National Institute for Clinical Studies Report for Phase 1, Evidence Uptake Network : Best Practice Community Care for Clients with Chronic Venous Leg Ulcers

Chronic leg ulcers cause significant pain, cost, decreased quality of life and morbidity for a considerable segment of the older population (Graham et al., 2003a). At any given time the prevalence of patients with open leg ulcers receiving treatment is between 0.11% - 0.18% (Briggs & Closs 2003). Chronic leg ulcers occur in approximately 1 - 2% of the over 60 population in the US, UK, Europe and Australia (Baker & Stacey 1994; Johnson 1995; Lees & Lambert 1992; Margolis et al. 2002). Considerable research has been undertaken to determine the best treatment practices that will aid in the management and the healing of these ulcers, and practical and effective strategies and techniques for healing venous leg ulcers have been trialled to demonstrate their beneficial effects (Nelson et al. 2004; Cullum et al. 2001)...

Teaching Teachers for the Future (TTF) project TPACK Survey : summary of the key findings

This paper presents a summary of the key findings of the TTF TPACK Survey developed and administered for the Teaching the Teachers for the Future (TTF) Project implemented in 2011. The TTF Project, funded by an Australian Government ICT Innovation Fund grant, involved all 39 Australian Higher Education Institutions which provide initial teacher education. TTF data collections were undertaken at the end of Semester 1 (T1) and at the end of Semester 2 (T2) in 2011. A total of 12881 participants completed the first survey (T1) and 5809 participants completed the second survey (T2). Groups of like-named items from the T1 survey were subject to a battery of complementary data analysis techniques. The psychometric properties of the four scales: Confidence - teacher items; Usefulness - teacher items; Confidence - student items; Usefulness- student items, were confirmed both at T1 and T2. Among the key findings summarised, at the national level, the scale: Confidence to use ICT as a teacher showed measurable growth across the whole scale from T1 to T2, and the scale: Confidence to facilitate student use of ICT also showed measurable growth across the whole scale from T1 to T2. Additional key TTF TPACK Survey findings are summarised.

The WTO, the national security exception and climate change

Article XX has been a valuable instrument to justify exceptions from the anti-discrimination provisions of the GATT 1994. In general, this Article is considered by experts to be the most likely defence for any climate change mitigation measure in breach GATT 1994 obligations. That assumption is not in dispute here; rather, this article considers the requirements of the Article XX exceptions, but also explores the conditions of the National Security exception contained in Article XXI. Although it is possible that this exception could be used for climate change mitigation measures, this paper argues that it is unlikely that the National Security exception could be legitimately applied in these circumstances without member agreement to the contrary.

Fertility and infertility : studies in reproductive epidemiology in Australia

Worldwide, there are few large-scale epidemiological studies on infertility. In Australia, population-based research on infertility is limited to a few small-scale studies. Therefore, the prevalence of infertility and unmet need for specialist medical advice and treatment cannot be estimated reliably. Women who have used assisted reproductive technologies (ART) are recorded in treatment registries. However, there are many infertile women who are excluded from these clinical populations because they neither seek advice nor use treatment. The thesis was based on a biopsychosocial model of health and used the methods of reproductive epidemiology to address the lack of national data on the prevalence of infertility in Australia. Firstly, numbers of births and pregnancy losses were investigated in two generations of women participating in the Australian Longitudinal Study on Women’s Health (ALSWH). The ALSWH is a broad-ranging, longitudinal examination of biological, psychological and social factors that impact on women’s health and wellbeing. Women from three age cohorts were randomly sampled from the population using the universal public health insurance (i.e., Medicare) database and ALSWH participants were representative of the female population. However, the studies in the thesis only involved data from two cohorts. The younger cohort were born in 1973-78 and completed up to four mailed surveys between 1996 (when they were aged 18-23 years, n=14247) and 2006 (28-33 years, n=9145). The mid-aged cohort were born in 1946-51 and completed four mailed surveys between 1996 (when they were aged 45-50 years n=13715) and 2004 (53-58 years, n=10905). Compared to other studies that focus on outcomes of single pregnancies, these studies included all pregnancy outcomes by developing comprehensive reproductive histories for each woman. Pregnancy outcomes included birth, miscarriage, stillbirth, termination and ectopic pregnancy. Women in the youngest cohort (born in 1973-78) were only just reaching their peak childbearing years and many (44%) had yet to report their first pregnancy outcome. Women from the mid-aged cohort (born 1946-51) had completed their reproductive lives and 92% were able to report on their lifetime pregnancy outcomes. Pregnancy losses, especially miscarriage, were common for both generations of women. Secondly, the prevalence of infertility, seeking medical advice and using treatment was identified for these two generations of women. For the older generation, the lifetime prevalence of infertility and demand for treatment was investigated in the context of the specialist medical services which became available circa 1980. By this time, however, most of these older women had already been pregnant and completed their families. For women who experienced infertility (11%), their options for advice and treatment were limited and less than half (42%) had used any treatment. More recently for the younger generation of women, who were aged 28-33 years in 2006, specialist advice and treatment were extensively available. Among women who had tried to conceive or had been pregnant (n=5936), 17% had experienced infertility and the majority (72%) were able to access medical advice. However, after seeking advice only half of these infertile women had used treatment with fertility hormones or in vitro fertilisation (IVF). Overall for infertile women aged up to 33 years, only one-third had used these treatments. Thirdly, the barriers to accessing medical advice and using treatment for infertility were identified for women aged less than 34 years. Among a community sample of infertile women aged 28-33 years (ALSWH participants), self-reported depression was found to be a barrier to accessing medical advice. The characteristics of these infertile women in the community who had (n=121) or had not (n=110) used treatment were compared to infertile women aged 27-33 years (n=59) attending four fertility clinics. Compared to infertile women in the community, living in major cities and having private health insurance were associated with early use of treatment for infertility at specialist clinics by women aged <34 years. In contrast to most clinical studies of IVF, the final study reported in the thesis took into account repeated IVF cycles and the impact of women’s individual histories on IVF outcomes. Among 121 infertile women (aged 27-46 years) who had 286 IVF cycles, older age and prolonged use of the oral contraceptive pill were associated with fewer eggs collected. Further, women in particular occupations had lower proportions of eggs fertilised normally than women in other occupational groups. These studies form the first large-scale epidemiological examination of infertility in Australia. The finding that two-thirds of women with infertility had not used treatment indicates that there is an unmet need for specialist treatment in women aged less than 34 years. However, barriers to accessing treatment prevent women using ART at a younger age when there is a higher chance of pregnancy.

