing viruses; transport of the droplets and ability of a virus to remain intact and infectious; and reception of the droplets (via inhalation). Our understanding of the transmission of influenza viruses via the aerosol route is poor, and thus our ability to prevent a widespread outbreak is limited. This study explored the fate of viruses in droplets by investigating the effects of some physical factors on the recovery of both a bacteriophage model and influenza virus. Experiments simulating respiratory droplets were carried out using different types of droplets, generated from a commonly used water-like matrix, and also from an ‘artificial mucous’ matrix which was used to more closely resemble respiratory fluids. To detect viruses in droplets, we used the traditional plaque assay techniques, and also a sensitive, quantitative PCR assay specifically developed for this study. Our results showed that the artificial mucous suspension enhanced the recovery of infectious bacteriophage. We were able to report detection limits of infectious bacteriophage (no bacteriophage was detected by the plaque assay when aerosolised from a suspension of 103 PFU/mL, for three of the four droplet types tested), and that bacteriophage could remain infectious in suspended droplets for up to 20 minutes. We also showed that the nested real-time PCR assay was able to detect the presence of bacteriophage RNA where the plaque assay could not detect any intact particles. Finally, when applying knowledge from the bacteriophage experiments, we reported the quantitative recoveries of influenza viruses in droplets, which were more consistent and stable than we had anticipated. Influenza viruses can be detected up to 20 minutes (after aerosolisation) in suspended aerosols and possibly beyond. It also was detectable from nebulising suspensions with relatively low concentrations of viruses.

Biological and environmental determinants

- describe the complex web of determinants as part of broad causal pathways that affect health - identify and discuss the range of physical, biological and environmental determinants that impact on health - suggest why it is important to the practice of public health that you understand how determinants contribute to health - understand the complexity of health and illness and the multifaceted role of health determinants - relate determinants of health to public health activity and realise the need for multisectoral action and multiple approaches when working to improve health