Health complaint commissions in Australia : time for a national approach to data collection

Health complaint statistics are important for identifying problems and bringing about improvements to health care provided by health service providers and to the wider health care system. This paper overviews complaints handling by the eight Australian state and territory health complaint entities, based on an analysis of data from their annual reports. The analysis shows considerable variation between jurisdictions in the ways complaint data are defined, collected and recorded. Complaints from the public are an important accountability mechanism and open a window on service quality. The lack of a national approach leads to fragmentation of complaint data and a lost opportunity to use national data to assist policy development and identify the main areas causing consumers to complain. We need a national approach to complaints data collection in order to better respond to patients’ concerns.

Forging the heteroglossic citizen : articulating local, national, regional and global horizons in the Australian Curriculum

This article offers a discourse analysis comparing selected articles in the national press over the consultative period for Phase 1 subjects in the new Australian Curriculum, with rationales prefacing official Australian Curriculum Assessment and Reporting Authority documents. It traces how various versions of Australia, its ‘nation-ness’ and its future citizens have been taken up in the final product. The analysis uses Lemke's analytic elaboration of Bakhtin's concept of heteroglossia and its derivative, intertextuality. It identifies a range of intertextual thematic formations around ‘nation’, ‘history’, ‘citizen’ and ‘curriculum’ circulating in the public debates, then traces their presence in official curriculum documents. Rather than concluding that these themes are contradictory and incoherent, the conclusion asks how these multiple dialogic facets of Australian nation-ness potentially offer a better response to complex times than any coherent monologic orthodoxy might.

Multicultural mental health awareness scale

Australia is one of the most culturally and linguistically diverse (CALD) society in the world. There are individuals from all over the globe settled in Australia. They enter Australia as migrants or refugees. Although, the process of migration differs from individual to individual, it can be an uprooting experience and can bring with it many mental health challenges which need professional attention. Mainstream allied and mental health professionals need to be prepared for this diverse population and their mental health issues and concerns. These professionals may have to offer multicultural counselling to clients from an ethnic and cultural background, which is very different from their own. It is therefore essential for them to demonstrate multicultural counselling competencies (MCC)...

A micro-level indexing model for assessing urban ecosystem sustainability

Purpose – As a consequence of rapid urbanisation and globalisation, cities have become the engines of population and economic growth. Hence, natural resources in and around the cities have been exposed to externalities of urban development processes. This paper introduces a new sustainability assessment approach that is tested in a pilot study. The paper aims to assist policy-makers and planners investigating the impacts of development on environmental systems, and produce effective policies for sustainable urban development. Design/methodology/approach – The paper introduces an indicator-based indexing model entitled “Indexing Model for the Assessment of Sustainable Urban Ecosystems” (ASSURE). The ASSURE indexing model produces a set of micro-level environmental sustainability indices that is aimed to be used in the evaluation and monitoring of the interaction between human activities and urban ecosystems. The model is an innovative approach designed to assess the resilience of ecosystems towards impacts of current development plans and the results serve as a guide for policymakers to take actions towards achieving sustainability. Findings – The indexing model has been tested in a pilot case study within the Gold Coast City, Queensland, Australia. This paper presents the methodology of the model and outlines the preliminary findings of the pilot study. The paper concludes with a discussion on the findings and recommendations put forward for future development and implementation of the model. Originality/value – Presently, there is a few sustainability indices developed to measure the sustainability at local, regional, national and international levels. However, due to challenges in data collection difficulties and availability of local data, there is no effective assessment model at the microlevel that the assessment of urban ecosystem sustainability accurately. The model introduced in this paper fills this gap by focusing on parcel-scale and benchmarking the environmental performance in micro-level.

Role of kilometer-scale weak circular heterogeneities on upper crustal deformation patterns: Evidence from scaled analogue modeling and the Sudbury Basin, Canada

The Sudbury Basin is a non-cylindrical fold basin occupying the central portion of the Sudbury Impact Structure. The impact structure lends itself excellently to explore the structural evolution of continental crust containing a circular region of long-term weakness. In a series of scaled analogue experiments various model crustal configurations were shortened horizontally at a constant rate. In mechanically weakened crust, model basins formed that mimic several first-order structural characteristics of the Sudbury Basin: (1) asymmetric, non-cylindrical folding of the Basin, (2) structures indicating concentric shortening around lateral basin termini and (3) the presence of a zone of strain concentration near the hinge zones of model basins. Geometrically and kinematically this zone corresponds to the South Range Shear Zone of the Sudbury Basin. According to our experiments, this shear zone is a direct mechanical consequence of basin formation, rather than the result of thrusting following folding. Overall, the models highlight the structurally anomalous character of the Sudbury Basin within the Paleoproterozoic Eastern Penokean Orogen. In particular, our models suggest that the Basin formed by pure shear thickening of crust, whereas transpressive deformation prevailed elsewhere in the orogen. The model basin is deformed by thickening and non-cylindrical synformal buckling, while conjugate transpressive shear zones propagated away from its lateral tips. This is consistent with pure shear deformation of a weak circular inclusion in a strong matrix. The models suggest that the Sudbury Basin formed as a consequence of long-term weakening of the upper crust by meteorite impact.

The causes of sinuous crustal-scale deformation patterns in hot orogens: Evidence from scaled analogue experiments and the southern Central Andes

The cause of upper-crustal segmentation into rhomb-shaped, shear zone-bound domains associated with contractional sedimentary basins in hot, wide orogens is not well understood. Here we use scaled multilayered analogue experiments to investigate the role of an orogen-parallel crustal-strength gradient on the formation of such structures. We show that the aspect ratio and size of domains, the sinuous character and abundance of transpressional shear zones vary with the integrated mechanical strength of crust. Upper-crustal deformation patterns and the degree of strain localization in the experiments are controlled by the ratio between the brittle and ductile strength in the model crust as well as gradients in tectonic and buoyancy forces. The experimental results match the first-order kinematic and structural characteristics of the southern Central Andes and provide insight on the dynamics of underlying deformation patterns in hot, wide orogens.

Current measure of food insecurity used in the National Health Survey may be underestimating its prevalence

Objective: Food insecurity may be associated with a number of adverse health and social outcomes however our knowledge of its public health significance in Australia has been limited by use of a single-item measure in the Australian National Health Surveys (NHS) and, more recently, the exclusion of food security items from these surveys. The current study compares prevalence estimates of food insecurity in disadvantaged urban areas of Brisbane using the one-item NHS measure with three adaptations of the United States Department of Agriculture Food Security Survey Module (USDA-FSSM). Design: Data were collected by postal survey (n= 505, 53% response). Food security status was ascertained by the measure used in the NHS, and the 6-, 10- and 18-item versions of the USDA-FSSM. Demographic characteristics of the sample, prevalence estimates of food insecurity and different levels of food insecurity estimated by each tool were determined. Setting: Disadvantaged suburbs of Brisbane city, Australia, 2009. Subjects: Individuals aged ≥ 18 years. Results: Food insecurity was prevalent in socioeconomically-disadvantaged urban areas, estimated as 19.5% using the single-item NHS measure. This was significantly less than the 24.6% (P <0.01), 22.0% (P = 0.01) and 21.3% (P = 0.03) identified using the 18-item, 10-item and 6-item versions of the USDA-FSSM, respectively. The proportion of the sample reporting more severe levels of food insecurity were 10.7%, 10% and 8.6% for the 18-, 10- and 6-item USDA measures respectively, however this degree of food insecurity could not be ascertained using the NHS measure. Conclusions: The measure of food insecurity employed in the NHS may underestimate its prevalence and public health significance. Future monitoring and surveillance efforts should seek to employ a more accurate measure.

Crime talk, FIFO workers and cultural conflict on the mining boom frontier

Australia is experiencing an unprecedented expansion in mining due to intense demand from Asian economies thirsty for Australia’s non-renewable resources, with over $260 billion worth of capital investment currently in the pipeline (BREE 10). The scale of the present boom coupled with the longer term intensification of competitiveness in the global resources sector is changing the very nature of mining operations in Australia. Of particular note is the increasingly heavy reliance on a non-resident workforce, currently sourced from within Australia but with some recent proposals for projects to draw on overseas guest workers. This is no longer confined, as it once was, to remote, short term projects or to exploration and construction phases of operations, but is emerging as the preferred industry norm. Depending upon project location, workers may either fly-in, fly-out (FIFO) or drive-in, drive-out (DIDO), the critical point being that these operations are frequently undertaken in or near established communities. Drawing primarily on original fieldwork in one of Australia’s mining regions at the forefront of the boom, this paper explores some of the local impacts of new mining regimes, in particular their tendency to undermine collective solidarities, promote social division and fan cultural conflict.

Risk factors for malnutrition in community-dwelling people with Parkinson’s disease

In the elderly, the risks for protein-energy malnutrition from older age, dementia, depression and living alone have been well-documented. Other risk factors including anorexia, gastrointestinal dysfunction, loss of olfactory and taste senses and early satiety have also been suggested to contribute to poor nutritional status. In Parkinson’s disease (PD), it has been suggested that the disease symptoms may predispose people with PD to malnutrition. However, the risks for malnutrition in this population are not well-understood. The current study’s aim was to determine malnutrition risk factors in community-dwelling adults with PD. Nutritional status was assessed using the Patient-Generated Subjective Global Assessment (PG-SGA). Data about age, time since diagnosis, medications and living situation were collected. Levodopa equivalent doses (LDED) and LDED per kg body weight (mg/kg) were calculated. Depression and anxiety were measured using the Beck’s Depression Inventory (BDI) and Spielberger Trait Anxiety questionnaire, respectively. Cognitive function was assessed using the Addenbrooke’s Cognitive Examination (ACE-R). Non-motor symptoms were assessed using the Scales for Outcomes in Parkinson's disease-Autonomic (SCOPA-AUT) and Modified Constipation Assessment Scale (MCAS). A total of 125 community-dwelling people with PD were included, average age of 70.2±9.3(35-92) years and average time since diagnosis of 7.3±5.9(0–31) years. Average body mass index (BMI) was 26.0±5.5kg/m2. Of these, 15% (n=19) were malnourished (SGA-B). Multivariate logistic regression analysis revealed that older age (OR=1.16, CI=1.02-1.31), more depressive symptoms (OR=1.26, CI=1.07-1.48), lower levels of anxiety (OR=.90, CI=.82-.99), and higher LDED per kg body weight (OR=1.57, CI=1.14-2.15) significantly increased malnutrition risk. Cognitive function, living situation, number of prescription medications, LDED, years since diagnosis and the severity of non-motor symptoms did not significantly influence malnutrition risk. Malnutrition results in poorer health outcomes. Proactively addressing the risk factors can help prevent declines in nutritional status. In the current study, older people with PD with depression and greater amounts of levodopa per body weight were at increased malnutrition risk.

The Multidimensional Loss Scale : validating a cross cultural instrument for measuring loss in Burmese refugees

The Multidimensional Loss Scale: Initial Development and Psychometric Evaluation The Multidimensional Loss Scale (MLS) represents the first instrument designed specifically to measure loss in refugee populations. Researchers developed initial items of the Multidimensional Loss Scale to assess Experience of Loss Events and Loss Distress in a culturally sensitive manner across multiple domains (social, material, intra-personal and cultural). A sample of 70 recently settled Burmese adult refugees completed a battery of questionnaires, including new scale items. Analyses explored the scale’s factor structure, internal consistency, convergent validity and divergent validity. Principal Axis Factoring supported a five-factor model: Loss of Symbolic Self, Loss of Interdependence, Loss of Home, Interpersonal Loss, and Loss of Intrapersonal Integrity. Chronbach’s Alphas indicated satisfactory internal consistency for Experience of Loss Events (.85) and Loss Distress (.92). Convergent and divergent validity of Loss Distress were supported by moderate correlations with interpersonal grief and trauma symptoms and weak correlations with depression and anxiety. The new scale was well received by people from refugee backgrounds and shows promise for application in future research and practice